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  • To eliminate cervical cancer in the next 100 years, implementing an effective strategy is critical

    To eliminate cervical cancer in the next 100 years, implementing an effective strategy is critical

    Vaccination, screening, treatment and palliative care are the key interventions of WHO’s Draft Global Strategy towards the Elimination of Cervical Cancer as a Public Health Problem,
    the fourth most common cancer in women.

    On World Cancer Day, new estimates show that this strategy could save more than 62 million girls and women from a cervical cancer death and prevent 74 million cases within the next 100 years – but only if these interventions are used effectively
    together.

    No single intervention can eliminate cervical cancer

    These estimates, published by the WHO Cervical Cancer Elimination Modelling Consortium (CCEMC) in The Lancet, are based on the draft strategy’s targets to achieve a global coverage of 90% vaccination, 70% screening and 90% treatment by 2030.

    lancet

    Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries

    Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries


    Developed by Member States, UN agencies and other partners, the draft global strategy seeks to redress the unequal burden of cervical cancer around the world. Nine in 10 cervical cancer deaths occur in low and lower-middle-income countries, where
    women lack access to health services.

    As Dr Tedros Adhanom Ghebreyesus, WHO’s Director-General has said, “It doesn’t have to be this way. Cervical cancer
    is one of the most preventable and treatable forms of cancer, as long as it is detected early and managed effectively.”

    This new analysis compares the impact of vaccination, screening and treatment of cervical pre-cancer lesions as single or combined interventions. Focusing on 78 countries where cervical cancer mortality is highest, the results clearly show that no
    single intervention will be sufficient to reduce levels of cervical cancer in the next 100 years to below the elimination target of 4 cases per 100,000 women per year.

    Acting immediately on all three fronts is crucial.                                                                                       

    90-70-90: a triple intervention by 2030 and beyond

    Vaccinating girls against cancer-causing types of human papillomavirus (HPV) before the age of 15 is the foundation for bringing every country’s incidence rate of cervical cancer down to the agreed elimination level.

    Right now, however, vaccination is not enough. As a single strategy, vaccination targets would only deliver a 0.1% reduction in cervical cancer mortality by 2030. Scaling up screening and treatment of cervical pre-cancer lesions at the same time would
    reduce mortality by more than one third, or 300,000 deaths, in the same period.

    The evidence shows that when all adult women are screened for cervical cancer at least twice, at ages 35 and 45, abnormalities are more likely to be detected before they become cancerous. When cancer has developed, screening increases a women’s
    likelihood of early and successful treatment, as well as palliative care if recovery is no longer an option.

    Meeting these triple-intervention targets would be a major contribution to target 3.4 of the UN Sustainable Development Goals (SDGs), a one-third reduction in premature mortality from non-communicable diseases by 2030.

    The future of cervical cancer elimination

    WHO’s global strategy towards eliminating cervical cancer aims to set the world on the right track by 2030, but it is just the beginning.

    At this pace, global elimination of cervical cancer is not predicted until 2120.

    While high HPV vaccination coverage is the primary prevention intervention, ensuring every woman has two cervical screenings in her life would accelerate elimination by 11 – 31 years, depending on the country.

    If no action is taken, cervical cancer deaths will rise almost 50% by 2030. Approval of the draft global strategy at the WHO World Health Assembly in 2020, and investment in mechanisms to deliver it, is vital.

    As the new World Cancer Report shows, only 18% of countries that currently provide screening for cervical cancer reached the recommended target of more than 70% coverage. An estimated 55% of low-income countries that reported offering
    cervical cancer screening generally lack accessible radiotherapy or surgery services.

    Elimination of cervical cancer is possible within the lifetime of today’s youngest girls, but the clock starts now and every intervention counts.

     

    To eliminate cervical cancer in the next 100 years, implementing an effective strategy is critical
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    https://www.who.int/news-room/detail/04-02-2020-to-eliminate-cervical-cancer-in-the-next-100-years

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  • World experts and funders set priorities for COVID-19 research

    World experts and funders set priorities for COVID-19 research

    Leading health experts from around the world have been meeting at the World Health Organization’s Geneva headquarters to assess the current level of knowledge about the new COVID-19 disease, identify gaps and work together to accelerate and fund priority research needed to help stop this outbreak and prepare for any future outbreaks.

    The 2-day forum was convened in line with the WHO R&D Blueprint – a strategy for developing drugs and vaccines before epidemics, and accelerating research and development while they are occurring.

    “This outbreak is a test of solidarity — political, financial and scientific. We need to come together to fight a common enemy that does not respect borders, ensure that we have the resources necessary to bring this outbreak to an end and bring our best science to the forefront to find shared answers to shared problems. Research is an integral part of the outbreak response,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “I appreciate the positive response of the research community to join us at short notice and come up with concrete plans and commitment to work together.”

    The meeting, hosted in collaboration with GloPID-R (the Global Research Collaboration for Infectious Disease Preparedness) brought together major research funders and over 300 scientists and researchers from a large variety of disciplines. They discussed all aspects of the outbreak and ways to control it including:

    • the natural history of the virus, its transmission and diagnosis;
    • animal and environmental research on the origin of the virus, including management measures at the human-animal interface;
    • epidemiological studies;
    • clinical characterization and management of disease caused by the virus;
    • infection prevention and control, including best ways to protect health care workers;
    • research and development for candidate therapeutics and vaccines;
    • ethical considerations for research;
    • and integration of social sciences into the outbreak response.

    “This meeting allowed us to identify the urgent priorities for research. As a group of funders we will continue to mobilize, coordinate and align our funding to enable the research needed to tackle this crisis and stop the outbreak, in partnership with WHO,” said Professor Yazdan Yazdanpanah, chair of GloPID-R. “Equitable access – making sure we share data and reach those most in need,  in particular those in lower and middle-income countries, is fundamental to this work which must be guided by ethical considerations at all times.”  

    During the meeting, the more than 300 scientists and researchers participating both in person and virtually agreed on a set of global research priorities. They also outlined mechanisms for continuing scientific interactions and collaborations beyond the meeting which will be coordinated and facilitated by WHO. They worked with research funders to determine how necessary resources can be mobilized so that critical research can start immediately.

    The deliberations will form the basis of a research and innovation roadmap charting all the research needed and this will be used by researchers and funders to accelerate the research response.

    Note to editors

    GloPID-R is a global alliance of international research funding organizations investing in preparedness and response to epidemics.

    World experts and funders set priorities for COVID-19 research
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    https://www.who.int/news-room/detail/12-02-2020-world-experts-and-funders-set-priorities-for-covid-19-research

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  • Is a common shoulder surgery useless?

    Is a common shoulder surgery useless?

    New research casts doubt on the true effectiveness of a common type of surgery used to ease shoulder pain.

    A British research team tracked outcomes for patients who underwent “decompression surgery” to treat shoulder impingement – a condition where a shoulder tendon rubs and catches in the joint.

    In decompression surgery, a small area of bone and soft tissue in the shoulder joint is removed, opening up the joint to prevent the abrasion that happens when the arm is lifted.

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  • How to Make Money Fast by Retrieving and Returning Shopping Carts

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    Are you looking for a way to make money fast? If you have a large utility vehicle, like a pick-up truck, you can retrieve and return shopping carts for a cash reward.

    Most every mid to large retail grocery, variety and department store has a stock of shopping carts on hand. They are purchased by the store, of course, so that customers can use them when shopping in their store.

    Shopping buggies are expensive. The average cost to the retailer for just one is between 75 and 100 dollars. Large ones like the kind you find at wholesale and club stores can run upwards of 200 dollars or more.

    Most retail stores have dozens of them; busy big-box stores may even have hundreds of them. Purchasing enough of them to meet a store’s demand and traffic levels requires a significant expenditure of cash.

    It is, therefore, in the best interest of the retailer to protect that investment. Most retailers do their best to make sure that carts remain on store property. However, shopping buggy theft is all too common. The average store loses about $8,000 $10,000 to per year to this problem.

    Because they are so expensive to buy, many store owners and retail companies pay cash rewards for the return of their carts which have been stolen (or “borrowed”) and not returned. Cash rewards typically range from 25 to 50 dollars per cart.

    Here’s how you can retrieve and return those buggies for cash: contact retailers in your area which have shopping carts. Find out if they pay for returned carts. Many do, but won’t give cash rewards to just anyone. (Store owners don’t want the public to abuse the reward system by stealing carts themselves in order to get the reward.) Usually you have to sign a cash-for-retrieval contract.

    You’ll have to provide some forms of identification, usually a driver’s license plus one other item (like a Social Security or credit card). You may have to sign a waiver absolving the store of liability in the event of something unforeseen.

    You can make arrangements with any or all of the retailers in your area. The more contracts you have, the more money you can make.

    If you’ve lived in your city for any length of time, you’ve probably seen common dump sites for stolen shopping buggies. Visit these areas regularly. Additionally, get in the habit of keeping your eyes open every time you’re out and about town. You’ll probably spot discarded shopping carts regularly. You can pick these up and return them as you come across them, or store them at home until you have several of them.

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    Source by Scott Lindsay

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  • The Four Horsemen of Marital Apocalypse

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    Stop to consider your last fight with your spouse. The exact subject may escape you at the moment. We understand. After a while, the spats – over bills, your job, in-laws or the dishes still in the sink – can all blur together. But contrary to popular belief, it’s not the amount of conflict in your marriage or what you argue about that determines your relationship’s survival rate. to marriage researchers, how a couple fights tends to be the best predicator of whether they’ll end up enjoying their golden years together or battling it out in divorce court. So learning to fight less may not be quite as important as learning to fight fair.

    Four Deadly Sins of Marriage

    Dr. John Gottman of University of Washington, one of the foremost marriage researchers, claims he can predict with 90 percent accuracy if a couple will divorce. In his storied “love lab,” Gottman studies how couples interact, particularly how they communicate with each other in heated moments. After 30 years of research, he has pinpointed four behaviors that seem to invariably spell disaster in any marriage. He ominously refers to them as “The Four Horsemen of the Apocalypse.” Every couple needs to be vigilant and ensure none of the four gallop into their marriage and wreak irreversible havoc.

    Horseman #1: Criticism

    The most common horseman that emerges in long-term relationships is criticism. Frustrations, annoyances and resentment inevitably build up when couples live together – day in and day out. And criticism can be how these emotions manifest in the heat of an argument.

    Note that criticism differs from complaining. Criticism focuses on the person. Complaining focuses on the behavior. This may seem like subtle nuance but research shows it is a distinction that makes a significant difference in the long term. For example, this is a critical statement: “You always drive around in circles. You are an awful driver with a terrible sense of direction.” These words are dripping with blame and accusation. They are a personal attack.

    Unlike criticism, complaining has more to do with how the other person’s behavior makes you feel. Complaining usually begins with an “I” instead of “you”: “I get so frustrated when you are driving and don’t know where you are going.” See the difference? The second statement is a negative comment about something you wish were otherwise. So though “I” statements can seem awkward, they really help keep the carnage manageable during explosive moments.

    Horseman #2: Contempt

    You’re an idiot. You can’t do anything right. You make me sick. These contemptuous words have no place in any relationship you value. They are meant to explicitly humiliate or wound. They are toxic and indefensible. Period.

    Contempt includes but is not limited to name-calling, hostility and sarcasm. Keep in mind that contempt can also be conveyed non-verbally. An excessively harsh tone or disgusted eye roll can escalate your garden-variety argument into WWIII in the blink of an eye. Avoid contempt in your arguments at all cost. It is the basest, most childish tactic to resort to in a fight. Strive to respect your wife even when you disagree or feel upset with her. Contempt is like a poison. It will single-handedly erode intimacy. It destroys a sense of security and mutual respect. It does real damage because it makes a partner feel belittled and unloved.

    Horseman #3: Defensiveness

    Criticism+Contempt=Defensiveness. Defensive statements become practically an involuntary reflex in homes where contempt and criticism are regular visitors. It is understandable. After all, who wouldn’t put up their guard in response to an accusatory, belittling spouse? Defensiveness is fundamentally a self-preserving tactic.

    As understandable as this response can be, it is still hugely destructive. It builds walls. Rather than allow room for connectedness, the foundation for conflict resolution, it tends to breed emotional distance. Defensiveness blocks healing and forgiveness.

    Horseman #4: Stonewalling

    Because stonewalling is not explicitly aggressive, couples often underestimate its destructive potential. But it can be just as devastating to a relationship in its passiveness. It is, in effect, giving up. It is withdrawing emotionally. It is essentially closing the door to a resolution.

    Stonewallers withdraw partly because they can feel overwhelmed with emotion. They may keep their faces expressionless, avoid eye contact, hold their posture rigid, avoid any signs of listening such as nodding or encouraging sounds. They radiate icy distance and disapproval to their partners.

    The Secret to Fighting Fair

    Now that you know the four horsemen, make a conscious effort to keep them in the stable before they trample your marriage. One of the best ways to do this is to make “repair attempts” during your next argument. According to Gottman, repair attempts are any words or actions that prevent a conflict from escalating out of control. As simple as it sounds, repair attempts keep a marriage from becoming negative, hostile and distant.

    Repair attempts can be as basic as changing the topic, giving a compliment, apologizing or saying, “I’ve been cranky all day, can we start over?” It can be as simple as saying, “Don’t worry, we’ll get through this” or cracking a joke to diffuse tension. Research even shows couples who touch during arguments also tend to show higher relationship satisfaction. Do whatever works for you when conflict rears its ugly head.

    Remember, the more entrenched the negative patterns of behavior in your marriage become, the more difficult it becomes to break them. Don’t become a victim of these negative cycles. When two mature people can take ownership and be flexible, they will keep their marriage strong even though they may not always agree. As a Scottish proverb says, “Better bend than break.”

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    Source by Grant Langston

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  • The Essence of Technical Writing

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    The Gist of Technical Writing

    Technical writing, though may seem to be complex outwardly, is not that much complicated when approached in a pragmatic and systematic way. To make it simple, technical writing is just the process of peeling the outer chunky cover of the complexity of the entailed subject and showing the common reader the right way to feel the inner softness at ease.

    The Objective of Technical Writing

    Technical Writing is the process of taking away the toughness of the subject and making it simple and straightforward so that even ordinary readers who do not possess the grasp of the subject can easily digest the topic. A technical writer must be capable to assimilate the subject technical communication in its entirety and must be competent enough to translate the same into a commonly used language avoiding all of the included technical jargon.

    Though the subjects can vary, an expert technical writer will have to be skillful in providing the readers practical and precise content regarding the discussed subject in an ordinary language. The topic may be based on issues such as computer snags, recently launched innovative apps, description of a consumer gadget, mobile phones, computer tablets, medical items, or many other such things that are par for the course of modern living. A talented technical writer will delve deep into the subject and will gather all the relevant practical points and then will pass them to the readers without losing the grip of the subject, but, in a simple language. There lies the real significance of a technical writer.

    Give Valuable Information to Readers

    One of the main points that all technical writers will have to take care is to include valuable information that will be useful to the readers rather than detailing the apparent technical data. Readers will be more interested in knowing what the item concerned will impart them, rather than the physical or technical specifications. That does not mean that the writer must completely avoid such technical details; the only thing that he or she must ensure that the detailing must be customer-oriented.

    One Basic Tip

    To become a good writer, one should become a good reader and when the topic comes to technical writing, the writer must be clued-up on the latest technological advancements. The writer must absorb the scientific advancements as and when it comes to pass, and in our time the best bet for it is to rely on the effectiveness of the various internet platforms. In short, all technical writers must comprehend and assimilate the subject concerned fully before trying to pass on to the readers.

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    Source by Kaliyath Achutha Kumar

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  • Distinguishing Drug Abuse From Drug Addiction

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    Though “drug abuse” and “drug addiction” are often used interchangeably, in reality the terms refer to two distinct behavior patterns. An individual can abuse or misuse drugs without being inevitably addicted to them. Abuse or misuse involves the use of drugs defying the culturally acceptable standards or medically prescribed doses to attain a certain effect. The substances abused may be legal, such as alcohol or prescription drugs, or illegal, like heroin and other street drugs which have no medicinal value.

    On the other hand, drug addiction, or compulsive drug use, refers to an uncontrollable desire to use a drug in spite of being aware of harmful psychological and physiological effects that they can have on the body. Addiction is often characterized by an insatiable appetite for substances by increasing the dosage, leading to a complete dependence on them.

    Since abuse and addiction are two distinct concepts, their causes are unique as well. Abuse is generally considered to be more complicated but it is not necessarily triggered by any motivational factor, unlike addiction which is caused by a powerful motivational force. Therefore, in most of the cases, abuse may not always result in addiction, but addiction can certainly lead to abuse.

    Impact of drug abuse and addiction on the brain

    It has been observed that both drug abuse and drug addiction have similar effects on mind and body. People often view abuse and addiction as a moral weakness or character flaw. One of the common myths surrounding drug use is that quitting it is directly linked to behavioral changes. In reality, addiction is a disease which alters the brain functions, hijacking the natural motivational control circuits. Thus, quitting is simply not a matter of choice or willpower. Though, the decision to use the drug initially might be voluntary, changes in the brain structure due to repeated drug use can inhibit someone’s self-control and decision-making ability, causing intense cravings.

    Experts attribute the inability to refrain from drug use to these changes in the brain. However, modern medical advancements have led to the development of an array of treatment and rehabilitation options to combat the disastrous effects of addiction and help abusers take control of their lives. Studies have shown that a combination of medications and behavioral therapy can boost the recovery process with minimal withdrawal effects.

    Possible reasons leading to drug abuse and addiction

    For those who are dependent on illegal substances, it can be difficult to know whether they have crossed the limit. Here are some possible reasons that can trigger drug abuse or addiction:

    • Connecting socially: A strong desire driven by an urge to fit into a certain group could lead people toward drugs.
    • Dealing with problems in life: Continuous drug use can get individuals accustomed to it, and soon it might become the only way to escape from problems and challenges.
    • Using drugs to combat other issues: Serious concerns, such as panic attacks or chronic pain, can cause dependence on drugs, until people discover healthier alternative methods to counter such problems.
    • Strong influence of any drug: Frequent use of drugs triggers dependence on them. Thus, what started as a voluntary choice may slowly transform into a physical and psychological need.

    Leading a drug-free life

    Many families and individuals have suffered great losses due to addiction to drugs. Fortunately, there is hope, though the battle to eliminate addiction and regain sobriety is challenging. There are numerous treatment strategies that can go a long way in helping people come out of their addiction-related problems.

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    Source by Barbara Odozi

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  • Herbal Cure For Joint Pain

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    Joint pain can be stressful and it can also limit the activities you can do comfortably. Severe joint ailments might also restrict mobility. The most common joint ailments that cause excruciating pain include arthritis and osteoarthritis. People are always looking for ways by means of which they can cure or at least relieve the discomfort. Herbal cure is probably one of the best that you can choose for pain relief. This is considering that it revolves around natural herbs which do not have any side effects.

    Ayurveda is a natural healing process which offers a holistic approach allowing the patients to attain higher self harmony (atmay), mind (manas) and helps in regaining vital energy from the universe (prana), body and the senses. The Ayurvedic treatment process combines natural herbs and herbal minerals with no side effects. Meditation, yoga and use of massage are also practiced under this treatment to achieve complete wellness besides, getting rid of joint pain.

    Arthritis Treatment

    This is the most common joint condition people suffer from. It is a systemic, chronic inflammatory disorder which affects organs and tissues, thus leading to pain and ailing. It is a disease that can start with morning stiffness and fatigue extending to muscle ache, weakness and loss of appetite. Those suffering from this condition might use pharmaceutical drugs to relieve the pain, but it is not always a good option. Ayurvedic treatment for arthritis is probably the most effective herbal way of dealing with the pain.

    This herbal treatment revolves around internal medicines and external therapies which help in dealing with and eliminating the pain of arthritis. It uses traditional Ayurvedic treatment methods together with classical Ayurvedic medicines to help with pain relief. The treatments are made up of:

    Choorna Kizhi:

    This is considered to be the most effective of all Ayurvedic treatments when it comes to rheumatoid arthritis, arthritis and osteoarthritis. The treatment uses a mixture of natural herbs which are applied to the body to an extent that the individual sweats profusely. The treatment requires that the patient is kept in different positions including left lateral, right lateral, supine and sitting positions.

    Abhyangam:

    This treatment uses special massage oil. The oil is applied using a variety of strokes lasting for up to 45 minutes every day for at least two weeks. The treatment is most suitable for osteoarthritis, obesity and body aches among others. The treatment nourishes the body, revitalizes the nervous system, helps overcome stress and fatigue, promotes good sleep, improves physical appearance, and builds self confidence.

    Njavarakizhi:

    This is another Ayurvedic treatment where the patient suffering from joint pain is rubbed with medicated herbal oils. It is applied all over the body and in different postures, including lying and sitting. The treatment uses cooked Njavara rice and a medicinal decoction used by the therapist for at least 14 days for complete joint pain relief to be enjoyed. Regular use of the Ayurvedic pain treatment methods has a way of offering a permanent cure for arthritis. This is because complete well being is promoted during the treatment.

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    Source by Shalini Mittal

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  • Anal Sex: Here’s How To Make Your Woman BEG YOU For It – YES, Really – BEG YOU FOR IT

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    You may think that the title of this article sounds too good to be true – but it’s 100% serious. You are about to discover exactly how to make your woman beg you for anal sex.

    If you want to do your woman ‘up the back door’ but she isn’t currently too happy about the idea, here is how to make her want anal sex.

    Most guys approach the issue of anal sex with their woman totally the wrong way. Here are a few examples of common methods that men use to try to get their woman to have anal sex with them.

    If you are currently using any of the following ideas, stop it straight away:

    Mistake #1: They try to persuade their woman to have anal sex with them by using logical arguments. For a woman sex is virtually 100% emotional. Therefore, logical arguments are a total waste of time.

    Mistake #2: Some men just try to ‘slip it in the back door’ when they are making love to them and hope their woman just lets them carry on with it. This is a terrible idea and one that you must avoid because it will probably hurt your woman and this could turn her off the idea of anal sex for a very long time.

    Worse still, it may break the sexual trust that you have with your woman. And when you lose that all important trust, you can say goodbye to your woman doing the really dirty, naughty stuff (like ‘back door action’) with you.

    So now that you know how not to try to get your woman to have anal sex with you, I can share the secret of how to make your woman beg you for anal sex.

    Pay attention, this is going to be fun…

    For starters, stop viewing anal sex as something that you need to ‘win’ from your woman and something that at best she’ll tolerate in order to allow you to have a good time. There isn’t a real man on the planet who thinks like that.

    Instead, adopt the belief that you are going to cause your woman to link massive amounts of pleasure to anal sex.

    That is the most important step, so I’ll repeat it – you are going to cause your woman to link massive amounts of pleasure to anal sex.

    And they way you do this is in very small steps.

    You cannot expect her to go from having never had anything up her butt, to taking your whole ‘tool’ all in one night.

    It ain’t gonna happen.

    No, no, no – your game plan for back door action has to be much cleverer than that. But don’t worry; I have already got the game plan for you, so all you have to do it put it into action…

    The 5 Step Plan To Make Your Woman Beg You For Anal Sex

    – Step 1: Use your tongue to give your woman oral pleasure, wait until she is just about to come and then gently rub her asshole with your finger. Keep rubbing it as she comes and you have started the process of getting her to link pleasure to her ass.

    – Step 2: Do the same as step one, but this time insert the tip of your finger into her butt as she is about to come and carry on doing it during her orgasm.

    – Step 3: Repeat the process again, this time inserting much more of your finger (all of it if possible), into her ‘back door’ as she gets on the verge of orgasm and during her orgasm

    – Step 4: Get a butt plug (start with a small one) and get her used to taking this up her ass. Be sure to insert the butt plug as she is about to come and during her orgasm. This way she links massive pleasure to her ass being touched by you

    – Step 5: Get your woman extremely turned on and wet. Give her a clitoral orgasm (with anal fingering) and then give her a deep spot orgasm. Next, bring out the lube and attempt to put your tool in her back door (use the doggy style position).

    Chances are that she’ll help you get inside her and totally enjoy the process. If she struggles to take you, repeat steps 3 and 4 and then retry step 5. Sooner or later she will beg you to take her in her butt.

    I’m the first to admit that this process is not set in stone.

    You have to be flexible in your approach. But this IS the way to do it if you want your woman to absolutely LOVE it when you take her in the butt.

    After-all, do you really want her to just oblige you because you begged for it, OR do you want to expertly and patiently make her crave back door action?

    If you want to make her crave it, use this 5 step process and be ready to repeat certain steps if need be. At the end of the day, it’s all good fun!

    Let me know how you get on.

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    Source by Adam A Armstrong

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