malefront.net
Firearms enthusiasts have the NRA, and civil liberties idealists have the ACLU. Blacks have Black Lives Matter, and Mexicans have their drug cartels. Unattractive and left-over women have feminism, and radical muslims the ISIS. Only normal males have no front to represent their interests. (Serge Kreutz)

Brutal: A gruesome video allegedly showing the executions of two men accused of working as police spies has been released by Nigerian Islamist group Boko Haram

Home | Index of articles

---

Adult sexual attraction to early-stage adolescents: Phallometry doesn't equal pathology

Abstract

Arch Sex Behav (2009) 38:329-??330 DOI 10.1007/s10508-008-9428-8 LETTER TO THE EDITOR Thomas K. Zander Published online: 18 October 2008 A Springer Science+Business Media, LLC 2008 The ending of Blanchard et al. (2008) that adult self-reports of sexual preference for early-stage adolescents generally matched their phallometric responses to such adolescents does not justify the broad and startling conclusion of these researchers that hebephilia exists as a discriminable erotic age-preference?? so as to justify an expansion of the DSM diagnostic category of Pedophilia to include early-stage adolescents. DSM-IV-TR draws the distinction between pathological and non-pathological age-related sexual arousal at the onset of pubescence: adult arousal to prepubescents is considered pathological and adult arousal to pubescents and post-pubescents is considered non-pathological. This distinction is more than academic. It has serious, real world implications, given that, in the U.S., a diagnosis of Pedophilia can result in the diagnosed individual being subject to potential lifetime confinement pursuant to so-called â??â??sexually violent predatorâ??â?? civil commitment laws (Zander, 2005). There are at least three major reasons why the Blanchard et al. proposal to extend the diagnostic criteria for Pedophilia to include adult sexual attraction to early-stage adolescents is a leap that is insufficiently supported by their data.

The ?nding of Blanchard et al. (2008) that adult self-reportsof sexual preference for early-stage adolescents generallymatched their phallometric responses to such adolescentsdoes not justify the broad and startling conclusion of theseresearchers that ‘‘hebephilia exists as a discriminable eroticage-preference’’ so as to justify an expansion of the DSMdiagnostic category of Pedophilia to include early-stageadolescents.

DSM-IV-TR draws the distinction between pathological and non-pathological age-related sexual arousal at the on set of pubescence: adult arousal to prepubescents is considered pathological and adult arousal to pubescents and post-pu-bescents is considered non-pathological. This distinction is more than academic. It has serious, real world implications,given that, in the U.S., a diagnosis of Pedophilia can result inthe diagnosed individual being subject to potential lifetime con?nement pursuant to so-called ‘‘sexually violent preda-tor’’ civil commitment laws (Zander, 2005). There are at least three major reasons why the Blanchard et al. proposal to extend the diagnostic criteria for Pedophilia to include adultsexual attraction to early-stage adolescents is a leap that is insuf?ciently supported by their data.

First, as conceded in their article, ‘‘The main methodo-logical limitation of the present study was the absence of models age 15–18 (mid- to late-adolescence) among the phallometric stimuli.’’ This means that we do not know if men who were aroused to early-stage adolescents—whom Blan-chard et al. would now classify as paraphilic—might not also be equally or more aroused to mid- to late-stage adolescents,with respect to which they acknowledge, ‘‘Few would want tolabel erotic interest in late-or even mid-adolescents as psy-chopathology.’’ Yet, their proposal may do just that by pa-thologizing men attracted to early-stage adolescents as part ofan overall arousal pattern to adolescents in all stages of sexual development. In other words, conspicuous by their absence are any data to refute the alternative hypothesis that sexual attraction to adolescents at all stages of sexual development is a discriminable, but not pathological, erotic preference.

Second, the proposal to extend the already problematic diagnosis of Pedophilia to include early-stage adolescents would complicate the diagnosis further by exacerbating theproblem of the diagnostic discriminability that Blanchardet al. aptly and punningly identify by pointing out that ‘‘[T]heonset of puberty varies from child to child and.. the bound-aries of puberty are fuzzy to begin with.’’ Clinicians alreadywrestle with the line of demarcation between pre-pubescenceand pubescence in the current diagnostic criteria, given: (1)the many de?nitions of pubertal onset (e.g., for girls is itmenarche [mean age, 12.1 years, for African-Americangirls] or thelarche/pubarche [mean age, 9 years, for African-American girls]); (2) the wide variability of individualpubertal onset age; and (3) the overall decreasing age of pubertal onset (Herman-Giddens, 2006). Imagine how muchmore impractical it would be to require forensic evaluators todetermine the existence of Pedophilia based on the stage ofadolescence of the examinee’s victim. Such determinationscould literally devolve into a splitting of pubic hairs—resulting in an interrater reliability for the expanded diag-nosis of Pedophilia that is even worse than is the case withthe current version (Wollert, 2007). Their proposal to havediagnosticians specify the examinee’s preferred age to whichhe is aroused does little to solve the problem of discriminatingearly-stage adolescents from mid- to late-adolescents given the aforementioned diagnostic ambiguities resulting from variable and decreasing age of puberty.

---

A woman tells her story: ‘Why did you cut my clitoris?’

Female genital mutilation is a widespread practice globally. One woman tells Rappler her experience and how she has never achieved an orgasm because of her circumcision.

JAKARTA, Indonesia – When Mary* was in elementary school, a male classmate was circumcised.

He received gifts from friends as a form of congratulations, prompting Mary to tell her mother when she got home, “I should get circumcised, Mom. I can get a lot of money.”

Her mother’s response was not what she expected.

“You’re already circumcised,” her mother said.

“I didn't know that. When?"

“When you were a newborn.”

Mary recalls walking away from that conversation thinking everyone got the procedure done – females at birth, males perhaps when they were a little older.

But it wasn’t until later that Mary understood the meaning of the conversation she had with her mother.

Mary is one of 200 million women worldwide who have undergone female genital mutilation (FGM). The number, according to a new report from UNICEF, is 70 million higher than what was reported in 2014.

While the top 10 countries with the highest prevalence of FGM from 2004-2015 is in Africa, the data shows that the increase is partly due to population growth and new data collected in Indonesia.

Indonesia, with its population of 250 million people, is one of 3 countries that account for half of all FGM victims in the world, along with Egypt and Ethiopia.

Cutting the clitoris

It was in junior high school when Mary first realized that female circumcision was not a regular practice.

In conversation with her girl friends, Mary learned that not everyone had undergone the procedure as a baby – even if all of them were Muslim.

First, she started to argue about how it was an obligation in their religion, as she had always thought it was, but becoming more curious, decided to read more on the matter.

She started reading books on sexual and reproductive health, studying photos of vaginas. She learned about the clitoris – and realized she didn’t have one.

Soon after, she read a book about female circumcision in Arab culture, including books by Moroccan feminist Fatima Mernissi, which thoroughly addressed and denounced female circumcision.

“I read the book and learned that the practice was one of many ways to control women. One way was through circumcision,” she told Rappler.

According to UNICEF, FGM includes all procedures “that involve altering or injuring the female genitalia for non-medical reasons.” It is a practice recognized internationally as a violation of human rights of girls and women, with February 6 being the International Day of Zero Tolerance for Female Genital Mutilation.

Even within Indonesia, the practice differs in various regions.

Secretary General of the Women's Coalition Dian Kartika Sari said the culture of female circumcision in each region is different.

"There is not just one cut," she told Rappler on Friday, January 8.

In the island of Madura for example, the clitoris is cut. In other regions, the feeling on the clitoris is “killed” by slicing off a small part, but it is not completely cut off. He also said it is still practiced in some urban areas.

In 2010, the Ministry of Health released a regulation that authorized certain medical professionals, such as doctors, midwives and nurses, to perform circumcision on female patients. The technical details of circumcision was even mentioned in the regulations: "Make a scratch on the skin that covers the front of the clitoris by using the tip of a disposable sterile needle, measuring 20G-22G of the mucosa toward the skin without injuring the clitoris” said article 4, paragraph 2.

The regulation was repealed by the Deputy Minister of Health Ali Ghufron Mukti soon after.

Because while FGM is widely practiced in Indonesia, many others in the country do denounce FGM as a violation of rights. According to UNICEF, FGM violates women’s and girls’ “right to health, security and physical integrity, their right to be free from torture and cruel, inhuman or degrading treatment, and their right to life when the procedure results in death.”

What orgasm?

For Mary, one of the rights taken from her was her sexual rights – at 33, Mary has never experienced an orgasm in her life.

She was first sexually active in college and is now married. But without a clitoris, Mary said she has never experienced an orgasm, a feeling her friends describe as “much like flying.”

“I can never relate when they talk about it,” she said. “It makes me sad.”

Mary said the books she read said women find it difficult to enjoy sex without a clitoris, admitting that she is unsure if her problem is psychological or physical.

Mary said the problem has caused stress for not just herself but for her husband, who for 5 years tried various ways to help her orgasm – but to no avail. She said she views sex now, as “just a waste of time,” describing her sex as “mediocre.”

There are two main reasons parents have their daughters undergo FGM in Indonesia: the first is religious, as many Muslims here believe that female circumcision is an Islamic requirement, or at the very least, is highly recommended in Islam. This is despite the fact that no formal links between Islam and FGM exist, and that no Islamic laws or Quranic verses speak of FGM, let alone make it a requirement.

Even Fatayat NU, the women's division of Nahdlatul Ulama, Indonesia's largest Islamic organization, have acknowledged that FGM is not mentioned in the Quran and is simply a cultural product.

The second reason FGM is popular in Indonesia is because it is believed to reduce women's sexual desire and libido.

This belief is widely held. All parents obviously want their children to live the best lives possible, and for most Indonesian parents, this includes no sex before marriage. In today's hypersexualized world, Indonesian parents would do all they could to ensure their children are safe from the risks of “seks bebas” or premarital sex.

Female genital cutting is believed by some to be one way of achieving this. Without it, it is thought, girls will become sexually aggressive and will actively pursue “undesirable” sexual relationships.

‘Never again’

Previously furious at her parents who asked that doctors circumcise her and her sister upon birth, Mary has since accepted her fate – and the fact that the effects of FGM is something she will have to live with for the rest of her life.

Mary said her parents were apologetic when she first confronted them about it, saying she was born in an Islamic hospital where it was common practice. Her parents, she told Rappler, didn’t know better.

UNICEF data shows Mary’s experience is not that unique. Data shows that parents are the ones who ask for circumcision for their children the most, followed by religious leaders, relatives, and community leaders.

Even today, many in Indonesia think FGM is still a necessity. Sari said many community leaders still preach FGM which is one reason why the practice still exists in Indonesia. It is also still a widespread myth that FGM has health benefits.

However there is no evidence that FGM affects cleanliness or vaginal health. Claims that urine and genital secretions accumulate and fester in the vulva, vagina or urethra have no medical backing. FGM does not reduce chances of urinary tract infections or infections of the reproductive system. Instead, data shows FGM causes risks to health.

Research reveals that FGM is carried out mostly on young girls between infancy and age 15. The procedure can cause severe bleeding and health issues like cysts, infections, infertility and complications in childbirth, with the increased risk of newborn deaths.

Mary, who now understands that FGM has had zero positive impact on her life, now advocates against the practice. She tells colleagues and other women to avoid the practice in their daughters.

---


95 percent of the victims of violence are men. Because women feel flattered when men fight each other and kill each other to prove that they are real men.

---

My vagina is too ‘loose’ says my boyfriend. What should I do?

I am glad that you did seek professional advice rather keeping it to yourself.

‘He told me that my vagina is big and loose’ – this is a heavy judgment laden sentence told to you by your new boyfriend. How does he know that yours is big and loose? It is well possible that his penis is smaller in girth and so he is not able to feel. It is also possible that you are well lubricated that he could not feel much of a grip (this is especially true if your boyfriend has always masturbated using his hands). Rather than jumping to a conclusion that your vagina is big and loose, you need to be confident about yourself that you previously had a mutually pleasurable sex. To some extent, vagina gets a bit loose after 2 years of sex. What is needed for you now is pelvic floor tightening exercise (Kegel’s exercise) and some medication/relaxation for your mind. There are many vaginal tightening creams/gels sold on the net but I have no recommendation for any. If you think it works and makes you feel confident, go for it (www.shycart.com). Open communication with your boyfriend is important. If he is not able to understand your position and sabotages the sexual experience due to the size, then there are few fundamental issues that you need to clarify/review with your boyfriend. Sex is part of life and in that intercourse is only a fraction of sex. Please do not let a very small aspect of your sex take control of your whole life.

---

Cambridge Conference: 'Paedophilia is Natural and Normal for Males'

Other topics discussed at the conference included Liberating the Paedophile: A Discursive Analysis” and “Danger and Difference: the Stakes of Hebephilia” – hebephilia being sexual attraction to children in early puberty.

The revelations come following an investigation by Telegraph journalist Andrew Gilligan, who says that the conference, entitled “Classifying Sex: Debating DSM-5”, featured a number of speakers who spoke in favour of sex with children

Attendees included Tom O’Farrell, a child sex offender and campaigner for the legalisation of sex with children, who wrote on his blog that the conference had been “Wonderful”. “It was a rare few days when I could feel relatively popular!” he added.

Another attendee, Professor Philip Tromovitch of Doshisha University in Japan, stated in a presentation on the “prevalence of paedophilia” that the “majority of men are probably paedophiles and hebephiles”, adding that “paedophilic interest is normal and natural in human males”.

The conference was convened last year to discuss the classification of sexuality in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the standard international psychiatric manual used by the legal system.

The American Psychiatric Association (APA), which produces it, had been locked in battle over whether hebephilia should be included as a disorder. This proposal had arisen because children are going through puberty younger and the current definition of paedophilia – attraction to pre-pubescent children – was missing ever more young people.

Professor Ray Blanchard of the University of Toronto said that unless hebephilia was incorporated into the new manual, it would be “tantamount to stating that the APA’s official position is that the sexual preference for early pubertal children is normal”. The proposal, however, was defeated.

The revelations come as more and more accusations of child abuse by famous people in the 1980s come to light.

Last week, painter and TV presenter Rolf Harris was jailed for five years and nine months for 12 indecent assaults against four girls, one aged just seven or eight. The offences took place between 1968 and 1986.

There was also renewed concern about the disappearance of a dossier containing the names of several prominent people who were suspected of paedophilia in the 1980s. Former Home Secretary Leon Brittan was forced at admit last week that he had been handed the document by MP Geoff Dickens and then passed it on to his civil servants. He could not recall what happened after, however.

---

Child sexuality: Recent developments and implications for treatment, prevention, and social policy

Abstract

Although the research on the effects of childhood incest experiences and sexual encounters with adults is still limited, some consistent trends emerge across studies. Such sexual experiences may be traumatic, inconsequential, or possibly even positive. There does not appear to be any basis established by research for regarding the determinants of the effects of childhood sexual experiences as fundamentally different from the factors operating in adult sexual experiences. The perception of the child of being a willing or unwilling participant is the aspect of such experiences with the single greatest explanatory power in accounting for differences in the child's evaluation of the experience and in the long term effects. From the research, rational policies can be derived for the areas of treatment, prevention, and law. The proposals presented follow logically from what is now understood about the effects of sexual experiences on children. Those who see the purpose of law and social institutions as being the enforcement of a particular morality or the protection of children from all sexual experience will sympathize with neither the approach nor its conclusions. But there are those who would have the law support the right of sexual self-expression and development of everyone's fullest potential as a person, protecting these from violation and intrusion by society as well as by other members of society.

Child sexuality: Recent developments and implications for treatment, prevention, and social policy. Available from: https://www.researchgate.net/publication/16509326_Child_sexuality_Recent_developments_and_implications_for_treatment_prevention_and_social_policy [accessed Jun 30, 2017].

---


It is the secret dream of every Swedish or German woman to marry a black men, or at least have sex with a black man. Every smart young African man should migrate to Europe. Free money, nice house, good sex!

---

Here's Why Your Period Blood Smells

From enigmatic PMS symptoms to an erratic poop schedule, your period throws some real curveballs at your body. Hell, it even changes colour depending on how it's doing.

One curveball that is less talked about but still perplexing is the odour of your period blood itself. You're pretty sure it's harmless, but you're still dying to know what's up with it. For real, why does period blood smell like that?

To get some answers, we spoke with Taraneh Shirazian, MD, assistant professor in the Department of Obstetrics and Gynaecology at the NYU Langone Joan H. Tisch Center for Women’s Health, to determine what makes your period blood smell, and if there's ever a time you need to worry about it. Here's what we learned:

It's totally natural.

"Blood itself has a certain odour," Dr. Shirazian says, adding that, as you probably already know, there's more to your menstrual fluid than just blood. You also expel bacteria, vaginal mucus, fluid, and tissue during your period, and that's why your period blood doesn't smell exactly like the blood that comes out of any other part of your body. That odour can be more or less intense, depending how long it sits in your uterus before leaving, but Dr. Shirazian says "it’s either bacteria mixed with old blood or it’s bacteria in the vagina that’s coming out with the blood" that plays the lead role in making your period blood odour special and specific to you. As far as what's normal and what isn't, Dr. Shirazian keeps it simple: "A healthy period smell just shouldn’t be fishy."

A change in odour can signal a problem.

Odour can also come from the bacteria that naturally accumulates during your period. "When you’re bleeding, you retain moisture in the vagina," Dr. Shirazian says, which can lead to "secondary vaginal infections like bacterial vaginosis, which has a strong, fishy odour." The thing to remember about bacterial vaginosis (sometimes shortened to BV) is that it occurs when the bacteria that's normally found in your vagina is out of balance, and can either go away on its own or be treated with antibiotics. While BV itself isn't an STI, it is known to increase your risk for catching an STI, so if you are experiencing odour, itching, or painful urination, you should definitely see your doctor for treatment. And, if you notice an out-of-the-ordinary odour when you aren't menstruating, you might want to talk to your doctor. You may have BV, vaginitis, or some other kind of infection that requires treatment.

Keeping things dry down there can help.

While there is nothing wrong with the natural blood smell (and the likelihood that it is noticeable to anyone but you is very small), Dr. Shirazian says keeping the surrounding area as dry as possible can help reduce it if it's bothering you. Change your tampon, pad, or menstrual cup regularly and try to "wear cotton underwear and breathable clothing, not a lot of spandex or tight clothing" during your period to reduce sweating, she says. Although it's not the main cause of period blood odour, sweat can definitely contribute to it. "Many types of bacteria can grow during your period that are due to both blood and sweat," Dr. Shirazian explains.

"Sometimes the issue is very heavy periods or a lot of bleeding. There’s just so much blood that it will allow bacteria to overgrow," she adds. This means that if your flow is naturally heavier, you're probably going to experience more odour than someone with a lighter flow.

If you notice that you're bleeding more than usual, or you're worried that you're bleeding excessively, Dr. Shirazian recommends talking to your doctor. "Heavier bleeding could be a sign of fibroids, polyps, or hormonal changes," she says. Plus, even if it turns out that you just have a naturally heavier flow, there's actually no reason to put up with an annoying period; you can just skip it entirely with the help of a hormonal birth control method.

Don't douche, ever.

The bottom line is that vaginal odour, much like vaginal discharge, is totally normal. As long as you're maintaining healthy period habits — keeping track of any weird changes to your normal cycle (including changes to the smell), changing your period protection regularly while you're bleeding, and most importantly, never, ever douching — you don't need to worry about the normal odour. As self-conscious as any odour may make you feel, there's no reason to go to extremes like douching, which, in fact, has been linked to bringing on the very infections (like BV) that cause even more (and honestly, much grosser) smells.

---

Here’s What Actually Happens When You Wake Up During Surgery Let’s talk about the bizarre thing that can happen on the operating table.

BuzzFeedNews

1. It's a clinical phenomenon called anesthetic awareness.

'Anesthetic awareness, also known as intraoperative recall, occurs when a patient becomes conscious during a procedure that is performed under general anesthesia, and they can recall this episode of waking up after the surgery is over,' Dr. Daniel Cole, president-elect of the American Society of Anesthesiologists, tells BuzzFeed Life. Patients may remember the incident immediately after the surgery, or sometimes even days or weeks later. But rest assured, doctors are doing everything they can and using the best technology available to make sure this doesn't happen.

2. One to two people out of 1,000 wake up during surgery each year in the United States.

"It's not a huge number, but it's enough people that it's definitely a problem," says Cole. Plus, the true rate could be even higher. "The data is all over the place because it's mostly self-reported." "Ideally, the anesthesiologist would routinely see the patient post-operation and ask them about intraoperative awareness," he says. But this opportunity is often lost because patients are discharged or choose to go home as soon as they can after surgery. "Even if they remember three, five days later, they might feel embarrassed and don't want to make a big deal so they don't mention it to their surgeon. So there can be underreporting of awareness."

3. It happens when general anesthesia fails.

General anesthesia is supposed to do two things: keep the patient totally unconscious or 'asleep' during surgery, and with no memory of the entire procedure. If there is a decreased amount of anesthesia for some reason, the patient can start to wake up. The cocktail of medication in general anesthesia often includes an analgesic to relieve pain and a paralytic. The paralytic does exactly what it sounds like — it paralyzes the body so that it remains still. When the anesthesia does fail, the paralytics make it especially difficult for patients to indicate that they're awake.

4. And it's not the same as conscious sedation.

Conscious sedation, sometimes referred to as "twilight sleep" is when you're given a combination of a sedative and a local or regional anesthetic (which just numbs one part or section of the body) for minor surgeries, and it's not intended to knock you out completely or cause deep unconciousness. It's typically what you would get while getting your wisdom teeth out, having a minor foot surgery, or getting a colonoscopy. With conscious sedation, you may fall asleep or drift in and out of sleep, but this isn't the same as true anesthetic awareness, says Cole.

5. Contrary to popular belief, it doesn't usually happen right in the middle of surgery.

"The anesthesiologist is very aware that this can happen and never relaxes or lets down their guard at any point during the surgery, no matter how long," says Cole. "Awareness tends to occur on the margins, when the procedure is starting and you don't have the full anesthetic dose or when you're waking up from anesthesia, because it's safest to decrease the amount of anesthesia very slowly and gradually toward the end." However, this also depends on the surgery and patient... which we'll get to in a little bit.

6. Patients often report hearing sounds and voices. "The most common sensation is auditory," says Cole. Patients will report that they were aware of voices, and even conversations that went on in the operating room — which can be especially terrifying if loud tools are involved. "If you look at the effects of anesthetics on the brain, the auditory system is the last one to shut down, so it makes a lot of sense."

And opening your eyes to see the surgeons operating on you? Basically impossible. "First of all, the anesthesia puts you to sleep, so your eyelids shut naturally. Even if you regain consciousness, the anesthesia still restricts muscle movement so your eyes will stay shut," Cole explains. "But there's still 10–20% eye opening when you sleep. So during surgery, we will cover the patient's eyes or tape them shut to prevent injury and keep the eyes clean."

7. Few patients experience pressure (and rarely pain) during anesthetic awareness.

Less than a third of patients who report anesthetic awareness also report experiencing pressure or pain, says Cole. "But that's still one too many, because the patient is kind of locked in and aware of what's happening to them but unable to move, which is terrifying." Typically, sufficient analgesic (pain reliever) is given, so that even if you wake up you won't feel pain. "More often, we use an anesthetic technique which includes a morphine-type drug to reduce pain. But this is really required for when the patient wakes up and they no longer have anesthetic so they are conscious and aware of pain," Cole says.

Even if the analgesic wears off, there should be sufficient anesthesia to keep the patient unconscious and pain-free. "It's rare. You'd have to both have insufficient anesthesia and insufficient pain medicine at the same time to feel prolonged pain during awareness," Cole says.

8. Anesthetic awareness can cause anxiety and PTSD.

"The potential psychological effects of awareness range greatly," says Cole. "It can cause anxiety, flashbacks, fear, loneliness, panic attacks — PTSD is the worse. It's been reported in a small minority of patients, but it can be very severe." says Cole. If doctors hear about someone having intraoperative awareness, they will try to get the person into therapy as early as possible, before memories can be embedded in a harmful or stressful way to patients. "If you were in the hospital for a week and on day two we heard that you woke up during surgery, we'd get a therapist in the same day. We always want to mitigate so we can try to reduce the severity of symptoms," Cole says.

9. It's most often caused by an equipment malfunction.

General anesthesia can either be given intravenously (where all or most is given through an IV) or more commonly as a gas, which you breathe in through a mask. If the equipment in either of these were to malfunction, and the anesthesiologist wasn't aware of it because the signal that gas is too low doesn't work, for example, then patients would stop receiving medication and start to wake up. Again, this is terrifying but rare.

"The anesthesia equipment is like an airplane," Cole says. "The anesthesiologist will do a pre-flight check and go over all equipment to make sure it works. But sometimes, that equipment can malfunction as short as an hour later so it won't show up before taking off." Likewise, there is equipment used to monitor the patient's vitals and brain activity, which can also fail to signal to doctors that the patient is waking up.

10. Less commonly, it's the physician or anesthesiologist's fault.

"Any time humans are involved, human error is always a possibility — but it’s more common that technology fails," says Cole. "Physicians and anesthesiologists are well-trained to look out for signs of awareness during surgery, which obviously includes any movement of muscles and changes in vitals." Since paralytics are often involved, doctors also closely monitor other signs like heart rate, blood pressure, tears, or brain electrical activity for any red flags. However, sometimes patients can be on medications that suppress the body's responses and inhibit the monitoring systems from effectively picking up warning signs of light anesthesia and awareness. These incidences can make it difficult to detect awareness, so physician anesthesiologists must closely watch an array of signs.

11. It is more likely to happen during surgeries that require "light" anesthesia.

Anesthesia also comes with risk factors, and can be harmful depending on the surgery or patient's risk. "Awareness can occur when there is too light of anesthesia, which we often do deliberately for high-risk situations," says Cole. According to the American Society of Anesthesiologists, high-risk surgeries include heart surgery, brain surgery, and emergency surgeries in which the patient has lost a lot of blood or they can easily go into shock. Or the patient may need a lower dose of anesthesia due to risk factors such as heart problems, obesity, a genetic factor, or being on narcotics or sedatives. "For instance, anesthesia depresses the heart, so a normal dose could be life-threatening to someone with heart problems," Cole explains.

"Sometimes you have to make a trade off," says Cole. "Would you rather have a high level of anesthesia which threatens your body's life functions, or a low level which ensures safety but increases the risks of waking up during the procedure?"

12. ...But if that's the case, your doctor will talk to you about it first.

Patients often feel better knowing that the decreased amount of anesthesia is for their own safety. "We tell the patient that there's an increased chance that you may hear some voices or fuzziness, but if it gets uncomfortable we can tell and will increase the dose," says Cole. "Patients are more understanding and happy when they understand that the risk of waking up is for their own safety."

Also, you should know that if you've had a previous incidence of awareness, that puts you at higher risk for another episode. Cole explains that in this case, doctors will spend a lot of time with the patient and anesthesiologist describing exactly what to expect, so that hopefully they won’t experience it again.

13. ALL THAT BEING SAID, the chances of this happening are slim, and medical professionals are doing everything they can to ensure that this does not happen.

According to Cole, it's always helpful to spend some time pre-operatively with the surgeon and physician anesthesiologist going over the procedure and how they'll get you through it safely and comfortably.

"I do something called 'patient engagement' and 'shared decision-making' so I can make sure the patient understands literally everything. Some patients don't want to talk about awareness because it will give them more anxiety, and they just trust us," says Cole. However, even if you aren't at risk, your doctors will be happy to answer any questions you have about anesthesia before the procedure.

---

Home | Index of articles