By S. Hengley. West Coast University. 2019.
Periodic Abstinence (Natural Family Planning) Avoidance of sexual intercourse during ovulation and for a safety margin before and after ovulation discount 25mg anafranil amex depression biblical definition. Various methods may be used to determine the fertile period: cervical mucus anafranil 75mg with amex mood disorder research articles, basal body temperature discount anafranil 50mg free shipping anxiety for no reason, rhythm. Benefits • No physical side effects it is cheap • No need for prescriptions by medical person • Improved knowledge of reproductive system and possible closer relationship between couples. Client Education • Requires high motivation • Has a high failure rate • Assumes a regular, perfect menstrual cycle • Requires proper record−keeping • Has no health risks, except for pregnancy. Consult a surgeon for drainage of pointing liver abscesses, bowel perforations (peritonitis), amoebomas and large bowel strictures • Amoebiasis and "vague" abdominal complaints: − where amoebiasis is common, there is a tendency to blame any abdominal complaints on amoeba. Usually these patients have cysts in stool but no 109 evidence of invasive disease e. Exclude other causes of abdominal pain • Asymptomatic cyst carriers: − only treat cyst carrier if patient is a food handler. Do not waste metronidazole: use it for appropriate indications Prevention • Provision of safe drinking water and sanitary disposal of faeces are important preventive measures • Regular examination of food handlers and appropriate treatment when necessary. Diarrhoeal Diseases Diarrhoea is defined as occurrence of at least 3 loose or watery stools in a day. Clinical Features − Dehydration The major cause of death from diarrhoea is dehydration, especially in infants and young children. Management is aimed primarily at evaluation, prevention, and treatment of dehydration. Diarrhoeal illness is classified for dehydration, dysentery and persistent diarrhoea. Management − Pharmacologic • that 50−60 % of acute gastroenteritis is viral • Other anti−diarrhoea drugs (e. If still breastfeeding, allow it more and for longer − give as much of these fluids as child will take − continue fluids until diarrhoea stops • Give the child plenty of food to prevent malnutrition: 114 − continue to breast−feed frequently or give usual milk (if not breast−fed) − encourage eating and offer food at least 6 times a day or one extra meal per day. Take−home messages: − Breastfeeding exclusively up to age 6 months and continue with other foods up to age 2 years − Solid foods ("complementary foods") should be introduced from about age 6 months − Proper sanitation: Provision of safe drinking water in sufficient quantities and disposal of faeces. Gastritis An acute ulceration of the stomach, usually multiple, non−recurrent and self−limiting. Peptic Ulcer Disease Ulceration of gastroduodenal mucosa that has tendency to be chronic and recurrent. Clinical Features Duodenal Ulcer • Epigastric pain, typically at night and when hungry • May present for the first time with complications [see later in this section] • Wide individual variation in symptoms and food that give pain • 95% of duodenal ulcers are caused by Helicobacter pylori (H. Gastric Ulcer • Epigastric pain, worse with food • Other features as in duodenal ulcer above. Admit For • All of the above • Indications for surgery in peptic ulcer disease: − intractable haemorrhage more than 5 units of blood in 24 hrs − recurrent bleeding after non surgical management during same hospitalisation − perforation − penetration to the pancreas − intractable ulcer pain − suspicion of malignancy especially in gastric ulcers. Aetiology • Oesophageal varies • Gastritis and gastric ulcers • Duodenal ulcers • A−V malformation 118 • Malignancies − stomach and oesophagus • Mallory −Weiss syndrome • Polyps. Clinical Features Vomiting of fresh bright blood or coffee−ground vomitus (haematemesis). Forceful vomiting followed by haematemesis suggests gastroesophageal junction tear. Excessive alcohol intake or ingestion of anti−inflammatory drugs may suggest erosive gastritis, previous epigastric pain suggests peptic ulcer. Lower Git Bleeding This may be frank bleeding (haematochezia) or occult bleeding depending on the cause. Management • Group and cross match if necessary • Treat the cause • Refer suspicious rectal bleeding. Cross infection: • Contamination of fingers with objects, clothing, toilet seats, etc. In general: • Safe water provision 122 • Hand washing and trimming of fingernails • Frequent changing of innerwear and sheets • Use of latrines. A critically ill child needing hospital admission must be given the appropriate vaccines upon recovery. Remember: • That a slight fever and/or other minor illness should not prevent you from immunizing a child • To inform mothers/child−caretakers about possible side effects of each of the given vaccines • To record all vaccinations on tally sheets and on the Child−Health immunization cards and instruct the mothers always to bring the cards along with them when taking children to a health facility • To instruct mothers to return the child for the next immunization date as indicated on the card • That vaccines are easily destroyed by heat and rendered ineffective • To handle the disposal of used sharp syringes appropriately • To ensure appropriate cold storage of the vaccines and follow the recommended cold− chain instructions for each of the vaccines carefully. Symptoms include severe cough followed by a whoop and vomiting, leads to malnutrition, can cause death, severe under 1 year old. Tetanus: [see tetanus] A clinical syndrome involving primarily the central nervous system and resulting from the tetanus toxins. Symptoms include rash, fever, cough, red eyes; is associated with blindness, malnutrition, deafness, pneumonia and death. Symptoms include pain and flaccid paralysis in limbs, fever, vomiting; can lead to permanent deformity and can cause death. Transmitted mainly by parenteral route, also from person to person by close contact through exchange of body fluids such as saliva, secretions from open wounds, blood, vaginal secretions and semen. Transmission between children is common, since they are often more infectious than adults. Infection may be transmitted either vertically (transplacentally from mother to unborn baby) or horizontally by close contact. Haemophilus Influenzae b: is a bacteria recognised as one of the commonest agents causing pneumonia and meningitis in children (see 21. If no reaction develops, the vaccination should be Child over 1 year, full repeated after 3 months. Follow manufacturers instructions on dosage Pentavalent vaccine Intramuscularly in the upper outer part of the thigh. A definite severe reaction to a preceding vaccine dose is a contraindication to further doses. The intramuscular route should not be used in patients with bleeding disorders such as haemophilia or thrombocytopaenia. Side−effects and adverse reactions to vaccinations Range from mild to severe for various vaccines. Major reactions are persistent crying, high pitched cry, excessive somnolescence, convulsions, encephalopathy and coma. Bacterial Infections Bacterial infections are a leading cause of morbid_ity and mortality. The following section summarizes the drugs of choice for common bacterial infections. The charts which follow provide comparison of the treatment cost for common antibacterial drugs. Penicillin Refers to narrow spectrum penicillin such as benzylpenicillin, procaine penicillin and phenoxymethylpenicillin. Benzylpenicillin is used in moderate to severe infections where high blood levels are required and because of its short half−life is given 4−6 hrly. Procaine penicillin is given by intramuscular route and is used in uncomplicated pneumonia and in treatment of gonorrhoea.
Flow chart for the treatment of peri-implant diseases adapted from the Dutch clinical guideline buy anafranil 75 mg cheap bipolar depression 4 years. Nowadays purchase anafranil 10 mg otc depression general symptoms, 4 dental implants are available in different materials cheap anafranil 10mg online depression symptoms en francais, sizes, and lengths and with different surface properties and coatings (Esposito et al. The currently available implant sys- 5 tems from the major implant manufacturers differ from their respective predecessors in mi- croroughness, physicochemical properties and nanoroughness (Wennerberg & Albrektsson 6 2010). These surfaces are those produced by the turning machine process of a titanium rod and are considered to be smooth surfaces 7 (Wennerberg & Albrektsson 2009). In implant dentistry the term ‘machined’ is mostly used to describe turned, 8 milled or polished surfaces (Wennerberg & Albrektsson 2009). Implant surface modifcations have led to improved bone-to-implant contact and better and stronger bone responses. They 9 have allowed for reduced healing periods and predictable treatment outcomes in numerous treatment indications, such as immediate placement and immediate loading (De Bruyn et al. The subtractive techniques remove material from the implant surface creating pits or pores on the surface and result in a concave profle. Examples for these techniques are electropo- lishing, mechanical polishing, blasting, etching and oxidation. The additive techniques add material and create a surface with bumps and a convex profle. Examples of these techniques are hydroxylapatite and other calcium phosphate coatings, titanium plasma spraying and ion deposition (Wennerberg & Albrektsson 2009). Surface roughness is often described in terms of Ra, a two-dimensional measurement, or preferably Sa, the corresponding three-dimensional parameter. According to their surface roughness, dental implant surfaces are classifed into four different groups. Smooth implant surfaces refer to a Sa value 220 Summary, Discussion… of less than 0. Currently, minimally and 2 moderate rough surfaces are accepted as the preferred surfaces for the part of the implant inserted into the bone (Wennerberg & Albrektsson, 2010; Buser et al. The roughness of the implant surface, as well as its chemical composition and surface free energy, has an impact on the amount and quality of plaque formation. Rougher 4 surfaces and surfaces with high free energy, which is a characteristic of titanium, accumulate and retain more plaque. The initial adhesion of bacteria starts at locations with high wetta- 5 bility, which is also a characteristic of titanium, and from surface irregularities, like pits and grooves, where bacteria are protected from shear forces (Teughels et al. Consequently implant surfaces have been found to accumulate more plaque than natural teeth (Quirynen 6 & Bollen 1995), and roughened titanium surfaces are considered to accumulate and retain more plaque than smooth surfaces (Quirynen et al. The surface of a 8 transmucosal abutment should be smooth to establish a long-lasting soft tissue seal and to avoid adverse soft tissue reactions (Sawase et al. Nevertheless a certain surface rough- 9 ness is required for an optimal soft tissue seal. Highly polished abutments favour less plaque retention but they have been found to negatively affect the soft tissue seal due to interac- tions between surface structure and fbroblast and/or epithelial cell attachment and prolif- eration (Bollen et al. Thus implant components exposed to the oral cavity should have a smooth surface to avoid plaque accumulation and to promote an optimal soft tissue seal. The Ra values of the transmucosal part of most implant systems, nowadays, range from 0. Yet, because of the limited hardness of titanium there is, in theory, a risk of surface roughening during self-performed or professional cleaning (Quirynen et al. Surface topography can affect the cell shape, orientation, proliferation and function (Könönen et al. Surface chemical composition is also important for tissue interactions (Sawase et al. It is generally accepted that the outermost atomic layer of the implant …& Conclusions 221 1 surface is an essential factor for the interaction with tissues. A major problem associated with the removal of plaque from implant surfaces is the possible damage to the implant surfaces. Any damage to the surface induces changes in the chemical oxide layer (Kasemo 2 & Lausmaa 1988) which in turn may affect the biocompatibility of the implant and conse- quently impair cell adhesion (Mouhyi et al. When the surface topography changes 3 also the surface chemistry or physics may change simultaneously. Furthermore, when the surface microtopography is changed, the nanotopography of the same surface usually also changes. All these factors may affect biological responses (Wennerberg & Albrektsson 4 2009). Ideally, the instruments used to effectively clean smooth surfaces should cause minimal or no surface damage, should not create a surface that is more conducive to bacterial colonization and should not affect the implant–soft tissue interface. If the soft tis- 7 sue attachment is disrupted, the instrumentation procedure should maintain a surface that is conducive to re-establishment of the soft tissue seal. When bone is lost, rough surfaces 8 become exposed resulting in the bacterial colonization of these surfaces. The decontami- nation of these surfaces is mandatory to achieve healing, with re-osseointegration being 9 the ultimate goal (Mombelli, 2002). In order to reduce microbial adherence and coloniza- tion on those rough surfaces that remain exposed to the oral environment, removal of the macroscopic and microscopic retentions is suggested (Jovanovic et al. The effect of mechanical instruments on smooth and rough titanium surfaces with respect to surface alterations, cleaning effcacy and biocompatibility has been evaluated in the studies pre- sented in chapters 2, 3 and 4. Surface alterations Chapter 2 scrutinized the available evidence on the effect of instrumentation on the surface roughness. Because of the nature of the question, experimental and mostly in vitro, studies were included in the analysis. Regarding smooth surfaces, a roughening of the surface was observed when these surfaces were treated with metal curettes or sonic and ultrasonic de- vices with metal tips. Although with titanium curettes this occurs to a lesser extent the use of these instruments on smooth surfaces is not advisable. Similar fndings were reported in 222 Summary, Discussion… an experimental study using a bone defect-simulating model. The implants were em- 3 bedded into plastic models, which were then attached to a phantom head. This study setup, the handling of the instruments and the subjective nature of the ranking method used to 4 evaluate changes may account for the observed differences. The use of non-metal instruments does not seem likely to produce a considerable level of surface roughening, although some 6 roughening of the surface can be seen after multiple use. The material of the instrument seems to be an important factor 7 for the amount of the damage seen.
Wearing a wrist bandage or support can help reduce trauma damage to the wrist while it is healing 50 mg anafranil with amex depression glass definition history. Numbness of hands generic anafranil 75mg fast delivery mood disorder vs schizophrenia, without wrist pain discount generic anafranil canada neonatal depression definition, is more often due to a brain problem with parasites and pollutants. If the pain goes away beforehand, while you are on the kidney cleanse, it shows you had deposits in your joints. Finger Pain This is pain in a joint, often accompanied by some enlarge- ment or knobbyness of the joint. It is not hard to recognize these as deposits of the same kind as we saw in the toes. In six weeks after starting the kidney cleanse and changing your diet, the knobs may already be shrinking. A large magnet (5000 gauss—used only as directed) may bring pain relief but only dental cleanup and environmental cleanup will give you lasting improvement. Pulling an infected tooth or cleaning a cavitation can bring complete relief, only to return the next time a tooth is extracted. Cleaning the liver can also bring immediate relief, only to find pain and stiffness to return months later. An allergic reaction to potatoes and tomatoes can express it- self in neck pain too. Perhaps they prefer to attach themselves at a particular neck site and cause inflammation here. Whiplash is often blamed for back-neck pain and indeed chiropractic ad- justments can bring total relief. Front Neck Pain Lymph nodes under the jaw strain your body fluids of the head, removing bacteria and toxins. Roland Sanford, 23, had minor pain and a lot of stiffness along the sides of his neck. He only had one metal tooth filling but his whole body was toxic with samarium, be- ryllium, indium, copper, cesium, and mercury. Audrey Doyle had severe neck pains she attributed to sitting all day and sleeping in her wheelchair. She knew eating cream and butter made it worse but she had no will power, she said. Ask the dentist to search for hidden tooth in- fections and to clean your cavitations (you will need to find an alternative dentist, and read Dental Cleanup, page 409). Begin immediately to heal these bone lesions with vitamin D (40,000 to 50,000 units once a day for 3 weeks, followed by 2 such doses per week forever), milk-consumption for calcium, and a magnesium oxide tablet. For extra muscle relaxation, take two magnesium tablets at bedtime and valerian capsules. Tooth Ache Before the pain becomes acute and excruciating, kill bacteria of the mouth, including “tooth decay” and “tooth plaque” frequencies (see frequency list, page 561). If zapping bacteria several times in a few hours relieves pain enough to get you through the night or past the weekend, do not delay a single day. Zapping does not reach into the middle of an abscess—it circles around, so some bacteria are left to repopulate. Removing them always helps and may let the jaw heal normally where they were extracted. Since the pain is caused by a bulging infection pressing on a jaw nerve, and because each tooth has a related organ(s) it is especially important to clear up all infections to protect these organs. Finding that teeth have the same tissue frequency as some distant organ sheds a little light on the situation. Until the meaning and function of these frequencies is understood we can only guess that they interact somehow. Bacteria have taken advantage of this common resonance and have invaded both organs. It is a common heart bacterium, causing much of our heart ailments, particularly mitral valve disease and irregularity problems. After wisdom teeth are extracted, the hole left in the jaw frequently does not heal, it picks up Staphylococcus aureus from the mouth and a chronic infection is started. Pain and body damage will return unless you do the proper re- pair and cleanup work. Throat Pain Recurring sore throats are always improved by removing dental metal and root canals, and by cleaning up hidden tooth infections. Bacteria and viruses that cause sore throats are thriving in hiding places under and around dental metal. It is quite difficult to reach the center of such places (abscesses) with electric currents. Even if you could, you would reinfect the very next time you ate non- sterile food! The eye is a favorite location for many para- sites, including Giardia, amoebas, hookworm, schistosomes, Toxoplasma, and innu- merable others. The eye has two large bodies of watery fluid: the aqueous humor and vitreous humor, where no blood Light travels through the cornea, through traverses to bring in extra the aqueous liquid, the lens, and then the white blood cells when vast vitreous humor, finally striking the the need arises. It has its super sensitive spot on the retina, called own protective devices, the macula. Toxoplasma infection could be the beginning of a lifetime of eye disease due to weakening of the eyes at an early age. Toxoplasma also invades the brain, frequently causing a dull ache or pressure at the back of the head. By killing all the large parasites plus a few bacteria (Staphylococci, Chlamydias, Neisserias) the eye can become pain free in a few days. No indoor pets should be kept by a person of low immunity, since infecting yourself daily and then killing parasites daily is not a solution. Tapeworm stages should be killed with an herbal preparation, Rascal, or with a zapper. Only a zapper can kill all the segments and eggs at once, leaving nothing alive to wander about and find a new tissue to invade. Even her eyes had a dull ache around and behind them, some- times reaching to the back of the head. She was full of Ascaris, amoebas and pin- worms which kept her legs twitching and jerking in bed at night, even waking her up. She was so much better after the kidney cleanse and parasite program she was eager to cleanse her liver. Jessie Healy, middle aged and in good health otherwise, had carried the anxiety of having inherited retinitis pigmentosa for forty years. She had eight parasites in the retina including Toxoplasma from association with cats years ago. Macular Degeneration Dolores Bollapragada, 50ish, had suffered from clinical ergot poison- ing in the past which put her in a coma for several weeks. It no longer detoxified solvents for her, allowing them to accumulate in her retina.
Complications of thyroidectomy • Haemorrhage and haematoma • Dyspnoea − can be due to oedema haematoma or neurological • Nerve palsy − recurrent laryngeal mainly tends to recover cheap anafranil 10mg with amex depression test for males, if "paresis" • Hypoparathyrodism − leading to tetany and convulsions • Hypothyroidism − give thyroxine buy anafranil 25 mg lowest price depression symptoms messy house. Refer If • Increase in size of the goitre • Suspicion of malignancy • Pressure symptoms • Large goitres for cosmetic reasons • Thyrotoxic patients who fail to respond to medical treatment • Goitres in children and male adults buy cheapest anafranil and anafranil depression lab test nih. Classification • Congenital failure of thyroid development (complete or partial) • Endemic cretinism • Iatrogenic − (after, thyroidectomy, radio−iodine therapy, pituitary ablation, drug induced) • Auto−immune thyroiditis • Goitrogens e. Diagnosis The deficiency ranges from mild with minimal or unrecognised clinical manifestation to severe mental retardation (cretinism). Diagnosis should be based on neonatal screening tests and not abnormal physical signs. Clinical Features Prolonged jaundice, feeding difficulty, lethargy and somnolence, apnoeic attacks, constipation, large abdomen, umbilical hernia, macroglossia, failure to thrive, delayed physical and mental development. Adult Hypothyroidism Clinical Features 91 Myxoedema is a very advanced form of hypothyroidism and this is not applicable to the more common milder degrees seen after thyroidectomy or autoimmune thyroiditis. Early symptoms include; tiredness, cold intolerance, menstrual disturbances, carpal tunnel syndrome. The physical signs include; slow pulse rate, dry skin, sparse and dry hair, periorbital puffiness, hoarse voice. Common Eye Conditions It is important to note that over 75% of all blindness in Kenya is either preventable or treatable. Most of the patients who come to clinics with eye complaints can be successfully treated by non−specialist medical workers. Important causes of blindness in Kenya are: Cataract 42%, trachoma 19%, glaucoma 9%, others include trauma, vitamin A deficiency. The table below shows some of the common eye diseases and the recommended management. Eye injuries include: Corneal and conjunctival foreign bodies and abrasions, burns (dry heat and chemical burns), blunt trauma (contusions), penetrating injuries to the eyeball (perforations), injuries to the eyelids, orbital injuries and cranial nerve injuries. Management − General • Check vision of all eye patients 92 • Use topical local anaesthesia for examination (not treatment) of a painful injured eye • Good lighting and magnifying lens make eye examination easier. Trachoma with Inturned upper lids with eyelashes Surgery: Refer to eye clinic entropion and trichiasis scratching cornea Prevention: Good hygiene 2(a). Asthenopia (eye Normal vision and complaint of pain Reassurance; if persistent refer to eye strain) when reading clinic Majority also anxious 4. Allergic conjunctivitis Red itching eyes Commonest in 0 5% zinc sulphate × 7 days children Usually recur on and off with or without treatment Refer If no Improvement 5. Conjunctivitis of the Bilateral copious pus in the eyes of Careful, constant cleaning of eyes newborn (ophthalmia newborn Local and systematic antibiotics. May be confused with cataract, could be glaucoma, retinal or optic nerve disorders. Leucocoria White pupil in children could be Refer to eye specialist more commonly congenital cataract or retinoblastoma. Refractive errors poor vision for either far or near Refer to eye specialist (especially objects children) 16. Pterygium Outgrowth on exposed parts of Reassure If It extends towards the pupil conjunctiva. Refer If • There is tissue loss and all patients with injured lacrimal drainage system (nasal angle of the eye). Refer if All cases if possible especially for initial assessment: • All diabetics for ophthalmic examination. Suspect in all patients who have painful proptosis (protrusion of the eye) and fever. In majority of patients, the illness is secondary to infection of paranasal sinuses. The infection may rapidly spread to the brain (carvenous sinus thrombosis and brain abscess) or lead to septicaemia. Investigation • X−ray paranasal sinuses Management • Monitor vital signs closely • Start patients on crytalline penicillin, chloramphenicol and metronidazole Refer • Urgently to Eye specialist. The health benefits of family planning play a major role in protecting the lives of infants, children, women and the family as a whole. The pill acts by: inhibiting ovulation and thickening cervical mucus, thus providing a physical barrier to spermatozoa and making the endometrium too thin for implantation. Take the next pill at the regular time, even if this means you take 2 pills on the same day. Side effects: Although many side effects of oral contraceptives use have been eliminated with low dose pills, some women still experience irregular menstrual bleeding, nausea, weight gain, headaches, skin colour changes, and other side effects that may go away after several months or continue as long as oral contraceptives are taken. Non−contraceptive Benefits • Reduce menstrual flow (lighter, shorter periods) • Decrease dysmenorrhoea. Wait 6 weeks removal post−partum 100 Combined oral 1−8 No May protect After 6 months Immediate to contraceptives (0. They act by altering cervical mucus making it thicker/denser, thus preventing sperm transport. Client Education • Used in breastfeeding mothers because it does not interfere with lactation • Has a high level of pregnancy protection • There is need for compliance on a daily regimen • Unrelated to sexual intercourse • May cause menstrual irregularities • If you forget to take one pill, take it as soon as you remember (see combined pills) • Return to the clinic immediately for a pregnancy check if 45 days have passed since your last menstrual period. Non−contraceptive Benefits • Does not affect lactation • Lighter shorter periods • Decreased breast tenderness • Do not increase blood clotting • Decrease dysmenorrhoea • Protect against endometrial cancer. Indication • Unprotected intercourse • Rape • Condom leakage • Condom breakage/slippage. They comprise of long acting progestogen usually administered as deep intramuscular injections. They act by: suppressing ovulation, inducing a thin atrophic endometrium, producing a thick cervical mucus difficult for 102 sperm penetration. Client Education • May be associated with heavy menses, amenorrhoea or spotting • Regular administration as required • Return to the clinic as scheduled to continue using this method • Return to the clinic if you suspect pregnancy, dizziness, heavy bleeding. Side effects: Users may experience menstrual irregularity (amenorrhoea, spotting, and rarely, heavy bleeding). Client Education • May be associated with prolonged menses, sporting or amenorrhoea • Requires a minor surgical procedure for insertion and removal • If possible return to the same clinic if you desire implant or removal • Return for removal any time you desire, but it can be kept in place for 5 years 103 • Return to the clinic if you: − suspect pregnancy − experience pain, swelling or pus at the implant site − experience dizziness, headache. Side effects: Users may experience infection at insertion site, irregular menstrual bleeding (longer bleeding episodes, amenorrhoea, or spotting). A plastic device usually bound with copper wire and placed in the uterus through the cervix. Benefits • Highly and immediately effective • Long−term protection with immediate return to fertility upon removal • Do not interfere with intercourse • Can be used in women who are breastfeeding Side effects: Users may experience pain on insertion and increased menstrual bleeding and abdominal cramps. Client Education • Before every intercourse, place condom on erect penis, leaving tip empty to collect semen • Withdraw the penis from the vagina after each ejaculation while the penis is still erect • Remove condom after use • Do not re−use condoms • Discard used condom immediately in toilet or pit latrine • Using spermicides with condoms increases the effectiveness • Complications may include local irritation if allergic to latex/lubricants • May interfere with sexual pleasure for some people.