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SEX AND AGING: GLENN’S STORY

The physical changes that come with age do not necessarily cause sexual performance problems. However, as can be seen in the example of Glenn and Lois, sexual problems do often result from anxiety caused by uneducated reactions to the sexual aging process.
Glenn was fifty-two years old and his wife, Lois, was fifty-seven. Glenn had undergone coronary bypass surgery at age forty-eight and had recuperated with no physical complications. Glenn's contact with me came after Lois was referred for help with depression. Her referring physician assumed that Lois's sad mood, withdrawn behavior, and general lack of zest were related to the empty nest syndrome created by the relatively recent marriage of her only child.
As I got to know this couple, several things quickly became clear. The marriage of their daughter certainly did begin a new phase of life for Glenn and Lois; they loved being parents, and they missed their former close contact with their only child. However, the empty nest had little to do with Lois's depression. More bothersome to her, marital intimacy had steadily dwindled in the preceding three years. She and Glenn had once been openly affectionate and spontaneously loving in their relationship. Now their marriage had turned into a relationship of tense distancing and avoidance of physical touch.
The difficulties began when they noticed that Glenn, who had typically been the sexual pursuer in the relationship, began having less firm and less spontaneous erections. In the past Glenn could become aroused and erect merely in reaction to the sight of his wife dressing or undressing. Beginning around age fifty, however, both partners noticed that Glenn required rather prolonged manual or oral stimulation of his penis by Lois before he could get fully erect.
This absolutely normal change in sexual responsivity frightened and confused this couple. Lois quietly wondered if her long-standing fear of losing her attractiveness to her younger husband was finally justified now. Glenn began to obsess about his fear that the atherosclerosis that had resulted in his need for coronary bypass surgery might now be blocking blood flow to his penis.
All this quiet worry and fear led to mutual tension about sex. This loving and open couple became progressively more withdrawn from each other and began avoiding the topic of sex. They soon became caught in a vicious cycle: the more they quietly worried, the more they avoided sex and physical affection. The more they avoided the more anxious and worried they became. As they both became more anxious, sex drive and sexual response were further squelched for both of them. In addition to distancing physically, each began to assume that the other was being quietly critical. Tension and irritability replaced their typical comfort when they attempted to communicate. Subtly and progressively, what had been a healthy, intimate marriage deteriorated into a relationship between two lonely and anxious people. Like many couples, Lois and Glenn were caught in the unfortunate trap of discomfort that results from misunderstanding the natural changes in sexual response that occur as the body ages.
The tragedy of the story of Glenn and Lois is that their difficulties would never have occurred if they had had a clear and realistic understanding of the basic facts about sex and the aging process. Knowing what to expect as the natural result of aging would have prevented the problems that were now threatening their happiness.
The main fact to remember about sex and aging is that, as we age, we need more direct and more prolonged stimulation of our sexual body areas in order to progress through the sexual response cycle. It is as though the hormonal changes that happen for both men and women beginning around age thirty-five result in a prolongation of the sexual response cycle. Whereas you used to be able to progress rapidly from non-arousal to arousal to orgasm, it is likely that you will need to be more patient, attentive, and physically loving of each other as age diminishes sexual hormones and slows your sexual responsivity.
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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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