Even the most sexual of women may find their thoughts turning away from intimate relations with their husbands when they have to deal with some of the symptoms of menopause.

Take Rita, 51, a woman who enjoyed a healthy sex life with her husband and liked what she saw when she looked into the mirror until she started experiencing the hot flushes, night sweats and mood swings that are symptomatic of menopause.

“How can you expect me to feel sexy and want to have sex when I’m uncomfortable all the time?” she complained constantly.

Rita is typical of many post-menopausal women in that her symptoms have had an effect on her quality of life as well as interest in sex.

Australian sex therapist and relationship counsellor Dr Rosie King said: “You can’t blame women for not feeling sexy at that point as they are likely to suffer from pain-in-the-neck symptoms such as mood swings, night sweats, hot flushes as well as insomnia.

“The drop in oestrogen levels can also affect the genitals as women experience a thinning of the lining of the vagina. As a result of this, the vagina may become dry and fragile, making sex painful,” she said.

Menopause does not have to translate to the end of a healthy sex life. “Women who take hormonal replacement therapy (HRT) can enjoy a better sex life. HRT is very effective in improving the health of the vagina and it increases lubrication as well,” said Dr King.

Sensitivity to your partner’s needs would increase a interest in sex. “Women need an average of 15 to 20 minutes to become aroused and older women need even more time. Her sexual responses slow down and her orgasm is less intense, but a man can help to increase her urge to merge.

“He should attempt to learn what turns her on. He should spend more time talking to her or hugging her. Buy her flowers and spend quality time with her. These are typical female sexual enhancers and may increase a woman’s interest in sex,” Dr King said.

Dr King added that other factors could affect an interest in sex in post-menopausal women.

“There is an association between depression and menopause, for instance. This could be related to the ‘‘empty nest’’ syndrome. This is usually the period in her life when the children have left home. All she has left is her husband.

“Many women become depressed as a result of the children growing up and going away and there is no doubt that depression is an inhibitor of sexual response,’’ she said, adding that treatment for depression also tends to inhibit sexual desire and arousal.

Ignorance can also be a factor in female sexual dysfunction in menopausal women, Dr King said. “Some women don’t understand what’s happening to their bodies and that it is a natural part of ageing. They blame themselves or their partners for what is happening. This, of course, tends to affect sexual function,” she said.

To prevent this from happening, Dr King recommends that women seek treatment. “Menopause is a time of great transition for women and it is crucial that they seek treatment if they exhibit symptoms. Be aware that help is available,” she said.

She added: “Husbands need to be patient and understanding even if their wives are irritable and forgetful. While he may never understand what his wife is going through, he should realise that these are the effects of the hormonal transition that his wife is experiencing.’’

Worrying about one’s sexual performance tends to be a factor for pre-menopausal and menopausal women.

The Pfizer Global Better Sex Survey (GBSS) indicates that 48% of Malaysian women aged between 45 and 54 and 22% of women aged between 55 and 64 worry about losing their ability to perform sexually as they and their partners grow older.

While their fears may be justified, Dr King is quick to point out that menopause doesn’t necessarily have to be a traumatic experience.

“For some women, it’s a liberating experience as they have said goodbye to period pain and worries about contraception. The good news is that some women actually enjoy sex more because they feel totally free of these worries,” she said.

Is There Sex After Menopause?

Symptoms of Menopause

• absence of menstruation for one year
• hot flashes
• night sweats
• mood swings
• anxiety
• palpitations
• depression
• insomnia
• vaginal dryness
• urinary changes

Sexual Desire and Menopause
Does menopause mean that sex is no longer an important or desired part of life? No! Countless numbers of both genders believe that menopause means less sexual desire; however, that is not neccessarily true. In fact, sex after menopause is often as enjoyable, sometimes even more enjoyable than before menopause. Since you no longer face any threat of pregnancy and your children have grown up, or at least are almost grown, you and your spouse are finally alone for what is, many times, the first time since you married. So, go ahead and enjoy your opportunity to have the best sex of your life!

Yes, it’s true that getting older, often means it takes a little longer to feel sexually aroused, and it’s quite normal to experience a small decrease in sexual desire as part of the aging process. But growing older doesn’t mean that your sex life is over.

If you have experienced a loss of sexual desire since menopause, before you decide that menopause or just getting older is responsible for your lowered libido, consider a few other possible causes.

Many medications such as anti-hypertensive medications, tranquilizers, and antidepressants can change how you feel about sex. Other issues that affect sexual response include diseases such as heart disease, diabetes, and arthritis, as well as your self-image and the amount of stress you must deal with on a daily basis.

Is Reduced Estrogen After Menopause the Culprit Behind Lowered Sexual Desire?

Researchers at the New England Research Institute and the University of Massachusetts Medical School have discovered an amazing fact. While many of us naturally assume that the drop in estrogen production experienced during menopause is responsible for the postmenopausal decrease in sexual desire often experienced by postmenopausal women, the fact is that key factors influencing who has sexual issues include individual attitudes towards sexuality, overall health and marital status play a significant role in determining who experiences sexual issues during menopause and that estrogen is not related to changes in sexual response in postmenopausal women. Researchers found only one issue related to decreased estrogen production during menopause – painful sexual intercourse.

What You Believe About Sex and Menopause is What You Get?
A key finding, by the researchers, is that the only women to experience loss of sexual desire during the postmenopausal period, were only those women who believed that loss of interest in sex is a normal part of the aging process.

Does Postmenopausal Testosterone Supplementation Increase Sexual Desire?
Many women are able to increase lost sexual desire using prescribed testosterone during menopause. The benefits of testosterone include increased relief of the vasomotor symptoms of menopause, i.e. hot flashes and night sweats; increased energy; a general feeling of well-being; and increased sexual desire.

While some evidence exists that supplementing with testosterone during menopause may increase sexual response in postmenopausal women, there are certain health risks and potential side effects associated with testosterone supplements in women (the female reproductive system naturally produces small amounts of testosterone.) One study presented in the Archives of Internal Medicine and based on more results from the Women’s Health Initiative shows that women, in the study, who used both estrogen and testosterone during menopause experience a 17.2 percent increase in breast cancer risk for each year of use. Women who used either estrogen alone or estrogen with progestins did not observe this increase.

Each women should weigh the potential risks against the benefits of hormone replacement therapy including the use of testosterone supplementation with her health care provider so that, together, you can reach an informed decision about what is right for you.

Two Points to Remember about Sexual Response and Menopause

• Loss of sexual response or desire is not experienced by the majority of menopausal women.
• Loss of sexual desire is not associated with decreased levels of estrogen.

Men Have Viagra… What About Us?
Will there ever be a Viagra for women? According to a New York Times report, a Viagra for women is already under development. However, this drug may take several years before it becomes available for women who suffer from menopausal decreased sexual desire.

If you experience decreased sexual desire after menopause, see your health care provider for information about your treatment options. Also, make sure to talk to your partner so he’s aware of your feelings and sexual needs.

P.S. You can check for information about female viagra, its side effects, safety information and prices HERE or HERE

Does sex late in pregnancy set off labor? A lot of folklore says it does and, for that reason, some obstetricians warn their patients against it. There are good scientific arguments to make us expect that the idea might be true. For instance, prostaglandin E., an ingredient of semen, stimulates uterine contraction and can start labor. So can breast stimulation, and orgasm while having sex during pregnancy increases uterine activity.

Actually, it would be very desirable if sex did play this role. For sound medical reasons—usually to protect the fetus from the negative effects of more than 42 weeks gestation or from the problems associated with maternal diabetes—doctors now use artificial means to stimulate the onset of labor. The artificial methods are amniotomy (”breaking of the waters”) and medications that stimulate contractions. But there are certain disadvantages: a higher rate of cesarean sections, forceps-assisted delivery, bleeding after delivery, and prolonged labor. In addition, by several different measures, the babies on average don’t do quite as well.

New study: If having sex late in pregnancy proved to be an effective natural method of starting off labor, it might be superior to the artificial methods (and many women might prefer it). Three obstetricians at the University of Malaysia set out to explore this question by recruiting a group of about 200 women late in pregnancy, chosen because they were all scheduled to be induced within the week if they didn’t spontaneously go into labor. Half the women were actively encouraged to have vaginal sex, and the remaining half—the control group—were neither encouraged nor discouraged.

Findings: About 60 percent of the women encouraged to have sex did so, compared with only 40 percent of the control group. So, did this increased rate of rowdiness trigger more spontaneous labor? Nope. The rate was virtually the same in both groups, as was the likelihood of complications like maternal fever, cesarean section, excess bleeding, or evidence of increased newborn stress or other problems.

Conclusion: Given these findings, then, there is no particular reason to recommend sex late in pregnancy as a way of averting artificial induction of labor. But the study suggests that there is a different benefit: pleasure. Of the women in both groups who reported having sex in the last week of pregnancy, more than 80 percent said they had an orgasm.

Earlier article:

Sex During Pregnancy

If you’re pregnant or even planning a pregnancy, you’ve probably found an abundance of information about sex before pregnancy (that is, having sex in order to conceive) and sex after childbirth (general consensus: expect a less active sex life when there’s a newborn in the house).

But there’s less talk about the topic of sex during pregnancy, perhaps because of our culture’s tendency to dissociate expectant mothers from sexuality. Like many parents-to-be, you may have questions about the safety of sex and what’s normal for most couples.

Well, what’s normal tends to vary widely, but you can count on the fact that there will be changes in your sex life. Open communication will be the key to a satisfying and safe sexual relationship during pregnancy.

Is It Safe to Have Sex During Pregnancy?

If you’re having a normal pregnancy, sex is considered safe during all stages of the pregnancy.

So what’s a “normal pregnancy”? It’s one that’s considered low-risk for complications such as miscarriage or pre-term labor. Talk to your doctor, nurse-midwife, or other pregnancy health care provider if you’re uncertain about whether you fall into this category. (The next section of this article may help, too.)

Of course, just because sex is safe during pregnancy doesn’t mean you’ll necessarily want to have it! Many expectant mothers find that their desire for sex fluctuates during certain stages in the pregnancy. Also, many women find that sex becomes uncomfortable as their bodies get larger.

You and your partner need to keep the lines of communication open regarding your sexual relationship. Talk about other ways to satisfy your need for intimacy, such as kissing, caressing, and holding each other. You also may need to experiment with other positions for sex to find those that are the most comfortable.

Many women find that they lose their desire and motivation for sex late in the pregnancy - not only because of their size but also because they’re preoccupied with the impending delivery and the excitement of becoming a new parent.

When It’s Not Safe

There are two types of sexual behavior that aren’t safe for any pregnant woman:

• If you engage in oral sex, your partner should not blow air into your vagina. Blowing air can cause an air embolism (a blockage of a blood vessel by an air bubble), which can be potentially fatal for mother and child.
• You should not have sex with a partner whose sexual history is unknown to you or who may have a sexually transmitted disease, such as herpes, genital warts, chlamydia, or HIV. If you become infected, the disease may be transmitted to your baby, with potentially dangerous consequences.

If your doctor, nurse-midwife, or other pregnancy health care provider anticipates or detects certain significant complications with your pregnancy, he or she is likely to advise against sexual intercourse. The most common risk factors include:

• a history or threat of miscarriage
• a history of pre-term labor (you’ve previously delivered a baby before 37 weeks) or signs indicating the risk of pre-term labor (such as premature uterine contractions)
• unexplained vaginal bleeding, discharge, or cramping
• leakage of amniotic fluid (the fluid that surrounds the baby)
• placenta previa, a condition in which the placenta (the blood-rich structure that nourishes the baby) is situated down so low that it covers the cervix (the opening of the uterus)
• incompetent cervix, a condition in which the cervix is weakened and dilates (opens) prematurely, raising the risk for miscarriage or premature delivery
• multiple fetuses (you’re having twins, triplets, etc.)

Common Questions and Concerns

The following are some of the most frequently asked questions about sex during pregnancy.

Can sex harm my baby?

No, not directly. Your baby is fully protected by the amniotic sac (a thin-walled bag that holds the fetus and surrounding fluid) and the strong muscles of the uterus. There’s also a thick mucus plug that seals the cervix and helps guard against infection. The penis does not come into contact with the fetus during sex.

Can intercourse or orgasm cause miscarriage or contractions?

In cases of normal, low-risk pregnancies, the answer is no. The contractions that you may feel during and just after orgasm are entirely different from the contractions associated with labor. However, you should check with your health care provider to make sure that your pregnancy falls into the low-risk category. Some doctors recommend that all women stop having sex during the final weeks of pregnancy, just as a safety precaution, because semen contains a chemical that may actually stimulate contractions. Check with your health care provider to see what he or she thinks is best.

Is it normal for my sex drive to increase or decrease during pregnancy?

Actually, both of these possibilities are normal (and so is everything in between). Many pregnant women find that symptoms such as fatigue, nausea, breast tenderness, and the increased need to urinate make sex too bothersome, especially during the first trimester. Generally, fatigue and nausea subside during the second trimester, and some women find that their desire for sex increases. Also, some women find that freedom from worries about contraception, combined with a renewed sense of closeness with their partner, makes sex more fulfilling. Desire generally subsides again during the third trimester as the uterus grows even larger and the reality of what’s about to happen sets in.

Your partner’s desire for sex is likely to increase or decrease as well. Some men feel even closer to their pregnant partner and enjoy the changes in their bodies. Others may experience decreased desire because of anxiety about the burdens of parenthood, or because of concerns about the health of both the mother and their unborn child.

Your partner may have trouble reconciling your identity as a sexual partner with your new (and increasingly visible) identity as an expectant mother. Again, remember that communication with your partner can be a great help in dealing with these issues.

When to Call Your Doctor

Call your health care provider if you’re unsure whether sex is safe for you. Also, call if you notice any unusual symptoms after intercourse, such as pain, bleeding, or discharge, or if you experience contractions that seem to continue after sex.

Remember, “normal” is a relative term when it comes to sex during pregnancy. You and your partner need to discuss what feels right for both of you.

In February, researchers from The Ohio State University released a study that found that the younger teens lose their virginity, the more likely they are to become juvenile delinquents. The study garnered little attention, however, because the theory had long been believed to be true and incorporated into the teachings of federal abstinence programs.

But a new study, released from researchers at the University of Virginia in Charlottesville, found the opposite to be true. This study, led by Paige Harden, a doctoral candidate in psychology, found that pre-teens and early teens that have consensual sex are less likely to develop antisocial tendencies compared to their celibate classmates.

The latest study relies on behavioral genetics, which seeks to clarify whether one behavior actually causes another, or whether they are merely correlated.

The earlier you have sex, the better, scientists say.

The study by researchers at the University of Virginia says that, contrary to popular perception, those who have sex in their early teens may not have stepped on the path to delinquency.

Rather, they may be less inclined to exhibit delinquent behaviour than peers who waited until they were older to have sex. Early sex may help them develop better social relationships in early adulthood, says the study.

The findings have been published in the online edition of the Journal of Youth and Adolescence.

The findings contradict parts of a study published earlier this year in the same journal that found links between early teen sex and later behavioural problems.

The research team analysed data on 534 same-sex twin pairs in the US gathered at three time points over a seven-year period.

By examining surveys of twins, the investigators were able to eliminate the genetic and socio-economic variables that otherwise might influence the behaviours of adolescents.

“We got a very surprising finding, particularly that early sex seems to forecast less anti-social behaviour a few years later, rather than more,” said Kathryn Paige Harden, the study’s lead author.

She said that there is a “cultural assumption” that if teens have sex early it is somehow bad for their psychological health.

“But we actually found that teens who had sex earlier seem to have better relationships later. Now we want to find out why,” she added.

Harden said that people assume there is an association between early sex and delinquency because “teen sex transgresses parental expectations” and is seen as impulsive.

“But people’s concerns about early sex leading to delinquency may not be warranted.”

Harden acknowledged that early adolescent sexuality is linked to early pregnancy and disease, but said these risks are not inevitable.

In Australia, for instance, there are similar rates and patterns of teen sexual activity as in the US, but drastically lower rates of teen pregnancy, she pointed out.

She attributed this to the poor level of sexual health knowledge in the US, ineffective contraceptive use and lower abortion rates.

Study Debunks Theory On Teen Sex, Delinquency

Researchers at Ohio State University garnered little attention in February when they found that youngsters who lose their virginity earlier than their peers are more likely to become juvenile delinquents. So obvious and well established was the contribution of early sex to later delinquency that the idea was already part of the required curriculum for federal “abstinence only” programs.

There was just one problem: It is probably not true. Other things being equal, a more probing study has found, youngsters who have consensual sex in their early-teen or even preteen years are, if anything, less likely to engage in delinquent behavior later on.

That new analysis, a reworking of the same data the Ohio team used, is one of several recent instances in which a more precise parsing of data has begun to turn long-standing societal presumptions on their head. By bringing evidence to bear on complex social issues, these studies are forcing individuals and policymakers to rethink such hot-button topics as the benefits of breast-feeding, the risks of teen child-bearing and, in the latest example, the harms long presumed to result from teen sex.

Like many of the newer studies, the latest one — led by Paige Harden, a doctoral candidate in psychology at the University of Virginia in Charlottesville — used the powerful techniques of behavioral genetics. The field specializes in studies on twins, research that can help tell whether behavioral traits are the result of genes or the social environment, and that has periodically stirred controversy when it has focused on the genetic underpinnings of criminality and intelligence.

But the specialty’s analytic methods can also help tell whether one behavior, such as early sex, is merely correlated with or actually causes a second behavior that is often found with it, such as delinquency. If two behaviors often exist in the same people but are found not to be connected by cause and effect, then a third factor is likely to be causing both.

That kind of finding can help identify better targets for prevention efforts, experts say.

“Behavioral geneticists have long sought to establish causal links between genes and complex behaviors. So it’s fascinating to see them use the tools of their trade to dispute widely held beliefs” about the social roots of some of those behaviors, said Erik Parens, a senior research scholar who has tracked the field intensively at the Hastings Center, a Garrison, N.Y., science and ethics think tank.

The latest example started when Dana Haynie, a sociologist at Ohio State, and her then-graduate student, Stacy Armour, published a study in February in the Journal of Youth and Adolescence. They analyzed data collected from more than 7,000 children as part of the National Longitudinal Study of Adolescent Health, a federally funded survey that in 1994 began gathering information about the health-related behavior of U.S. schoolchildren who were then in grades seven through 12.

Haynie and Armour divided the children into three groups based on when they first had sex: when they were younger, about the same age or older than the age at which most of their local peers lost their virginity. (It varies by region, but on average, U.S. children lose their virginity at age 16.) They also compiled information on graffiti-painting, shoplifting, drug-selling and other “problem behaviors” by those young people in later years.

Their conclusion: One year after losing their virginity, children in the early category were 20 percent more likely than those who started having sex at the average age to engage in delinquent behavior, even when several other relevant factors such as wealth, race, parental involvement and physical development were taken into account.

Those findings supported the widely held notion that loss of virginity at a relatively young age appears to, as Haynie and Armour wrote, “open the doorway to problem behaviors.”

Harden, at the University of Virginia, didn’t believe it.

Looked at from a similarly high altitude, she said, people might conclude that red meat is a health food, since people live longer in countries where more is eaten. Only when the issue is studied within one country does red meat’s link to chronic diseases appear.

Suspecting such an error in the Haynie study, Harden and three colleagues, including her adviser, Eric Turkheimer, an expert in behavioral genetics, studied more than 500 pairs of twins in the same national survey analyzed by the Ohio team. Because twin pairs share similar or identical genetic inheritances (depending on whether they are fraternal or identical) and the same home environment, twin studies are useful for seeing through false cause-and-effect relationships.

The team looked at identical twin pairs in which one twin initiated sex younger than the other, then team members tallied subsequent problem behaviors. If sex really adds to the chances of delinquency, then early-sex teens should end up delinquent more often than their later-sex twins.

“It turns out that there was no positive relationship between age of first sex and delinquency,” Harden said.

The way to reconcile that with the previous evidence of a link is to conclude that some other factors are promoting both early sex and delinquency, she said. In an e-mail, Haynie agreed. And the Virginia study, to appear in the March 2008 issue of the Journal of Youth and Adolescence, offers some clues.

It found that identical twins, who have the same DNA, were more similar to one another in the ages at which they lost their virginity than were fraternal twins, whose DNA patterns are 50 percent the same — an indication that genes influence the age at which a person will first have sex. Other twin studies have found the same pattern for delinquency.

Together, those findings suggest that some genes — perhaps, for example, those that increase impulsivity and risk-taking — may underlie both behaviors.

“You need to have some appetite for risk-taking to be a delinquent. And the same if you’re 13 and going to have sex for the first time,” Harden said.

Efforts to prevent delinquency can hardly take aim at people’s genes. But the Virginia study also indicates that social factors, as yet unidentified but perhaps involving relationships with family and friends, have an even bigger impact than genes on whether a child will become delinquent. Those are the things that should be identified and targeted by delinquency-prevention programs, said Jeanne Brooks-Gunn, co-director of Columbia University’s National Center for Children and Families.

“I wouldn’t be focusing on early sexuality . . . to alter rates of delinquency,” she said.

Perhaps most surprising, the Virginia study found that adolescents who had sex at younger ages were less likely to end up delinquent than those who lost their virginity later. Many factors play into a person’s readiness for sex, but in at least some cases sexual relationships may offer an alternative to trouble, the researchers say.

Even then, there are emotional and physical risks. Young adolescents, in particular, are less likely to use condoms and so are vulnerable to sexually transmitted diseases and unwanted pregnancies.

The team looked at identical twin pairs in which one twin initiated sex younger than the other, then team members tallied subsequent problem behaviors. If sex really adds to the chances of delinquency, then early-sex teens should end up delinquent more often than their later-sex twins.

“It turns out that there was no positive relationship between age of first sex and delinquency,” Harden said.

The way to reconcile that with the previous evidence of a link is to conclude that some other factors are promoting both early sex and delinquency, she said. In an e-mail, Haynie agreed. And the Virginia study, to appear in the March 2008 issue of the Journal of Youth and Adolescence, offers some clues.

It found that identical twins, who have the same DNA, were more similar to one another in the ages at which they lost their virginity than were fraternal twins, whose DNA patterns are 50 percent the same — an indication that genes influence the age at which a person will first have sex. Other twin studies have found the same pattern for delinquency.

Together, those findings suggest that some genes — perhaps, for example, those that increase impulsivity and risk-taking — may underlie both behaviors.

“You need to have some appetite for risk-taking to be a delinquent. And the same if you’re 13 and going to have sex for the first time,” Harden said.

Efforts to prevent delinquency can hardly take aim at people’s genes. But the Virginia study also indicates that social factors, as yet unidentified but perhaps involving relationships with family and friends, have an even bigger impact than genes on whether a child will become delinquent. Those are the things that should be identified and targeted by delinquency-prevention programs, said Jeanne Brooks-Gunn, co-director of Columbia University’s National Center for Children and Families.

“I wouldn’t be focusing on early sexuality . . . to alter rates of delinquency,” she said.

Perhaps most surprising, the Virginia study found that adolescents who had sex at younger ages were less likely to end up delinquent than those who lost their virginity later. Many factors play into a person’s readiness for sex, but in at least some cases sexual relationships may offer an alternative to trouble, the researchers say.

Even then, there are emotional and physical risks. Young adolescents, in particular, are less likely to use condoms and so are vulnerable to sexually transmitted diseases and unwanted pregnancies.

Similar re-analyses have begun to undermine other conventional notions about health.

A recent study by Scottish researchers asked whether the higher IQs seen in breast-fed children are the result of the breast milk they got or some other factor. By comparing the IQs of sibling pairs in which one was breast-fed and the other not, it found that breast milk is irrelevant to IQ and that the mother’s IQ explains both the decision to breast-feed and her children’s IQ.

In another example, Arline Geronimus, a University of Michigan professor of health behavior who is now a fellow at Stanford University’s Center for Advanced Study, knew that babies born to teenagers are more likely to die in their first year of life than those born to older women.

“But that is an apples-to-oranges comparison,” she said. In New York City, for example, far more teen mothers live in Harlem than on the Upper East Side, she said, and “there are a lot of differences between those groups.”

So Geronimus looked more closely and got a different answer.

“If you compare Harlem teen moms to Harlem older moms, you find that the kids of the teen moms are actually less likely to die,” she said. The reasons include the fact that, unlike older women, poor teenagers are generally not juggling jobs and have older relatives to help.

It can make sense for poor women to have children when they are quite young, Geronimus concludes, and any effort to change that ought to treat it as an economic problem, not a health education problem.

In a different re-analysis, Geronimus made another counterintuitive finding. While it is true that, in general, teen mothers are less likely to breast-feed their babies than older moms, it is not true among poor women. Poor teenagers are actually more likely to breast-feed than poor older moms, in large part because the older women have jobs that don’t grant them the time to breast-feed or pump milk.

Because of that misconception, programs promoting breast-feeding have targeted teens instead of older women, Geronimus said. And they have taken aim, in part, at a concern that teenagers were believed to have: the cosmetic effects of breast-feeding on their breasts.

“So you’ve targeted the wrong population,” Geronimus said, “and come up with the wrong kind of intervention.”

A Harbinger of Heart Trouble

Few men may realize it, but if they’re having problems achieving or sustaining erections, it may signal underlying heart trouble.

Erectile dysfunction, or impotence, affects more than 18 million American men, according to a recent study by researchers at the Johns Hopkins Bloomberg School of Public Health.

And now a growing body of research ties erectile dysfunction to vascular diseases, such as coronary artery disease.

“Erectile dysfunction is often caused by vascular disease,” explained Dr. Ian Thompson, professor and chairman of the department of urology at the University of Texas Health Science Center at San Antonio. “A man could perceive decreased blood flow to the penis as being a less strong, a weaker erection, and that may actually be one of the first indicators of blood vessel disease.”

One recent report found men with erectile dysfunction had poorer scores on exercise tests and other measures of coronary heart disease. They also had evidence of significant coronary artery blockages.

“Our study found that among men who were sent for a stress test by their doctor, the presence of erectile dysfunction was a potent predictor — a strong risk factor — for significant underlying heart disease,” said lead researcher Dr. R. Parker Ward, an assistant professor of medicine and director of the cardiology clinic at the University of Chicago Hospitals.

“It was a stronger risk factor than some of the traditional risk factors we commonly ask questions about, things like high blood pressure and high cholesterol,” he added.

Ward’s study, published last year in the Archives of Internal Medicine, involved men who had been referred to cardiologists for nuclear stress testing, a noninvasive way to determine the severity of coronary heart disease. But even among men without heart symptoms, erectile dysfunction is a strong risk factor for future risk of heart attack, he noted.

In the same issue of the journal, Dr. Steven A. Grover and colleagues studied a group of 3,912 Canadian men, nearly half of whom reported having erectile dysfunction in the four weeks prior to visiting their family physicians. The men’s cholesterol, glucose and blood pressure measurements were taken.

“When you calculated a global cardiovascular risk, [it] was strongly associated with the probability that you had erectile dysfunction,” said Grover, a professor of medicine and epidemiology at McGill University Health Centre in Montreal. “And subsequently there have been other studies that have shown that people who have erectile dysfunction are, in fact, more likely to develop cardiovascular disease in the future.”

Thompson and his colleagues provided the first substantial evidence linking erectile dysfunction and subsequent risk for heart disease in a December 2005 report in the Journal of the American Medical Association. Yet the connection is not as well recognized among doctors and patients as cardiologists and urologists think it should be.

“A lot of men don’t have physicians,” Thompson explained. “They may not know what their blood pressure is or their lipid profiles, or they may be smokers, and they may never have been counseled to stop smoking or to reduce their weight.

“We think that if men with erectile dysfunction went to see their physicians, it may enable the interaction with the physician to discuss other coronary risk factors,” he said.

Erectile problems aren’t always vascular in nature. Sometimes the trouble is psychological or neurological and wouldn’t necessarily be associated with a higher risk of heart disease, Ward cautioned. Still, research linking erectile dysfunction (ED) and heart disease suggests that a proactive approach is the best medicine.

“We as physicians should be asking about, and men should be reporting to their physicians, symptoms of ED, so it can be considered as we work to modify their risk — treat blood pressure, cholesterol more aggressively, advise healthy lifestyle changes like exercise and healthy diet,” he said.

Erectile dysfunction, sometimes called “impotence“, is the repeated inability to get or keep an erection firm enough for sexual intercourse. The word “impotence” may also be used to describe other problems that interfere with sexual intercourse and reproduction, such as lack of sexual desire and problems with ejaculation or orgasm. Using the term erectile dysfunction makes it clear that those other problems are not involved.

Erectile dysfunction, or ED, can be a total inability to achieve erection, an inconsistent ability to do so, or a tendency to sustain only brief erections. These variations make defining ED and estimating its incidence difficult. Estimates range from 15 million to 30 million, depending on the definition used. According to the National Ambulatory Medical Care Survey (NAMCS), for every 1,000 men in the United States, 7.7 physician office visits were made for ED in 1985. By 1999, that rate had nearly tripled to 22.3. The increase happened gradually, presumably as treatments such as vacuum devices and injectable drugs became more widely available and discussing erectile function became accepted. Perhaps the most publicized advance was the introduction of the oral drug sildenafil citrate (Viagra) in March 1998. NAMCS data on new drugs show an estimated 2.6 million mentions of Viagra at physician office visits in 1999, and one-third of those mentions occurred during visits for a diagnosis other than ED.

In older men, ED usually has a physical cause, such as disease, injury, or side effects of drugs. Any disorder that causes injury to the nerves or impairs blood flow in the penis has the potential to cause ED. Incidence increases with age: About 5 percent of 40-year-old men and between 15 and 25 percent of 65-year-old men experience ED. But it is not an inevitable part of aging.

ED is treatable at any age, and awareness of this fact has been growing. More men have been seeking help and returning to normal sexual activity because of improved, successful treatments for ED. Urologists, who specialize in problems of the urinary tract, have traditionally treated ED; however, urologists accounted for only 25 percent of Viagra mentions in 1999.

How does an erection occur?

The penis contains two chambers called the corpora cavernosa, which run the length of the organ (see figure 1). A spongy tissue fills the chambers. The corpora cavernosa are surrounded by a membrane, called the tunica albuginea. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries. The urethra, which is the channel for urine and ejaculate, runs along the underside of the corpora cavernosa and is surrounded by the corpus spongiosum.

Erection begins with sensory or mental stimulation, or both. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the spaces. The blood creates pressure in the corpora cavernosa, making the penis expand. The tunica albuginea helps trap the blood in the corpora cavernosa, thereby sustaining erection. When muscles in the penis contract to stop the inflow of blood and open outflow channels, erection is reversed.

Figure 1. Arteries (top) and veins (bottom) penetrate the long, filled cavities running the length of the penis—the corpora cavernosa and the corpus spongiosum. Erection occurs when relaxed muscles allow the corpora cavernosa to fill with excess blood fed by the arteries, while drainage of blood through the veins is blocked.

What causes erectile dysfunction (ED)?

Since an erection requires a precise sequence of events, ED can occur when any of the events is disrupted. The sequence includes nerve impulses in the brain, spinal column, and area around the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa.

Damage to nerves, arteries, smooth muscles, and fibrous tissues, often as a result of disease, is the most common cause of ED. Diseases—such as diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, vascular disease, and neurologic disease—account for about 70 percent of ED cases. Between 35 and 50 percent of men with diabetes experience ED.

Lifestyle choices that contribute to heart disease and vascular problems also raise the risk of erectile dysfunction. Smoking, being overweight, and avoiding exercise are possible causes of ED.

Also, surgery (especially radical prostate and bladder surgery for cancer) can injure nerves and arteries near the penis, causing ED. Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to ED by harming nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa.

In addition, many common medicines—blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine (an ulcer drug)—can produce ED as a side effect.

Experts believe that psychological factors such as stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure cause 10 to 20 percent of ED cases. Men with a physical cause for ED frequently experience the same sort of psychological reactions (stress, anxiety, guilt, depression). Other possible causes are smoking, which affects blood flow in veins and arteries, and hormonal abnormalities, such as not enough testosterone.

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Among prostate cancer patients undergoing a high-tech form of radiation therapy, exposure to a higher amount of radiation over a shorter time span poses no added risk for impaired sexual function, new research reveals.

“For men getting a high dose of radiation in a shorter amount of time than is typical — meaning getting higher doses per day for fewer days — a loss of sexual function is the chronic side effect that concerns most,” noted study co-author Dr. Eric Horwitz, a clinical director in the department of radiation oncology at Fox Chase Medical Center in Philadelphia.

“But we found that sexual function wasn’t any worse than when patients got radiation in the conventional high-dose way,” he said.

Horwitz and lead author Mark Buyyounouski, also at Fox Chase, were expected to present their team’s findings at the annual meeting of the American Society for Therapeutic Radiology and Oncology, in Los Angeles.

The finding comes on the heels of work conducted at Fox Chase last year That study indicated that high-dose radiation should be considered the first line of attack in combating prostate cancer, given that it appears to be the most effective way to limit the disease’s spread.

The team focused on a form of radiation therapy called intensity-modulated radiation therapy (IMRT). According to the American Cancer Society, IMRT is a cutting-edge, 3-D form of high-dose radiation therapy. The treatment is delivered by a computer-controlled machine that moves around the patient to target diseased tissue while avoiding healthy tissue, thereby allowing for the safer use of higher doses of radiation.

In the current study, Horwitz and his colleagues tracked the IMRT radiation treatment outcomes of 155 men diagnosed with intermediate to high-risk prostate cancer.

Half the men were assigned to receive 2 Gray (Gy — a measurement of radiation) in 38 sessions spread over seven and a half weeks.

The other half were exposed to 2.7 Gy in 26 sessions spread over just five weeks.

All the patients then completed questionnaires regarding treatment side effects six months, 12 months, and 24 months following radiation.

Older age, as well as poor sexual function prior to radiation, did increase the risk for sexual impairment after radiation treatment, the researchers said. However, they report no appreciable difference in sexual function between the men receiving the shorter course/higher dose regimen or the more conventional regimen.

“The key to curing more prostate cancer is to give higher does of radiation,” observed Horwitz. “And over the last few years, more and more men have been getting higher dose radiation, because the radiation oncology community knows that dose matters and that low dose radiation is just not effective compared to high dose. And this study shows that we have the ability to give these high doses in different ways, and in all these ways, men do very well.”

Horwitz said he and his colleagues plan to take the current research to the next level.

“We will build on this experience and go with even higher doses,” he said, “to see how that impacts not only sexual function but urinary and bowel function as well.”

Dr. Peter T. Scardino is chairman of the department of urology and head of the Prostate Cancer Program at the Memorial Sloan-Kettering Cancer Center in New York City. He described the finding as a small but important step toward developing shorter course/higher dose radiation therapies.

“This is the trend nowadays,” said Scardino. “This is where this is going: toward a time when perhaps we will be giving radiation therapies all in a single day.”

“Animal studies have already indicated that you may be able to achieve as much or more with a single dose of radiation than with a protracted course,” Scardino noted. “So, the big question is, are you going to find more complications as a result of this kind of a shift in dosage? Now, cutting back from seven and a half weeks to five weeks is a slight move in this direction, but they found no difference in sexual side effects, and that’s valuable. And I certainly think we’ll be seeing a lot more research in this area.”

Prostate Cancer Radiotherapy Won’t Affect Sexual Function

High-dose precision radiation therapy doesn’t harm the sexual function of prostate cancer patients, U.S. researchers say.

A team at Fox Chase Cancer Center in Philadelphia tracked 155 men with intermediate- to high-risk prostate cancer who underwent intensity-modulated radiation therapy (IMRT), a technique that more precisely targets the tumor.

“IMRT is revolutionizing how we treat men with prostate cancer, because it improves our ability to avoid normal tissue. As a result, more radiation dose can be delivered to the prostate by increasing the amount of radiation each day. Increasing the radiation used each day is particularly attractive, because it also shortens the treatment time by several days,” study lead author Dr. Mark Buyyounouski, attending physician in the radiology department at Fox Chase, said in a prepared statement.

“We need to make sure there’s a balance between risk and benefit, and sexual function is a major consideration. Fortunately, this study shows no decrease in sexual function from the higher doses of radiation,” he said.

One group of men in the study received 2 Gy of radiation in 38 sessions over seven weeks, three days, while another group received 2.7 Gy in 26 sessions over five weeks, one day. At six months, one year, and two years after treatment, there were no significant differences in sexual function scores between the two groups.

The findings were expected to be presented Monday at the annual meeting of the American Society for Therapeutic Radiology and Oncology, in Los Angeles.

Prostate Cancer Treatment Options

What are some of the treatment options for prostate cancer?
The treatment options for prostate cancer depend in part on whether the tumor has spread. For tumors that are still inside the prostate, radiation therapy (using x-rays that kill the cancer cells) and a surgery called radical prostatectomy are common treatment options. “Watchful waiting” is also a treatment option. In this approach, no treatment is given until the tumor gets bigger. Watchful waiting may be the best choice for an older man who has a higher risk of dying from something other than his prostate cancer.

Generally, tumors that have grown beyond the edge of the prostate can’t be cured with either radiation or surgery. They can be treated with hormones that slow the cancer’s growth.

What is radical prostatectomy?
Radical prostatectomy is a surgery to remove the whole prostate gland and the nearby lymph nodes. Most men who have this surgery are under general anesthesia (puts you into a sleep-like state). After the prostate gland is taken out, a catheter (a narrow rubber tube) is put through the penis into the bladder to carry urine out of the body until the area heals.

What are the risks and benefits of radical prostatectomy?
If you’re in good health, the short-term risks of this surgery are low. The hospital stay is usually 2 to 3 days, with the catheter left in place for 2 to 3 weeks. You’re usually able to go back to work in about 1 month. You shouldn’t have severe pain with this surgery. Most men regain bladder control a few weeks to several months after the surgery.

The main advantage of surgery is that it offers the most certain treatment. That is, if all of the cancer is removed during surgery, you are probably cured. Also, the surgery provides your doctor with accurate information about how advanced your cancer is, since the nearby lymph nodes are taken out along with the tumor.

Surgery does have risks and complications. You could lose a lot of blood during this surgery. Before the surgery, you might want to save about 2 units of your own blood in case you need a transfusion. The main risks of this surgery are incontinence (lack of bladder control) and impotence (loss of the ability to get or keep an erection long enough to have sex). Fortunately, only a very low percentage of men have severe incontinence after radical prostatectomy. Up to 35% of men have a little accidental leakage of urine during heavy lifting, coughing or laughing.

The chance of impotence decreases if the surgeon is able to avoid cutting the nerves. This may not be possible if the tumor is large. Your age and degree of sexual function before the surgery are also important factors. If you’re under 50 years old when you have this surgery, you’re likely to regain sexual function. If you’re older than 70, you’re more likely to lose sexual function. Remember, even if the nerves are cut, feeling in your penis and orgasm remain normal. Only the ability to get a rigid penis for sexual intercourse is lost. However, there are medicines and devices that can help make the penis rigid.

What is radiation therapy? What are its risks and benefits?
There are 2 types of radiation therapy. In one type, called external beam radiation therapy, radiation is given from a machine like an x-ray machine. In another type, radioactive pellets (called “seeds”) are injected into the prostate gland. This is sometimes called seed therapy or brachytherapy. Both types work about the same in curing prostate cancer.

The machine therapy is usually given 5 days a week over 7 weeks, which you might find time-consuming. However, you don’t need any anesthesia. The side effects are milder than the side effects that can come with seed therapy. However, seed therapy can be done with just one hospital visit. For seed therapy, you have to have anesthesia for a few minutes, but you should be able to go home right after the treatment. In seed therapy, higher doses of radiation can be put right on the cancer. You may feel more discomfort after this treatment.

About one half of patients become impotent within 2 years of having radiation therapy. Many men feel very tired at the end of the treatment period. About 15% to 30% of men who have radiation therapy have urinary burning, urinary bleeding, frequent urination, rectal bleeding, rectal discomfort or diarrhea during or shortly after the treatment. Serious complications are rare. However, a degree of uncertainty goes along with radiation treatment. Since the prostate gland and the lymph nodes are not taken out, your doctor can’t tell the exact size of the tumor. The cancer could come back many years after radiation treatment.

At 10 years after treatment, cure rates are about the same for radiation therapy and radical prostatectomy. There are no surgical risks for men who have radiation therapy. There’s no risk of bleeding. You don’t have to stay in the hospital. You’ll recover faster. Daily activities can usually go on during the treatment. Incontinence is extremely rare afterward. However, surgery may give you a better chance of cure over the long term.

What are the risks and benefits of watchful waiting?
Many prostate cancers are small and grow slowly. Because many men with a slow-growing tumor have the same life expectancy as men who don’t even have prostate cancer, it may not be necessary to treat very small, very slow-growing prostate tumors. Also, some men feel that the side effects of treatment outweigh the benefits. In watchful waiting, you get no treatment, but you see your doctor often. If there’s no sign the cancer is growing, you continue to get no treatment. Hormone therapy can be started if the cancer starts to grow.

It can be hard to tell if a small tumor is going to grow slowly or quickly. Your doctor will get clues about the way your tumor will grow by checking your prostate-specific antigen (PSA) level, examining the biopsy tissue and giving you a rectal exam. The choice of watchful waiting is up to you.

What is the purpose of hormone therapy?
The purpose of hormone therapy is to lower the level of the male hormones, called androgens, which are produced mostly in the testicles. This is because androgens, such as testosterone, help the prostate tumor grow. Monthly shots can be given or the testicles can be surgically removed. Once the testosterone is out of your body, the prostate cancer usually shrinks. Hormone treatments are most often used in patients with cancer that has already spread beyond the prostate gland.

While prostate cancer usually responds to 1 or 2 years of hormone therapy, after some time most tumors start to grow again. Once this happens, the treatment goal is to control symptoms. No treatment can cure prostate cancer after hormone therapy stops helping.

What happens after prostate cancer treatment?
You should get PSA (prostate-specific antigen) blood tests every 6 months for 5 years, and then once every year. A rise in PSA levels usually means that the cancer has come back. A digital rectal examination should be done once a year.

Where can I get more information about prostate cancer?
Your family doctor, your oncologist (cancer doctor), the radiotherapist and your urologist can give you information. Your local hospital or cancer center may refer you to a local prostate cancer support group, where you can meet other men who have had this cancer.

Australian coal miners are being taught to explore their wives and understand menopause in order to have a healthy sex life, which in turn will make them happy, productive workers.

The “Toolbox Talks” at the Bulga coal mine in the Hunter Valley, north of Sydney, have been such a success that the Xstrata mining company is considering running them at other mines.

“The Toolbox Talks are a series of health briefings … addressing issues such as fatigue, prostate cancer, nutrition, heart disease and this month we are addressing the issue of menopause,” said Xstrata spokesman James Rickards.

“Even though it is a predominately male working environment we have to look at the lifestyles of our employees, making sure they are fit and healthy at work, but also fit, healthy and happy at home,” Rickards told Reuters on Thursday.

Bulga’s miners are aged mainly from late 40s to 50s and menopause may be affecting their wives, sisters and friends, said Rickards.

“The health briefings provide them with information on how to help and assist their loved ones who may be going through this or approaching this period of their life,” he said.

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