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SEX AND HEART ILLNESS: RESOLVING SEX DRIVE DIFFERENCES

One possible solution to sex drive problems is testosterone replacement therapy, which typically involves either injections or oral administrations of testosterone. Although this therapy is considered medically sound and is quite effective for many, it is not a miracle cure. Many individuals do not respond to testosterone replacement therapy with any marked increase in sex drive, and the possible medical complications from the treatment prohibit its usage for many heart patients. High doses of testosterone can cause increased water and salt retention—obvious complicating factors for individuals who suffer from high blood pressure or congestive heart failure.
However, even if your physical differences in levels of sex drive cannot be erased with hormone therapy, there are many ways you can create and maintain an enjoyable sexual relationship. You simply have to work openly and cooperatively together. Couples who live in harmony are generous and accepting of each other's differences. Couples who enjoy their sexual lives are generous and accepting of their sexual differences. They simply tend not to make as big a deal of sex as many other couples do.
The key to managing differences in sex drive is in remaining open, playful, generous, flexible, and appreciative of your partner with reference to this difference. If you do so, you are much likelier to reach some mutually satisfactory compromise. Many couples ruin their sex life by taking it too seriously. They put sex in a special category within their relationship and lace it with magical expectations and ritualized procedures. In this way, they turn their sexual relationship into something that is strained, at best, or downright weird.
For example, many couples relate sexually only according to some fun-inhibiting formula that dictates when, how, and under what circumstances sex may occur. One couple with whom I worked followed this sexual formula: they had sex only if at least seventy-two hours had elapsed since the last time they had had sex; and if they both had had relatively relaxed days; and if they had engaged in considerable amounts of nonsexual physical affection throughout the preceding thirty-six hours; and if they each had at least one glass of wine; and if it was after 9:30 P.M. on an evening before a morning on which neither of them had to arise before 6:30 A.M.; and if the wife waited for the husband to initiate sex play. These two were amazed and appalled once we wrote out the legal-sounding list of ifs to which they had attached their right to play sexually. They had become stuck in the habit of acting this way and had never really reexamined whether such carefulness in relating to each other was necessary.
As the years of a marriage go by, most couples narrow the range of situations in which they express sexual affection and the ways they interact sexually. This seems to be a simple function of the fact that in marriage, we develop habitual ways of relating. This relationship pattern becomes a special problem for partners who start off with considerable differences in biologically based sex drive. If you limit the types of situations in which sexual relating is permissible, you will severely limit how frequently you have affectionate sexual encounters. Couples who enjoy their sex life tend to be free and flexible in general when dealing with each other. They openly give and ask for special attention in their marriage.
Notice how the preceding sentence was worded. These people freely ask for and get from each other many special favors in the course of week-to- week living together. They also resist developing rigid patterns of relating to each other. Their favors might include giving back rubs, fetching glasses of water, preparing special meals, and running errands, as well as sexual interactions.
Here are two good rules to follow in being married:
(1) Do not be unreasonable or insensitive in what you ask of each other; and
(2) do not feel that the other's gift counts only if he or she really, really wants to give it. In other words, you are more likely to remain flexible and generous in your relationship if you do not ask for sexual or behavioral favors that make either of you very uncomfortable. And it is important to view any favor, sexual or otherwise, as acceptable if it is given in a spirit of love and generosity, even though the giver may not be passionately involved in the act of giving.
In this vein, making love or simply giving or receiving sexual pleasure through oral or manual stimulation can be done in a spirit of playful affection. If you get rid of any expectation that both of you have to be sexually aroused, passionately involved, and ultimately orgasmic every time either of you feels sexy, you will greatly relax—and improve—in your sexual relating.
The reason? Such openness and mutual respect lessens tensions that might otherwise accumulate in response to your sex drive differences. By becoming more relaxed about sex, you can avoid becoming tense and emotionally stingy in dealing with each other. This is important, because tension in your relationship can magnify biologically based differences in sex drive. If this happens, you run the risk of accumulating resentments that then erode intimacy throughout your marriage. What begins as a manageable physical difference becomes a seemingly unmanageable fact of life for many couples.
An additional problem for couples caught in this trap is that tensions arising from struggles over sex drive differences can create other problems in sexual performance.
As is discussed at length in the following pages, anxiety about sex can cause such problems as impotence and orgasmic dysfunctions.
If you have struggled with frustrations over your sex drive differences, you may first need a period of relationship cleansing and rebuilding before your sexual differences can be addressed. To become playful and generous in the ways described in the preceding paragraphs, you must first come to peace with each other. Only then will you feel safe enough to try new ways of dealing with each other sexually.
Finally, I want to emphasize that it is perfectly normal to experience a lessening of sex drive in conjunction with being physically ill. As we get sick, our bodies experience a shutting down of physical systems in ascending order of importance to our survival. The systems that are least necessary to survival are shut down first, followed by progressively more important ones. The extreme of this process is a coma, in which all but the most primitive of our life-sustaining physical operations are shut down.
Now, sexual relating may be one of the most fun and pleasurable of our needs, but it is also one of our least physically necessary functions. We do not have to have orgasms to survive, so sex drive is very likely to diminish during times of increased physical alarm, such as when coping with illness or with prolonged periods of stress. Be realistic in understanding and accepting this fact, and your sexual energies will return as your body heals.
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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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