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CORRECTING SEXUAL PERFORMANCE PROBLEMS: SEX AND AGING

We generally make one of two possible mistakes in our assumptions about the sexual changes of growing older: we either underestimate or overestimate the effect that the normal aging process has on sexual response. The fact is that clear and predictable changes in sexual responsivity begin as early as the mid-thirties. This certainly does not mean that you are over the sexual hill by your fortieth birthday; enjoyable and effective sexual response can be maintained throughout your life. However, it is essential that you and your mate be realistic and sensible about the facts of sex and aging.
As they age, men require more direct and more lengthy stimulation of the penis to get erect. Furthermore, the erection may not be quite as full or as hard as in prior years. Correspondingly, aging women may require more direct and more lengthy stimulation of the breasts and clitoral area to become aroused. There may also be less vaginal lubrication during arousal than in prior years. Once aroused, both men and women require increased direct stimulation of the sexual areas to trigger orgasm as age advances. The orgasm response may be somewhat less intense than in younger years—very relaxing and satisfying, but less explosive.
To understand sex and aging, it is helpful to understand the effects that hormones have on both male and female sexual response. The effects of the male hormone testosterone were discussed in the Sex Drive section. As the testosterone level drops with each advancing decade past age thirty-five, sexual responsivity slows down in the ways just described. But even though the level of this hormone diminishes as we age, our sexual hormones do not disappear. Most men and women continue to have ample testosterone to fuel sexual response throughout life.
The sexual consequences of aging are somewhat more complicated for women because of the abrupt hormonal changes that occur during menopause. During menopause (which typically occurs sometime around age fifty), there is a sudden decrease in the primary female sex hormone, estrogen. Decreased estrogen does not directly lessen sex drive, arousal, or orgasm response in women. It is therefore often said that there is no physical reason for a woman's sex life to be negatively affected by menopause.
So how is your sex life, from a biological perspective? If you suspect or know that some physical or chemical factor is negatively affecting your sexual response, don't give up; get more information about your condition and the possible medical treatments available to you. Recent medical advances have made possible the accurate evaluation and successful treatment of many organically caused sexual problems. Pelvic angiography can assess the degree of circulation to the pelvic area. It is also possible to determine penile blood pressure as a means of evaluating whether a biological problem underlies erection difficulties.
Medical aids can enhance blood flow to the penis, and surgical procedures can often restore or aid sexual response. One such procedure involves grafting new blood flow pathways to the penis to aid erection. Another surgery involves the insertion of a penile prosthesis into the penile cavities to allow for the simulation of a natural erection. These surgeries are safe, medically sound, and most often effective in enhancing the sex life of any partners who are otherwise open and loving in their efforts to maintain intimate connections through all the years of their life together.
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EPILEPSY AND PREGNANCY

Women with epilepsy are quite often concerned about getting pregnant. There appear to be five reasons for this concern. They wish to know:
if they are likely to hand their epilepsy on to their children;
whether their fits will get worse during pregnancy;
whether it is safe for the baby that the mother should take anticonvulsants drugs during pregnancy;
if there will be any problems in the newborn baby from these drugs;
if they can safely breast feed the baby.
With regard to handing on epilepsy to one’s children – as mentioned earlier, if one parent has epilepsy, the chances of one of the children having epilepsy are no greater than in the population at large. If both parents have epilepsy, it would appear that the risk of a child having epilepsy is about 10 per cent. So in fact the chance of a child inheriting epilepsy, particularly idiopathic epilepsy, is negligible.
As far as seizures during pregnancy are concerned, the situation is not as clear as it might be. There is evidence that for some women, seizure control may deteriorate, while for others there may in fact be no change or even an improvement. A patient told me recently that “she would like to remain pregnant forever” as she had not had a single fit during her pregnancy, compared with six fits in the preceding nine months!
As a general working rule, it is suggested that people who have more than one grand mal fit a month are those who are most likely to have a deterioration in seizure control during pregnancy. The deterioration, if it occurs, is most likely during the first three months of pregnancy. There are a number of theories why this may happen, but none has been proved. It may be of value to check the blood anticonvulsant levels during pregnancy, especially if there is a deterioration in seizure control. The blood levels may fall, necessitating an increase in dosage during the pregnancy.
The main concern for parents is whether the anticonvulsants can harm the unborn baby (foetus). It is known by most people with epilepsy that this is a potential hazard. The effects include physical abnormalities in the baby, a process known as teratogenesis. Abnormalities have been reported in the offspring of mothers on all the commonly used anticonvulsants with the exception of carbamazepine. This is particularly applicable to phenytoin, barbiturates and sodium valproate. Babies born to mothers who have been on carbamazepine have not been shown to have any physical abnormalities, but have a smaller head size than other babies. This has not been shown to be any handicap to the babies who have been followed up for five years.
The risk of abnormalities in the baby is difficult to assess, but it seems to be most common in mothers on polytherapy (receiving numerous drugs), especially if they are on three or more anticonvulsants. The risk in mothers on phenytoin, with or without other medications, appears to be about a 10% chance of the baby showing features of the ‘foetal hydantoin’ syndrome. This syndrome consists of cleft palate, abnormalities of the fingers, possible heart abnormalities and mild mental retardation. Thus, at present, if it is possible, it would seem wise to try to change patients over to carbamazepine before conception. This may not be possible in all patients and, of course, many women will first visit their doctor when already pregnant, at which time there is no purpose in making the change.
Anticonvulsants taken by the mother during pregnancy may have some effects on the baby immediately after birth, as they are transmitted to the baby across the placenta. These include the possibility of a mild bleeding tendency and some drowsiness. In mothers who have been taking barbiturates, the infant may occasionally show features of a withdrawal reaction with irritability, jitteriness and poor sucking. None of these features is [...]

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ERECTILE DYSFUNCTION SYMPTOMS

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