Heartburn

Heartburn is the common classical symptom of the disorder gastro-oesophageal reflux disease (GORD). Heartburn is experienced as a gripping, substernal (below the breastbone) discomfort that may be made worse by lying, eating or bending. In some cases heartburn may be confused with cardiac chest pain but the former is relieved by antacids whilst pain associated with ischaemic heart disease is relieved by nitrate sprays.

Heartburn is extremely common in the Australian population and is most cases can be easily managed with simple lifestyle changes and over-the-counter antacid medications. However, if the pain is persistent you may require further investigations as severe disease can progress to adenocarcinoma of the oesophagus. This is a type of cancer that develops in a very small number of patients.

Heartburn is the hallmark symptom of gastro-oesphageal reflux disease (GORD) and a common complaint amongst the general population. Heartburn is described as an intermittent retrosternal (behind the breastbone) burning discomfort that is exacerbated by eating, lying down, bending, stooping or straining. The pain is typically central but it may spread across the chest and into the neck and may be mistaken for the pain associated with ischaemic heart disease.

Virtually everyone will experience some mild heartburn at some time during their lives whilst up to 20% of the population will experience it weekly and 40% on a monthly basis. Doctors are faced with the challenge of deciding who needs further investigation for this extremely common complaint to identify those patients with gastro-oesophageal reflux that may progress to oesophagitis (erosion and destruction of the lining of the oesophagus), cellular morphological changes (called Barrett's oesophagus) and occasionally adenocarcinoma.

As forementioned, heartburn is commonly caused by gastro-oesophageal reflux disease. In this disorder the sphincter mechanism at the lower end of the oesophagus (the tube from the back of your throat to your stomach) is faulty. This means that when food enters the stomach, the gap between the oesophagus and stomach doesn't close properly and food can move backwards (reflux) into the oesophagus. This causes damage to the oesophagus and pain because the lining of the oesophagus is not designed to withstand the acidic environment of the stomach. In addition, the muscular walls are thought to spasm when food is refluxed further contributing to pain.

There are a number of conditions that can predispose to dysfunction of the lower oesophageal sphincter or make heartburn symptoms worse. These include:

Hiatus hernia- In this condition the top part of the stomach pushes up through a defect in the diaphragm (a muscular structure dividing the chest from the abdomen). This causes weakening of the sphincter and upsets the stomach's closure mechanisms. Food is more likely to propel back from the stomach to the oesophagus. Obesity. Pregnancy- Presumably predisposes to reflux due to increased abdominal pressure and loosening of ligaments and muscles (including those of the sphincter mechanism in the diaphragm) in the body in preparation for childbirth. Smoking and alcohol consumption. Medications- Certain medications used to treat blood pressure problems, depression or asthma have been associated with heartburn symptoms. If you suspect one of your medications is causing heartburn do not hesitate to consult your doctor.

In many cases the doctor can make the diagnosis of your condition from history of your symptoms alone. They will ask you detailed questions about the location of the pain and whether it spreads anywhere. The timing of the pain in relationship to meals, effects of posture and duration of the pain is also important information. Your doctor will also ask questions about your diet, smoking, alcohol and current medications. You will also be questioned about other symptoms such as blood or black material in your vomit or stools. In particular, weight loss and difficulty swallowing are important symptoms as they may suggest a serious problem.

Not all patients will have the classic symptoms of heartburn and sometimes your symptoms may seem more like a respiratory problem such as a cough or wheeze at night. Along with chest discomfort you may also have other symptoms of oesophageal dysfunction including:

Difficulty swallowing. Painful swallowing due to damage to the lining of the oesophagus. Acid regurgitation. Excessive salivation.

Unfortunately the severity of your symptoms does not correspond well with the severity of the damage to your oesophagus. This is a problem if patients have mild symptoms but there is extensive damage that may progress to more sinister conditions.

In many cases no further investigation is required, particularly if you are young with longstanding classic symptoms of heartburn. However, if you are older or you doctor is concerned they may order further tests to confirm the diagnosis of reflux and grade the severity.

These tests may include:

Upper gastrointestinal endoscopy and biopsy (tissue sampling)- This lets the doctor visualise damaged areas. Tissue samples can help exclude early precancerous changes. Barium studies- This may detect a hiatus hernia. Manometry- A tube is inserted down the nose to measure the pressures generated by the lower oesophageal sphincter. Oesophageal pH monitoring- This is done over a 24 hour period with a special device positioned in the lower oesophagus. The device can detect reflux episodes by the degree of acidity.

In most cases the main aim of treatment will be to relieve your symptoms. However in some cases the doctor may be more concerned that the oesophagus is completely healed, particularly if you have severe disease or are at risk of complications. In these cases follow-up endoscopies and biopsies may be needed. At least half of patients will respond to lifestyle changes and simple antacid medications.

Lifestyle changes

Lose weight if overweight. Raise the head of the bed- Placing blocks or bricks securely under the legs of the head of the bed can reduce the risk of stomach contents flowing back up into the oesophagus. Eat small, regular meals and avoid intake of food or beverages within three hours of bedtime. Avoid lying, bending or exercising just after eating. Avoid drugs such as NSAIDs that damage the oesophageal mucosa and drugs that impair oesophageal motility (nitrites, anticholinergics, certain antidepressants etc.). ask your doctor for advice regarding your current medications. Avoid smoking and alcohol. Avoid foods that are known to exacerbate your symptoms such as spicy foods, tomatoes, citris fruits and peppermint. Reduce stress.

Medications

If the above measures don't work you can try medications such as:

Antacids: For example Mylanta can neutralise stomach acid and is available at chemists and supermarkets. They can however alter bowel motions and cause fluid retention. Alginates: These are also over-the-counter drugs and work by forming a gel or 'foam raft' on top of the stomach contents to provide a physical barrier to reflux. If the above two types of drugs do not relieve symptoms within four weeks it is best to see a doctor who may arrange an endoscopy investigation (tube with a camera down the throat to have a look). Acid suppression therapy: Your doctor can prescribe two classes of drugs called H2-receptor antagonist or Proton-pump inhibitors (PPIs) which markedly reduce acid production. The latter is the best treatment for severe disease and can be used long-term to prevent recurrence. Your doctor may also try agents that speed up the stomach's emptying activity to reduce reflux.

Surgery

In a small number of patients surgery is indicated. This is only suitable if you have very severe symptoms of heartburn and the condition is confirmed by radiology or pH-monitoring. Surgery is normally done laparoscopically (key-hole surgery) and aims to fix defects in the diaphragm and sphincter mechanism. This may be considered a favourable option for young patients who would require long-term maintenance therapy.

For more information on acid reflux and heartburn and related investigations, treatments and supportive care, see Acid Reflux and Heartburn. de Caestecker J. ABC of the upper gastrointestinal tract. Oesophagus: Heartburn. BMJ. 2001;323(7315):736-9. [Abstract | Full text]Cohen S, Parkman HP. Heartburn: A serious symptom. N Engl J Med. 1999;340(11):878-9. [Abstract]Kumar P, Clark M (eds). Clinical Medicine (5th edition). Edinburgh: WB Saunders Company; 2002. [Publisher] Longmore M, Wilkinson I, Rajagopalan S. Oxford Handbook of Clinical Medicine (6th edition). Oxford: Oxford University Press; 2004. [Publisher] Longstreth GF. Heartburn [online]. Bethesday, MD: MedlinePlus; 2005. Available from: URL link Talley N, Moore M, Sprogis A, Katelaris P. Randomised controlled trial of pantoprazole versus ranitidine for the treatment of uninvestigated heartburn in primary care. Med J Aust. 2002;177(8):423-7. [Abstract | Full text] Product Information: Somac Heartburn Relief Tablets. North Ryde, NSW: Nycomed Pty Ltd; 31 July 2008.Fox M. Gastro-oesophageal reflux disease. Clinical review. BMJ. 2006; 332: 88-93. [Abstract | Full text]
Duggan AE. The management of upper gastrointestinal symptoms- is endoscopy indicated? Med J Aust. 2007; 186(4): 166-7. [Full Text]Braunwald E, Fauci AS, Kasper DL, et al. Harrison's Principles of Internal Medicine (15th edition). New York: McGraw-Hill Publishing; 2001. [Publisher]Tierney LM, McPhee SJ, Papadakis MA (eds). Current Medical Diagnosis and Treatment (45th edition). New York: McGraw-Hill; 2006. [Publisher]DeVault KR, Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol. 2005; 100(1): 190-200. [Abstract]Murtagh J. General Practice (3rd edition). Sydney: McGraw-Hill; 2003. [Publisher]

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Female Condom

The female condom is a transparent, loose fitting, polyurethane sheath inserted into the vagina prior to sexual intercourse (either vaginal or oral). A female condom is 17 cm long, and has a flexible ring at each end. One end of the condom is closed and this end is inserted into the vagina to capture male semen during heterosexual intercourse. The other end of the condom is open, and this end remains outside the woman's vagina during sexual activity, partially covering her external genitalia. The woman's partner inserts their penis or tongue into the open end of the condom during vaginal or oral sexual activity.

Like the male condom, the female condom is a barrier method, that is, it creates a barrier between the woman's vagina and her partner's penis or mouth, which prevents the mixing of fluids during sexual activity. In doing so, the female condom provides users with a high degree of protection against pregnancy and sexually transmitted infection (STI) spread via genital fluids (e.g. HIV). As the female condom provides greater anatomical coverage than the male condom (it covers much of the woman's external genitalia in addition to the penis and vagina), it may also provide a higher degree of protection than male condoms against STIs spread through skin contact (e.g. herpes).

Female condoms have been available in Europe and the US since 1992, and have been marketed under various names, including Femidom and Reality. They first became available in Australia in 2000, where they are sold as the Female Condom.

The female condom was developed as an alternative to male condoms, in recognition that the decision to use male condoms was highly dependent on the willingness of the male sexual partner as the male condom is fitted onto the male sexual organ.

As the female condom is applied to the female genital organs, it was hypothesised that women would find it easier to initiate the use of a female condom than they would with a male condom. Because of this, it was thought that the female condom would empower women, who often lack decision making power and control in sexual relationships, to take greater control their sexual health. The female condom has been widely labelled the only "female initiated" method of preventing STIs.

The female condom works by providing a barrier which sexual fluids cannot penetrate and thus protects against both pregnancy and STIs. In terms of contraception, preventing semen and sperm from entering the vagina prevents pregnancy. Sperm cannot fertilise an egg if they are trapped in a condom.

In terms of STIs, the female condom prevents the male partner being exposed to the female partner's vaginal fluids and the female partner being exposed to the male partner's semen during heterosexual intercourse. Thus it prevents the spread of STIs which are transmitted via sexual fluids (e.g. chlamydia).

The female condom also covers some of the woman's external genitalia (e.g. the vulva, labia), and thus should provide a greater degree of protection against STIs spread through skin contact, than the male condom. During oral sex, the female condom also prevents contact between a woman's vaginal fluids and her partner's mouth.

Female condoms are suitable for use during vaginal and oral sex, but not during anal sex.

In order to protect against pregnancy, female condoms should be used at every act of penetrative vaginal intercourse when another effective contraceptive is not being used.

As an STI prevention device, female condoms should be used both for oral and penetrative vaginal sex, particularly when the partner's STI status is unknown (most typically with casual partners, but also with some regular partners). The condom should be inserted before any contact between partners' genital areas occurs.

Despite their efficacy, female condoms are not widely used and account for only 0.2% of the global condom supply. They are still not readily available in many countries and remain much more expensive than male condoms. In 2008, 34.7 million female condoms were sold worldwide.

Like male condoms, female condoms provide a barrier which is impenetrable by sexual fluids. As female condoms provide greater anatomical coverage than male condoms (they also cover much of the woman's external genitalia), they are, at least in theory, even more effective in preventing the transmission of STIs than male condoms. However while evidence is somewhat limited, it suggests that female condoms are no more effective than male condoms in practice. This appears to be because they are more difficult to use and are therefore subject to higher rates of mechanical failure (e.g. slippage, breakage).

Effectiveness in preventing pregnancy

In relation to contraceptive efficacy, the World Health Organisation reports an annual incidence of unwanted pregnancy of 5%, when female condoms are used correctly and consistently. This compares to an annual incidence of 3% with correct and consistent use of male condoms.

Effectiveness in preventing STIs

In relation to STI prevention, studies investigating the effectiveness of female condoms have examined rates of breakage and slippage, semen exposure and new cases of STI amongst female condom users. A study examining new cases of STI in female users of male and female condoms found no significant differences in incident STIs between the groups. In terms of mechanical failure, research indicates that female condoms are less likely to break but more likely to slip during sexual intercourse, compared to male condoms (0.1% breakage of female condoms vs 3.1% breakage of male condoms; and 5.6% slipping in female condoms vs 1.1% slipping in male condoms). However, a study investigating semen exposure reported no difference in the proportion of vaginal fluid samples which had been exposed to semen, between users of male and female condoms. This is despite much higher rates of mechanical failure while using female condoms (34% compared to 9% for male condoms).

Effectiveness in empowering women to negotiate condom use

In terms of their ability to empower women by enabling female initiation of barrier method use, evidence to date suggests that women are no more able to initiate the use of a female condom without their partner's consent, than they are a male condom. That the female condom is applied to the female genitalia does not negate the fact that many women lack the power to insist on its use, nor does it do away with the discrimination and stigma a woman might experience for carrying a condom (e.g. women have reported being labelled as promiscuous for carrying condoms).

Some argue that promoters of female condoms have failed to consider the widespread impact of discriminatory gender relations and, that to fulfil its STI and pregnancy prevention potential, the female condom needs to also be promoted amongst men, as a device which can increase their sexual pleasure.

Many women find inserting a female condom difficult at first, but research indicates that insertion becomes easier and less mistakes are made with practice. It is therefore recommended that women who wish to use a female condom, practice inserting them several times in a private, comfortable environment, prior to using them during sexual intercourse. It may also be necessary for women to use female condoms during several sexual encounters before they become used to the feel and appearance of female condom.

Women who wish to use a female condom should familiarise themselves with the following instructions about the application of female condoms:

Open the packet carefully and remove the condom. Rub both sides to distribute the lubricant evenly across the condom.Choose a comfortable position for insertion (e.g. squatting, raising one leg or lying down).While holding the condom at the closed end, grasp the flexible inner ring and squeeze it with the thumb and forefinger so it becomes long and narrow.With your free hand, hold the outer lips of the vagina open and gently insert the ring up into the vagina, using the thumb and forefinger.Place your index finger inside the ring and push the condom up the vagina as far as possible, until it is above your pubic bone. (The pubic bone can be felt as a large lump by putting your finger inside your vagina and moving it up and to the front.) Once the female condom is properly inserted, the pubic bone will hold it in place and prevent it from slipping out of the vagina during intercourse.The outer ring should stay outside of the vagina.The female condom should not create any discomfort, and once properly inserted, the woman should not be able to feel it.

When having sexual intercourse using a female condom, women should:

Guide the penis with their hand into the open end of the condom, making sure it goes into the condom and not to the side. As the condom is lubricated and slippery it is easy for the penis to slip between the condom and the vagina if the penis is not carefully guided;Ensure there is enough lubricant so the condom stays in place during sex. If the condom is pulled out or pushed in, there is not enough lubricant. You can add more lubricant to either the inside of the condom or the outside of the penis;To remove the condom, twist the outer ring then pull it out. Be careful not to let the semen leak out. If the woman was not upright during intercourse, she should remove the condom from her vagina before standing up, to prevent semen leaking out;Wrap the condom in a tissue and throw it in the bin. Do not flush it down the toilet.

In addition it is important that female condom users are aware that:

male and female condoms should not be used together; andthe female condom should only be used once.

If the condom breaks during intercourse, the penis should be withdrawn immediately. If the sexual partners still wish to continue having sex, a new condom should be applied prior to any further genital contact.

As a precautionary measure against unwanted pregnancy, women who experience condom breakage should visit their general practitioner and obtain a prescription for an emergency contraception pill. Emergency contraceptives can be used up to 120 hours after intercourse, to reduce the risk of pregnancy.

Both male and female partners should also test for a range of STIs if they experience condom breakage and are unsure of their partner's STI status. Many STIs are easily treated with antibiotics once detected. However, as many STIs remain asymptomatic for extended periods of time, leaving them untreated can lead to infertility and other complications. For more information see STI.

STI prevention

The female condom is one of only two biomedical devices (the other being the male condom) which provides a high level of protection against a range of STIs in sexually active individuals. Condoms thus enable individuals who choose to be sexually active, and particularly those who choose to be sexually active with multiple partners, to reduce the risk of adverse health effects associated with sexual activity. They offer a degree of sexual freedom to individuals living in a world characterised by numerous health risks stemming from sexual activity.

Appropriate for temporary or permanent contraceptive use

As female condoms are applied immediately prior to sexual intercourse, an individual does not need to plan condom use in advance as they do for many other methods of contraceptives (e.g. hormonal contraceptive pills must be taken for extended periods). When used consistently and correctly, female condoms provide a high level of protection against unwanted pregnancy.

Made from polyurethane

Female condoms are made from polyurethane - an odourless, soft material, which has a more natural feel than the latex from which most male condoms are made. This is largely because it is thin and conducts heat more efficiently, and thus increases sensitivity.

Heat resistant

Changes in temperature or humidity do not affect the polyurethane from which female condoms are made. Male condoms on the other hand are sensitive to heat and must be stored at room temperature.

Less likely to split

Female condoms are less likely to break than male latex condoms.

Non-allergic

Unlike latex, the polyurethane with which female condoms are made does not cause allergies, thus female condoms are suitable for people with latex allergies.

Lubrication

Female condoms can be used with both oil and water based lubricants, unlike male latex condoms which must be used only with water-based lubricants.

Greater anatomical coverage

The outer ring of the female condom gives protection to the female's external genitalia. The female condom therefore provides better coverage and protection against STIs transmitted through skin contact than a male condom.

Offers flexibility in the timing of insertion and removal

The female condom can be inserted up to eight hours before intercourse and does not need to be removed immediately after male ejaculation. This gives greater sexual spontaneity than male condoms. In addition, unlike the male condom, use of the female condom is not contingent on the male partner achieving an erection.

Greater female control

As the female condom is applied to the woman's genital organs, it is theorised that it provides women with a greater sense of control over their sexual health than the male condom, which is applied to the male genital organs. While evidence suggests that women are no more able to enforce the use of female condoms than male condoms, there is also evidence that women do find it empowering to have access to a product which they wear.

Despite the many advantages of female condoms compared to male condoms, they remain a much less popular method of either contraceptive or STI protection than male condoms. Some of the disadvantages of female condoms which may create barriers to their use are discussed below.

User satisfaction

User satisfaction with female condoms, at least amongst some groups of women is low, and considerably lower than satisfaction with male condoms. For example, one study reported that only 11% of women reported that sex with the female condom felt "good" or "very good". Women also reported low levels of satisfaction with the female condom amongst their partners.

Appearance

The female condom is large and some women find its overall appearance off-putting. In addition, once inserted, the outer ring is visible outside the vagina, which can make some women and their partners feel uncomfortable.

Noise

Female condoms typically make a rustling noise during intercourse.

Difficult to use

Users of female condoms report far greater incidence of mechanical difficulties (breaking, slipping) than do users of male condoms. Most health practitioners acknowledge that inserting the female condom is difficult and requires practice.

Failure rate

While the polyurethane from which female condoms are made is impenetrable, there is the possibility that the condom will slip up inside the vagina or the penis will enter the vagina and not the condom, and lead to condom failure.

Female condoms are much more likely to slip out of place during sexual intercourse than male condoms (e.g. one study reported 5.6% rate of slippage for female condoms compared to 1.1% for male condoms). Despite the higher rate of slippage, research indicates that the risk of semen exposure is comparable between male and female condoms.

Expense and availability

Female condoms are much more expensive than male condoms and, in Australia are available only from specialty outlets like pharmacies (and not supermarkets and petrol stations). They can also be expensive compared to male condoms. However, some student services do provide free female condoms.

Female condoms are available from family planning services, community health centres and pharmacies. Some student services also distribute free female condoms.

In 2005 a new female condom called FC2 was released by the manufacturers of the female condom. While it has a similar design to the original version of the device, FC2 is made from a material called nitrile. This makes it cheaper to produce than the polyurethane version and also eliminates the noise associated with polyurethane condoms. Female condoms made from latex are also being developed, which has the potential to further reduce costs.

For more information on different types of contraception, female anatomy and related health issues, see Contraception.Gollub E, Warren M. The female condom: A guide for planning and programming, World Health Organisation. 2005. [cited 2009, March 15] available from: http://www.who.int/reproductive-health/publications/RHR_00_8/PDF/female_condom_guide_planning_programming.pdfUnited States Department  of Veteran's Affairs. Tips for using condoms and dental dams. 2008. [cited 2009, March 15] available from: http://www.hiv.va.gov/vahiv?page=sex-condomtips Padian, N.S. Buve, A. Balkus, J. et al, Biomedical Interventions to prevent HIV: evidence, challenges and new ways forward The Lancet. 2008;372:585-99.McNamee K. The female condom. Aust Fam Physician. 2000;29(6):555-7.Valappil, T. Kelaghan, J. Macaluso, M. Male and Female Condom failure among women at high risk of sexually transmitted diseases. Sex Transm Dis. 2005;32(1):35-43.Mantell, J.E. Dworkin, S.L. Exner, T.M. et al The Promises and Limitations of Female-initiated methods of HIV/STI prevention. Soc Sci & Med. 2006;63:1998-2009.Family Planning New South Wales. The Female Condom. 2009. [cited 2009, March 15] available from: http://www.fpnsw.org.au/sex-matters/factsheets/52.html Anonymous. The female condom: Still an underused prevention tool. [Editorial] Lancet Infect Dis. 2008;8(6):343.Avert. The Female Condom. 2008. [cited 2009, March 15] available from: http://www.avert.org/femcond.htm Macaluso, M. Blackwell, R. Jamieson, D.J. Efficacy of the Male Latex Condom as Barriers to Semen during Intercourse: a randomised clinical trial. Am J Epidemiol. 2007. DOI: 10.1093/aje/kwm046. [cited 2009, March 15] available from:  http://aje.oxfordjournals.org/cgi/content/abstract/kwm046v1 French. P.P. Latka, M. Gollub, E. et al. Use effectiveness of female vs male condoms in preventing sexually transmitted disease in women. Sex Transm Dis. 2003;30(5):433-9.Attorney General's Department. National Sexually Transmissible Infections Strategy 2005-08. Commonwealth of Australia. [cited 2009, March 15] available from:  http://www.health.gov.au/internet/main/publishing.nsf/Content/0333DF52D0E2F3EDCA25702A0025132F/$File/sti_strategy.pdf Kulczycki, A. Kim, D. Duerr, A. et al. The acceptability of the Female and Male Condom: a randomised crossover trial. Perspect Sex Reprod Health. 2004;36(3):114-9.

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Male Condom

Male condoms are latex or (less commonly) polyurethane sheaths which are put on the erect penis prior to sexual activity. They provide a barrier to the mixing of the partners' sexual fluids during sexual activity. Male condoms are more commonly used than their female counterparts (the female condom) and are usually referred to simply as condoms.

A male condom prevents the male partner's semen from entering their partner's vagina, anus or rectum, and also protects the male partner from coming into contact with a female partner's vaginal fluids or male or female partner's blood (e.g. from abrasions to the rectum which can tear easily during anal intercourse) during anal or vaginal penetration.

As semen and vaginal fluids are the predominate routes by which sexually transmitted infections (STIs) are spread, male condoms play an important role in preventing the spread of STIs, during heterosexual and homosexual intercourse. While condoms are primarily promoted as devices for preventing STIs, they are also an effective method of contraception.

The use of condoms can be traced back to the ancient Egyptians, who used linen sheaths primarily as protection against disease. In the 1500s when syphilis was becoming an epidemic in Europe, the use of linen soaked in a solution of salt and herbs was documented. In the 1700s, condoms made from animal intestines became available but they were very expensive and often reused. The Chinese used oiled silk paper while the Japanese used leather and tortoise shell sheaths. It was not until 1839 and the development of rubber by Charles Goodyear that the first rubber condom was manufactured.

Since the nineteenth century, condoms have been one of the most popular methods of contraception in the world. Condom use as a contraceptive method declined after the advent of the oral contraceptive pill, sterilisation and other contraceptive methods. However, condom use for the prevention of STIs has increased significantly since the discovering in the early 1980s that HIV is sexually transmitted.

The male condom works to prevent pregnancy and STIs because the latex or polyurethane with which it is made cannot be penetrated by sexual fluids. As it creates an impervious barrier, condoms provide protection against pregnancy and the spread of STIs which are transmitted via sexual fluids (e.g. HIV, hepatitis B, chlamydia and gonorrhoea).

While male condoms do protect against some skin to skin content, they do not provide complete anatomical coverage of the genital skin during sexual intercourse. This means they are less effective in preventing STIs transmitted through skin contact (e.g. herpes).

Male condoms are used throughout the world as contraceptive and STI prevention devices. They are used by individuals who wish to prevent pregnancy and/or STI, either with steady or casual partners. More than 12 billion male condoms were distributed in 2007.

In Australia, individuals who are young and those who have sex with casual or non-cohabiting partners are more likely to use condoms than their older counterparts and those individuals who live with their sexual partners. Women who do not use other forms of contraception are also more likely to use condoms.

A recent study in Australia reported that about 7% of people used condoms consistently with regular partners and 40% used them with consistently with casual partners. While condom use in casual relationships is much higher than in steady relationships, it remains strikingly low, given Australia's high prevalence of STIs (more than 50,000 cases of chlamydia were reported in Australia in 2007, and over 4% of Australian men and women report experiencing genital warts in their lifetime).

In order to protect against STIs, condoms should be used at every act of sexual intercourse (including vaginal, anal or oral sex). In order to protect against pregnancy, condoms should be used at every act of vaginal intercourse.

The effectiveness of male condoms depends on the purpose for which they are being used and the extent to which individuals use condoms correctly. While intact latex and polyurethane are completely impenetrable by sexual fluids, condoms may break or slip off during sexual activity, and are therefore not 100% effective.

Condom users should also be informed that, due to the limited anatomical coverage of condoms (they cover only the penis and not external genitalia), they provide much less effective protection against STIs which spread through skin contact (e.g. herpes).

Despite the incorrect use of condoms reducing their effectiveness as a contraceptive or STI prevention device, studies of condom use within sexual partnerships still report fairly high rates of effectiveness.

As a contraceptive device, condoms are typically regarded as being less effective than permanent contraceptive methods (in particular hormonal methods) when user error is taken into account but still provide a high level of protection compared to no contraceptive use. Condoms provide 98% contraceptive protection, when used consistently and correctly.

As an HIV prevention method for heterosexual couples, male condoms have been estimated to be 80% effective when used consistently and 95% effective when used correctly and consistently. These estimates are based on the study of infections in couples who use condoms consistently and where one partner is HIV positive and the other does not have HIV (sero-discordant couples).

While no studies have monitored the incidence of other STIs amongst sero-discordant couples, studies reporting lower incidence of chlamydia and gonorrhoea amongst consistent condoms users suggest that condoms are also effective in preventing these STIs. Condom use also reduces the risk of contracting herpes simplex virus type 2 in females by around 15%.

As condoms are more likely to break or slip off during sexual intercourse if they are used incorrectly, it is important that users are knowledgeable about their proper use. Health professionals should counsel their patients on the importance of correct and consistent use of condoms and other factors which can affect condom efficacy.

Expiry date

Condoms have a limited shelf life and an expiry date will be printed on each condom packet. Users should be advised to check the expiry date prior to use. They should also be advised that exposure to heat reduces the shelf life of condoms, and to discard any condoms that have been exposed to heat (e.g. in a pocket or in sunlight).

Packaging

Condoms come individually wrapped in foil packaging. Users should ensure that the packet is in good condition and has not been opened or damaged. They should open the packet carefully, taking care not to tear the condom with nails or teeth.

Appearance

The condom will be rolled up in the packet. There will be a thick rim and a circle of loose fine rubber.

Disposable

Condoms are designed for single use only. Users should never attempt to use a condom for more than one act of sexual intercourse in which the penis remains erect. If the penis loses its erection during sexual activity, the couple should remove the condom and wait until the penis is erect again, before applying a new condom. Men who suffer from erectile dysfunction may find female condoms more appropriate, as their use is not contingent on an erection.

Applying and using a condom

Wait until the penis is fully erect before attempting to apply a condom.Hold the condom so that the rim can unroll towards you.The closed end of the condom will have a loose, nipple shaped tip. Hold and squeeze the tip between thumb and forefinger to remove any trapped air. This will create a space for the semen to collect.While holding the tip and with the condom still rolled up, place the condom on the head of the penis.Using the free hand, unroll the condom all the way down to the base of the penis. The condom should unroll easily. If it does not, the condom may be on backwards, may be damaged or too old. Discard the condom and use a new one.Lubricant can be put on the condom prior to sexual intercourse if desired although most brands of condoms are already lubricated. The lubricant may wear off during sexual intercourse. If this occurs, it is important to apply additional water based lubricant (not oil based lubricant as this can damage latex) to reduce the chance of the condom breaking. This point is particularly relevant for patients using condoms for protection during anal sex, as, unlike the vagina, the anus has no natural lubricating mechanism.The condom should be removed immediately after ejaculation and while the penis remains erect. The user should hold the condom at the base while withdrawing the penis from the vagina or anus, and carefully withdraw the penis, taking care not to spill any semen.The user should then remove the condom from the penis and tie a knot at the open end to keep the semen inside.Dispose of the condom by wrapping it in tissue and putting it in the bin. Do not flush it down the toilet.

The main reasons that a condom will fail to protect against STIs is because it either breaks or slips off during sexual intercourse. Condoms which become damaged prior to sexual intercourse (e.g. by teeth or fingernails while opening or applying the condom) will also provide inadequate protection. Factors which can increase the risk of slippage or breakage include:

Not holding the condom firmly at the base while the penis is being withdrawn from the vagina;Not completely unrolling the condom onto the penis;Using a condom which has been exposed to heat or sunlight (such as in a car's glove box or individual's pocket) or has passed its expiry date;Using oil based lubricants, as this can weaken latex condoms and cause them to break more easily;Use of some vaginal preparations or drugs at the same time as condoms.

It is also important to highlight to patients that condoms are only effective while they are being worn. If genital contact occurs prior to the application of a condom, there is a risk that STIs will be transmitted through this genital contact, even if the man has not yet ejaculated his semen. Current research indicates that in Australia, one in eight condoms used are not applied until after genital contact has occurred.

For greater protection against pregnancy, condoms can be combined with other forms of contraception such as the pill. They should not be used in conjunction with female condoms.

There are a number of vaginal preparations which may weaken latex condoms and increase the likelihood of a condom breaking. Women should not use latex condoms at the same time as any of the following preparations:

Dalacin V cream (clindamycin hydrochloride). (Metronidazole gel is safe.) Nilstat vaginal cream (nystatin). (Canesten cream (clotrimazole) is safe.) Fungilin (amphotericin) Pro-feme (progesterone) Monistat vaginal (miconazole nitrate) Prevaryl vaginal (econazole nitrate) Ecostatin (econazole) Nizoral cream (ketoconazole) Premarin (oestrogen cream). (Ovestin and Vagifem (oestradiol) are safe.)

If the condom breaks during intercourse, the penis should be withdrawn immediately. If the sexual partners still wish to continue having sex, a new condom should be applied prior to any further genital contact.

As a precautionary measure against unwanted pregnancy, women who experience condom breakage should visit their doctor to get a prescription for an emergency contraception pill which can be used up to 120 hours after intercourse, to reduce the risk of pregnancy.

Patients should also be informed to test for a range of STIs if they experience condom breakage. Many STIs are easily treated with antibiotics once detected. However, as many STIs remain asymptomatic for extended periods of time, leaving them untreated can lead to infertility and other complications.

STI prevention

The male condom is one of only two biomedical devices (the other being the female condom) which provides a high level of protection against a range of STIs in sexually active individuals. Condoms enable individuals who choose to be sexually active, and particularly those who choose to be sexually active with multiple partners, to reduce the risk of adverse health effects associated with sexual activity. They offer a degree of sexual freedom to individuals living in a world characterised by numerous health risks stemming from sexual activity.

Widely and cheaply available

Male condoms are available from most pharmacies, supermarkets and even petrol stations, meaning that they can be accessed most of the time. Unlike most contraceptive methods, users do not require a prescription to purchase condoms. Free condoms are also distributed by many student services and family planning clinics for individuals with budget constraints.

Temporary or permanent use

As condoms are applied immediately prior to sexual intercourse, an individual does not need to plan condom use in advance as they do for many other methods of contraceptives (e.g. hormonal contraceptive pills must be taken for extended periods). When used consistently and correctly, condoms provide a high level of protection against unwanted pregnancy.

Limited side effects

The only known side effect of the male condom is allergic reaction to latex, which occurs in a small proportion of users (estimated 1-3%). On the contrary, many hormonal contraceptive methods produce a wide range of side effects.

Condoms provide a theoretically high level of protection against both pregnancy and STIs, and the side effects of condom use are negligible. While a small proportion of condoms users (1-3%) report an allergic reaction to the latex with which condoms are made of, the allergic symptoms are temporary and there are no other known side effects of use.

There remain however, numerous barriers to the use of male condoms which mean that male condoms are often used inconsistently or not at all, even in situations where individuals are aware that their sexual activity may involve health risks (e.g. sexual activity with unknown partners) if a condom is not used. The key barriers which limit the use of condoms are discussed below.

User satisfaction

While user satisfaction with male condoms is higher than with female condoms, satisfaction remains poor, particularly amongst men. One study found that less than half of women reported the male condom felt "good" or "very good" during sexual intercourse and that women reported their partners were even less likely to be satisfied with the feel of male condoms. Common reasons cited for reduced satisfaction with male condoms is the associated reduction in sensitivity and sexual enjoyment and the disruption to natural sexual activity (i.e. the need to interrupt sexual activity to apply a condom).

Breakage and slippage

Even when used correctly, condoms can break or slip during sexual intercourse. In Australia, some 23.8% of male condom users responding to the Sex in Australia survey reported at least one incident of condom breakage during sexual intercourse in the year prior to the survey, while 18.1% reported at least one incident of a condom slipping off during sexual intercourse. Breakage and slippage was associated with less experience using condoms, indicating that a significant proportion of these failures were induced by user error.

Need for correct and consistent use

To effectively prevent STIs and pregnancy, condoms must be used correctly at every act of sexual intercourse and applied prior to any genital contact. While many Australians use condoms at some point in their life, only 40% use them consistently with casual partners and one in eight condoms are not applied until after genital contact has occurred.

Condom use is less likely when the sexual partners have consumed alcohol at intoxicating levels (according to Australian guidelines- for more information see Alcohol Intoxication).

Reliance on male partner

Condoms are user dependent and rely mainly on the male partner agreeing to use and applying the condom correctly (despite the female partner being at higher risk of STI and bearing most of the responsibility for unwanted pregnancy).

Condoms are available in variety of sizes, shapes, textures, colours and flavours to suit personal preference. The majority of condoms available are made of latex rubber.

Polyurethane condoms known as Duran (brand name: Avanti) were introduced to the market in the mid-1990s. They provided an alternative for those who were allergic to latex or who did not like the feel and reduced sensitivity that latex condoms produced.

In comparing latex to non-latex condoms, a large proportion of people appear to prefer polyurethane condoms. Polyurethane condoms are thinner, conduct heat better than latex and are less restrictive around the glans of the penis, therefore increasing sensitivity. Users report that the polyurethane condom has a more natural feel, look and smell than latex. Polyurethane is more durable than latex in that it can withstand exposure to heat and is suitable for use with oil or water based lubricants. One study reported no significant differences in the rate of breakage or slippage between latex and polyurethane male condoms.

Male condoms provide effective protection against STIs and pregnancy when they are worn correctly and consistently.Male condoms must be applied prior to every act of vaginal, anal or oral sex to provide protection.Male condoms should be applied to a fully erect penis, prior to any genital contact.A new condom should be applied if the condom slips or breaks.For more information on different types of contraception, male anatomy and related health issues, see Contraception.Padian NS, Buvé A, Balkus J, Serwadda D, Cates W Jr. Biomedical interventions to prevent HIV infection: Evidence, challenges, and way forward. Lancet. 2008; 372(9638): 585-99.Family Planning NSW. Male condom fact sheet [online]. 31 March 2008 [cited 1 March 2009]. Available from URL: http://www.fpnsw.org.au/ fs.020_male_condom08.pdf Centres for Disease Control and Prevention. Male latex condoms and sexually transmitted disease: Fact sheet for public health personnel [online]. 16 December 2008 [cited 1 March 2009]. Available from URL: http://www.cdc.gov/ condomeffectiveness/ latex.htm de Visser RO, Smith AM, Rissel CE, Richters J, Grulich AE. Sex in Australia: Experience of condom failure among a representative sample of men. Aust NZ J Public Health. 2003; 27(2): 217-22.Gilliam ML, Derman RJ. Barrier methods of contraception. Obstet Gynecol Clin North Am. 2000; 27(4): 841-58.United Nations Population Fund (UNFPA). Donor support for contraceptives and condoms for STI/HIV prevention 2005 [online]. 22 March 2007 [cited 1 March 2009]. Available from URL: http://www.unfpa.org/ upload/ lib_pub_file/ 681_filename_dsr_2005.pdf  National Centre in HIV Epidemiology and Clinical Research (NCHECR). HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia: Annual surveillance report 2008 [online]. University of New South Wales. 14 September 2008 [cited 1 March 2009]. Available from URL: http://www.nchecr.unsw.edu.au/ NCHECRweb.nsf/ resources/ SurvReports_3/ $file/ ASR2008-revision.pdfGrulich AE, de Visser RO, Smith AM, Rissel CE, Richters J. Sex in Australia: Sexually transmissible infection and blood-borne virus history in a representative sample of adults. Aust NZ J Public Health. 2003; 27(2): 234-41.Macaluso M, Blackwell R, Jamieson DJ, Kulczycki A, Chen MP, Akers R, et al. Efficacy of the male latex condom and of the female polyurethane condom as barriers to semen during intercourse: A randomized clinical trial. Am J Epidemiol. 2007; 166(1): 88-96.World Health Organization. Family planning: A global handbook for providers [online]. 31 August 2007 [cited 20 June 2009]. Available from URL: http://www.who.int/ entity/ reproductivehealth/ publications/ family_planning/ 9780978856304/ en/ index.html Pinkerton SD, Abramson PR. Effectiveness of condoms in preventing HIV transmission. Soc Sci Med. 1997; 44(9): 1303-12.Weller S, Davis K. Condom effectiveness in reducing heterosexual HIV transmission. Cochrane Database Syst Rev. 2002; (1): CD003255.Shlay JC, McClung MW, Patnaik JL, Douglas JM Jr. Comparison of sexually transmitted disease prevalence by reported level of condom use among patients attending an urban sexually transmitted disease clinic. Sex Transm Dis. 2004; 31(3): 154-60.Wald A, Langenberg AG, Link K, Izu AE, Ashley R, Warren T, et al. Effect of condoms on reducing the transmission of herpes simplex virus type 2 from men to women. JAMA. 2001; 285(24): 3100-6.Valappil T, Kelaghan J, Macaluso M, Artz L, Austin H, Fleenor ME, et al. Female condom and male condom failure among women at high risk of sexually transmitted diseases. Sex Transm Dis. 2005; 32(1): 35-43.Farmer L, Everett S. Non-hormonal contraception. Obstet Gynaecol Reprod Med. 2008; 18(2): 33-8. Australian Government Department of Health and Ageing. National sexually transmissible infections strategy 2005-2008 [online]. Commonwealth of Australia. 27 June 2006 [cited 1 March 2009]. Available from URL: http://www.health.gov.au/ internet/ main/ publishing.nsf/ Content/ 0333DF52D0E2F3EDCA25702A0025132F/ $File/ sti_strategy.pdf  Kulczycki A, Kim DJ, Duerr A, Jamieson DJ, Macaluso M. The acceptability of the female and male condom: A randomized crossover trial. Perspect Sex Reprod Health. 2004; 36(3): 114-9. Sheary B, Dayan L. Contraception and sexually transmitted infections. Aust Fam Physician. 2005; 34(10): 869-72.Mantell JE, Dworkin SL, Exner TM, Hoffman S, Smit JA, Susser I. The promises and limitations of female-initiated methods of HIV/STI protection. Soc Sci Med. 2006; 63(8): 1998-2009.Rosenberg MJ, Waugh MS, Solomon HM, Lyszkowski AD. The male polyurethane condom: A review of current knowledge. Contraception. 1996; 53(3): 141-6.

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Weight Loss Drugs

Weight loss drugs are designed to help people who are classified as obese lose weight. Obesity is an increasing epidemic in Western societies. In 2005, 18% of Australian adults were obese (approximately 3.1 million people) compared to 13% in 1995.

The main aims of obesity treatment are to:

Lose weight;Maintain weight loss; and Prevent any further weight gain.

The most important way of obtaining these goals is developing a healthy diet and exercise regime, and developing strategies and thinking patterns that will help maintain these lifestyle changes.

For some people who are obese, weight loss with these changes alone is very difficult, and it may be beneficial to use medication to aid in initial weight loss. Large studies repeatedly report that weight loss associated with medication is greater than weight loss associated with lifestyle changes alone.

The body mass index (BMI) is a scale used to determine broad weight range categories. Weight loss medication may be prescribed to people with a BMI greater than 30 who have not adequately responded to a weight-reducing lifestyle regimen. People with a BMI of 27 who also have lifestyle risk factors may also be prescribed weight loss medication.

Risk factors for overweight patients include:

This tool needs Javascript enabled to run.

The formula for calculating your body mass index is:
BMI = weight (kilograms) / (height (metres) * height (metres))

For example:
A man who weighs 85 kilograms and is 1.8 metres tall would have a BMI of
BMI = 85 / (1.8 * 1.8)
BMI = 85 / 3.24
BMI = 26.2

This information will be collected for educational purposes, however it will remain anonymous.

Weight loss medication is most effective for initial and short-term weight loss. Studies have shown that once people stop taking the medication, they are at risk of regaining the weight they have lost. Weight regain can have serious psychological effects associated with failure. It must be emphasised that weight regain is no reason to give up hope. Obesity is a relapsing condition and is very difficult to treat. Regaining weight is not a sign of failure, but a valuable experience that can provide motivation to try again.

Medication should only be used as an aid to lose weight. The first line of treatment should always be a diet (500–1000 kcal/day deficit) and exercise plan. Dietitians and exercise physiologists have recently been added to the Pharmaceutical Benefits Scheme (PBS) so that people who require help to change their lifestyle can receive a rebate. Medical professionals can design a diet and exercise regime specifically for a person's lifestyle, tastes and realistic expectations of weight loss and dietary control. Tailoring the program will have a dramatic effect on the success of the regime. Combining lifestyle and pharmacological treatments can help encourage the development of a healthy lifestyle so that it is possible to maintain the weight loss when the medication is stopped.

Weight loss drugs can be classified into three broad categories:

Drugs that decrease food intake;Drugs that alter the metabolism of food; and Drugs that increase thermogenesis (energy expenditure).

Drugs that decrease food intake, called sympathomimetic agents, suppress appetite and induce satiety earlier. Satiety is the satisfaction or "full" feeling obtained from eating. Sympathomimetic agents work on by mimicking a neurotransmitter in the brain related to appetite, called noradrenaline (NA). Sympathomimetic drugs share a similar chemical structure to NA and therefore can bind to the same receptors as NA. They also increase NA activity in the "feeding centre" of the brain, the hypothalamus. The hypothalamus regulates the energy balance in the body. Information about energy stores is integrated in the hypothalamus, which then controls appetite and food intake. NA binding and activity in the hypothalamus has a negative effect on appetite.

Phentermine (Duromine)

Phentermine (Duromine) is the sympathomimetic anoretic available for use in Australia. Phentermine increases NA and dopamine (DA) levels in the hypothalamus, resulting in an appetite suppressant effect. 

The longest phentermine (Duromine) trial, conducted in 1968, resulted in an average weight reduction of 12.6 kg over a period of 36 weeks for both continuous and intermittent use (weight loss in the placebo group was 4.8 kg). Participants also adhered to a calorie-controlled, low-carbohydrate diet regimen (1000 kcal/day).

Sibutramine (Reductil)

Sibutramine is an appetite suppressant. It increases both NA and serotonin levels in the brain, which then bind to their receptors and exert their effects on appetite and satiety.

On average, sibutramine treatment with diet and exercise will result in 4.6 kg more weight loss than diet and exercise alone. Sibutramine (Reductil) has been approved for up to two years of use. 

Along with decreasing food intake, sibutramine has been found to:

Orlistat (Xenical)

Orlistat is a potent gastric and pancreatic lipase inhibitor. Dietary triglycerides are digested with the aid of gastric and pancreatic lipases. These lipases enzymatically break the triglycerides down into free fatty acids, which can then be absorbed in the small intestine. Pancreatic and gastric lipase inhibitors form bonds with the gastric and pancreatic lipases in the lumen of the stomach and small intestine, rendering these enzymes unable to function properly. By inhibiting the action of these lipases, the digestion of dietary fat is also inhibited and the triglycerides are excreted in faeces. Orlistat prevents approximately 30% of the dietary fat from meals being absorbed into the body (when 30% of the energy in the meals is supplied by triglycerides). After one year, the average weight loss with a combination of orlistat (Xenical) and lifestyle changes is approximately 8.5 kg.

Along with decreasing the absorption of dietary triglycerides, orlistat has been found to:

It is also thought that the gastrointestinal adverse effects of orlistat acts similarly to negative reinforcement, encouraging those on the medication to adhere to a low fat diet. 

Some people will respond differently to others when taking the same weight loss drugs. Some find it difficult to adhere to the necessary lifestyle and dietary changes, whereas others simply may not respond to the medication. Everyone using weight loss medication must be assessed by their doctor within 6 weeks to 3 months of starting the treatment to determine whether it is working effectively.

Weight loss medication has a modest effect on weight loss. For obese people, even a modest weight loss is helpful. As little as 5–10% weight lost should be considered a success. Even if still technically overweight or obese after the weight loss, people who have lost weight will have improved lipid profiles, glucose control and insulin levels compared to others of the same BMI who have not lost weight. This decreases the health risks for diabetes, stroke, heart attack, and so on.

It cannot be stressed enough that any weight loss medication must be combined with a healthy diet and exercise plan.

For more information on obesity, health and social issues, and methods of weight loss, as well as some useful tools, see Weight Loss.Overweight and obesity in Australia [online]. Canberra, ACT: Parliament of Australia Parliamentary Library; 5 October 2006 [cited 10 June 2009]. Available from: URL linkYates J, Murphy C. A cost benefit analysis of weight management stategies. Asia Pac J Clin Nutr. 2006; 15(Suppl): 74-9. [Abstract | Full text]Schnee DM, Zaiken K, McCloskey WW. An update on the pharmacological treatment of obesity. Curr Med Res Opin. 2006; 22(8): 1463-74. [Abstract]Caterson ID, Finer N. Emerging pharmacotherapy for treating obesity and associated cardiometabolic risk. Asia Pac J Clin Nutr. 2006; 15(Suppl): 55-62. [Abstract | Full text]Elfhag K, Rössner S. Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain. Obes Rev. 2005; 6(1): 67-85. [Abstract]Clinical practice guidelines for the management of overweight and obesity in adults [online]. Canberra, ACT: Australian Government Department of Health and Ageing; 12 November 2003 [cited 20 August 2008]. Available from: URL link Bray GA. A concise review on the therapeutics of obesity. Nutrition. 2000; 16(10): 953-60. [Abstract]Gill T. Epidemiology and health impact of obesity: An Asia Pacific perspective. Asia Pac J Clin Nutr. 2006; 15(Suppl): 3-14. [Abstract | Full text]Carek PJ, Dickerson LM. Current concepts in the pharmacological management of obesity. Drugs. 1999; 57(6): 883-904. [Abstract]Dixon JB, Dixon ME. Combined strategies in the management of obesity. Asia Pac J Clin Nutr. 2006; 15(Suppl): 63-9. [Abstract | Full text]Bray GA. Drug Insight: Appetite suppressants. Nat Clin Pract Gastroenterol Hepatol. 2005; 2(2): 89-95. [Abstract]Munro JF, MacCuish AC, Wilson EM, Duncan LJ. Comparison of continuous and intermittent anorectic therapy in obesity. BMJ. 1968; 1: 352-4. [Full text]Duromine (Phentermine) Product Information. Thornleigh, NSW: iNova Pharmaceuticals (Australia) Pty Limited; 18 May 2007.Langlois KJ, Forbes JA, Bell GW, Grant GF Jr. A double-blind clinical evaluation of the safety and efficacy of phentermine hydrochloride (Fastin) in the treatment of exogenous obesity. Curr Ther Res Clin Exp. 1974; 16(4): 289-96. [Abstract]Padwal R, Li SK, Lau DC. Long-term pharmacotherapy for overweight and obesity: A systematic review and meta-analysis of randomized controlled trials. Int J Obes Relat Metab Disord. 2003; 27(12): 1437-46. [Abstract | Full text]Reductil [online]. St Leonards, NSW: MIMS Online; 28 April 2008 [cited 28 December 2008]. Available from: URL linkXenical [online]. St Leonards, NSW: MIMS Online; 4 May 2007 [cited 28 December 2008]. Available from: URL linkFaucher MA. How to lose weight and keep it off: What does the evidence show? Nurs Womens Health. 2007; 11(2): 170-9. [Abstract]Elfhag K, Finer N, Rössner S. Who will lose weight on sibutramine and orlistat? Psychological correlates for treatment success. Diabetes Obes Metab. 2008; 10(6): 498-505. [Abstract]

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5 Biggest Weight Loss Workout Mistakes

Sometimes, exercisers with the best intentions lose the least amount of weight. What's worse is that they often see their friends slim down just weeks after starting a new workout program. It can be frustrating and confusing.

So what makes one weight loss workout plan effective and another one fail? There could be a number of factors involved. But in many cases, the cause can be traced to one of these blunders. If you've been struggling to shed a few pounds and your exercise plan isn't yielding any results, see if you are making one of these common workout mistakes.

Doing the same workout day after day. It's not a bad thing to exercise every day, and it's not necessarily a bad to do the same workout everyday to maintain heart health. But if you want to lose weight, repeating the same workout mode, intensity, or duration day after day won't work. Why? Your body adjusts to the daily workload and you hit a dreaded plateau.

Fix this blunder: Develop a workout schedule that involves different activities, different intensity levels and different session lengths. For example, if you normally do 40 minutes of walking, keep that activity on your workout schedule two or three days per week. But as an added challenge, walk for 60-75 minutes one day during the week. On the remaining days, mix in a cycling workout and a day of walk/run intervals. If you are healthy enough for vigorous activity, add HIIT workouts, which have been shown to be effective at burning fat.

Compensating by eating more. When you add exercise to your daily routine, you are likely to become more hungry than usual and want to eat more. Dealing with that hunger can be an uphill battle, because there is often a little voice inside your head that says, "I can eat whatever I want because I exercised today."

That rationale makes sense. But if you are trying to lose weight with exercise, you need to achieve a calorie deficit at the end of the day. If you satisfy your post-exercise hunger with high calorie foods or with too much food, you'll end up replacing all of the calories you burned. Then, your calorie deficit and your potential weight loss disappears.

Fix this blunder: Before you start or change your workout program, monitor your calorie intake or get your total daily expenditure evaluated by a professional such as a personal trainer or registered dietitian. When you begin your exercise program make sure that you only increase your food intake so that you still maintain a calorie deficit at the end of the day. A deficit of 500 calories per day or 3500 calories per week should result in a one pound weight loss each week.

Lopsided training. A good fitness schedule includes cardiovascular (aerobic) training, strength training and flexibility work (stretching). This balanced workout program ensures that your body stays healthy and fit. But each of these three components also has weight loss benefits . If you skimp on one or two of them, you'll end up with a lopsided workout program and you won't reap the full weight loss rewards of your exercise sessions.

Fix this blunder: Most weight loss workout programs include aerobic activity so it's unlikely that you'll have to add cardio. But you should also make sure that you do 2-3 days of strength training, as well. If time is an issue, do a circuit workout and complete short intervals of strength exercises between 5-10 minute bursts of cardio. Then, finish every workout with 10-15 minutes of stretching so that you maintain healthy joints and an injury-free body.

Decreasing non-exercise physical activity. It's great if you go to the gym every day and complete a killer workout - unless the payoff is that you spend the rest of the day on the couch. If you compensate for your workout by decreasing the amount of non-exercise physical activity that you do during the day, your total daily caloric expenditure may end up being the same as if you hadn't gone to the gym at all.

Fix this blunder: Non-exercise activity thermogenesis (NEAT) should account for a significant percentage of the calories that you burn each day. When your NEAT decreases, your metabolism slows, you don't burn as many calories each day and you don't lose weight.

If your workouts drain you to the point of exhaustion, it may be time to re-evaluate your program. Make sure that your high intensity workouts are relatively short and that you include some easy recovery days during the week to give your body a chance to recuperate and rebuild.

Also, keep in mind that it's not always the workout that is causing the lack of NEAT. Sometimes the choice to lay on the couch or sit in a chair all day is made out of habit rather than genuine fatigue. Try to skip the afternoon nap and go for an energizing walk instead. Stuck at work? See if you can use a standing workstation or take short breaks to get out of your chair and move around.

Using supplements/sports drinks. Do you refuel during your workout with sports drinks or bars? Do you grab a high calorie, high sugar supplement drink or bar after the workout is complete? If so, you're probably erasing the calorie deficit that you just earned. In some cases, athletes need sports drinks, but for most exercisers water is the best choice for hydration. And your post workout diet supplement is probably not helping either. There are hundreds of products on the market and, sadly, most of them do nothing but make empty promises and drain your wallet.

Fix this blunder: Instead of investing in bars, drinks, or supplements, invest in a visit with an accredited sports nutritionist or registered dietitian. They will help you to make sure you are getting enough of the right kind of calories to recover adequately from your workout. They can also help you to decode and perhaps debunk the claims of the supplement that you want to use.

Regardless of your size, exercise should always be a part of your daily routine. You'll experience countless health benefits if you participate in physical activity every day. But if you are engaging in a workout program specifically to lose weight you need to be especially careful to optimize your plan to meet that goal. Make just a few small adjustments, avoid these common mistakes, and you're more likely to see the results on the scale.

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Lose Weight by Counting Calories

Calories -- knowing how to find them, how to count them and how to cut them, are key to lose weight on your own. Calorie counting is easy and effective. This article will help you understand what you need to know about calories.

The first step to losing weight by counting calories is to understand what a calorie is and how it applies to your weight. A calorie is a unit of measurement that measures the amount of energy contained in a food or beverage.

Your body uses caloric energy to perform everything from basic biological functions to typing on your keyboard or jogging around the block. We all have a certain caloric requirement needed to maintain our current weight; if you eat fewer -- or burn more -- calories than that, you will eventually lose weight. This is called a caloric deficit. A good rule of thumb is that a caloric deficit of 3,500 calories leads to a weight loss of approximately one pound.

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Weight Loss Tips for Women Over 40

Weight loss is harder when you get older, but it's not impossible. You just need to take a few extra things into consideration. Use these tips, designed just for women over 40, to help you lose weight and get the body you've always dreamed of.Burke:Triolo Productions/Getty Images

Make sure that you are healthy enough for diet and exercise. Find out if a health condition such as hypertension or diabetes might affect the type of diet you should choose. If you’ve been struggling with your weight for some time, make sure that there are no medical or physical barriers to losing weight.

zSB(3,3)Ralf Nau/Getty Images

Is menopause affecting your weight? Many women struggle with weight loss before, during, and sometimes even long after menopause. This is also a time when many women make changes to their daily routines that may affect their weight. For example, after the kids leave home some women are not as busy during the day with non-exercise physical activities like carrying groceries, lifting laundry baskets and other household chores. Evaluate your lifestyle to make sure that a change in your daily habits isn’t affecting your weight.

Richard Boll/Getty ImagesYes, you read that right. Get sexy, get confident and get empowered. You might think that you’ll feel better about your body after the diet, but the truth is that the better you feel about yourself before you diet, the more likely you are to have the confidence to endure the lifestyle changes necessary for weight loss. Indulge in a few things that make you feel good about yourself: bubble bath, a new hairstyle, or a sexy new pair of pumps. Marcy Maloy Photography/Getty Images

Goal setting is one of the most important parts of any successful weight loss process. If you want to lose ten pounds or less, you can stick to short-term goals. But if you want to lose more weight, set long-term goals and them create short-term mini-goals to reach along the way

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If you’re like most women over 40, you’ve dieted before. And it’s possible that many of those plans didn’t work. What weight loss barriers have stood in the way of your success in the past? Come up with a game plan before the challenges arise and you’ll be more likely to overcome them.

Peter Dazeley/Getty ImagesIf you’ve never exercised before, now is the time to start. If you’ve always been active, you need to shake things up and create a new plan. Are you healthy enough for vigorous exercise? Then make sure you add at least one day per week of intervals. Never exercised before? Start slow and build gradually. Use these resources to set up a plan: Jose Luis Pelaez/Getty Images

The best diet for you depends on your goal and your lifestyle. There is no single plan that works for everyone. But you can begin by evaluating your daily eating pattern to see what simple changes you can make. For example, can you drink coffee with fewer calories? Do you have a glass or two of wine at night? Can you cook with less fat? Start with small changes and build from there.

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How to Choose a Good Diet Plan for Weight Loss?

The truth behind weight loss may not be always what you see at the face value.

First, you should realize that weight loss involves 100% dedication and a diligent adherence on your part towards the set diet plan. Make sure there is not even a slight deviation from your target.

Prepare a checklist to chalk out a good diet plan, which includes:

i. Your lifestyle

You may not be ready to remodel your lifestyle drastically. For example, if you practice just 2 meals/day and the schedule stresses on 4-5 times/day, then you may not feel comfortable with it.

ii. The level of exercises you undertake

In case you like to take up exercise sessions on your own, with no rigid conditions, whereas the proposal forces you to do exhaustive exercises at a stretch, then you should think twice before choosing it.

iii. Suitability to continue

It is not wise to stick to a diet plan just temporarily; you should feel good to follow it throughout your life.

iv. The ingredients

Sometimes, you may be required to replace the usual items with food that is prepared in a special manner or has some unusual ingredients. Check if you are comfortable with such a requirement.

v. The pace at which you aim to lose weight

Understand the difference between the actual loss of weight and the seemingly quicker loss of water, which may give a wrong impression. So, it is advised that you aim at reducing your weight in a slow and steady manner.

vi. The elimination of any kind of undesirable habit you possess

You may have to give up habits like spending the night time in a bar or being a couch potato to accommodate the new plan of diet.

vii. The possibility of including your all-time favorite items

Denial of your favorite foods can lead to an unstoppable urge to indulge in overeating binges, which is detrimental to your weight loss preparation.

viii. Your ability to adapt to changes that are recommended

Determine the nature of changes you will need to adapt to so that you can prepare your mind and body!

ix. The need to use any supplements or detox techniques

Most of the times, you don't need any kind of supplements as a perfectly followed schedule of food intake and exercises is self-sufficient in managing the pounds you gain and lose for a healthy body.

x. The nature of the plan

If you like flexibility, you should choose a plan that allows you to select your own menu that is by all means a healthy platter.

Fiber-rich foods help you in reducing weight considerably by removing unwanted collections of fats from your body. Make sure your diet plan includes high fiber foods like soups, vegetables and fruits to maintain the intake and expenditure levels of calories in a healthy way.

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Are You Caught Up In The Insanity Of Weight Loss

There are many things which humans do well and many things we do badly. There is so much good and bad information on almost any topic you can imagine. But there is no popular field of interest which stirs up so much hope and emotion as weight loss.

In fact there is so much craziness written and said about weight loss that the whole topic is a form of insanity. You can go crazy just thinking about all the diets you have tried.

Insanity may seem harsh, but so much of the weight loss industry is pure madness.

Some weight loss insanity examples include:

Caffeine infused underwear. Wearing these garments are supposed to boost your metabolism.Tongue sprays to suppress your appetite. In spite of claimed studies, these were proven to be a big con.Weight reduction teas, again some have been totally proven to be a con, none have proven successful under any rigorous studies.Ab machines in many shapes and designs. Complete rubbish, working your abs to death won't make any difference to your butt.Weight loss belts which buzz when you relax your abs, encouraging you to hold tension in your muscles.Most weight loss powders and protein bars. Basically just expensive skimmed milk powder with some cheep vitamins thrown in.The new diet which hits the shelves every week, based on some crazy idea.Detox programmes which promise that you will cleanse your body in seven days, using only lemons or some other cheep ingredient. A true detox is done in specific stages over at least six weeks.Prolonged fasting, which causes a strong stress effect in the body and a massive oxidation cascade.Consistent severe calorie reduction which the body sees as a state of threat and responds by protecting its fat stores.

Of course you need to eat a sensible diet, but that is really easy. You already know what you need to do.

Daily exercise and activity is a no brainer, you don't need crazy machines just move and have fun, dance exercise is perfect, or just walk and listen to music which keeps you moving.

But most importantly you must get your head around eating well and exercise. The simple way to do this is with weight loss hypnosis. The quick easy way to bring sanity and success into your life and your into your goal to achieve your ideal weight as quickly as possible.

And now if you would like to discover the missing key to weight loss Ian Newton invites you to go to http://www.successfulweightlossnow.com/

Keep healthy and happy

Ian Newton

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This Is More Fun Than Getting Fat!

What if in the next 3 weeks you designed and followed a very simple exercise routine? What if in the next 3 weeks you developed the habit of eating smaller meals? Essentially, you learned to "eat to live and not live to eat"? You might be amazed at how your body responds.

If you start a tiny little, stress-free exercise routine and follow it daily for 21 days, you might just have created a habit that will benefit you for a lifetime. The key here is that it must be so easy that you have not reluctance in doing it each day. Don't be intimidated by all those TV ads that show people panting and sweating as they try to be super-fit. You will be very impressed at what just a few simple exercises and possibly a daily stroll will do for your physique.

How about food? If you could learn to be happy with meals less than 500 calories each, combined with your simple exercise program, you would lose weight and re-shape your body. At the end of 3 weeks your life could very well be changed forever.

Three weeks is such a short time to create life changing habits. We can all do it. It's really no giant thing. But it does provide giant payoffs.

What if your morning exercise routine became as natural as brushing your teeth? Keep it simple enough and it can be. What if you made a list of meals you enjoy that are less than 500 calories each and you stuck with those meals most days for 3 weeks? Does that sound hard? Of course it's not.

The physical and mental rewards of slimming down and firming up are priceless. Not only are you being kind to your body but you are enjoying a more attractive appearance, more energy, and much more self confidence. Losing weight and getting back in shape is definitely more fun than getting fat!

In this day of instant gratification people think they can drop pounds fast by purchasing magical pills, machines and potions. That's stupid! You are making no life changing habits. You aren't enjoying the experience of using your body's own functionality to get down to a weight it is comfortable with.

Try the suggestions above for 3 weeks. See for yourself that your body is ready, willing and even eager to get stronger, slimmer, more agile and more attractive. Don't compare yourself with anyone else. Don't be intimidated by anyone else. Just allow yourself to enjoy the ride.

The author is just wrapping up 3 weeks of playing Joe's Fat Book - The Weight Loss Game. It has been tremendously rewarding and is documented on his site http://joesfatbook.com/ The rewards of simple exercise and eating smaller meals are priceless. Not only that, but you will find that using simple tools to monitor your progress provides you a win almost every day.

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3 Reasons to LOVE Your Workout: Confessions of a Fitness Addict

I sometimes get strange stares when I tell people I love to workout. But it's true! I look forward to that time of day when I can step away from everything else and just concentrate on my body. I have truly become an addict. I get cranky when I miss a workout and my day somehow feels incomplete. I absolutely love the feeling I get from working out.

You, too can love your workout. The longer you stick with it, the more engrained it will be in your habits and the more results you'll see. Even in 6 weeks, the results can be dramatic.

What are 3 things you can love about your workout?

1-Relieves stress

Exercise lowers cortisol, a stress hormone. You can take what could be a negative emotion like anger, frustration or anger and use it as fuel for your workout. You can successfully redirect that negative emotion into a positive outcome.

Exercise is also a great distraction to get your mind off problems and put you in a better state to be able to deal with them. If nothing else, it can get you out of the four walls you normally stare at, giving you a fresh perspective.

That deep breath and sense of calm you get while doing cardio is hard to replace with anything else. Everything feels clear - your lungs, your skin, your thoughts. It's a great time to think as you're pounding away the miles.

2-Feels great

Have you ever heard anyone say, "Man, I sure do regret that I worked out today." Probably not! But you most likely have heard someone talk about how proud she was that she DID workout today or three times this week.

It just plain feels good to workout. Exercise increases endorphins which are your body's "feel-good" chemicals. There is often a feeling of euphoria with working out; a "high." Who can't use some of that? There is a sense of accomplishment and pride that comes with it. It's what keeps people coming back time after time... and the fact that they like the way their clothes are fitting and the positive comments they are receiving from people who are noticing a change in them.

Besides, when else do you get to listen to obnoxiously loud music in the middle of the day? Playlists make great workout buddies. You can adjust your music to the type of activity you're doing, the speed at which you want to do it and your overall mood or the mood you want to have. Music is a great pick-me-up. At the end of a workout, not only will you feel good from the workout, but from the music as well.

3-See progress & succeed at something

When you work out consistently, you will see progress. You'll see progress towards your goals whether that be fat loss or muscle gain. You'll also notice that you can do things today that you couldn't do last month. You'll notice you can go longer, faster and at a higher resistance doing cardio and that it becomes easier. Maybe last week you couldn't walk on the treadmill and carry on a conversation without being winded but now you can talk with ease. Maybe you started out doing a chest press with 10 pounds and now you use 20. Progress means success. And we all like the feeling of success. If you succeed in one area, it gives you confidence to succeed in another.

Did anything of those sound familiar? You've probably heard or experienced some or all of these things already.

And here's a bonus reason to love your workout:

When you workout, it gives you added incentive to stay on your meal plan. If you go to the gym an hour a day, there are still twenty three hours in a day to screw up your results. Who wants to work that hard in the gym just to blow it with her diet? Working out regularly adds some incentive to eat right.

Stacie Dickerson is the CEO of the Healthy Lifestyle Institute for Women. Access their free article archive, become a member absolutely free and get your health & fitness tools at  http://hliwconnect.com/.

This post was made using the Auto Blogging Software from WebMagnates.org This line will not appear when posts are made after activating the software to full version.

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