SkullRing.org Medical Weblog

In our eagerness to correct the old misconceptions, we do need to be wary of falling into the trap of replacing one assumption with another — that all older people want to continue to be sexually active and that every one of us will have sexual needs until the day we die. One thing is true. We are all individuals. Some people will keep their interest in sex as they get older, but there are others who are quite happy to lose the urge as other aspects of their lives take precedence. Of course there are still others who never liked it much anyway and that’s not likely to change.

What might change is the way you want to express your sexual feelings. Harold is in his sixties. He explains, ‘In many respects the peaks of intense sexual feelings are not as keen as in my younger years and I’ve certainly slowed up. Although I still have orgasms, touching, companionship and just being close have become much more important than in my youth.’

One of the inevitabilities of growing old is the prospect of separation from your partner because of illness or death. Losing the person who has shared your most intimate moments is devastating. If you ask someone who is recently widowed what they miss the most, it’s often the little things like the Sunday morning cup of tea, or curling up on the lounge to watch television, asking their opinion on a flower arrangement or tucking up in bed together on a stormy night.

Molly, widowed at fifty-two, and now in her seventies frankly says, ‘I’d vomit if another man touched me. When I was young I was brought up to believe that you had one partner for life arid if anything happened to him that was the end of your sex life for good. You just can’t change the sort of ingrained idea that it would be somehow unfaithful to his memory to start seeing someone else. My friends tried to match-make me with any Tom, Dick or Harry but I just wasn’t interested. I found the most difficult time to cope was in bed at night. I would just miss knowing he was lying next to me in the bed. Sometimes even now I wake up and think I can hear him breathing. I was grieving so much at the time that sex was the last thing on my mind. When I started getting over the grief I never seemed to get my interest back. When I get miserable I get by with a hot bath and putting lots of pillows in the bed. I get a lot of affection and love from my daughter and my grandchildren.’

*145/17/9*

Some forms of sexual activity are more strenuous than others and a crisis like this can be an incentive to exploring new ways of sexual expression, like massage, oral sex or manual stimulation of yourself or your partner.

It has been only in fairly recent years that medical researchers have taken a close look at the way different types of surgery affect sexual attitudes and behavior. As our understanding grows, a number of features keep cropping up. Sexuality is an integral part of most people’s lives and just because someone doesn’t ask questions or talk about their concerns doesn’t mean they don’t want to know. In facing a crisis like cancer or other surgery, there needs to be detailed information on what to expect afterwards: physically, emotionally and sexually. An important step in overall patient care has been the emergence of specialized counsellors and nursing staff who are aware of the issues and who have the time and the skills to talk them through with people facing them.

There is also a growing body of evidence that positive thinking can have a powerful impact on the outcome of many different illnesses, including cancers. If a person can face an uncertain future with a degree of optimism that they will still be able to enjoy life, and that includes their sexuality, then the implications will be far-reaching. It may well be a matter of survival.

A social worker who counsels patients with heart disease told me, ‘I generally find that if a couple’s sexual relationship was good before the cardiac event, it will be good again. I must say I worry about the older men with much younger partners, particularly if the relationship is fairly recent. They tend to be more anxious about whether they will be able to perform as well as before. I always bring up the issue of sexuality because we can’t assume that because someone doesn’t ask, they don’t want to know. This is particularly true of women. You know, there are literally no studies that look at the sexual attitudes of women in this situation, so I have to rely on experience.’

*143/17/9*

Heart disease is the foremost killer in the Western world, thanks to smoking, high blood pressure and fatty diets. Although a heart attack is predictable in many people because they collect risk factors like football cards, for many it comes as a bolt out of the blue. Coronary artery bypass surgery is now more commonplace than having your tonsils out, but that is not to say it’s a breeze. Quite often a heart attack or heart surgery is the first time a person comes face to face with their own mortality, or faces the prospect of losing their partner. During the early weeks after the event, the foremost thing on your mind has to be your immediate survival and even if the question of resuming sex did occur to you, it’s hard to get the opportunity to ask.

Ward rounds before discharge from hospital have to be seen to be believed. You might have the surgeon, the registrar, a resident or two, the physiotherapist,”, dietician, occupational therapist, ward pharmacist, nurses, spouse and assorted relatives crowded around the bed discussing anything from your latest cardiac echo to a warning about never smoking again. ‘Any questions, Mrs Jones?’ ‘Well, Doctor, my husband and I were actually wondering whether a big orgasm might bust my stitches and kill me?’ is probably not the first question to spring to your lips under the circumstances. Many people are sent home wondering whether they will ever be able to have sex again.

Jack is a man in his late sixties. Married for forty years, he had recently undergone heart surgery. He told me, ‘We had always enjoyed a good, relaxed sex life. In fact the last twenty years have been better than the first twenty. After the operation I knew I would be able to do it, but I didn’t know if it would be normal. For the first few weeks I was too tired to really even think about it but as I got stronger we thought it was time to give it a go. I had to reassure my wife that it wasn’t going to hurt me. You see, I had asked my doctor if it would be alright, and he said that when I could walk up two flights of stairs I wouldn’t have any problems with sex. At first the chest wound made sex uncomfortable in some positions, so we tried out some different positions to see what was best. Anyway, we took it slowly and now after a couple of months things are pretty much back to normal.’ He smiled warmly at his wife. ‘Yes, we’re doing alright.’

*142/17/9*

Inflammation inside the ear – frequent cause of earaches and periodic hearing loss – is often the result of an allergic reaction in the nose or throat. Airborne allergens – pollen, dust and the like – are the most common offenders, and the problem shows up most frequently in children with hay fever or asthma. But adults can be affected, too.

In one study, eight people with hay fever developed ear trouble after breathing ragweed or timothy grass pollen, common allergens to which they were allergic. (Their hay fever flared up at the same time.) But when they breathed pine pollen – to which none of them were allergic – their ears were fine.

In another study eleven out of twenty-five people with hay fever had ear trouble after exposure to rye grass pollen (Wellcome Trends).

Ear inflammation can also be caused by sinusitis, infections, enlarged tonsils or adenoids, nasal polyps or congenital defects. But, in any of those conditions, allergy can aggravate ear inflammation.

Decongestants and antihistamines can temporarily clear up an allergic ear inflammation. But unless all allergic factors are recognized and avoided, the problem may persist – and eventually cause permanent hearing loss. In fact, uncontrolled ear inflammation is the most common cause of deafness in children.

If ear inflammation is caused by an infection, your doctor may prescribe antibiotic ear drops. But if you’re allergic to antibiotics, the problem is likely to persist – or get a lot worse. A study in Britain found that out of forty adults who had ear inflammation for longer than a year, fourteen were allergic to one or more antibiotics in the ear drops they were using. Neomycin, framycetin, gentamycin and ciolquinol – four commonly used antibiotics – were to blame. The doctors reporting these cases recommend that people with persistent ear inflammation should be tested for possible allergy to antibiotics (Journal of the Royal Society of Medicine).

Medicated ear drops can also cause contact allergy on the outer ear. So can earrings, spectacle stems and perfumes.

*139/65/5*

A woman from Denver whom I met on a plane told me that she had had dizzy spells off and on for a couple of years. She’d be walking down the street, for example, when suddenly her head would start to spin. She’d begun to worry that she might have a brain tumour. But a thorough neurological exam, including a brain scan, failed to detect one.

An allergist eventually discovered that the woman was allergic to yeasts and moulds in foods – cheese, wine, mushrooms and so forth – and that they were the cause of her dizzy spells.

The woman told me that she still eats an occasional piece of cheese or drinks some wine at parties, but not very often and not very much. The biggest relief, she said, comes from knowing that she doesn’t have a brain tumour or some other life-threatening illness.

Dizzy spells can be pretty scary. So when a controllable cause is uncovered, doctor and patient alike are relieved. Allergy, however, is rarely suspected. And allergic causes are rare – but they exist. Dizziness from allergy to foods or inhalants results when they cause fluid retention in the inner ear that throws equilibrium off balance. You feel faint, or have the sense that you’re going to fall.

The allergen can be anything from an easy-to-avoid food to a hard-to-avoid chemical. Marshall Mandell, an allergist in Norwalk, Connecticut, tells of a ten-year-old girl who became quite dizzy when leaving the kitchen to walk to school every morning. (The kitchen had a gas stove.) She also became dizzy and nauseous in school every time freshly printed papers were passed around in class or when she was in the same room with a mimeograph machine. When Dr Mandell tested her for allergy to ethanol (a petroleum product in gas and copying fluid) and other environmental substances, the girl became very ill.

At Dr Mandell’s suggestion, the girl’s parents then replaced all gas appliances in the home with electric models and discarded any household cleaning materials that contained petroleum byproducts.

‘This environmental change was of considerable benefit,’ says Dr Mandell. ‘[The girl's] morning dizziness disappeared along with her fatigue’ (Dr Mandell’s 5-Day Allergy Relief System).

*138/65/5*

I remember some years ago when I was working as a junior resident assigned to the gynecology wards, nearing the end of the surgical admissions for theatre the next day. Things had been pretty routine that afternoon … a few patients in for curettes, one woman having a vaginal repair, and a couple of women listed for hysterectomies.

The final patient on my list was a woman in her late thirties who had been putting up with very heavy periods for a couple of years and conservative treatment just wasn’t controlling the bleeding anymore. The decision had been made to do a hysterectomy. When I walked in to see her, I found her sitting on the side of the bed quietly sobbing. I thought at first that she must be anxious about the operation the next day.

Who wouldn’t be? So we got talking, and I asked her if she had any particular concerns.

She had been living with hopelessly heavy periods for a couple of years now and hormone treatment and two curettes had helped, but not for long. She had come to terms with never being able to have any more babies but there was another problem. She hadn’t felt able to discuss it with anyone but the decision to have the operation, she told me, had been a very hard one for her and her husband because it meant they wouldn’t be able to have intercourse anymore. She was worried about how her marriage would change. Whoa! Bit of an information gap here! I asked her why she thought they wouldn’t be able to have intercourse anymore. ‘Well,’ she said, ‘when they cut out my uterus, they have to stitch across the vagina, don’t they?’ ‘Yes,’ I answered. ‘But only the top end, not the bottom end. You will still have a vagina, and it won’t take long before things are pretty much back to normal.’ The relief was palpable, and it just goes to show how accurate information can make such a difference.

There is still a lot we don’t know about the effects of hysterectomy on sexual function but it probably depends on the woman’s sexual responses before the operation. Some women find that contractions of the uterus heighten their orgasm; others depend on deep vaginal and cervical stimulation to trigger their orgasm. These women may notice a change in the quality of that orgasm after the operation. Other women say their sex life improved afterwards because they weren’t tired all the time from heavy bleeding, and they no longer had to worry about contraception.

*138/17/9*

There is no doubt that most cultures see the breast as a symbol of femininity and the loss of a breast is frequently mourned because of this. Surgeons try to be as conservative as possible but where the priority is longterm survival, and hopefully a cure, the cosmetics take a back seat. Losing a breast can cause a massive psychological reaction, so it is now a relatively common practice for the cancer surgeon to work with a plastic surgeon to reconstruct the breast at the time of the mastectomy. Nonetheless, many women notice a change in their sexual behavior after a mastectomy. This seems to be particularly true of women who rely a lot on breast and nipple stimulation for arousal or orgasm. Sensate focus exercises also come in handy here. The different touching techniques used on other areas of your body stimulate the erotic feelings that build towards orgasm. In the case of mastectomy, it takes the emphasis away from the breasts by discovering other parts of the skin that will give you a similar response.

The loss of a breast can also mean a loss of self-confidence and a reluctance to initiate sex. Rita was forty-two when her breast cancer was diagnosed. ‘I was devastated. I thought they must have put the wrong name on the mammogram. The whole ordeal felt like some terrible nightmare. Matthew and I

had always had a great sex life. We married late and I suppose we were making up for lost time or something. He was always a big breast man and he always said how much he loved the fact that I was well-endowed. When I heard I had to have a mastectomy I thought, “Well that’s it then, he won’t have any interest in me sexually any more. This will turn him right off.” The strange thing was that it was me who had the trouble with sex. I couldn’t bear to let him see me without a shirt on, and I would freeze if his hands went anywhere near my chest. He said it really didn’t matter to him, he was just so glad he still had me. He was so patient and so gentle, I don’t know how I would have coped on my own.’

*136/17/9*

For the first four or five months of life, babies do little more than eat, sleep and cry. If the crying goes beyond occasional fussiness to hours of constant shrieking, parents become frustrated. And if a clean nappy, a warm breast or bottle and lots of cuddling fail to silence the baby’s cries, parents become frightened – and probably ask their doctor for help. In most cases, the doctor says the baby has colic. In other words large amounts of gas are building up in the baby’s intestines, causing lots of discomfort and the constant crying.

Allergy to milk is the most common cause of colic. In bottle-fed infants, the treatment is simple and obvious: change from a milk-based formula to a soya-based or other type of milk-free formula.

But occasionally, even a breastfed infant will get colic.

‘The colicky breast-fed infant is also allergic to milk,’ says Del Stigler, a pediatrician and allergist in Denver. ‘Not to the mother’s milk, though, but to the cow’s milk the mother is drinking. Particles of cow’s milk reach the infant through the breast milk and cause colic. Take the mother off cow’s milk and the baby will be well in two or three days.’

Many parents have been delighted to discover that a milk-free diet for Mum wipes out colic for baby. In a study by Swedish doctors, eighteen mothers of colicky babies were put on a milk-free diet. ‘Colic promptly disappeared in thirteen of the infants,’ say the researchers. ‘We conclude that infantile colic in breastfed infants can be caused by cow’s milk consumption by the mother, and we suggest a diet free of cow’s milk for the mother’. (Lancet.)

Any hard-to-digest foods that a nursing mother eats or drinks are also apt to pass through her breast milk to the baby and cause colic. So in addition to suggesting a milk-free diet to nursing mothers, many pediatricians recommend that they avoid ‘gassy’ foods such as beans, beer, broccoli, brussels sprouts, cabbage, carbonated beverages, champagne, lentils and mushrooms, plus any spices that seem to cause irritability in the breastfed baby.

If colic persists, the next step is to eliminate cereals or any other solid foods that the baby is eating. Most foods require several enzymes for digestion. A young baby’s body needs time to develop all the enzymes required to digest more complex food. If you give a baby solid food before his stomach and intestines are equipped to handle it, he’ll get gas. After a couple of months of freedom from colic, you can reintroduce solid foods – one at a time and several days apart – to test the baby’s tolerance.

Doctors sometimes also suggest that parents of a colicky baby temporarily withhold the baby’s vitamin supplements, to see if sugars or additives in those products could be the problem.

*131/65/5*

One of the most common sexual difficulties for women is not being able to reach orgasm — all of the time, or some of the time. Perspective is also important here. If you have been led to believe the myth that sexual success means an orgasm with every sexual encounter, then you will believe you have a problem if you fall short of the 100 percent. Anxiety to achieve an orgasm can be self-defeating because the more anxious you are, the less likely you are to get there. This is the female version of performance anxiety.

Sexual technique makes a big difference. It can be embarrassing to admit that you think your sexual skills might need some sharpening. Whenever you bring up the subject of improving sexual technique there are some who criticize the emphasis on performance. Now while I’ll be the first to admit that technique isn’t everything, there is a lot to be said for the elements of sensuality and tactile finesse. While some people are what you’d call ‘naturals’ much of this can be learned or at least improved upon. The ham-fisted jump on, do your thing and go to sleep approach is hardly the formula for a lifetime of mutual sexual bliss. Similarly, people who are sexually inhibited and self-conscious may never be able to relax enough to discover their sexual potential. Sensate focus exercises can help here too. So can some of the reputable sex manuals and self-help videos. It’s been interesting over the last few years to see these move from under the counter of the local bookstore or down in the dark, back corner of the video library to the front shelves. They can show you anything from communication skills to different arousal techniques and intercourse positions you might not have thought to try. Above all, they are often a great way to start conversations between partners about sexuality and give you the opportunity to find out aspects of each other’s attitudes and needs you may never have discussed.

A common theme in many of the letters I receive is the concern that the woman is not able to orgasm during penetration. Now this is perceived by the correspondents as a sexual problem. One typical letter said, ‘My wife and I have been married for nearly a year and we still have a lot to learn about sex. We are both worried that she cannot seem to have an orgasm when I have my penis inside her, no matter how long I can last. I figure I must be doing something wrong.’ Once it is pointed out that this is in fact the normal course of events, that many women usually need something else like stimulation of the genitals with their; partner’s fingers or mouth (before, during, after or instead of intercourse), or the ‘woman on top’ position, then it needn’t be seen as a problem. Mind you, some men find it difficult to accept that a penis is not an essential for a woman to be sexually satisfied.

*129/17/9*

To unstick your breathing equipment, drink plenty of fluids. Water and other beverages act as natural expectorants, keeping mucus thin and coughable, says Doris J. Rapp, author of Allergies and Your Family (Sterling Publishing). She recommends drinking one-half to one cup of liquid every waking hour, if at all possible. Just be sure you don’t drink cold beverages – the chill can shock sensitive airways into spasms. And be careful to avoid drinks that contain cola or food dyes, common asthma triggers.

Taking your beverages hot helps even more. A warm drink acts as a natural bronchodilator, or airway relaxer, as it glides past respiratory passages. Drinking soup or herb tea when you feel an attack coming on will do fine.

‘Sometimes a warm liquid relaxes the bronchial tubes and you may not even need to use your bronchodilator spray,’ says Dr Falliers. ‘We’ve had kids in the hospital for treatment, and when they can’t breathe, we try to get them to drink something warm, maybe just water or something with a little more flavor, like hot apple cider. They relax, control the panic and start breathing quietly again.’

Controlling panic is a big part of controlling asthma. If you know you’re an asthmatic and begin to sense an attack coming on, you may tend to panic and fight for air. That tightens your chest further. For children, the anxiety is heightened if they see Mum or Dad panic, too. If your child has asthma, you can help by simply trying to appear calm and confident, no matter how frantic you may actually feel. The sight of a reassuring adult in itself may help the youngster.

‘Some children relax the minute they see their doctor enter the room, even before they’re given any medication,’ says Dr Rapp.

Relaxation, in fact, is such a useful shield against asthma that many doctors are teaching child and adult asthmatics variations of the relaxation technique. Because it loosens tightened muscles surrounding airways, relaxation is a form of protection that can be used whenever an asthmatic feels an attack coming on.

In a subconscious effort not to tax temperamental lungs, asthmatics tend to take short, shallow breaths. Doctors call it ‘stingy breathing’. By filling and emptying only the top portion of the lungs, however, asthmatics don’t pull in enough oxygen. During an attack they get even less. ‘The average asthmatic is breathing at only 60 or 70 per cent of capacity,’ Dr Falliers told us. ‘And during an asthma attack, that can drop to 20 per cent.’ In the throes of an asthma attack, you may actually turn blue for lack of oxygen.

‘But if you’re having an asthma attack, you don’t think about breathing physiology and oxygen metabolism,’ says Dr Falliers. ‘You just think of how to get your next breath.’ By learning to breathe deeply and efficiently, you can increase the amount of oxygen you take in, so an attack isn’t nearly as disabling.

*122/65/5*