What is a ketogenic diet?

PUT simply, it is a way of eating that promotes ketosis. Ketosis is a state where your body begins using fat for fuel, either from the foods you eat or your body fat, rather than carbohydrates.

The Ultra Lite Weight Management Program is a tried and tested ketogenic eating plan that promotes fat loss and has assisted thousands of people for greater than two decades.

This way of eating is low in carbs, moderate in protein and moderate in fats.

Relying on carbs as your sole energy source can lead to a rollercoaster of blood sugar.

You eat sugar and it spikes, only to crash later, causing you to eat more sugar to boost up your body’s blood sugars again.

A ketogenic eating plan, being higher in good fats, provides a slower burning energy.

This minimises the swings in blood sugar, leading to more stable levels of energy throughout the day.

It is best to transition slowly to becoming fat burning.

If you are like most people, you have spent your whole life carb adapted and teaching your body to use another source of fuel can take time.

It can be helpful to transition to eating ketogenic under the supervision of a trained practitioner as they can help you avoid a lot of common pitfalls.

Tips to get started:

Gradually extend the period spent fasting overnight to 12 hours or more, eg; finishing dinner at 7:30pm and starting breakfast at 7:30am the next day.

Doing a little bit of easy, fasted exercise in the morning like a walk can also be great.

Gradually increase your consumption of healthy fats including avocado, coconut oil, olive oil, nuts, seeds and olives while gradually reducing consumption of high carbohydrate foods like refined and packaged foods, breads and pastas, potatoes and lots of grains and including more fibrous vegetables such as green leafy vegetables, zucchini, broccoli, cauliflower, onions and asparagus

JERF: ‘Just Eat Real Foods’

Whole, minimally processed foods probably not sold in a packet.

This includes fresh fruits and vegetables, nuts, legumes and beans, animal products, extra virgin olive and coconut oil. Going for real foods keeps cravings down in several ways. There is no real one size fits all approach, what has worked for your friends may be different to what works for you.

We are all unique so this is where having a practitioner on your team really shines.

On top of keeping you accountable, practitioners can properly assess where you are right now and work with you to determine the best steps to control your cravings.

From our experience we can also help you to avoid many common pitfalls, especially the ones that come with changing the way you eat.


The many warning signs of male depression

MANY men may suffer undiagnosed depression due to the varied symptoms. Men are often less willing to seek treatment for depression than women. Understanding how male and female depression symptoms may differ is crucial.

It can assist in raising awareness of depression among individuals and their loved ones. Recognising depression is the initial step in the healing process.

Depression is an often-undetected mental condition that is prevalent among men. COVID-19 and the effects of lockdown may have worsened rates of male depression.

Financial losses have added to the problem. Statisticians are still assessing the effects on the job market. Some estimates say it could be as high as 1.5 million jobs lost.

Some depressive symptoms are more prevalent in men than women because of genetic, hormonal, physiological, or social causes.

Men with depression may exhibit the following alterations in behaviour:

Drinking more or taking drugs; Avoiding family or social encounters; Working beyond normal hours; Struggling to balance work and family duties; Partnerships becoming more domineering or abusive; engaging in risky conduct, such as gambling or dangerous sexual conduct; attempting suicide; a loss of interest in hobbies and passions; a loss in libido (men with depression may have a diminished desire for sexual activity); low mood; frustration, anger, aggression, or irritability.

Centres for Disease Control and Prevention says women are likelier to suffer depression. Even so, more men than women avoid reporting depression.

So, the numbers for men may be more significant. According to some estimates, two-thirds of depressed individuals still need a diagnosis.

A doctor may also misdiagnose depression in men. Men may be more prone to report physical problems. Men might also experience sleeping difficulties. As a result, the physician may provide an incorrect diagnosis.


Transplants that help ailing organs


IT IS no secret that we have travelled light years in term of medical technology.

When someone said that it would be possible to transplant a heart in South Africa more than 50 years ago, he would have been the joke of the town. Fast forward to today, almost anything is possible with new medical technology.

People born without limbs, for example, can have prosthesis fitted, and even run marathons better than those born with fully functioning limbs.

But what other medical prosthetics are available on the market to help with our failing organs?

If one has a heart that is not functioning properly, or a bladder that cannot control itself anymore, is there anything that can be fitted to assist the organ?

We had a chat with physician Dr Clement McKenzie, who gave us an overview of some of the medical procedures that can be performed to assist ailing organs.

Cochlear implant

For centuries, deafness was seen as a permanent disability, with no aid or hope of ever hearing sounds again. That is, until cochlear implants came about, and have given hope to people with hearing loss to assist with giving them the sensation of sound again.

“This is a device that is fitted to someone who has had hearing loss, and are designed to provide a sense of sound to those with deafness as a result of damage to the sensory cells in the ear.

“It is important to note, however, that this device does not restore normal hearing, but can assist the patient with a unique representation of sound, and help them understand speech, making communication easier,” McKenzie says. “The cochlear implant communicates directly with the brain through the auditory

nerve, which is what makes it distinct from a hearing aid. The device is two-fold, and consists of an external piece placed behind the ear, and another piece which is inserted surgically underneath the skin.

“A lot of speech therapy will be needed by the cochlear device receiver after the fact, as the person will have to learn how to interpret the different sounds, as well as how to understand speech. But over time, it is a very effective aid for hearing loss patients.”

Pacemaker implant

The pacemaker is a godsend for those with irregular heartbeats. Some people have heartbeats that palpitate rapidly, and some have a weak, faint heartbeat.

Both are the direct result of various, often serious, medical conditions, but the pacemaker was designed to regulate one’s heartbeat and get it beating at a normal rate again.

“Some people have often referred to the pacemaker as the heart with a watch. This is not true. A heart cannot have a watch although the pacemaker has a battery, and would need to be replaced once the battery runs low. This can, however, take years.”

The pacemaker is a device that ensures heartbeat is normal, by either slowing a fast blood pump, or picking up the speed of a slow blood pump, either of which can have serious implications for the sufferer.

The pacemaker is attached to the heart muscle after an incision is made in the chest.

Recovery time is relatively rapid but regular check-ups with your doctor is strongly recommended.

Penile implant

Most people would be forgiven for thinking that a penis is cut off a cadaver and placed onto someone who lost their penis, at hearing the concept of a penile implant. The truth, however, is less severe.

“A penile implant is performed to assist men who cannot get erections, or with erectile dysfunction.

“Men who have used erectile dysfunction drugs and injections without any improvement are the most likely candidates for a penile implant surgery. This is usually accompanied by a series of tests to determine the root of the erectile dysfunction, and if implant surgery is the best option.

“The actual procedure involves the surgeon placing a pump in the scrotum, which is then used to literally inflate the penis to achieve an erection, and deflate it again after intercourse.”


It is characterised by the involuntary leak of urine during coughing, laughing or suddenly getting up, which can be a very embarrassing problem. Although commonly affecting women, men can also suffer from incontinence.

“The treatment of incontinence in women is usually done with noninvasive surgery, with the insertion of a mesh-like material called a sling into the vagina placed under the urethra to provide support and prevents any leakage of urine during any physical activities.”


Is your partner a sex addict?

It has always been difficult to define the word “addiction” because people’s perceptions vary. Some individuals minimize or have a fixed idea that they aren’t addicted because they are still able to function fairly well. Underneath, however, they might feel that they have to hide their feelings and actions because they are worried that others will judge them or force them to get treatment that they do not believe they need.

Sometimes people are worried about their partner, family member or friend because there are showing signs of addiction accompanied by denial that anything is wrong. It can be very painful to watch someone who you love make poor choices over and over again without acknowledging this or getting any help. Well, you can’t push a rope! Maybe you are the one who needs help to deal with the stress.

Long-time sex researcher Dr. Patrick Carnes has used research that was published in the American Society of Addiction Medicine to develop a reliable tool to use for diagnostic purposes. PATHOS is a brief screening that takes only a few minutes to complete. It has a high reliability and validity. Several studies “support the use of PATHOS as a screening instrument to detect potential sexual addiction in clinical settings.”

In 30 seconds you can find out if you or your partner may be addicted to pornography or sex.

  • Preoccupied – Do you often find yourself preoccupied with sexual thoughts?
  • Ashamed – Do you hide some of your sexual behavior from others?
  • Treatment – Have you ever sought therapy for sexual behaviour you did not like?
  • Hurt others – Has anyone been hurt emotionally because of your sexual behavior?
  • Out of control – Do you feel controlled by your sexual desire?

Sad – When you have sex, do you feel depressed afterwards? A positive response to just one of the six questions would indicate a need for additional assessment with a certified sex addiction therapist. Two or more are considered to certainly indicate sexual addiction.

If you complete the PATHOS and have further questions, do not hesitate to contact a professional who has specialized training in this field. You will never be judged or treated like you are “bad.” You will be provided with excellent tools and support that will help you to regain your confidence and rebuild your health and relationships.

An old expression states “The truth hurts” but in clinical settings we believe that awareness is the first step to healing. If the PATHOS has opened your eyes to a problem, do not despair. The good news is that there is help for you. The first step is to call for an appointment today. I am sure you will be glad that you did.


Pregnancy if You Have Diabetes, Preconception care can improve your chances of getting pregnant

Planning for a baby is an exciting time, but the strategies don’t just begin after you’ve become pregnant. Accredited Practising Dietititan Cindy Shea of the Baker Heart and Diabetes Institute, shares her expert advice on what you need to know about planning pre-conception

Your health in the lead up to pregnancy is an important yet often forgotten consideration that is especially critical for people with diabetes. It is best to start planning three to six months prior to trying to conceive so that you can establish and maintain a good health routine. As health professionals, we are seeing more people enter pregnancy with diabetes, with the rise of rates of early onset type 2 diabetes. The increase is due to a number of factors such as a higher proportion of women who come from ethnic groups being at high risk of type 2 diabetes (such as people from a South East Asian and Middle Eastern background), the increasing prevalence of women who are at a higher body weight prior to conceiving and the increase in couples choosing to start a family later in life.

Preconception care is important for all couples who are planning to get pregnant. Statistically, 50 per cent of pregnancies are unplanned. The literature is very clear that the environment prior to conceiving has an impact on genetic programming which can influence a baby’s future development and risk of health conditions such as obesity and diabetes. We also know that the period from pregnancy to when the baby is two years old – the first 1000 days – also plays a crucial role in their future health. This is influenced by the couple’s eating habits, lifestyle and exposure to various environmental factors.

For women and men living with diabetes (type 1 and type 2 and others) it is more important to start preparing for conception at least three to six months prior. Elevated blood glucose levels can impact your level of fertility, but if you can optimise it three to six months prior trying to conceive, it can greatly improve your chances of becoming pregnant and having a healthy pregnancy.

The main goals are to:

  • Optimise glycaemic levels
  • Maintain healthy diet and lifestyle habits
  • Review medications and conduct appropriate medical checks including diabetes-related complications such as eye checks.

Optimising glycaemic levels

When preparing for pregnancy, it is advised to aim for a HbA1c of 6.5 per cent or less (48 mmol/mol) or come as close as possible to this. This is to reduce the risk of congenital abnormality and miscarriage, particularly in early gestation. A target should be discussed individually with your health team as they will assess your hypoglycaemia risk.

Healthy diet is key

The Australian Healthy Eating Guidelines provide good advice for optimising your diet prior to getting pregnant. We know that eating well and maintaining a healthy lifestyle helps to improve the quality of the women’s eggs, and the health of men’s sperm. It takes about two to three months to see the effects of a healthy diet, that’s why establishing a good routine that you can adhere to is really important.

Here are some key nutrients to include:

  • Choose wholegrain breads, cereals and grains
  • Incorporate variety of fresh fruits and vegetables
  • Ensure adequate dairy or intake of dairy alternatives for calcium
  • Choose folate-rich foods such as green leafy vegetables
  • Limit saturated and trans fat
  • Minimise sugar-sweetened beverages
  • Moderate amounts of caffeine (<200mg/day)
  • Ensure adequate omega 3 intake such as oily fish (aiming for 2-3 times/week) or plant-based sources
  • Avoid or limit alcohol consumption This is a great opportunity for you and your partner to implement healthy eating and lifestyle habits. It helps you develop good habits and makes it easier when you do get pregnant.

Do I need to use supplements?

You should aim to meet most of your nutritional requirements with food first. Folic acid is the only supplement that is advised when trying to conceive. For the general population, women are advised to take 400 micrograms/day folic supplement at least once a month prior, and up to 12 weeks gestation. For women living with diabetes, it is advised to take a higher dose of 2.5-5mg/day at least three to six months prior conceiving and up to 12 weeks gestation. This is to reduce the risk of neural tube defect. It is best to speak with your doctor first before commencing on this supplement. Other supplements will be based on each individual and it is best to see an Accredited Practising Dietitian who specialises in pregnancy and diabetes.

Men’s health is important too

Nutrition and maintaining good lifestyle habits affect the health and quality of both egg and sperm. For men living with diabetes, it’s also important to optimise blood glucose levels as elevated glucose levels can lead to damaged sperm DNA and lower testosterone levels. Elevated glucose levels can also lead to other fertility issues such as erectile dysfunction and decreased sex drive (libido).

Some specific nutrients that can help with enhancing sperm health:

  • Choose selenium-rich foods such as Brazil nuts and seafood
  • Include zinc-rich foods such as oysters, fish, poultry and meat
  • Limit trans and saturated foods
  • Ensure adequate omega 3 intake including oily fish 2-3 times/week or plant-based sources such as walnuts and chia seeds
  • Limit or avoid alcohol

Into pregnancy and beyond

For women living with diabetes, there are increased risks of pregnancy complications. These include a greater likelihood of neonatal hypoglyceamia, neonatal intensive care unit admission, miscarriage, caesarean before labour, pre-eclampsia and being large for your gestational age. All of this can be confronting and stressful or even put you off wanting to get pregnant. However, many women with diabetes have healthy pregnancies and babies. To make things less daunting and to empower you to make informed decisions about your diabetes management, it is important to ensure appropriate planning prior to conceiving and to have a supportive diabetes team to assist you. Your diabetes team should include an obstetrician, endocrinologist, diabetes educator, dietitian, and may include a physiotherapist and psychologist – all who specialise in managing diabetes in pregnancy care. Pre-conception planning gives you the opportunity to better understand your glycaemic patterns, implement appropriate nutrients and lifestyle habits and importantly, set you, your partner and future baby’s health. When you are pregnant the targets for BGLs or CGMS do change. Your diabetes team will be able to guide you during this process.

Important things to know:

  • Planning for pregnancy is important to optimise glycaemic levels, dietary intake and lifestyle habits. This will set you, your partner and future baby on the road to good health.
  • Ensuring good nutrients and maintaining healthy lifestyle improves the fertility and quality of women’s eggs and men’s sperm. This impacts on your baby’s development and risk of health conditions.
  • Women with type 1 and type 2 need a high dose of folic acid. It is advised to take a high dose of 2.5 to 5mg/day three to six months prior conceiving, then up to 12 weeks gestation.
  • Women with type 1 are eligible for free CGMS for pre-pregnancy planning, during pregnancy and post pregnancy. Speak with your diabetes team to find out more.

How to get your mojo back and increase sex drive

ERECTILE dysfunction is the inability of a man to develop and/or maintain an erection for satisfactory sexual performance or intercourse.

International research estimates that at least 52 percent of men between the ages of 40 and 70 are affected by erectile dysfunction or impotence.

A study carried out in the Western Cape has strongly suggested that the incidence of the condition in South Africa may be higher than the international studies indicate.

With men being men, they do not often talk about this sensitive topic, sometimes not even with their doctor.

We need men to know that often erectile dysfunction is a precursor to a more serious illness, such as cardiovascular disease.

It is estimated that 80 percent of erectile dysfunction cases are cardiovascular disease-related.

Mariska Fouché, public affairs manager for Pharma Dynamics, says erectile dysfunction or impotence remains an uncomfortable topic for many – doctors included.

“Physicians are often reluctant to bring up a topic that may cause offence, even when there are pressing medical reasons to discuss it – especially when it is of a sexual nature, which can compromise the care patients receive,” says Fouché.

“A man in his 80s could have a fulfilling sex life with regular erections.

“There are numerous famous men who became fathers when they were relatively old, like rock star Mick Jagger at 57, artist Picasso at 68 and actor Charlie Chaplin at 73.

“In the majority of cases of chronic impotence or inability to get and maintain an erection, the reason is an underlying health problem, such as cardiovascular disease, diabetes or hypertension.”

All of these are closely linked to numerous lifestyle choices, such as lack of exercise, smoking, eating food that is high in fat, sugar and salt, and drinking too much alcohol.

“For an erection to occur, the penis must be supplied with sufficient blood. When patients cannot achieve erections regularly, it is often a sign that they have hardened arteries or atherosclerosis.

“In turn, this could be a symptom of cardiovascular disease, which is caused by poor diet, lack of exercise, smoking and drinking excessively.

“The smaller penile arteries will clog up faster than the larger cardiac ones. Studies show that men with erectile dysfunction are more likely to experience a heart attack within the following two to five years.

TOUCHY SUBJECT: Many men are unaware that they are sufferers or even that their performance in the bedroom is an early indicator of cardio

“Diabetic men can expect to experience erectile dysfunction between 10 and 15 years earlier than other men their age who don’t have diabetes.

“Diabetes can damage the blood vessels and nerves necessary for erections to occur, and is a chronic illness that has its origins in a sedentary lifestyle and a diet rich in processed foods with low nutritional value.”

Cardiovascular disease, diabetes and hypertension are all on the increase as more and more South African men become obese. But many men are unaware they are sufferers or that their performance in the bedroom is an early indicator.

International research shows that for every 9kg a man is overweight, he experiences a 3 percent decline in erectile function.

“Smoking and drinking also damage the delicate blood vessels,” Fouché said.

“A man who smokes, drinks alcohol in excess, doesn’t exercise regularly, is overweight and eats an unhealthy diet has a heightened risk of developing diabetes, cardiovascular disease and other chronic ailments that will often go undetected until he seeks medical advice because his erections have been affected.

“Erectile dysfunction is often a symptom of a larger health issue.”

The good news, says Fouché, is that lifestyle diseases and erectile dysfunction can be successfully managed.

“The key is to be more active, stop smoking, drink moderately, eat lean meat, limit fat, salt and sugar, and seek medical help for chronic diseases. Your erectile dysfunction is nature’s way of telling you to look out for your overall health,” says Fouché.

Mild erectile dysfunction is described as being able to maintain an erection seven or eight times out of 10 attempts at intercourse, moderate erectile dysfunction as four to six times, and severe as zero to three times.

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is aimed at destigmatis- ing the condition, while encouraging discussion and teaching the public and health care practitioners to see it as part of an overall health problem,” says Fouché.

“It is estimated that at least 77 percent – or three out of four – South African men between the ages of 35 and 70 are affected by erectile dysfunction, mostly due to heart problems that are strongly linked to their diet, lack of exercise and other bad habits.”

The campaign will also be driven on line through an interactive website, www.edtreatmentindia.com, where men and women can find out, without giving their names, more about erectile dysfunction.

Users will be able to assess their risk of suffering from erectile dysfunction with a survey screening tool. A urologist and a psychologist will be on hand to answer questions.

Partners of men with erectile dysfunction may also ask questions through the site during Mojo Week, should they need any help or advice on how best to approach this issue.



Having a well-balanced diet boosts your immunity and helps to protect against cancer and other diseases. Here’s what to eat

What we eat impacts our health. Making smart food choices may help reduce our risk of developing cancer, especially foods with beneficial compounds that can fight the disease. Here are some superfoods to add to your grocery list:


Garlic is a potent superfood you want to add to your list. Not only does it help to reduce blood pressure and cholesterol levels, but it also contains sulphur compounds that can shore up your immune system to fight against cancer, as well as potentially reduce tumour growth.


Antioxidant-filled berries of any kind are one of nature’s best superfoods. They contain polyphenols, a group of phytochemicals, and two active cancer-fighting compounds – anthocyanins and ellagitannins – which work together to help reduce the risk of colon cancer.


Specifically, green or black tea. Black tea and green tea are derived from the same plant, but black tea is made from the fermented leaves of the plant. Green and black tea contain polyphenols, antioxidative plant compounds that help to fight and inhibit the growth of cancer cells.


According to the American Institute for Cancer Research, all types of nuts have cancerfighting properties, but none more so than walnuts. In one animal study, mice that were fed whole walnuts and walnut oil showed higher levels of tumoursuppressing genes than those that were fed vegetable oil.

Fatty fish

Fatty, oily fish like salmon, mackerel and anchovies are rich in essential nutrients like omega-3 fatty acids, vitamin B and potassium, which may

help guard against heart disease and cancer. A diet high in freshwater fish can reduce the risk of colorectal cancer by 53 per cent, while another study showed that eating fish oil and fish oil supplements can significantly lower the risk of prostate and colon cancer.

Milk ‘increases risk of prostate cancer’

DRINKING milk can raise the risk of prostate cancer, a study shows.

It found those who downed around three-quarters of a pint a day were 25 per cent more likely to develop the disease than men who drank less than a quarter of a pint a week.

Scientists believe milk contains hormones and proteins that stimulate fuel cell division which can lead to cancer. In the latest, large-scale study, more than 28,000 men in the US were monitored for nearly eight years.

Results showed the connection to prostrate cancer applied to all milk – full-fat, semi-skimmed and skimmed.

But no link was found in other dairy products, such as yoghurt and cheese, potentially because hormones and proteins are lost during fermentation.

As studies continue, lead author Prof Gary Fraser, of Loma Linda University, California, said men with a family history of prostate cancer should be cautious and consider non-dairy milks like “soy, oat or cashew”. The same team previously found a link between traditional milk and breast cancer.


LET’S TALK ABOUT PORN – Pornography’s Effect on the Brain

Author Natalie Lee advocates for feminist, ethical pornography

Dwaso you remember the first time you saw pornography? I do. I was seven or eight years old. A local older boy babysitting me and he’d invited another boy from our street over. Somehow they’d found the VHS tapes on the shelves that the adults had (unsuccessfully) tried to hide by labelling them with innocuous film titles. The boys laughed hysterically while the stripper seduced an older man and proceeded to bounce up and down on his lap, making noises that appeared animal-like to my young ears. I had no idea what was going on but I was intrigued and, from the boys’ reaction, I knew there was something thrilling about it. Once the video was over, I watched the boys as they carefully rewound the VHS to exactly the same moment where it had previously ended and placed it back on the shelf in exactly the right spot. I wondered what was so appealing about it, and why it needed to be concealed. Over the years, I’d see more of these kinds of images – both accidentally and intentionally. I’d find copies of magazines lying around that were filled with images of naked women. Sometimes I’d take down one of the badly hidden VHS tapes and put it on. The first porn collection I found was straight out of the 1970s; men sported mullets and women had big, bushy pubic hair – normally a strong, handsome man and a weak, beautiful damsel in distress. The woman always seemed to be angelic and innocent, but as soon as she started having sex she transformed into a kind of wild animal. As a young girl set on being ‘good’, this was fascinating to me. ‘So I’m supposed to be good all the time, except when I’m having sex?’ I wondered. I didn’t play these videos to make myself

‘Most porn portrays sex as a purely physical act, without any feelings or even consent’

aroused, at least not consciously; I was trying to understand what sex was all about.

In the absence of detailed sex education and honest conversations with my family or friends, these secret screenings helped me piece together what sex actually was.

I’m not the only one who used pornography as a way of supplementing sex education. According to a recent report by the British Board of Film Classification (BBFC), kids often stumble across porn from as young as seven, usually before they receive sex ed at school. And in a survey of 18-25-year-olds by BBC Three show Porn Laid Bare, 55% of men and 34% of women said it was their main source of sex education. The problem is that most of the sex we see in porn is unrealistic. It portrays sex as a purely physical act, without any of the accompanying feelings, communication or even consent. It’s often violent and abusive and these distressing images can leave their mark.

When I started dating as a teen, I had no idea what I was doing and looked to porn as a necessary guide. It taught me how to put on a good show. I flung my (long, straight, chemically relaxed) hair around, arched my back, writhed around and viewed sex like a performance. Whenever my teenage boyfriend and I had sex, it was clear he was just emulating what he had seen in porn, too. It’s a shame, really, that we were both so focused on giving each other the ‘right’ image that there was no space for vulnerability. As teenagers, inexperience is expected, and part of the joy of sex should’ve been exploration, gentleness, generosity and plenty of giggling as we figured out what felt good. Porn ruined that for us.

The women in these movies didn’t look like me – or anyone else I knew. Not only did they have blemish-free skin, perky tits and toned bottoms, but they were basically all white with long blonde hair and blue eyes. All this did was reinforce what I had already been fed – that my blackness was undesirable, and that a carbon-copy image of whiteness is what men find attractive. Without realising it, the absence of seeing myself in the sex I was watching impacted my self-esteem. It made me think that true sexiness was a space I’d never be able to occupy.

In my 20s and 30s, my relationship with porn shifted again. The first free, advertisingsupported and easily accessible porn websites popped up in around 2006, when I was 26. Suddenly, porn became easier to access. But just as I was growing into my identity as a feminist, the link between porn and patriarchy came into sharp focus. I could tell that all the porn on these sites was created through the male gaze, and marketing to those desires had distinctly misogynistic undertones. Like many other women, I came to the conclusion that porn was inherently bad. The space wasn’t created for us, and it was clear we weren’t welcome (unless we were watching it alongside our male partners). I still craved the titillation that porn could provide, but the industry felt so grimy and anti-women that watching it felt like I was contributing to the exploitation. I didn’t want any part of that.

Then, five years ago, I stumbled across Swedish indie adult filmmaker and pioneer of feminist and ethical porn Erika Lust on Instagram. The idea that porn could be both feminist and ethical intrigued me, as both of these claims seemed to be the antithesis of the porn world I knew. I discovered that she runs four online cinemas: Xconfessions, Lust Cinema, Else Cinema and The Store by Erika Lust, all of which contain porn movies that are designed specifically through the female gaze. Rather than focusing on male pleasure, they focus on the eroticism of human sexuality and relationships. Her movies represent a wide range of identities, sexualities and human body types and she also follows a strict ethical code: paying everyone fairly, from interns to performers; being transparent about who is involved in making the films; and ensuring safe sex by requiring every performer to have an STI test and choose a safe method of contraception. Reading all this, I paid for an Xconfessions subscription. Not only are they beautifully shot – so much more cinematic and

aesthetically pleasing than any other porn film I had watched – they did exactly as they promised, featuring women of all different races, shapes and sizes. These women were all desiring and being desired. Finally, I felt like I could see myself (and other women I knew) represented in sexy scenes. It helped me believe that I could be the object of desire and eroticism.

‘We can’t generalise our desires, as every woman is obviously different,’ Erika Lust has explained. ‘But I think what really excites and empowers women is to have a voice in the story, both on screen and in real life. Women want to see other women enjoying and freely living their sexuality while they are in charge of their bodies, whether the film is romantic, kinky or anything in-between.’ She’s right.

In watching sex that is realistic and, fundamentally, human, I could be fully immersed in what was happening and allow my pleasure to take over. Rather than believing porn must be intrinsically bad and shameful, I realised that it does have benefits. One study by psychologist Sean Mcnabney looked at how porn consumption affects women’s satisfaction and relationships. He found that more frequent porn use was related to less difficulty in becoming aroused and greater orgasm pleasure, both alone and during partnered sex.

Women are sexual beings, too, with fantasies and desires to match any man’s, and I’m pleased that the mainstream porn industry is beginning to see that. Although Lust notes: ‘The porn industry’s highest positions of power are still overwhelmingly dominated by white, cisgender men. In maledirected heterosexual porn, the female becomes the object of the combined gaze of the filmmaker, male performer and male viewer, so the woman always becomes secondary. This is why I believe that in order for porn to change, we need more women, queer, BIPOC and Asian people behind the cameras. The most crucial difference between my indie porn and a massive amount of mainstream porn is that I constantly show my name and face and share my values with the public.’ We also need to normalise paying for porn. Before, I would have been ashamed to admit I’d taken out a paid subscription to a porn site, but now I’m proud that I’m contributing to an ethical industry where workers are paid fairly.

I have come on quite a journey with how I view porn. Now, I can watch Lust’s films alone with a glass of wine in bed, or sometimes with a partner. It not only elevates my sex life, it makes me feel liberated. For you, it might be erotic fiction (think Fifty Shades Of Grey, or even some fan fiction on Wattpad), or perhaps you’d prefer erotic storytelling through audiobooks and podcasts; if so, Dipsea (dipseastories.com) is perfect. There’s nothing to be ashamed of when exploring desires through porn.

My biggest hope is that, eventually, the mainstream porn industry will follow ethical standards. I hope that all porn stars are treated with dignity and respect so that the industry can be a truly safe space for desires and fantasies to be met. I hope that men will watch porn and not believe they have to perform aggressively to impress women; I hope they will see realistic porn that places vulnerability and communication above heavy thrusting and unrealistic orgasm noises.

I hope that all women and non-binary people will see themselves in the porn they watch; that it can boost their confidence rather than making them feel inadequate.

I hope you will discover porn that will allow you to explore your wildest desires, to liberate you sexually and remind you that you are completely normal and your pleasure is worthy and valid. There’s a reason porn exists – to titillate, excite, arouse – and we all deserve the chance to get in on the action.


Penile Prostheses Offer Safe, Long-Term Erectile Dysfunction Solution

Phil Shulka is a retired Naval Corpsman who served in the Naval Reserve from 1969 to 1970 and was stationed in Guantanamo Bay on the USS Rich (DD-820). Phil also attended Naval Corps School in Great Lakes Illinois. He has led an active life, exercised regularly and was rarely sick.

Phil Shulka is a retired Naval Corpsman done Penile Prostheses surgery after prostate cancer

At age 55, Phil had a routine blood test that detects prostate specific antigen (PSA) in blood. PSA is supposed to be in the prostate, not in blood. Phil said, “If you have an unusual amount of PSA in the blood, that means that something is going on and you need a biopsy. I did have a biopsy done at age 55, but back then, they only did six samples and hoped that they would hit something. The test missed it. I went home; fat, dumb and

happy, thinking okay, I’m fine.”

Four years later, Phil’s wife reminded him that he was due for a physical. Part of the physical included another PSA blood test. “At age 60, I scheduled the physical and PSA test. If a PSA has a value above four, it is something to watch. If it is above ten, it is considered bad. If it is above 20, it is very bad. My PSA came back at 30 and they found that my cancer was already outside

of my prostate, invading the seminal vesicle.”

Phil chose the most aggressive treatment available, which kept the cancer under control for many years. Phil said, “I suffered the side effects that most men are worried about. My cancer had compromised the nerves that are responsible for getting an erection. Pills would not work and I never tried the injections. Instead, I went in for the penile implant Surgery. Everything is done internal, so you do not see it. You could be in a locker room and nobody will know you have it. If you had prostate surgery before, the nerves that cause erections may have been severed, but the nerves that cause sensations are still there so you can still experience everything, including orgasm.

Phil Shukla is now a two-time prostate cancer survivor and a certified prostate cancer recovery coach. “The penile implant is a game changer because you can act with a moment’s notice. There is nothing to

inject. There is nothing that you need to put around yourself, it is all internal and discreet. If you feel that this can be a game changer for your life, investigate and find a doctor who is competent. Life is short, get as much as you can out of life.”


The long and short of penile implants

When other treatments for erectile dysfunction fail, penile implants may become the last option.

The malleable penile implant is made up of two pieces of a semirigid implant and is the less expensive and simpler option to perform.

ERECTILE dysfunction (ED), also known as impotence, is a male health problem that can greatly impact a man’s self-esteem.

A person who suffers from ED is unable to get or maintain an erection firm enough to have sexual intercourse, which may put a strain on physical relationships and generate self-doubt and a sense of emasculation.

Depending on a person’s condition, there are various ways to tackle this issue, including psychological counselling, medications and surgery.

There is a common locker room misconception that penile implants, which involve surgery, are only designed to give extra length and size.

While they are not size boosters, they constitute one of the most effective approaches in overcoming ED and can serve to restore self-esteem and confidence in patients.

Penile implants are reserved as a last resort for patients suffering from ED but they can also be offered to patients with severe penile curvature with erection issues.

Before implants are considered as a solution, patients are usually offered a variety of other treatments depending on the degree of their ED.

Patients with milder symptoms can be offered medication, but if he is unable to tolerate the side effects of the medication or is deemed unsuitable to take them, a penile pump, medicated injection or an implant will be advocated as an alternative.

Patients who have had prostate cancer surgery are also at risk of ED as the surgery to remove the tumour-laden prostate might involve removing nerves contributing to erection and urinary continence.

Even a surgery meant to treat benign prostate enlargement runs a small risk of resulting in ED, which is why it is of vital importance for patients to understand risks before consenting to surgery.

ED can also be found in patients suffering from various medical conditions such as diabetes hypertension, high cholesterol levels, heart issues, kidney failure, spinal cord injuries etc.

Men who suffer from stress, anxiety or other psychological issues might also find themselves unable to attain erections.

Types of implants

There are two types of penile implants: malleable (two-piece) and inflatable (three-piece) penile implants. Both are concealed in the body.

The malleable type is made up of two pieces of a semi-rigid implant and is the less expensive and simpler option to perform.

The surgery involves implanting both the implants in the shaft of the penis, which can be bent upwards, simulating an erection. The malleable implant may have some side effects such as giving the penis an unnatural partial erectile appearance and occasionally cause thinning or erosion of the penile tissue, as the semi-rigid nature of the implant exerts some degree of pressure on the flesh.

The inflatable penile implant is a soft saline-fluid-filled device. It comprises of two thin penile tubes (where the saline enters), a pump and a reservoir.

Whenever the patient wants to attain an erection, he can press the pump which is placed in the scrotum beside the testicles. The fluid from the reservoir, placed inside the abdomen, will then be channelled to the thin tubes implanted in the penile shaft, creating an erection.

While comparatively more expensive, the inflatable penile implant gives a better aesthetic appearance and has fewer side effects compared to the malleable type.

Both types of implants do not alter the sensation of the penis or reduce the orgasm. An optimal size will be implanted in order to not cause pain to the patient or overstretch the penile shaft.

What to know before you consider implants

It is important to first gauge the expectations and understand the risk and complications of a penile implant before surgery is done.

There are several factors which might affect the success of the operation – the size of the penis and scrotum, the degree of penile curvature, previous radiotherapy/ penile surgeries, the patient’s premorbid status and his commitment to hygiene.

While the incident rate is quite low, it is crucial to bear in mind that the penile implant is still a foreign gadget in the human body, despite being bio-compatible and may run a risk of infection, bleeding, pain and mechanical malfunction.

Many ED patients have plenty of productive years ahead of them and penile implants can offer them a life-changing solution. ED patients who have not experienced success with medications should consider penile implants as they might restore quality of life and give the patients a boost of confidence.

Dr Warren Lo is a Consultant Urologist. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.