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Sunday, October 4, 2009

Are health problems ruining your sex life?

Back pain and arthritis can affect love lives, but few tell their doctors Regrets? I’ve had a few, but seemingly not as many as the group of British pensioners recently asked what they would change about their lives if they could turn back the clock. Four out of ten said they would pursue a different career. Just over half would travel more. But by far the most popular wish was to have spent more time making love. I am wary of statistics on sexual practices because it is just too tempting to exaggerate, but there is something refreshing about the candour of elderly people who have nothing to prove. Sexual activity tends to peak early (twenties for men and early thirties for women) and then decreases. But if people would like to be more active for longer, what is going wrong? There are a number of recurring themes that account for the lion’s share of those seen by most GPs, and they can be divided into three broad complaints. It’s uncomfortable If making love hurts then it is only natural to avoid it. Vaginal dryness is one of the most common causes and a real problem for many women who are going through, or have been through the menopause. Lack of oestrogen thins the tissues in and around the vagina, reduces lubrication and can make sex very uncomfortable (dyspareunia). Fortunately this responds well to using extra lubrication (such as KY Jelly) and the application of oestrogen creams or pessaries (a type of local HRT that doesn’t carry the risks associated with the conventional form). Endometriosis, where the lining of the uterus extends out of the womb into the pelvis, is a common cause of dyspareunia in younger women. Telltale signs include deep discomfort on making love and heavy painful periods. Treatment depends on the severity but milder cases can often be helped by the Pill. Back pain and arthritis also interfere with sex life, but few share concerns with doctors. Fortunately there is advice from websites such as www.rheumatoid.org.uk and www.arc.org.uk. Headache may be a clichéd excuse but some types can be triggered by sexual activity — the best known being orgasmic cephalalgia, a sudden onset headache that often occurs at the point of orgasm and which affects as many as one in 100 people. Treatment involves using migraine drugs such as propranolol. I’m not in the mood Poor libido in men and women is nearly always a symptom of an underlying problem rather than a medical condition. Common causes range from depression and changes associated with the menopause, to being too tired to bother and/or not fancying your partner any more. And that’s assuming that you have a “problem”. Sex drive only becomes an issue when it doesn’t match that of your partner. Wanting to make love once a month may be normal for some couples, but will lead to tension in others if one partner wants to do it more often. Although hormones are often the first thing that springs to mind in older women, relationship problems are far more common. Many people simply don’t find their partner sexually attractive any more — a point ably demonstrated by the behaviour seen in those having an affair. The same woman who dreads her husband’s touch can be an insatiable tiger in her lover’s bedroom. Men tend to have higher sex drives, so it’s little surprise that most of the women I see complaining of low libido are there only because their partners think there’s a problem. A surprising number admit to being happy with the status quo. In younger women on the Pill, loss of sex drive can result from its mix of hormones, a problem that can often be helped by switching to another brand. I can’t manage it Viagra celebrates its 11th birthday this month. Although once controversial, the little blue pill is now part of the establishment and has transformed the sex lives of millions of men. It has also de-stigmatised erectile dysfunction (ED) making it much easier for men to admit that they have a problem maintaining n erection — as around half of all of those over 40 do at some time. Nearly every man can now be helped, but men have to pluck up the courage to ask. It pays to mention ED to your doctor as it is often a sign of underlying problems such as diabetes or high blood pressure which, left untreated, can lead to early stroke and heart attack. For more information visit www.patient.co.uk E-mail questions to drmark@thetimes.co.uk or write to times2, 1 Penningon Street, London E98 1TT source: The Times