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SEX AND AGING: HORMONAL CHANGES

The hormonal changes that occur in menopause do create various physical side effects, however, which may affect female sexual response. Because estrogen is the hormone that fuels the development of female sexual organs, the long-term effects of lowered levels of this hormone include physical changes in the vagina. These changes include a gradual thinning of the vaginal walls and a subsequent loss of vaginal elasticity and cushioning. The result is a narrowing of the vaginal opening. Losing estrogen also results in a lessening of vaginal lubrication during sexual arousal. This combination of lessened vaginal lubrication and elasticity can result in discomfort during intercourse unless additional lubrication is used. Such lubricants include surgical jellies (like K-Y Jelly), Albolene Cream, and Lubrin.
Many women going through menopause are treated with estrogen replacement therapy to lessen the uncomfortable symptoms of this period of hormonal changing. A combination of estrogen and progestin is prescribed in order to mimic the body's former cycle of hormonal secretion, and symptoms such as hot flashes, irritability, and vaginal changes are thus diminished.
Estrogen replacement therapy was originally thought to increase the risks of breast and uterine cancer and to pose particular risks for women suffering from hypertension or heart illness. However, current medical thought seems to be that, when properly prescribed and taken, this is a relatively safe and effective therapy for virtually all menopausal women, including those suffering from heart illness. I strongly recommend that you consult your gynecologist about this option. Most menopausal women report significant improvements in overall quality of life and enhanced sexual enjoyment as a result of estrogen replacement therapy.
It is obviously true that aging does, indeed, affect sexual responsiveness. However, the good news is that we maintain our ability to respond sexually throughout our lives, particularly if we continue to exercise our sexual organs. Men and women in their sixties and seventies respond more fully to sexual stimulation if they maintain patterns of regular sexual response, either through lovemaking or through masturbation. In other words, the best way to keep from losing it is to keep using it.
Advancing age also typically brings increased maturity, wisdom, and relationship security. These factors should lead to increased flexibility in your attitudes toward sex. Expand your perspective from the narrow notion that sex has to do only with an erect penis inside a lubricated vagina. Think of your sexual relationship with the freeing notion that lovemaking has to do with orchestrating a whole symphony of intimacy containing many movements, variations on the themes of affection and communication, and intimate behaviors. With this expansion of attitude comes the stuff that makes a better sex life.
Even though your body changes in the direction of some slowing of the sexual response as you age, remember my prior comment: The body's largest sexual organ is the brain. Understanding the facts about sex and aging should help you develop and maintain a soothing attitude about this aspect of life.
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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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