Dyspareunia is persistent or recurring pain experienced before, during or after the act of sex. It
can affect both males and females of all ages, but it is most common in females. The pain is often
due to physical or medical conditions, but it can also be psychological. It is a common condition
that can have negative emotional and psychological effects on an individual and greatly affect
the quality of their sex life, subsequently leading to loss of intimacy and causing strain between
partners.

What are the different forms of Dyspareunia?
The different types of dyspareunia experienced can be classified on the basis of location, and
timing.
With location; the pain could either be:

1. Entry Pain: This can be felt superficially, on the external aspect of the genitals which is the vulvar region, or at the opening of the vagina, when penetration is initiated. Some factors associated with entry pain are little or no lubrication, superficial injury or infection in the area.
2. Deep Pain also known as Collision Dyspareunia: With this, the pain is felt more internally, deep in the vault of the vagina or deeper inside the pelvis with more penetration and greater pressure against the cervix.
3. Some also feel the pain in multiple places concurrently.

With regards to timing, the pain could either be:

• Primary: Pain that has been felt ever since becoming sexually active, in effect from the very onset or first attempt of intercoure. 
• Secondary: Pain that develops after one has hitherto been experiencing pain-free sex, for example after nursing an injury or battling an infection, or in association with the menstrual cycle.
• Complete: Pain which is felt every time one engages in sexual intercourse.
• Situational: Pain which is felt only when sex is had at certain times, with certain  partners, or under certain circumstances etc.

What are the causes of dyspareunia?
In Females:
For women, in most cases, pain during sex is experienced when there is not enough lubrication
of the vagina during intercourse and can be resolved with increased or prolonged foreplay, or
with the use of a lubricant.

In other cases, a woman may have painful intercourse if one or more of the following conditions
is present:

• Vaginismus; which is the involuntary tensing or contracting of the muscles around the vagina upon any attempt to penetrate it, mostly due to fear of sex or having anxiety around sex, possibly due to a past sexual abuse, or traumatic experience.
• Vaginal atrophy which is the thinning up of the lining of the vagina, causing it to lose its normal moisture and thickness and become dry, thin and inflamed. This can be brought about by certain medications, the onset of menopause or other hormonal imbalances.
• Vaginal infections
• Cervical Infections or inflammation: The penis is able to reach the cervix at maximum penetration,therefore any infection or inflammation at the cervix can cause pain during deep penetration.
• Presence of pathologies such as Uterine Fibroids, Ovarian cysts
• Endometriosis: A condition in which the endometrium (tissue lining the uterus) grows in locations outside the uterus causing pain which will be worsened by penetration.
• Pelvic inflammatory disease
• In a Case of an Ectopic pregnancy which is the event where a fertilized egg develops outside of the uterus, a painful occurrence on its own and can be exacerbated by sexual intercourse.
• Having Intercourse too soon after childbirth, or a gynecological surgery due to inadequate healing.
• In cases of an active Sexually transmitted infection, or a bout of Pelvic Inflammatory Disease. 
• Psychological issues: Anxiety, depression and low self-esteem can prevent sexual arousal. If you have been a victim of sexual abuse, it can also contribute to your pain during sex.

In Males:
Males; although it is much less common, can feel pain during intercourse if there is not enough
vaginal lubrication leading to friction. This can be resolved by using a lubricant. Other penile
disorders which can cause pain in men include:

• Injury to the foreskin caused by rubbing or tearing in uncircumcised males.
• Sexually transmitted infections (STIs), yeast infections etc
• Penile deformities
• Priapism which is the incidence of persistent, painful erections.

What are the symptoms of dyspareunia?

• Sharp pain during penetration or on the onset of entry.
• Deep pain during the act of thrusting.
• Throbbing pains after intercourse has been had.
• Burning pains during or following intercourse.
• Pelvic cramping.
• Muscle tightness or spasms during intercourse.

How is dyspareunia treated?
Not all cases of Dyspareunia require medical intervention. Some lifestyle changes can be
employed. For example, with regards to a case of painful intercourse after pregnancy and
delivery, or after gynecological surgery, it is best to wait at least six weeks after the procedure
before initiating intercourse to allow for adequate healing. Gentleness and patience will also go a
long way in such a case.

In cases in where the main issue is vaginal dryness or a lack of lubrication, using lubricants, or
ensuring prolonged and adequate foreplay to stimulate enough natural lubrication is advised. If
the vaginal dryness is due to onset of menopause, it is advisable to see a gynecologist for further
assessment and management.

In all other cases causing unbearable pain with no identifiable cause, it is advised to be assessed
by a general medical practitioner who will refer you to a gynecologist if need be. However, in
cases where is no underlying physical or medical cause, where the cause is most often than not,
psychological, seeing a psychotherapist is advised as for some people, there may be a need to
deal with past traumas, anxieties, unresolved guilt, or inner fears and struggles regarding sex in
order to be able to experience relief.

Driving anxiety or driving-related fear (DRF) is a state characterized by a pathological fear of
the act of driving. It is a strong, intense, persistent fear of being involved in activities relating to
driving, car traffic, or in some cases all other vehicular modes of transportation. It is such that it
affects a person's lifestyle, and can even render them unable to participate in certain activities or
jobs due to the fear and avoidance of driving. It can get to the point where the sufferer begins to
make excuses as to why they can't go out, will tend to take unnecessary longer routes in order to
avoid busy roads and highways, or feel the need to outsource driving to someone else which
could cause them financial burden.

The fear of driving may be triggered by some particular situations, such as main roads or
highway driving, or situations of very dense traffic. Driving anxiety can range from a mild
concern from time to time, to a strong phobia affecting ones quality of life.

What are the symptoms of a Driving Phobia?
The fear of driving can be exhibited through various physical and emotional symptoms that vary
from person to person. Some such symptoms are:

1. Increased or profuse sweating
2. Increased heart rate or tachycardia
3. Hyperventilation or a state of rapid, deep breathing.
4. A false feeling of losing control while driving, even in situations that are actually reasonably safe
5. Nausea
6. Dizziness
7. Dry mouth
8. Lightheadedness or feeling faint
9. Trembling
10. Chills
11. Palpitations
12. Stomach Cramps and indigestion

What are the causes of Driving Anxiety?

1. The most common cause of driving anxiety and fear of driving is the fear of road traffic accidents, whether in someone who has experienced one themselves, been affected directly by the consequences of one, or someone having been close to experiencing one, or even being an eyewitness to one. For some people the fear is worsened by specific situations for example when near large vehicles such as buses, tipper trucks and articulated trucks, but in some people, the fear can be triggered just by sitting in a car or even just the thought of having to travel in a car in the near future.
2. There is also the case of new drivers who have not necessarily been involved in a road traffic accident, but harbour anxiety surrounding the possibility of one.
3. The fear of driving can also stem from modelling; or observing someone with it express and talk about their fears over time, also depending on ones proximity to the person, and the amount of interaction had or time spent together.

How can Driving Anxiety be managed?

1. Through Exposure therapy facilitated by a psychologist. Exposure therapy involves gradually exposing an individual to the very images or situations that trigger their symptoms in a controlled environment with a professional supervising, in order to learn to manage the fear in question. Participants in exposure therapy get to learn deep breathing and relaxation techniques to use before and during exposure, they are shown images and videos of situations involving the trigger which in this case is vehicles, then they graduate to sitting behind the wheel, or the passenger seat of a stagnant vehicle, followed by a moving vehicle in a controlled environment like an empty parking lot, and then finally the road.
2. Virtual reality; employing the use of virtual reality to simulate the above described scenarios for the patient to be exposed to and sensitized to.
3. Cognitive behavioral therapy (CBT) provided by a psychologist will teach a sufferer of driving anxiety how to change the way they receive stimulus regarding driving, and how they respond to situations which will trigger their symptoms. 
4. Medications: In extreme situations, medication may be prescribed by a psychiatrist.  You must see a doctor as soon as possible if you find yourself experiencing Panic attacks associated with driving, or persistent anxiety that interferes with your ability to get on with your daily life and functioning, or interrupts your sleep.

Dyslexia is a learning disorder which is characterized by difficulty reading that stems from
problems with identifying speech sounds and learning their relation to letters and word, difficulty
spelling words, reading quickly, "sounding out" words in ones head in order to read them,
difficulty pronouncing words while reading out loud as well as difficulty understanding what one
reads.

The difficulties are purely involuntary, and people with the disorder tend to have a normal desire
to learn like everyone else. The disorder is usually first picked up or noticed at school. It is also
known as a reading disability. It must be noted that Dyslexia is not due to problems with
intelligence, hearing or vision. Children with dyslexia can, with the right support and tutelage, do
well academically. Emotional support from family, and teachers is also very important.

What are the Symptoms of Dyslexia?
Before the child starts school here are several signs that could indicate that they may be at risk of
Dyslexia:

• Delayed talking
• Slow in learning new words/phrases
• Issues with the forming of words correctly, or confusing words that sound alike etc
• Problems recalling and mentioning the names of letters, numbers and colors correctly
• Difficulty with learning to sing nursery rhymes etc

Signs in a child of School going age:

• Reading below the expected reading level for the child's age
• Problems processing and understanding what is read.
• Difficulty formulating correct answers to questions asked
• Problems with remembering sequences
• Difficulty seeing the similarities and differences between letters and words
• Being unable to sound out or pronounce unfamiliar words.
• Difficulty spelling
• Spending a prolonged amount of time to complete reading and writing tasks.
• Trying to avoid class activities that involve reading out loud or writing in front of the class.

Signs in a Teen or adult are similar to that of children:

• Difficulty reading in general, including reading aloud during meetings, or presentations or anywhere it demands.
• Reading and writing in a way that is slow and labor-intensive and appears cumbersome.
• Problems with spelling words.
• Avoiding and opting out of activities that involve any reading or writing especially publicly.
• Mispronouncing names and words, or problems remembering them.
• Spending a prolonged amount of time completing tasks that involve any reading or writing.
• Having significant difficulty summarizing a story
• Having a lot of trouble when trying to learn a foreign language

Complications of Dyslexia
Left untreated, dyslexia can lead to several problems in the individual’s life and general functioning including:

• Falling Behind: Because reading is a skill that cuts across most subjects and academicactivity, most people with dyslexia tend to fall behind their peers academically and will need to do a lot of work to keep up.
• Social Issues: If untreated, dyslexia may lead to onset of low self-esteem, behaviorial problems, anxiety and depression, as well as a sense of isolation from peers, and other stakeholders such as siblings, parents and teachers.
• Comorbidities: Children who have dyslexia are at increased risk of having other comorbid conditions such as attention-deficit/hyperactivity disorder (ADHD), and vice versa. ADHD for example can cause hyperactivity and impulsive behavior, which can make dyslexia harder to treat.

How is Dyslexia Managed?
Dyslexia is managed through therapy and educational support. With timely intervention
individuals with dyslexia can learn to read and write. The use of specialised techniques and
technical aids also assist in concealing the symptoms of the disorder and helping them subside.

The main aim is to increase the child's awareness of how the various graphemes (more
commonly known as letters) and phonemes (the sounds made from each letter) correspond, and
to be able to transfer this information to reading and spelling by learning how the sounds blend
into words.

Although there's no cure for dyslexia, with an early assessment , diagnosis and intervention, the
best results can be achieved. There are times where dyslexia will go undiagnosed for years and
will not be diagnosed officially till adulthood, but even with that it's never too late to seek help.

Delayed ejaculation is characterized by the persistent inability of a man to achieve an orgasm
regardless of ample sexual desire and stimulation. Ordinarily, a man is able to reach orgasm
within moments of continuous active thrusting during sex, but in the event where a man has
delayed ejaculation, he will not be able to have orgasms at all, or cannot have an orgasm until an
extended period of intercourse which could last for about 30 or 45 minutes to an hour.
Sometimes men with delayed ejaculation are unable to orgasm or ejaculate at all.

Delayed ejaculation can be a temporary problem or something more long-term. It is fairly normal for a
man to experience delayed ejaculation from time to time. However, it becomes an issue when it
increases in frequency or becomes a more constant occurrence, leading to strains on the
individual and on the partnership.

Types of Delayed Ejaculation:
Delayed ejaculation is classified based on the following:

• Lifelong or acquired. 
  Lifelong delayed ejaculation: The case where the problem has been present since coitarche or the first instance of sexual maturity. Acquired delayed ejaculation is where the problem comes about after having experienced a period of normal sexual functioning.
   
• Generalized or situational.
  Generalized delayed ejaculation is such that the problem is not peculiar to specific sexual partners or specific kinds of sexual stimulation. Situational delayed ejaculation is such that it only comes about under particular circumstances or influenced by specific factors.

Causes of Delayed Ejaculation
Delayed ejaculation can result from a myriad of things. Usually, it is due to a cocktail of both
physical and psychological issues.

Some Psychological causes of delayed ejaculation are:

• Depression, anxiety or other specific mental health conditions
• Specific problems in the relationship or partnership due to stress, poor communication or insecurity and lack of trust etc.
• Anxiety about sexual performance. 
• Issues with body image and self esteem.
• Guilt surrounding Cultural or religious taboos.
• Distractions such as financial constraints, work-related issues, and stresses of daily life and survival.
• Preoccupations with certain fetishes or styles of masturbation in order to achieve orgasm.

Other causes of delayed ejaculation include:

• Certain medications can have the side effect of decreased libido and delayed ejaculation.
• Excessive alcohol use and other substance use.
• Some birth defects that affect the male reproductive system
• Infections such as a urinary tract infection
• Neurological diseases, such as stroke
• Hormonal conditions like low testosterone level
• Retrograde ejaculation, a condition in which the semen goes backward into the bladder rather than out of the penis

Treatment of Delayed Ejaculation involves the use of sex therapy and medications.

Delusional disorder is a condition that is characterized by the act of holding firmly unto false
beliefs and ideas, in the face of clear, reasonable evidence pointing to the contrary, occurring in
the absence of any other symptoms of psychosis.

The delusions in question may be either bizzarre or non-bizzarre in nature. Bizzarre delusions are
such that they are quite literally implausible or unlikely. However, non-bizarre delusions involve
situations that could possibly occur in reality, such as being attacked, poisoned, hit on, targeted,
followed or cheated on by a partner in a relationship.

Symptoms and Signs of Delusional Disorder:
Early noticeable symptoms of delusional disorder may include feelings and preoccupations such as
being targeted or being the center of evil ploys, being exploited, being lied to, feelings of distrust of
friends or partners in a relationship , or having the tendency to read absurd meanings into things said,
or happenings that are benign.

Different types of delusions:

• Erotomanic delusions are such that the patient believes that another person is in love with them and makes serious effort to contact the subject of the delusion and can sometimes get to the point of stalking or harassment which has led to patients with this type of delusion having encounters with law enforcement.
• Grandiose delusions are such that patients believe they have great power or influence or abilities which are in fact untrue and not congruent with their lifestyle. They have an overinflated sense of self-worth, power, knowledge or identity. 
• Jealous delusions are such that patients believe strongly that their partner is being unfaithful to them and the belief is usually not backed by evidence.
• Persecutory delusions involve patients believing that they are being targeted, schemed against, spied on, followed, sought after, or being the target of a ritual or vodoo charm.
• Somatic delusions are such that the patient believes he has a physical deformity or a malformation in their body, or an abnormality such as a pungent smell or parasite infestation etc.
• Mixed Delusions: Patients with this have two or more of the afforementioned delusions existing concurrently.

How is Delusional Disorder Treated?
Treatment for delusional disorder hinges on psychotherapy and supported with medications.
With the help of therapy, people with delusional disorder can be taught to manage their
symptoms, and to be able to identify signs of imminent relapse and develop healthy coping
mechanisms.
Medications known as antipsychotics as well as others such as anxiolytics and
antidepressants are used to buttress the treatment.
Anxiolytics help in situations where the patient has a very high level of anxiety or difficulty sleeping due to the delusions they are harbouring.
Antidepressants can help treat depressive symptoms arising in patients with
delusional disorder as well.

There’s no sure way to prevent delusional disorder from occurring, but with prompt diagnosis
and treatment, a patient can have a full life with moderate disruption of his or her general life and
functioning, as well as relationship dynamics.

The prognosis of cases of delusional disorder varies depending on factors such as the sub- type
of delusional disorder, the severity of the delusions being harboured, the availability or lack of
social support, and personal willingness to comply with treatment.

What are the complications of Delusional Disorder?
If Delusional disorder is left untreated and the severity of the delusions being harboured
increases, the following complications can occur:

• Depression 
• Becoming socially isolated or withdrawn
• Having to battle legal issues coming about as a result of acting on a delusion such as stalking, violence, harassment etc. 
• Self-injurous behaviour or inflicting harm on others which is usually seen in somatic, jealous and persecutory delusions.

Depression is a mood disorder that causes one to have a persistent feeling of sadness and low
mood coupled with a loss of interest or loss of enthusiasm activities and subjects that would
previously have given them joy or pleasure.

Depression can also manifest as difficulty with cognitive activities as well as activities of daily living such as self care, eating and sleeping.
It’s normal to feel down from time to time, or to have some periods of loss of interest, however
depression is different in the sense that it persists, and manifests everyday for at least two weeks,
and that feeling of sadness is associated with other symptoms in the same period.
Left untreated, depression worsens and in severe cases can lead to self injurous behaviour, or
suicide.

What are some specific types of depression?

1. Clinical depression (major depressive disorder): This is the most severe form of depression and one of the most common. 
2. Persistent depressive disorder (PDD): This is a mild or moderate form of depression which spans over at least two years. The symptoms are less severe than that of a major depressive disorder but they persist over a longer period of time. It can also be referred to as dysthymia.
3. Disruptive mood dysregulation disorder (DMDD): This is a case of chronic, intense episodes of irritability and frequent outbursts or tantrums in children, usually starting from the age of ten. 
4. Premenstrual dysphoric disorder (PMDD): is characterized by the occurrence of premenstrual syndrome (PMS) symptoms alongside mood symptoms, such as extreme levels of irritability, anxiety and, other depressive symptoms. These symptoms tend to subside within a few days after the period starts, however in some cases they are severe enough to interfere with the quality of life.
5. Depressive disorder due to another medical condition: Living with a chronic medical condition can predispose one to depression.

There are also specific forms of major depressive disorder dependent on circumstance, including:

• Seasonal affective disorder or seasonal depression)is a form of major depressive disorder that typically arises during colder and chillier weather, as well as rainy seasons with grey skies and less sunlight. 
• Prenatal depression and postpartum depression: Prenatal depression is depression which has its onset during pregnancy whereas that of . Postpartum depression develops within four weeks of delivery.

What are the symptoms of depression?
They vary from person to person and each patient can have a combination of the following:

• Persistent feeling of sadness 
• Losing pleasure in things that were previously pleasurable.
• Being easily irritated or frustrated by situations that ordinarily would not warrant such a reaction. 
• Unhealthy eating habits such as overeating or undereating which may result in drastic weight gain or weight loss.
• Having difficulty sleeping (insomnia) or oversleeping (hypersomnia).
• Having low energy or low motivation to do anything that requires effort.
• Having a difficult time concentrating, focusing on anything, completing tasks, making decisions.
• Increasing Forgetfulness
• Physical symptoms such as headache, dizziness, stomachache or sexual dysfunction such as delayed ejaculation, reduced libido. (See Delayed Ejaculation)
• Having thoughts of self-harm or suicide.

What causes depression?
There isn't an exact cause leading to depression however several factors can influence it.

• · Brain chemistry of the individual
• Genetics: If you have a first-degree relative (biological parent or sibling) with depression, you’re more likely to develop the condition, however that does not mean it is definite. You can also develop depression sporadically, that is without having had any family history of the illness.
• Stressful life events can serve as a trigger for the development of depression
• Dealing with Chronic pain and chronic medical conditions can predispose one to depression.
• Some medications can cause depression as a side effect, substance useincluding alcohol can also precipitate or worsen it.

How is depression treated?
Treatment options available for patients with depression include:

• Psychotherapy Sessions
• Medicationby way of antidepressants.
• Electro Convulsive Therapy
• Lifestyle modifications such as; physical exercise, meditation, yoga, improving sleep hygiene, eating healthy, avoiding substances, indulging in activities that foster connection and community.

What is the prognosis when someone has depression?
The prognosis of depression varies depending on factors such as:

• The type of depression
• The level of severity of the depressive symptoms
• The duration of the depressive episode
• The rate of recurrence
• The course of management used
• The level of compliance to the treatment
• The presence of co-morbid conditions.

However with early intervention and treatment, depression can be well managed and the
individual can live a full life. It’s essential to seek help as soon as possible if you’re experiencing
depressive symptoms or having suicidal thoughts.

Dementia refers to a group of conditions characterized by the loss of cognitive functioning such
as thinking, remembering, and reasoning to the extent that it interferes with a person's daily life
and ability to carry out activities.It can lead to a distortion of the persons personality. Persons
with dementia have a decline in memory, reasoning, language, coordination, mood regulation,
and behaviour.

Dementia can be mild, where its just beginning to affect the person's functioning, or severe,
which renders the person completely dependent on others to carry out even basic activities of
daily living.

What are the signs and symptoms of dementia?

• Increasing forgetfulness or memory loss,Forgetting recent events or information.
• Exhibiting poor judgment in situations
• Confusion
• Difficulty speaking and articulating oneself, as well as expressing ones thoughts, reading, and writing
• Difficulty understanding others
• Repeating comments made or questions asked over a very short period.
• Wandering off, and getting lost in familiar neighborhoods and areas previously frequented.
• Not knowing the date, time or the season.
• Misplacing commonly used items or placing them in unusual spots.
• Difficulty handling money
• Using unusual, non-corresponding words to refer to familiar objects
• Taking longer to complete normal daily tasks.
• Hallucinating or experiencing delusions or paranoia
• Acting impulsivelynd showing disregard for other people’s feelings which may not be usual of the person.
• Having problems with balancing, or with movement

Signs of worsening dementia

• Further decline of memory.
• Communication becomes more difficult.
• Performing simple daily tasks become increasingly challenging until they can no longer be performed without assistance.
• Rational thinking abilities further decline
• Sleeping patterns become more and more distorted.
• Worsening anxiety, frustration, confusion, agitation, suspiciousness, sadness and other signs ofdepression.
• Experiencing visual and auditory hallucinations or experiencing delusions or paranoia

Symptoms however vary from person to person, depending on what area of their brain is damaged, and the extent and duration of the damage etc.

How does dementia come about?
Dementia is caused by irreversible damage to brain tissue. It affects brain nerve cells, and
destroys the brain’s ability to communicate within its various components. These breaks in
transmission result in the symptoms afforementioned. Dementia can also result from blocked
blood flow to the brain, causing it to be deprived of the oxygen and nutrients it needs to thrive.
Without those, the brain tissue loses viability.

What are the risk factors for dementia?

• Age is the strongest risk factor as ones chances of developing dementia increases with increasing age. Most cases of dementia have their onset after the age of 65. 
• Family history: One is more likely to develop dementia if they have first degree relatives with the disease. 
• History of high cholesterol levels, high blood pressure, atherosclerosis, diabetes, stroke or a history of smoking, can increase risk of dementia. 
• People of African or Hispanic descent have a higher chance of developing dementia. 
• A history of brain injury can put one at risk of developing dementia.

Management of Dementia
There is no cure for dementia however there are medications that slow the progression, or
alleviate the symptoms that have already begun to exhibit themselves. Physiotherapy,
psychotherapy, and recreational therapy can also be employed as supportive treatment.
Family support, and good social support is key to helping these patients thrive.

How can Dementia be prevented?
Although there is no definitive treatment or proven way to prevent dementia from occurring,
leading a healthy lifestyle will significantly reduce your chances of developing dementia

• Maintaining a healthy blood pressure
• Managing blood sugar levels
• Maintaining a healthy weight.
• Eat a healthy diet.
• Exercising regularly
• Keeping your mind engaged and active with activities such as reading, writing, playing board games, taking up new hobbies, learning new skills, volunteering etc
• Engaging in social activities
• Practicing good sleeping habits
• Protection against head injury
• Ceasing or reducing intake of alcohol.
• Stopping tobacco use or other recreational drug use.

It is not guaranteed that making the above lifestyle changes will protect against dementia, but
these changes are overall good for one's health and maintaining a healthy body and will
significantly reduce one's risk of developing lifestyle diseases in general.