Health News.

Many elderly people are prescribed and take too many drugs. Because older people suffer from degenerative diseases, often of different systems, they are seen and treated by different specialists, who forget to find out what treatment other doctors have given. The result is that many elderly people are walking pharmacies. This can cause symptoms of mental decay, which are thought to be due to old age, not to doctors’ errors. An example was given in the British Medical Journal in July 1977:

Mrs. А.В., aged 68, moved here three weeks ago to live with her daughter. She has been asthmatic for many years and has been receiving prednisone (10 mg. daily) for the past 15 years. She has also had osteoarthritis of her knees and hips for nine years and has been taking ibuprofen (800 mg. thrice daily) for three years. Two months ago she consulted her GP because of a slight tremor of her hands, and because of insomnia. He started her on benzhexol (5 mg. thrice daily) and nitrazepam (10 mg. nightly) and also gave her a supply of pentazocine to take as necessary for her osteoarthrosis. Since then, she has become increasingly incapable of looking after herself; she has become confused, disorientated, and sometimes hallucinated. Her family felt that she could no longer look after herself, and she has come to live with her daughter. We would like advice on two matters; are her drugs responsible for her recent deterioration; can we rationalise her drug treatment?

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It is wrong to call the emotional instability of a man’s middle years the ‘male menopause’. There are two reasons: he does not menstruate, and no changes occur in the production of his gonadotrophin hormones, his testosterone levels do not decrease, nor does he produce fewer sperms. But many middle-aged men do go through a period of emotional anxiety, of depression, and of stress. To call this the ‘male menopause’, because it occurs during the same years that a woman inevitably ceases to menstruate, is catchy and comforting. It is comforting because it implies that the ‘crisis of middle age’ is not due to a man’s actions or inactions, but to his altered hormones and, consequently, is inevitable. This is not true: our faults are not in our hormones, but in ourselves.

The emotional problems of middle age may be due to a man’s actions – or to his lack of action. They will only be solved if he alters his way of life. He does not lack hormones, he does not need hormone injections and they do not help!

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A disturbing condition affecting men particularly, which appears to be sexually transmitted, has increased in reported numbers in the past two decades in several countries. In England and Wales, for example, 11,500 cases were reported from hospital clinics in 1952; ten years later this had risen to 25,000, by 1972 to 50,000, and by 1980 to over 110,000. In 1980, 40,000 more cases of NSU were reported than of gonorrhoea.

The condition is called non-specific urethritis, because no specific cause, such as gonorrhoea, trichomoniasis, chemical irritation, or anxiety-induced irritation, can be found.

About 10 to 30 days after sexual intercourse, usually with a casual partner, the man discovers that he has a discharge from his urethra, which may be clear or purulent. When he urinates, the passage of the urine along his urethra causes pain, although often this is only mild. Occasionally the symptoms are more severe. The man develops bladder pain and an urgent and frequent need to pass urine. If he seeks medical examination he should avoid passing urine for at least two hours before seeing the doctor. The doctor may massage his penis along the urethra, to express a bead of pus, or it may be present without the need to do this.

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Communication is important, as many men who are premature ejaculators are unwilling (or unable) to bring their sexual partner to orgasm.

The researchers in St. Louis have found that when the couple followed their therapeutic programme, the woman obtained increased sexual satisfaction. The couple were no longer so inhibited when they talked to each other and touched each other, so the tensions were reduced. As the woman became involved in correcting her partner’s sexual problem, she obtained psychological pleasure in the obvious improvement, and became less tense about her own sexuality. During the period of immobility when she sat with the man’s penis quietly contained in her vagina, she was actively involved in sexual intercourse. Before this, often through the entire relationship, she had been a pressed-upon, inferior, inert, recipient of an urgent, rapidly completed sexual assault. Now, for perhaps the first time, she had sexual freedom and sexual responsibility and, by helping her partner to cure his premature ejaculation, she obtained pleasure because he lasted longer before ejaculating.

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During pregnancy, changes in a woman’s sexual desire and in her response are usual. Most pregnant women have a reduced sexual interest in the first half of pregnancy, which continues, with considerable individual variation, through the second half of pregnancy. Once aroused, however, pregnant women experience an increased amount of swelling around the vagina, so that sexual intercourse itself can be very pleasurable to both partners.

It is not clear why women are less sexually aroused in pregnancy. While it is probably due to the hormones which are produced by the placenta, there is also an emotional factor. Some women find that sexual intercourse is uncomfortable; others fear that the man’s thrusting penis may injure the baby; others are embarrassed about their enlarged, droopy breasts and their swollen abdomen, and see themselves as unattractive and not sexy. In contrast, some women enjoy sex more in pregnancy, as they have proved their fertility and are no longer fearful of becoming pregnant.

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