The American Academy of Pediatrics is strengthening its recommendation to ban spanking and other forms of corporal punishment, citing new research that says that type of discipline can affect normal brain development.

Harsh verbal punishment, such as shaming or humiliation, is also a threat to children, the AAP says in an updated policy statement.

“The good news is, fewer parents support the use of spanking than they did in the past,” said Dr Robert Sege, policy statement co-author and a past member of AAP Committee on Child Abuse and Neglect.

“Yet corporal punishment remains legal in many states, despite evidence that it harms kids – not only physically and mentally, but in how they perform at school and how they interact with other children,” Sege said in an academy news release.

More effective discipline methods

Research shows that striking, yelling at or shaming children can elevate stress hormones and lead to changes in the brain’s structure. Harsh verbal abuse is also linked to mental health problems in preteens and teens, according to the AAP.

One study found that children who were spanked more than twice a month at three years of age were more aggressive at age five. By age nine, the negative effects of spanking were still evident, the findings showed.

Along with affecting brain development, spanking and verbal punishment can increase aggression in children in the long run and do not teach them responsibility and self-control. Other ways of teaching children right from wrong are safer and more effective, according to the AAP.

Parents should be educated on more effective discipline methods that protect children from harm, the academy recommends.

No benefit to spanking

According to policy statement co-author Dr Benjamin Siegel, “It’s best to begin with the premise of rewarding positive behaviour. Parents can set up rules and expectations in advance. The key is to be consistent in following through with them.”

Sege added: “There’s no benefit to spanking. We know that children grow and develop better with positive role modeling and by setting healthy limits. We can do better.”

The academy recommends that paediatricians use office visits to help parents with age-appropriate strategies for handling their child’s discipline.

The policy statement will be discussed at the AAP’s annual meeting in Orlando, Florida. It will also be published online in Pediatrics.

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It goes without saying that, as is the case with all of your other body parts, washing your penis should be a part of your daily shower routine. But if you’ve been practicing poor hygiene, or just generally neglecting to thoroughly wash down there, beware: You may have developed smegma.

A common condition that affects guys who don’t clean their junk enough (or don’t clean in the right way), smegma, a.k.a. “penis cheese”, is a white substance that typically collects around the head of the penis. While anyone can get it, guys who are uncircumcised are particularly prone.

Read more: How does circumcision really affect your sex life? Here are the facts

But what is smegma, and how do you prevent it? We asked clinical sexologist Eric Marlowe Garrison and Dr Debby Herbenick, a professor at the Indiana University School of Public Health and director of the Center for Sexual Health Promotion, for more information.

What is smegma?

Smegma is a combination of secretions from sebaceous oil glands and dead skin cells that collect under the foreskin of your penis. This results in a white, cheese-like substance. (Actually, “smegma” is the Greek word for “soap”, which is both ironic and makes buying toiletries in an Athens hotel gift shop extremely awkward.) When these substances “build up underneath the foreskin, it can provide a host for bacteria”, says Garrison.

Garrison also notes that it’s possible for both uncircumcised and circumcised men to develop smegma. (It’s also common in women, where it’s most likely to appear between the folds of the vagina’s labia or around the clitoral hood.)

Because “no circumcision is perfect” Garrison says, even circumcised men may have a tiny bit of foreskin remaining, creating the opportunity for smegma to build up. They may also develop smegma beneath the corona of the penis (i.e., underneath the head), because “most American families don’t teach young adults how to care for their sex organs”, says Garrison.

Read more: STD symptoms that affect the rest of your body

Is smegma common?

Yes, according to Dr Herbenick. “We all have skin cells and sebaceous glands,” she says. “Together, these create smegma for both males and females.” Indeed, the oils that result in smegma are naturally secreted by the body to lubricate the genitals and keep them from feeling dry. So having smegma doesn’t mean you’re dirty or unclean – it just means you should probably wash and clean your penis a bit more thoroughly.

In itself, smegma is pretty harmless. But if you let it build up, it can result in the smegma hardening and producing a bad smell.

“The combination of dead skin cells and bacteria not only leads to an unsightly (and foul-smelling/tasting) collection of cells, but it can also cause skin irritations and breaks in the skin that could facilitate a sexually transmissible infection,” Garrison cautions.

If you’re uncircumcised, and you let it build up for a really long time, it can also cause your foreskin to stick to the penis, which can necessitate a painful trip to the dermatologist’s office.

How to treat and prevent smegma

Basically, this is all you need to do:

If you wash with soap and water regularly, then any light smegma build-up is nothing to worry about. “It does not need to be treated or gotten rid of, other than being gently wiped away with fingers or a washcloth (kind of like how ear wax is just wiped away),” says Dr Herbenick.

Read more: Guys share the cringeworthy sex injuries that landed them in hospital

That said, if you’re uncircumcised and you’ve been accumulating quite a bit of smegma, Garrison says you may need to be more aggressive about your hygiene practices. Gently pull the foreskin back and use a washcloth, some warm water, and a mild soap to clean underneath the head of the penis.

“A lack of foreskin hygiene, not merely the presence of a foreskin, [may be linked to] an increase in HIV infections among uncircumcised men,” he says. “Anytime that penile skin is compromised, it can become a route for infection, [which can] be a path for a bacterium, virus or fungus to take hold.”

In a small number of cases, smegma build-up and hardening can cause the penis to become irritated and red, which can lead to a condition called balanitis. “If a person has an infection underneath the foreskin as a result of smegma, they should see a dermatologist before it gets worse. Or before they might acquire an STI,” says Garrison.

The best way to prevent smegma is the same method used to treat it: Wash your penis at least twice a week, and if you’re uncircumcised, pull back your foreskin and wash with soap and water. Practicing good hygiene will save you a lot of trouble further on down the road.

^{This article was originally published on www.menshealth.com}

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People with peanut allergy can protect themselves from an allergic reaction by consuming a small amount of peanut powder every day, a new study suggests.

The “breakthrough” findings mean this new treatment is ready for review by the US Food and Drug Administration, the researchers added.

“We’re excited about the potential to help children and adolescents with peanut allergy protect themselves against accidentally eating a food with peanut in it,” study co-author Dr Stephen Tilles said in an ACAAI news release.

“Our hope when we started the study was that by treating patients with the equivalent of one peanut per day, many would tolerate as much as two peanuts,” he said.

“We were pleased to find that two-thirds of the people in the study were able to tolerate the equivalent of two peanuts per day after nine to 12 months of treatment, and half the patients tolerated the equivalent of four peanuts,” noted Tilles, a Seattle allergist and ACAAI past president.

The study included 551 patients, aged 4 to 55, with peanut allergy. One-third were given a placebo, while two-thirds were given peanut protein powder in increasing amounts until they reached the maintenance dose equivalent of one peanut a day.

“This is not a quick fix, and it doesn’t mean people with peanut allergy will be able to eat peanuts whenever they want,” said study co-author Dr Jay Lieberman, vice chair of the ACAAI food allergy committee.

“But it is definitely a breakthrough,” he added. “The hope would be to have a treatment available in the second half of 2019. If that happens, people who receive and are able to tolerate this treatment should be protected from accidental exposures.”

Big impact

Allergist Dr Punita Ponda agreed.

“The doses patients tolerate are high enough to likely prevent reactions with cross contamination or allow patients to eat foods with ‘may contain’ or ‘manufactured in’-type labels,” added Ponda, who is assistant chief in the Division of Allergy and Immunology at Northwell Health, in Great Neck, New York, She was not involved with the study.

“This would make a large impact on the lives of patients with peanut allergy who may be afraid to eat outside of the house for fear of cross contamination or have to severely limit their diet due to the difficulty of avoiding products with the above mentioned safety labels,” Ponda noted.

The study was to be presented Sunday at the American College of Allergy, Asthma and Immunology (ACAAI) annual meeting, in Seattle, and published simultaneously in the New England Journal of Medicine.

There are no approved treatments for peanut allergy. If approved by the FDA, this treatment would be available by prescription and patients would need to continue taking it to stay protected from accidental peanut exposure.

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The sense of loss women feel after losing one or both nipples post-mastectomy is hard to describe, but perhaps this sums it up best: “Without a nipple, a breast isn’t a breast – it’s just a mound,” says Dr Joshua Levine, a natural breast reconstruction surgeon in New York City.

That’s why nipple reconstruction can have a huge impact on the emotional-recovery process of mastectomy patients, say experts like Dr Anastasia Bakoulis, assistant professor of surgery at Stony Brook School of Medicine’s breast centre.

Her research suggests that about 90% of women now opt for breast reconstructions after mastectomies (up from just 10% in the 1980s). Nipple-sparing mastectomies are a choice for some, depending on the specifics of the cancer, but others are limited to options like tattooed-on nipples, reconstructions built from, say, leg tissue, or prosthetics that need to be reapplied for each use.

Research backs up the fact that nipples play a key role in the emotional-recovery process: One recent study, for example, found that women reported significantly higher levels of psychosocial and sexual well-being after a nipple-sparing mastectomy, compared to a total mastectomy.

“The nipple restores a sense of normalcy and health to a woman,” says Dr Levine. “It can help her leave the memory of surgery and disease behind her.”

For patients who can’t keep their nipples, reconstructed, tattooed or prosthetic options can greatly improve their quality of life. “I’ve seen women who have refused to remove their bras in front of their husbands for years that have no problem whipping off their tops to show off their marvellous breasts today,” says Friday Jones, a tattoo artist who does post-operative tattooing. “It’s like they finally recognise themselves again.”

Here, five women who have undergone post-mastectomy breast reconstruction share how they dealt with the loss of their nipples – and how it impacted their lives. 

‘Getting my nipples surgically reconstructed was the one part of this process that felt like it was for me.’

“I was only 25 when I was diagnosed with invasive breast cancer, so everything about it – from the diagnosis through my recovery – was a total shock.

“I had a life-threatening diagnosis, so at the beginning, I was so worried about surviving that I didn’t care at all about losing my breasts, much less my nipples. Having a mastectomy was something I needed to do to live, so I did it.

“I chose to have reconstruction surgery for both breasts shortly after my double mastectomy, but I had to wait several months for my previous surgery to heal before I could have nipple-reconstruction surgery – it ended up being three years between my first surgery and when I had my nipples done.

“I was really excited to get the surgery – seeing my new breasts with no nipples was just too weird. But I had to make a lot of decisions I never thought I’d have to think about – like how far I’d want my nipples to stick out.

“My surgeon used grafts of my own skin from the inside of my upper thigh for the nipple reconstruction. It was incredibly painful – I couldn’t walk for weeks afterward – but totally worth it. The skin from my thigh gradually darkened on its own into the areolas, and the nipples themselves were created by a series of incisions and tucks in the skin and fat.

“When I finally saw my new nipples after the bandages came off, I immediately knew I’d done the right thing. Even though there was a lot of healing to do still, I felt like myself again.

“Since my nipple reconstruction, I’ve ended up talking about them a lot. I’ve had conversations about my post-cancer nipples with female acquaintances who were curious about my reconstruction process, I’ve shown them to women who were about to go through their own breast-cancer battle, and I’ve even had to convince more than one well-meaning mother that, no, I really couldn’t breastfeed my child, even though I technically had nipples.

“These days, I’m super-happy with how my breasts and nipples look; the reconstructive surgeries have given me a lot of peace.

“The nipple reconstruction was especially gratifying, as it was the one surgery I did just for me. Every other one was because I didn’t want to die, or didn’t want my body to be so messed up. It felt wonderful after years of my life being in the control of the medical community to make a decision that was purely mine.” – Mary Smith, 42, diagnosed at 25

Read more: 5 signs of breast cancer that have nothing to do with lumps

‘My fake nipples look better than my real ones ever did.’

“I have a long family history of breast cancer, so I decided to get tested. Sure enough, I have the BRCA2 mutation. So in 2017, I chose to have a preventative double mastectomy, followed by reconstruction.

“At the time, I was told I was a good candidate for nipple-sparing surgery, where they keep your original nipples and reattach them to your new breasts, but that it would involve one extra surgery. I think everyone was surprised when I told them not to bother. Unlike a lot of women, I never had any real attachment to my nipples. In fact, I had always thought they were too big and looked kind of weird.

“Even though I felt no emotional attachment to my original nipples, I wondered if I’d look down after the surgery and feel upset that they were gone.

“I didn’t miss the old nipples at all, but I wanted to look whole again, and I wanted my breasts to look as natural as possible. So I decided to have nipple-reconstruction surgery.

“I chose to go down a few sizes – from a 34DDD to a 34D – so I knew my boobs were going to look different. The surgeon created new nipples out of little flaps of skin. Then, a few months after that, I got tattoos done on the new nipples to make them look more realistic. My tattoo artist even added little bumps to mimic the glands women have on the areolas.

“They look so good that my doctor forgot they weren’t real for a minute at my checkup.

“Ultimately, I couldn’t be happier with my decision. The one downside is that I don’t have any sensation in my nipples. I do miss feeling aroused there, but my breasts look amazing – better than they did before the surgery.” – Maggie Gaines, 45

Read more: This woman documented her double mastectomy in the most incredible way

‘I’m not sure if I’ll reconstruct my nipples at all.’

“My experience losing my nipples to breast cancer is hard to put into words.

“I wasn’t a candidate for keeping my nipples, because of the type of cancer I had, and I went through a real grieving process for them – it felt like I was losing an essential part of my femininity.

“After I woke up from the mastectomy surgery, I was in so much pain, and all I could see were the drains and expanders and bandages – my body looked like a medical battlefield.

“At first, it was gut-wrenching, but as I looked at the scars seared across my chest, I realised how strong I really am and that the scars where my nipples used to be were just one more sign of how I’d kicked cancer’s ass and won. That, to me, was worth way more than keeping my nipples.

“After my mastectomy, I had several breast-reconstruction surgeries, and currently, I don’t have any nipples – I’m not even sure if I want them at all, tattooed ones or reconstructed ones.

“This surprises people, but I don’t feel like I need nipples to be sexy. Real men – the kind worth having around – are just happy you’re alive and won’t care about the no-nipples thing.

“Besides, I’ve had a lot of fun trying on ‘new’ nipples – using pepperonis, whipped cream, cherries, peach candy rings. For me, keeping a sense of humour about everything has been one of the most important parts of my recovery.

“I also have two daughters who may or may not have the same breast cancer gene I have. I want them to know that nipples and breasts are feminine and sacred – but when it comes to cancer, it’s not about saving your breasts, it’s about saving the brave, badass woman underneath them.” – Brooke Parker, 31, diagnosed at 28

Read more: Every woman should know about how breast cancer affects fertility

‘As soon as my nipple prosthetics arrived in the mail, I couldn’t wait to try them on.’

“There are four generations of breast cancer in my family, so in 2015, after finding two precancerous growths, I decided to have both my breasts removed as a preventative measure.

“I opted for a double mastectomy immediately followed by reconstructive surgery. One year after my mastectomy, I got the final surgery to put my breast implants in, and three months after that, the soonest I possibly could, I had nipple-reconstruction surgery. Unfortunately, it didn’t work at all.

“The surgery didn’t take, and the new nipples totally flattened back out and looked strange – which can sometimes happen after reconstruction, I was told. My surgeon tried to tattoo them so at least the colour would give the appearance of nipples, but they just didn’t look real.

“I was devastated. I felt so unattractive that I refused to take my top off during sex and cried to my boyfriend about how awful I felt. I had no self-confidence. Finally, I went to a tattoo artist and had 3-D tattoos done over the ones my surgeon had done. These turned out a lot better, but as great as the tattoos were, my nipples still didn’t stick out at all from my breast, so they didn’t look real.

“Then, I was searching on the Internet one night and came across Pink Perfect, a company that makes prosthetic nipples for women. They had a bunch of different style, size and colour options so I could find a pair that felt right for me.

“As soon as they arrived in the mail, I couldn’t wait to try them on. They attach with a removable adhesive, and once I stuck them on, they felt totally natural. I ran to my room and put on a tight T-shirt. When I saw my nips poking out through the fabric, I was overjoyed. I don’t think I’ve ever felt more beautiful than I did in that moment.

“The nipple prosthetics look unbelievably real. When I went to my follow-up appointment with my plastic surgeon, neither my doctor nor the nurses realised they were fake at first. Now, I wear the prosthetic nipples all the time – to the gym, out running errands and, yes, during sex. They change my overall look and give me so much more confidence. They’re life-changing.

“I’m really happy with my look now, and my health is great. I even found out after my surgery that one of my breasts really did have breast cancer, and I am so lucky we caught it that early.” – Dana Reinke, 45, diagnosed at 42

‘Doctors can’t even tell my 3-D nipple tattoos aren’t real.’

“I’ve had breast cancer twice. The first time, we treated it with chemo and radiation. When it came back two years later, I decided to get a double mastectomy, immediately followed by reconstruction surgery.

“I wasn’t able to do the nipple-sparing surgery on the side with cancer, but I was told I could keep the healthy nipple if I wanted to. I opted to have both removed because I didn’t want them to be mismatched.

“The first time I saw my breasts after the implant surgery, which followed my mastectomy, I remember thinking how good they looked… except for the lack of nipples. It was a huge shock to see two large, oval-shaped scars where they should have been.

“Honestly, losing my nipples was one of the hardest parts of my cancer. Every time I felt cold or aroused and my nipples didn’t react, it was just another reminder of how much I’d lost to this disease.

“I was desperate to feel normal again, so a year after my breast-reconstruction surgery – as soon as I was healed – I decided to have nipple-reconstruction surgery. My surgeon was a genius, but I was not prepared for what I would see post-surgery – my new nipples looked like raw meat. They were so red and inflamed and were covered in stitches. I’m not sure what I was expecting, but they looked terrible at first.

“Caring for my new nipples was also lot of work. Every day for weeks, I had to put on ointment, cover them with bandages, and then try to figure out a decent outfit I could wear without needing a bra, since I wasn’t able to wear one during the recovery period. It was overwhelming, and even worse, I still wasn’t thrilled with how they looked when they were healed.

“They didn’t look like ground meat anymore, but they still didn’t look real. The areola was too big, and the colour was lighter than the surrounding skin – not darker, how nipples typically look.

“About a year later, I decided to get my reconstructed nipples tattooed. It’s unbelievable how realistic the tattoos look. The artist corrected the colouring and added details like shading and dots that look exactly like real nipples. In fact, the last time I went in for a checkup, neither my dermatologist nor my gynae realised they weren’t real.

“Today, I wouldn’t change a thing about my nipples. And interestingly enough, my choice to get both nipples removed turned out to be a life-saving one: When the pathology came back on the ‘healthy’ nipple, I found out I had a second cancer on the other breast. So now when I look in the mirror, I’m both happy and healthy.” – Jana Muntin, 44, diagnosed at 40

Special thanks to Dr Oren Lerman, for his consultation services.

^{This article was originally published on www.womenshealthmag.com}

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The US Food and Drug Administration said on Thursday it will take steps to limit or ban access to flavoured e-cigarettes, menthol cigarettes and flavoured cigars.

The move against flavoured e-cigarettes stops short of the full ban that had been expected from the agency. Instead, sales of these products – thought to be especially alluring to teens – will only be allowed in stores within special closed-off areas made inaccessible to minors, The New York Times reported.

More unexpected was the FDA’s proposed ban on menthol cigarettes and flavoured cigars, products which have long been thought to disproportionately harm the health of black Americans.

The menthol ban still has regulatory hurdles to overcome, so removal of those products from the market could take two years, the Times noted.

Still, the move would come as a huge blow to the tobacco industry, since menthols make up more than a third of the cigarette market.

All three moves are aimed at curbing uptake of vaped and smoked nicotine by the young. More than 3.6 million Americans under the age of 18 now vape, the agency noted.

The announcements come after the leading vape maker, Juul Labs, announced Tuesday that it would voluntarily withdraw most flavours of its hugely popular vaping product from the marketplace.

Juul, which controls 70% of the e-cigarette market, has come under increasing pressure to do something about the surging popularity of its vaping devices among youth.

In a statement released Tuesday, Juul CEO Kevin Burns said, “Our intent was never to have youth use Juul. But intent is not enough. The numbers are what matter, and the numbers tell us underage use of e-cigarettes is a problem.”

And in a statement released on Thursday, FDA Commissioner Dr Scott Gottlieb noted that “almost all adult smokers started smoking when they were kids. Today, we significantly advance our efforts to combat youth access and appeal with proposals that firmly and directly address the core of the epidemic: flavours.”

Nevertheless, the decision to restrict but not ban flavoured e-cigarettes came as a surprise, since leaked documents had suggested a full FDA ban was imminent. In the end, the complex legalities of imposing a ban may have meant drawn-out court battles, something the FDA may have wanted to avoid, legal experts told the Times.

Instead, Gottlieb said that within the next three months, e-cigarette manufacturers should remove the products from “where kids can access them and from online sites that do not have sufficiently robust age-verification procedures”.

Disappointment

Anti-smoking advocates expressed some disappointment at the FDA’s announcement, however.

“We commend the FDA for recognising the grave threat posed by electronic cigarettes on our children, and for imposing restrictions on manufacturers,” Nancy Brown, CEO of the American Heart Association, said in a statement.

“With e-cigarette use having jumped by 78% among high school students and 48% among middle school students, the need for action is urgent,” she added. “But limiting the sale of e-cigarettes is not enough – the FDA should also remove flavored e-cigarettes from the market and prohibit companies from marketing their products in ways that appeal to kids.”

And Matt Myers, president of Campaign for Tobacco-Free Kids, wondered to the Times, “Does this mean a simple curtain with a sign like we used to see at the entrance to the pornography section of video stores?”

Lyle Beckwith, a spokesperson for the National Association of Convenience Stores, said his group “will be reviewing the regulation and advising our members accordingly” as to how to best implement the new rules.

He noted that, according to his teenaged son, most minors already get their flavour pods from older youth, not convenience stores.

The FDA first began its crackdown on flavored e-cigarettes earlier this year, as the number of teens using the products reached epidemic proportions, the Times reported. By far, the leading vaping product is made by Juul, whose e-cigarette devices resemble small computer flash drives. Use of Juul has skyrocketed among teens over the past year.

Flavoured versions of e-cigarettes – including chicken and waffles, rocket Popsicle and “unicorn milk” – have boosted sales among the young even further, experts contend.

“The availability of flavours in e-cigarettes is one of the top reasons that middle and high school students cite as their motivation for using e-cigarettes,” said Patricia Folan, director of the Center for Tobacco Control at Northwell Health in Great Neck, New York. “Young people are more likely to try flavored e-cigarettes and consider them less harmful than tobacco-flavored e-cigarettes.”

Challenges

The vaping industry has countered that flavoured e-cigarettes actually provide a potential health benefit, helping to encourage tobacco smokers to quit.

“Flavours are important for switching,” Dr Moira Gilchrist, a scientist with Philip Morris International, said during a visit to Washington in October for an FDA public meeting.

Phillip Morris hopes to market its IQOS heat-not-burn device in the United States in tobacco and menthol flavors.

“The focus should be on what is the right thing to do for the 40 million men and women in the United States who would otherwise continue to smoke cigarettes,” she said.

As for the ban on menthol cigarettes and flavoured cigars – both highly favoured by black Americans – challenges lie ahead. The US tobacco industry has long fought hard against such a ban. But health advocates were heartened by the news.

“Studies show that menthol cigarettes increase initiation, especially among youth,” Brown noted. “Menthol also has a disproportionate impact on minorities including African-Americans, who favor menthol cigarettes and find them more difficult to successfully quit.”

Delmonte Jefferson, executive director of the National African American Tobacco Prevention Network, told the Times, “While we’re saddened by the number of lives lost and new smokers addicted over the past decade, we’re pleased that the FDA is moving in this direction.”

The group also praised the agency for taking on flavoured cigars.

“Little cigars like Black & Milds and Swisher Sweets are heavily marketed to African Americans and are often cheaper in our neighborhoods,” said LaTroya Hester, a spokesperson for the network.

“A lot of young, black kids don’t know that cigarillos are just as dangerous, so hopefully this will send that message. This is a huge step in protecting their health. It’s about time our young people are prioritised.”

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