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SEX AND HEART ILLNESS: SEXUAL RESPONSE

The famous sexual researchers William Masters and Virginia Johnson once made the point that every man and every woman periodically experience difficulties in progressing through the sexual response cycle. Every man has periods of erectile failure or of ejaculation control difficulty. Every woman sometimes has difficulty becoming sexually aroused or experiencing climax. This does not mean that we all suffer from sexual dysfunction. It simply means that we all are human and that the human sexual response cycle is rather fickle—contrary to popular mythology, which suggests that all of us "real" men and women are sexual machines, ready to strike as soon as a breedable mate slows down long enough for us to mount.
Sexual dysfunction occurs when a person experiences persistent , difficulty in progressing through any of the phases of the sexual response cycle.
In understanding your own and your partner's sexuality, it is important to know the basics about the human sexual response cycle. If all goes well during attempted sexual interaction, our bodies progress through fairly predictable stages.
First comes sexual arousal, during which time males experience erection because blood is flowing into the penis, and females experience vaginal lubrication and swelling because of similar vascular activity. Next comes the plateau phase of arousal. Continued sexual interaction is experienced as pleasurable and results in growing sexual tension and arousal. Finally, sexual tension and arousal culminate in the pleasurable release of orgasm, which may or may not be accompanied by ejaculation for males.
Some women are capable of experiencing multiple orgasms, but many women and most men experience a physical resting phase following orgasm. During this resting phase (which is sometimes also called the refractory phase), the body shuts down the sexual response cycle. Further physical signs of arousal from sexual stimulation may not be possible during this resting phase, even if high levels of mental arousal still exist. In other words, during this sexual resting phase, it may not be possible for a man to gain another erection or for a woman to experience another orgasm, even though they may continue to feel sexy. As one of my patients put it, "After I have an orgasm, I feel so close to my wife and am so attracted to the sight of her body lying next to me that I want to keep making love to her. At that point, I can do all kinds of things in my head, but my penis won't cooperate."
This resting phase begins quite abruptly for men, resulting in rapid loss of erection. A woman's body both turns on and reverses the sexual response much more gradually. I believe that herein lies the reason why many men want to roll over and go to sleep after sex, whereas women tend to want to cuddle, talk, or continue to interact in affectionate or sexual ways. It is not just that we men are insensitive and uncommunicative (even though that may also be true); the abrupt turning off of the sexual response cycle can result in temporary feelings of sleepiness and relaxation.
Although a woman's physical sexual response is more gradually reversed, a woman does not always desire prolonged sexual stimulation. In fact, many women find sexual stimulation unpleasant after orgasm, like the feeling of over stimulation that results if you get tickled for too long.
Another result of this sexual resting phase is diminishment of sex drive. The length of time during which sex drive is quieted after orgasm varies from individual to individual and varies during a person's life. As will be seen in our discussion of the sexual effects of aging, lengthening of the resting phase of sexual response occurs inevitably as we grow older.
Finally, it is important to emphasize that no one always progresses neatly through the phases of sexual response. Rather, you move all along the continuum of sexual responding during a typical lovemaking encounter. You may become highly aroused, then momentarily lose arousal, only to regain it if pleasurable interaction and relaxation continue. In fact, research studies charting penile blood flow during sexual arousal have shown that blood actually flows into and out of a man's penis in a manner that can be charted as an upwardly moving stock market graph. Knowing this fact can help prevent needless anxiety if you notice a momentary lessening of arousal as you are making love. Just relax, and arousal will return.
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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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