It is difficult to notice anything suspicious on examination of the tonsil other than slight enlargement or the development of firmness around the area. The carcinoma may occur in one or more sites deep within the tonsillar crypts. It may be accompanied by the enlargement of the tonsil. The affected tonsil grows into the oropharyngeal space making it noticeable by the patient in the form of a neck mass mostly in the jugulodigastric region. As the tonsils consist of a rich network of lymphatics, the carcinoma may metastasize to the neck lymph nodes which many are cystic. Extension of tumor to skull or mediastinum can occur. The additional symptoms include a painful throat, dysphagia, otalgia (due to cranial nerve involvement), foreign body sensation, bleeding, fixation of tongue (infiltration of deep muscles) and trismus (if the pterygoid muscle is involved in the parapharyngeal space).On the other hand, the tumor may also present as a deep red or white fungating wound growing outwards, breaking the skin surface with a central ulceration. This wound-like ulcer fails to heal (non-healing) leading to bleeding and throat pain and other associated symptoms.During biopsy, the lesion may show three signs: gritty texture, firmness and cystification owing to keratinization, fibrosis and necrosis respectively.Cervical lymphydenopathy may be present. Cause
Smoking and alcohol abuse are the major risk factors. Viral causes have recently been taken under consideration as one of the risk factors. Viruses such as Epstein-Barr virus (EBV) (majorly involved in causing nasopharyngeal carcinoma) and human papilloma virus are included in this category.
They should also be aware of how stereotypes affect their clients. This is especially true for LGBT-identified clients.Older adults may also need more education about their sexuality and sexual functioning. Curriculum for this includes communication, masturbation, body image, and spirituality. It also teaches about talking to a doctor about sexual activity. It is optimal that sex education for older adults includes information about sexually transmitted infections (STDs/STIs), such as HIV/AIDS. History
Sex therapy has existed in different cultures throughout time, including ancient India, China, Greece, and Rome. It has taken the form of manuals, spells, anaphrodisiacs or aphrodisiacs, and tantric yoga, among others. Much of sex therapy and sexual dysfunction in Western cultures was limited to scientific discussion, especially throughout the 19th century and into the early 20th century.Sexologists such as Henry Havelock Ellis and Alfred Kinsey began conducting research in the area of human sexuality during the first half of the 20th century. This work was groundbreaking and controversial in the scientific arena.In the 1950s, sex therapy was concerned with "controlling sexual expression" and repressing what was then-considered deviant behaviors, such as homosexuality or having sex too often. Masters and Johnson are credited with revolutionizing sex therapy in the mid-century and included couple therapy and behavioral interventions that focused on being present in the moment such as sensate focus exercises. Dr. Helen Singer Kaplan modified some of Masters and Johnsons ideas to better suit her outpatient practice, including introducing medication. Both integrated cognitive behavioral therapy into their practice and Kaplan used psychodynamic therapy as well.