Men’s Health-Erectile Dysfunction


How realistic is it to expect that an infected partner will tell you that they have something like herpes simplex if they know about it? In the early stages of a sexual relationship it can be very hard to broach the subject. It is embarrassing to reveal it to another person and there is the very real risk that a prospective partner will be scared off unless they have all the information, but it is absolutely essential for them to be aware so that they can make the decision for themselves. It is a form of sexual abuse to knowingly expose another person to an infection like herpes. Although herpes simplex is not curable, outbreaks can be controlled with lifestyle changes and if necessary a tablet called Acyclovir, but it is one of those STDs with a bad reputation and the psychological effects can be worse than the physical symptoms.

One woman in her thirties talked about the effect it had on her life. ‘I got my first attack of herpes about five years ago from a boyfriend who didn’t tell me he had it. When the doctor told me I was in shock. I mean, this couldn’t be me; I didn’t sleep around. I had only had a few longterm relationships and I thought I knew Rob really well. When I confronted him with it he said he was going to tell me ages ago but he was too embarrassed, and he thought I would have given him the flick. I broke off the relationship then and there. I was furious. At least if I’d known I could have protected myself. Since then I haven’t been able to trust anyone completely. A few times I have met men that I have been attracted to but I don’t have the same sort of confidence as I used to have sexually. On the odd occasion when I have had sex it just isn’t the same. It can be really depressing.’

Lyn tells a different story. ‘After my marriage broke up I started dating again. I had been seeing this one man for a couple of months and there was definitely a chemistry between us, but every time we got into an intimate situation he would make some excuse and back off. It was really confusing; I thought maybe he didn’t find me attractive but my instincts told me otherwise. This went on for weeks and weeks until he finally told me that just before we met he had suffered his first attack of herpes and he was terrified of giving it to me. Well, I didn’t know enough about it to know what to do, so we went along to the Sexual Health Clinic and spoke to the counsellor there. She answered all our questions about the risks to me, and I decided that if we used a condom every time then I would feel safe.’

*63/17/9*

Technically speaking, vasectomy is a simple matter of making a tiny cut in the scrotum, picking up the tube on each side that carries sperm (the vas deferens), cutting it and sealing the ends. The whole thing is usually done under a local anesthetic and takes about twenty minutes.

A number of people have misgivings about vasectomy because they have heard all sorts of scary stories about it. One man said, ‘I am worried about it because I want to know where all the sperm go. I can imagine walking around with these balls that look like Zeppelins.’

The sperm that are produced are absorbed directly into the body, and in many cases this prompts the immune system to develop antibodies that attack the sperm as ii they were invading organisms. This may be a factor in unsuccessful vasectomy reversals later on but it does not appear to create any health problems. The rest of the fluid that is produced as part of the ejaculate continues to be released in the normal way. In fact there is no apparent loss of volume of the fluid ejaculated. There has been talk about a possible link between vasectomy and heart disease or cancers like prostate or testicular cancers. Doctors have been looking for harmful side effects of vasectomy for years and a large study recently looked at nearly 30,000 men for twenty years after the operation. They found that it did not increase the risk of any of these diseases over this time period.

Whenever a man has a vasectomy he is encouraged to think of it as permanent. Despite this, up to one in twenty-five men will ask for their vasectomy to be reversed, and many men are hedging their bets by having their sperm frozen and stored before the operation just in case they change their minds later on. Richard is in his late forties. Eight years ago he had a vasectomy. ‘I could not have imagined in my wildest dreams that I would ever want another baby. The vasectomy was great at the time. We didn’t have to worry about contraception at all and it was a real relief for my wife to be able to go off the Pill. Well, to cut a long story short, when I met my second’ wife she said she didn’t care about having children, but she changed her mind. You know, she’s thirty-six and the clock’s started ticking. I thought I would give it a go for her sake.’ So the ‘what ifs’ really can happen.

*56/17/9*

Women confront new sexual issues at menopause. The most obvious is that you have physical evidence that you can no longer get pregnant. The relief from having to deal with contraception or worry about periods can mean a new found freedom of sexual expression. Jane recalls, T never realized how much contraception interfered with our sex life. I hated being on the Pill, I couldn’t use an IUD because my periods got so heavy, Bob just refused to use condoms, so it was up to me to use a diaphragm. I found that a real bore too after a few years, so it got to the stage where I’d figure out exactly where ‘I was in my cycle before I’d decide whether I could be bothered messing around with spermicides and things. Once I knew I was past all that, we went through a real sort of renaissance in our sex life. It was like starting again except we were much more experienced. The kids had all left home and we started doing things we hadn’t dared do before. We were both much more spontaneous.’

Just as aging brings about physical changes in men that alter their sexual function, so women also undergo a natural process of change after menopause. Your vaginal tissue becomes thinner and drier but being dry doesn’t mean you are not as sexually aroused. The dryness can cause some pain with intercourse if you don’t find an alternative way of lubricating (like lubricating gel or saliva). As the labia (lips around the vulva) shrink in size, the clitoris becomes more exposed and it loses some of its sensitivity. Many of these difficulties can be solved by hormone replacement therapy. We are used to hearing about the value of pelvic floor exercises to tone up the muscles around the vagina and urinary outlet (urethra) for women having babies. These exercises are worth learning in your teens and continuing right through life. In older age groups they have been shown to increase the blood flow around the vagina (improving lubrication), increase the vaginal muscle tone (which can enhance orgasm) and help to prevent the common problem of incontinence.

After menopause, a woman’s orgasm is different too. As well as the slower clitoral response, the muscle contractions of orgasm are not as strong. In spite of these changes, a woman’s need for affection and physical closeness continues.

*150/17/9*

A few years ago there was an attempt to describe the ‘change of life’ in a man, and the term ‘male menopause’ was invented. It depicted a man’s reaction to the realization that he was getting older. Its symptoms included a totally new wardrobe, a hair transplant, a new sports car (preferably red) and a younger girlfriend (preferably blonde).

Now it is obviously impossible for a man to have a menopause because he has no menses to pause. I propose a syndrome I will call ‘Menopause Envy’, to borrow from Freud for a moment.

Although the changes in a woman’s body are gradual, there is a definite landmark where hormone production drops dramatically and her periods stop. In Western countries this happens fairly predictably at an average age of fifty-one. It is an unmistakable indication that you have moved on to the next phase of your life and it explains all sorts of symptoms from hot flushes to mood swings.

A big part of this ‘Menopause Envy’ is the fear of the unknown, and of the ‘known and inevitable but when?’ At least a real menopause has a sense of moment, like a biological punctuation mark. This uncertainty is compounded by the serious lack of information sources for older men. Take a look at any newsstand. The magazines targeted at men presume a common interest like sport or investment, and the magazines with a sexual theme are more for the voyeuristic value than discovering more about your relationships or problem-solving. It is hard to find a magazine that talks about the male experience of divorce or what it was like having your prostate tested. Women’s magazines play a vital role in networking. Through them, women can discover the experiences they have in common with other women and find out answers to the questions they might be too embarrassed to ask. But where does a man go to find out if it’s normal for his testicles to get softer as he gets older? How would you know whether the pain you’ve been getting when you ejaculate has anything to do with your enlarged prostate? They are not the sort of topics of conversation that come up at the pub over a few beers.

For men, there is no single event that you can hang your hat on and say, ‘This is my change of life’ to explain what you are going through. Instead there is this slow (and for some men painstaking) process of changing body image: losing hair (or for the optimists, ‘gaining forehead’), losing your muscle bulk, putting weight around the middle and changing sexual function, like feeling less of a need to ejaculate every time you have sex.

*148/17/9*

When a person becomes too sick or weak to stay in their own home, a retirement village or nursing home might be the only practical alternative. Doctors who look after people in nursing homes are occasionally asked by nursing staff to see a resident who is causing them trouble because they are thought to be having sex with one of their visitors … ‘Could you fix it please Doctor?’ The problem is not so much the activity itself, but the perception that a need for sexual expression in the elderly is an abnormality that needs to be ‘fixed’. The problem has even more to do with architecture than attitudes. If you actually look at the layout of some of the older institutions you will see that they virtually ignore any right to privacy. A flimsy curtain suspended from the ceiling in a room with four beds occupied by strangers is hardly conducive to a quiet cuddle for two people who may have shared the same bed for over fifty years.

Elderly homosexual people have particular difficulties in this area. Retirement villages and nursing homes are just not geared for people who prefer same-sex partners, and so aging will make the prospect of social isolation even more likely. The problem is probably greater for men than for women because society has less trouble accepting close and loving relationships between women than between men. In either case it is clear that this group of people have special needs as they age that are not being met by the current system. Part of the reason for this is that this group in the community has been virtually invisible until this generation. So what are the solutions?

The first is to somehow integrate the needs of elderly homosexual people into the existing structures. Now this may sound simple enough on the surface, but when you consider the potential barriers it is not as easy as it sounds. To overcome those barriers there would need to be special training or selective employment of nursing and domestic staff. The heads of various government departments and administrators of the nursing homes or retirement villages would need to be supportive of the idea and willing to spend the money to put the changes in place, and the relevant politicians would need to see some political gain for themselves.

The other option is to develop special purpose retirement and nursing home facilities to cater specifically for the needs of the aging gay population. This concept is already in practice for some ethnic and religious groups. Some might say that this approach is separatist, far removed from the cosier notion of everyone accepting the individuality of others. But we are trying to deal with realities here. No single solution is going to be the right one, so what we are talking about is choice, freedom and right to privacy.

*146/17/9*

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