IS DEAFNESS A NATURAL CONSEQUENCE OF AGING?
Many people develop some mild impairment of hearing as they grow older. Often it will not significantly interfere with your function, although in some instances it can be disabling. If you suffered from an injury to your eardrums many years ago and it was not properly treated, a decrease in hearing may persist and become worse with time. This might respond to surgical repair. Wax in the ears alone does not usually cause a significant decrease in hearing. However, if your ear canals are completely blocked by wax, you may experience some decrease in your hearing in addition to a feeling of fullness or pressure in the ear. In this case a hearing aid may not work properly until the wax is removed.
One cause of decreased hearing is otosclerosis. Even though it is more common in younger people, it can progress throughout life. In this condition the small bones in the ear that help transmit sound become rigid and no longer vibrate properly, so the sound waves do not pass the middle ear to the inner ear.
There is some controversy as to whether older people might benefit from surgery to make the bones mobile again. There is good evidence that in some older individuals, this type of surgery may be very successful. In some instances the surgery alone restores hearing. In others surgery can improve the results of using a hearing aid, which may be needed after the operation.
A very common cause of hearing loss is the deterioration of the inner ear (nerve deafness). The exact cause is unknown, but it affects most older people to some degree. Some people seem to be able to hear with no problem until they are very old, whereas others begin to lose their hearing earlier. Although no special treatment will return hearing if you have this problem, some improvements can be made. In some instances a hearing aid may be of value, although it is less often helpful in this kind of deafness.
Aspirin, often prescribed for arthritic conditions, can interfere with hearing and may cause ringing of your ears. This improves when the aspirin is stopped or the dosage reduced. Some strong antibiotics used in serious infections may also interfere with hearing and with balance.
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PARKINSON’S DISEASE
Parkinson’s disease is more common in the elderly, but its cause is not known. Because the degree of symptoms vary, some people may be completely incapacitated by the illness, whereas others may not even realize that they have it. The most prominent symptoms are slowness in walking, shaking and stiffness of the limbs, and difficulty in speaking and swallowing. Your facial muscles may droop and friends or family may wonder why you always appear “unhappy.” You may develop a “shuffling gait,” which means that you do not lift your legs from the floor when you walk and often you have difficulty in turning. This often causes falls. The difficulty you experience in walking and getting out of a chair or bed may be attributed to arthritis or “just growing old.” Often, because the symptoms are mild, a diagnosis may be overlooked. Tranquilizers or drugs for the treatment of a hiatus hernia (metoclopramide) can cause a drug-induced type of Parkinson’s disease.
Even though some people with severe Parkinson’s disease have difficulty speaking, their memory and judgment are usually quite good. There is some suggestion that after the disease has been progressing for many years some loss of mental function may occur, but this may not be as severe as in other diseases of the brain. Unfortunately, many people assume that because a person cannot move or speak quickly the mind is also impaired, and this can be very frustrating and aggravating.
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GYNECOLOGICAL TUMORS
The most common gynecological tumors are found in the cervix (the part of the uterus that projects into the vagina), but growths in the uterus are also common. There has been some controversy about the factors that contribute to the high incidence of such tumors. It appears that numerous pregnancies and numerous sexual partners may make women more prone to cervical cancer.
Cancer of the uterus appears to be somewhat more common in women who take female hormone (estrogen) medications after menopause, even though there are many positive aspects to the use of these medications. The data are conflicting, but it seems that the use of estrogen medications alone slightly increases the chances of developing uterine cancer. If a small amount of progesterone is added to the estrogen, the risk seems to decrease a great deal. Controversy continues as to whether women should take these medications. Medical opinion has been shifting steadily toward recommending the use of combination estrogen and progesterone after menopause to decrease the risk of osteoporosis (weak bones).
Having a Pap test of the cervix every one or two years is an important way to decrease the chance of developing cancer of the cervix or uterus. The Pap smear can indicate the disease in the early stages, when treatment is simpler. If a malignancy is found, local surgical removal of a small part of the cervix or the use of radiation, and recently the use of locally applied chemotherapeutic agents, may be of value. In more advanced stages removal of the whole uterus (hysterectomy) may be required. The results are usually good, especially if the disease is found early. Even in advanced cases some improvement in symptoms and relief of discomfort can result from a combination of chemotherapy and radiation therapy.
Cancer of the uterus may first show itself with bleeding after menopause, an important symptom that should never be overlooked. If you have been taking estrogen hormones alone for menopausal symptoms, bleeding during therapy or between cycles of drugs should not occur. Sometimes if progesterone is added to the estrogen, there may be some bleeding between drug cycles. However, if you have never experienced bleeding with these medications you should see a physician if bleeding develops at a later date. Do not assume that the symptom, especially if it occurs in the midst of a cycle, is due to hormone therapy. Bleeding of any type should always be reported to your physician.
The ovaries can also be affected by cancer, and growths are sometimes found during routine gynecological examinations. For this reason, it is important to have a pelvic examination every year or two even after you have stopped menstruating. The first symptom may be a feeling of fullness in the lower part of the abdomen.
Treatment includes surgery to remove the tumor, and some women require radiation therapy and chemotherapy. The response to treatment can be good. Although the tumor may return, a further course of treatment can be initiated.
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OTHER GYNECOLOGICAL PROBLEMS
Vaginal Itching and Pain
Vaginal itching can be very embarrassing. Many women with this problem avoid consulting a physician. A number of infections cause vaginal itching. A common one is the result of a yeast called Candida albicans. This may be the first sign of diabetes mellitus. Infections of the urinary tract may also cause local irritation, but this is more common if you have some urinary incontinence. Senile vaginitis may cause itching and pain in addition to bleeding, but it usually is prevented by cyclical hormone therapy or treated by local application of estrogen cream. Other skin problems in the vaginal area can easily be diagnosed and treated.
Vaginal Prolapse
A prolapse is a weakening of the vaginal wall that causes the bladder to sag into a vagina. The most common symptoms are a fullness or heaviness in the vaginal area and a leakage of urine when coughing or straining. There may be an increased susceptibility to urinary tract infections. Sometimes part of the intestine may protrude into the vagina and also cause problems with bowel movements.
In many instances surgical repair of a prolapse is the most effective treatment to relieve your symptoms completely. A pessary (a doughnut shaped device that is placed in the vagina) may be successful, although surgical repair is preferable for most people.
Malignant tumors of the cervix, uterus, and ovaries can occur at any age. The symptoms may be vaginal bleeding or weight loss and abdominal swelling.
Treatment is usually directed by a gynecologist and oncologist (cancer specialist). This may include surgery, radiation, and chemotherapy, or a combination of any of these treatments. Many women respond very well to such treatment. If your physician believes that this therapy may succeed, it should not be refused because of your age.
Vaginal Odor
Some women notice an offensive odor in their vaginal area. Odor can be associated with a vaginal discharge, but the most common causes are various infections, such as that of the yeast Candida albicans, often associated with diabetes mellitus. Perspiration due to poor hygiene and obesity may exaggerate the odor.
Occasionally a tumor in the vulva, vagina, cervix, or uterus produces a foul-smelling discharge which may contain blood. Such a discharge is not normal, and you should consult your physician about it immediately.
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GENITOURINARY AND GYNECOLOGICAL DISORDERS
The genitourinary system consists of the kidneys, ureters, bladder, and urethra, as well as the organs of reproduction. From the kidneys to the bladder, the urinary systems are exactly the same in men and women. In women the urethra has only a short distance to travel before it reaches the surface, just above the entrance to the vagina. Women’s organs of reproduction are close to the bladder and urethra. Because of this, abnormalities of the urinary system can affect the organs of reproduction and vice versa.
In men the urethra passes through the prostate gland and the penis before it exits from the body. Because the distance along which the urethra must pass is longer, the possibility of urological disorders is greater.
For most problems occurring in the male genitourinary system a urologist is consulted. Women would consult a gynecologist for genitourinary problems.
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THE VIRILITY SOLUTION: THE BEGINNING OF A NEW LIFE
At the suggestion of a friend who was already participating in the Vasomax study, Ron came to see me. After carefully screening him, I concurred with the urologist. For the most part, his health was excellent. He didn’t smoke, and exhibited no signs of hypertension, diabetes, prostate cancer, or Parkinson’s disease, the major ailments typically associated with ED.
I told Ron that his primary symptoms, which included slower arousal time, the need for increased stimulation to achieve an erection, and the inability to maintain an erection, were early signs of ED. He was accepted into the study and before he left that afternoon, I gave him a one-month supply of Vasomax pills, along with diaries that both he and his wife were to fill in as soon as a sexual encounter was over. I told him that a stuffy nose was a possible side effect, and that he might I eel lightheaded or a quickening pulse. He should carefully record any unusual changes he might experience.
Before he left, Ron asked me one more question: “If the pills work lor me, will I have to take them forever?”
I told him what I tell all my patients taking the new medications. Reactions vary from patient to patient, depending on the nature of their particular erectile problems. But if it turned out that Ron did need them indelmitely, I didn’t foresee a problem. “I ook at it this way,” I said. “The help you need is available to you. Just take that little white pill—and live the most satisfying life you can.”
Like so many men whom I’ve treated, Ron now regards his sex life as pre- and post-Vasomax. In the old era, he and his wife would try to have sex once or twice a week, with a lot of uncertainty on Ron’s part. Post-Vasomax, they quickly rediscovered the joys of spontaneous sex. Ron’s fear of inadequacy vanished. And gone forever was the very unpleasant option of having to inject himself.
Ron summed up his experience in a way I’ll always remember. “When I left your office after taking Vasomax for the first time, Amy and I went to dinner. I started to feel differently. I became acutely aware of how lovely she looked, and, all of a sudden, my emotional response to her was matched by a really powerful physical urge. I was overcome with desire for her. In fact, we skipped dessert in the restaurant—and had it at home, if you know what I mean.”
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THE VIAGRA TESTS
The tests on Viagra (sildenafil) were no different. In the first human trial of the drug, a dozen men in England who were experiencing ED took it three times a day for a week. The results were extremely encouraging but researchers had to pose some realistic questions: Does anyone really want to take a pill three times daily? And who could afford such a costly treatment?
Another short trial was begun. This time, the dozen men took a single dose every day. Remarkably, ten of them showed positive results, and the researchers concluded that the drug was “a well-tolerated and efficacious oral therapy and represents a new class of peripherally acting drugs for the treatment of this condition.”
Phase II drug trials spread beyond the west of England to other parts of the United Kingdom, as well as France and Sweden. In one study, forty-two men, between the ages of thirty-four and seventy, all of whom had experienced ED for at least three years, were divided into two groups. Half took Viagra in 25, 50, or 75 mg doses daily while the others received a placebo. Later, the two groups switched pills. After twenty-eight days, more than 90 percent of the men reported significantly improved sexual performance. This was confirmed by the answers they provided on detailed sexual activity questionnaires. Not only were they filled out by the men taking part in the study, they were answered by their partners as well. It turned out that the men who experienced profound improvement had been taking Viagra.
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THE VIRILITY SOLUTION: MEDICATIONS
Many times, ED is a side effect of taking a drug. The most common offenders are prescription drugs for high blood pressure, heart ailments, and allergies. Medications used to combat depression, especially the selective serotonin-reuptake inhibitors (SSRIs), such as Prozac, Zoloft, and Paxil, can also be the culprits.
Frequently, if a man is taking more than one medication, the damaging effects are cumulative. For example, I have seen cases where a patient is taking a drug for his depression, and, while he is experiencing some difficulty maintaining an erection, he can still have sex. However, if a second medication, say for hypertension, is added, his sexual performance will be severely impaired. A complete loss of erectile function can result.
The men in these predicaments have sex lives held hostage by the very medications that can save them. It’s an ironic and frustrating situation to be in. I have seen men blame themselves, or their partners, when they weren’t even aware that their problems had a physiological cause.
Sometimes, men will suspect that the medication mix is responsible for, or contributing to, their ED. On their own, they may decide to try lowered dosages or stop taking the drugs altogether. This very dangerous action can be deadly and must be avoided. In the case of hypertensive medication, lack of the drug may cause blood pressure to suddenly soar to-dangerously high levels. The outcome can be a stroke or a heart attack.
Right now, there are more than two hundred medications on the market that can seriously compromise creel ions and sexual performance. Unfortunately, the Food and Drug Administration, the government agency that approves all medication, doesn’t require pharmaceutical companies to reduce potential sexual side effects. But then, men rarely voice their concerns about something as personal as diminished sexual performance. Therefore, reporting erection difficulties brought about by a particular medication to a physician is a rare event. Many doctors aren’t even aware of the problem their prescriptions are causing. And, for those men who do seek help from their doctors, the frequent recommendation is for them to get’psychological counseling, which leaves them, as far as treatment for their ED is concerned, back in the middle of the twentieth century.
When it comes to avoiding certain medications because of their effect on sexual response, there is no simple answer. Not every drug will give each man who uses it trouble. If you suddenly notice that you are having erection problems where none existed before, take a good look at any and all medications that you are using.
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THE VIRILITY SOLUTION: MODERN METHODESOF CURES
Penile injection therapy came about by chance. In 1980, the French physician Ronald Virag reported that during surgery on the penis, he inadvertently injected an anesthetized patient in the wrong part of the penis with papaverine, a nitrogen-containing substance derived from the opium poppy. The resulting relaxation of the smooth muscle of the penile arterial walls created an unexpected two-hour erection. The mistake by Virag set in motion serious research into the use of injectable medication for relief of ED.
At around the same time, Giles Brindley a British physiologist and research scientist, found that when the drug phenoxybenzamine was injected directly into the corpora cavernosa of the penis, an erection could be produced within a few minutes. Still, even though it was a powerful substance, phenoxybenzamine had serious side effects, including cardiac arrhythmia, nausea, and hyperventilation. Additionally, it was found to be carcinogenic in test animals.
In 1984, in Paris, a New York urologist, Dr. Adrian Zorgniotti, presented his first case studies of self-injection using a dual combination of papaverine and phentolamine. The latter drug interrupts the passage of neurotransmitters, which then causes relaxation of the smooth muscles of the penis. Two years later, Japanese researchers presented evidence that injections of prostaglandin E-l produced powerful erections. Finally, modern medicine had injectable drugs that, used either alone or in combination, were able to give a man an erection whenever he wanted one. Slowly, news of the favorable results with the injectable medication began to spread within the small international community of urologists who were treating ED. Most began utilizing all three—papaverine, phentolamine, and prostaglandin E-l—in what was referred to as “tri-mix.”
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THE VIRILITY SOLUTION: FOLK MEDECINE
Folk medicine has always been applied whenever a man’s virility showed signs of waning. A seemingly endless succession of herbal potions, drugs, and mechanical devices has been employed over the centuries, from crushed rhinoceros horn and pulverized antelope, deer, and horse testicles, to parings of human nails. In times of desperation, a piece of bone was actually eased into the urethra to stiffen the penis.
The mandrake plant, a member of the nightshade family, was used extensively in medieval Europe, northern Africa, and Asia as both a painkiller and a cure for ED. It is even mentioned in the Old Testament, under the name “dudaim,” as the stimulant used by Jacob. Stemless, with bell-shaped flowers, the plant’s long and thick root, which often divides into two sections, resembles the lower male torso. It contains many alkaloids of medicinal value, making it one of the most discussed plants in medical literature, as well as the subject of myth and superstition. Alkaloids are a diverse group of nitrogen-containing substances produced by plants that have powerful effects on body function; some of the more common alkaloids include atropine, morphine, quinine, and codeine.
And then there was food. Throughout history, edibles, especially those phallic in shape, were employed as virility boosters. Asparagus, bananas, carrots, and cucumbers stood out in this category. Some indigenous tribes in coastal areas traditionally rubbed long, slender fish against their penises in the hope that they would become similarly long and hard.
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