Health News resources and information

The most common symptom of PID is pain in the pelvis and lower abdomen. The pain is usually dull, and it can occur on one side or both sides of the pelvis. Other symptoms—discharge and an odor from the vaginal area, burning with urination, and spotting between periods or after sexual intercourse—may also be present. A woman may notice heavier than usual periods and pain during intercourse. With more severe infection, there can be fever and chills, and nausea and vomiting. In addition, PID can sometimes spread into the abdominal cavity and cause infection around the liver, experienced as pain in the upper right part of the abdomen. This condition is known as Fitz-Hugh Curtis syndrome. In other cases there may be no symptoms with PID, and the infection may go undetected until it is discovered during a pelvic examination.

Symptoms generally occur within a few days to a few months after infection, but they may take longer to show up. With each episode of PID, a woman undergoes a 20 percent reduction in her future fertility and runs a 20 percent risk of being subject to chronic pelvic pain and an increased risk of an ectopic (tubal) pregnancy.

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Many people want to know the likelihood of getting herpes from a partner who is infected with genital herpes. For a couple who abstain from sex during an outbreak but have sex without a condom between outbreaks, the average risk is 10 percent for the uninfected person to acquire herpes from the infected partner over the course of a year.

90 people out of 100 will remain uninfected.

As noted earlier, women have a higher risk of becoming infected. An uninfected man having sex with an infected female partner in the above scenario has about a 4 percent risk of getting genital herpes

In other words, 10 people out of 100 in such a relationship will, after a year, have contracted herpes from their partners via asymptomatic shedding, but after a year, whereas a woman having unprotected sex with an infected male partner has about a 10 percent chance of getting herpes after a year if she already has type 1 herpes orally, but about a 32 percent risk of getting herpes after a year if she is completely negative for herpes. These statistics are derived from studies of discordant couples (one person has herpes and the other doesn’t) over a specified period of time. Whether these statistics hold for every year a couple has been together, or whether they change with time, is not yet known. Usually the longer a person has herpes, the less active that person’s virus becomes, so for any specific couple these numbers may decrease over time. Studies are under way to evaluate further the risk of infection.

Statistics for men who have sex with other men or women who have sex with other women are not yet available. For a woman having unprotected sex with a female partner, the risk is probably lower overall, although transmission may still take place through genital rubbing and through oral sex.

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Prostatitis of bacterial etiology is also treated with antibiotics. Treatment is usually initiated once the infection has been diagnosed, before the actual organism causing the infection is known. The appropriate antibiotic depends on the person’s age and history and what is found on examination and through testing. How long the antibiotics are used depends on whether the infection is acute (a new, very symptomatic infection) or chronic (characterized by less severe symptoms of a longer duration).

If the cause of acute prostatitis is thought to be a sexually trans: mitted bacterium, then treatment for infections such as gonorrhea, chlamydia, and nongonococcal urethritis should be started. (See the sections on these specific infections.) However, the course of antibiotics is usually longer (lasting two weeks) for an infection of the prostate than for urethral infection alone. One possible treatment program includes ceftriaxone along with doxycycline. Prompt treatment of urethritis caused by sexually transmitted bacteria decreases the likelihood that the infection will progress to a prostate infection. Chronic infection rarely occurs following acute prostatitis from a sexually transmitted infection.

For men who have acute prostatitis, who are older, or who perform anal sex on partners, a different antibiotic is commonly used; ofloxacin is usually administered for two weeks or sometimes longer. For chronic prostatic infection of any cause (sexually transmitted or otherwise), a much longer course of antibiotics is prescribed. The antibiotics of choice are ofloxacin, ciprofloxacin, or trimethoprim-sulfamethoxazole, often for four weeks or longer.

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When you talk with your partner, make sure you are alone in a quiet place with little chance of being interrupted. Explain as calmly as you can what your health care provider told you. Explain what your diagnosis was, how you are being treated, and what your provider recommended for your partner. You may want to talk with your partner about whether or not he or she has been with someone else. You may need to tell your partner that you have been intimate with someone else. If there has been another partner, the discussion may be very emotional and almost certainly will be difficult. Try not to make things worse by adding blame and guilt, tempting as this may be. If the idea of facing your partner with this information is overwhelming, you can ask your provider to talk to both you and your partner together, to explain what is going on.

Being diagnosed with an STD does not mean that you are a bad or immoral person. STDs are caused by germs with which people can become infected while having sex. Some are curable; some are not. If you are diagnosed with an STD, you may want to evaluate your sexual practices and think about how to make yourself safer in the future. Being diagnosed with an STD causes many people to become more open in their discussion of STDs with new partners, and this frankness can lead to safer sexual relationships and, often, better relationships. It does not mean you can never have sex again, even if you are diagnosed with a chronic STD. You may need to take more precautions, but for most people it does not mean the end of their sex life.

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Prostate infection. Infection of the prostate (called prostatitis) can be either bacterial or nonbacterial in origin. Bacterial prostate infection can be acute or chronic, and it may cause a discharge from the urethra. There may also be pain between the scrotum and the anal area, frequent urination, pain with urination and ejaculation, and blood in the semen. Prostate infections may be caused by sexually transmitted bacteria or by other bacteria. A sexually transmitted urethral infection that is not promptly treated may progress to infection of the prostate.

Reiter’s syndrome. Reiter’s syndrome is a condition that can result after chlamydial infection or NGU or after certain intestinal infections. Men with Reiter’s syndrome complain of an inflamed urethra, discharge, and burning with urination, as well as joint pain and inflammation of the conjunctiva of the eyes. Symptoms usually start one to four weeks after the infection that triggered the advent of Reiter’s syndrome, whether or not the infection was treated.

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Should we be doing what thousands of people around the world do every morning when they wake up? They rise and swallow what some call the greatest anti-ageing pill of the century.

This small pill offers some protection from heart attacks, thrombosis, colon cancer and, perhaps, prostate cancer and stroke. It may also offer some protection against diabetes and gastric cancer and provide relief from pain, sore joints and even a hangover.

This small pill is not only cheap, but it is also available over the counter.

It is the humble aspirin.

More than 100 billion aspirins are taken worldwide every year, and since it was first commercially produced in the 1890s, the success of aspirin has been unrivalled.

It had a few knocks along the way, endured occasional patches of bad publicity and was a little thrown by the development of competitors such as paracetamol and ibuprofen, but it survived and today is almost the gold standard for medicines.

Aspirin, however, has a dark side. In high doses it has been linked to gastrointestinal ulcers, cerebral haemorrhages and ringing in the ears. It can be harmful to asthmatics and has been associated with an increased incidence of some cataracts.

The drug’s manufacturers warn healthy people against taking a pill every day, just to be on the safe side. Yet some doctors not only recommend taking aspirin daily but take it themselves. Among middle-aged people there is already a trend towards taking an aspirin a day.

Is it safe? For certain groups of men it probably is. Those who stand to benefit most are those who have already had a heart attack, a mini-stroke or a full stroke or are at high risk of these events. A daily aspirin can reduce the likelihood of a second of these events by 25 to 30 per cent. Given that aspirin is so cheap and available, this is a most respectable benefit.

Reputable studies have shown that if those men who have no cardiovascular symptoms take an aspirin a day it will offer them marginal protection against an event. It does however, increase their chance of having a cerebral haemorrhage (a bleed into the brain).

Aspirin makes the platelets in the blood less sticky and less able to form clots. Normally when a blood vessel is damaged platelets rush to the area, combine with other blood components to form a plug and release substances to encourage the wall of the vessel to contract.

If the platelets have lost their stickiness, they cannot do this efficiently. It takes a week for them to regain stickiness.

Some groups of men should not even think of taking a daily aspirin without their doctor’s permission. Among these is anyone with a history of ulcers or abnormal kidney function, anyone suffering from a bleeding disorder or asthma and anyone with high uncontrolled blood pressure.

It used to be thought that aspirin protected against cataracts but a large study in the Blue Mountains in New South Wales found the contrary to be true. It found that people who used aspirin for 10 years or more had a higher prevalence of posterior subcapsular cataracts than nonusers and short-term users.

However, doctors warned people that the benefit of aspirin to those at risk of a cardiovascular event outweighed the risk of cataracts. Compared to a stroke or heart attack, a cataract is a minor problem that can be successfully treated with surgery in 99 per cent of cases.

When trying to decide whether or not to take aspirin, the risk-benefit ratio must always be analysed. Consider, for example, the drug’s effects on the gastrointestinal tract. In the long term, aspirin has been shown to be protective against colon cancer. Some studies say that people who take aspirin regularly have a 40 per cent lower risk of developing this cancer than the general population. One study of women who took aspirin for more than 20 years put the risk reduction at 50 per cent.

But aspirin causes damage higher up the tract. It can corrode the lining of the stomach, which often leads to slight blood loss. It can also aggravate existing ulcers.

Taken daily, aspirin can lead to the formation of ulcers and complications such as internal bleeding and perforation. Even small doses can hurt. To try to overcome this, a specially coated pill has been manufactured to prevent the aspirin being released in the stomach. It passes through and is released lower down the intestines where it is absorbed gradually into the bloodstream. Despite this the aspirin can still reach the stomach.

The risk of adverse effects from aspirin depends on the dose: the smaller the daily dose, the smaller the risk of problems. In clinical trials before 1985, enormous doses of 500 mg to 1500 mg a day were evaluated. Today it is known that the cardiovascular benefit can be achieved with doses of 75 mg to 150 mg daily. This is best achieved by taking either a single 100-mg tablet or half a 300-mg. If cost is not a consideration, the best option is a low-dose coated pill.

Aspirin keeps on turning new tricks. It has been the miracle drug of the century and shows no sign ofletting up. It is claimed that one scientific paper on aspirin is published somewhere in the world every 2 hours.

If you are a cautious soul and don’t want to risk an aspirin a day, you could try wearing them instead. In the 1980s, Burmese mountain people were seen wearing chains of neatly threaded aspirins around their necks as amulets against pain and disease -surely that can’t hurt.

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Take a pen to the simple questions at the end of this section. If you tick one or more boxes, you should ask for a blood-sugar test next time you see your doctor; you may be among the 350 000 Australians our health authorities are trying to trace.

This staggering number of people are happily going through their days, quietly nurturing a lifestyle disease called diabetes type II. While some have no obvious symptoms, many have symptoms they mistakenly accept as a natural part of ageing. Fatigue is a common one, as is passing urine more frequently than normal, which can, in turn, lead to a constant thirst.

Blurred vision, dizziness, recurrent skin infections that are slow to heal and erectile difficulties are also common in people with diabetes type II. The authorities are extremely keen to identify such people because, by controlling this disease, they can save individuals untold misery and the health budget billions.

Diabetes type II used to be called mature-onset diabetes because it showed up in people past the age of 40. Sadly, it is now appearing a decade earlier, particularly in high-risk groups such as our indigenous people, Pacific Islanders and people from Asia.

Once a person has diabetes type II, they have it forever. There is no cure.

It is different from type I, which is less common but equally serious; type I is usually diagnosed during childhood and must be treated with insulin injections if the sufferer is to survive.

The problem with diabetes type II is that you only know you’ve got it when it is already causing damage. The earlier you find it the better. It is an extremely powerful force for premature ageing from the inside out. Once it takes hold, it can damage the arteries, cause early heart disease, compromise vision, lead to kidney failure and initiate deterioration in the nerves.

When advanced, it can lead to loss of limbs, heart failure and death. It is the sixth major cause of death by disease in Australia.

Diabetes type II is the world’s fastest-growing disease, and every 10 minutes someone in Australia is diagnosed with it. By the year 2010, more than 1.2 million Australians will have it.

While a diagnosis of diabetes can be devastating, it is best to take the blow now and stop it in its tracks. Recent research shows that proper treatment can reverse some of the complications and even prevent them occurring. Although there is no such thing as ‘mild’ diabetes, it can be controlled so that its effects are mild or even absent. Erectile problems may be alleviated by treatment.

Diabetes occurs when the amount of sugar in the blood is too high because the body is unable to use it properly. The body can’t effectively convert the sugar into energy, which is why those with the disease feel tired. Either too little of the hormone insulin is produced, or what is produced is inefficient. Insulin’s job is to regulate sugar.

This can happen because a person has been overweight for too long, has been sedentary for too long or has a genetic tendency that is unmasked by ageing and an unhealthy diet – particularly a diet rich in animal fat and refined sugar.

During pregnancy a foetus can also be ‘reprogrammed’ to increase its risk of diabetes in adult life.

Recently, a 36-year-old, inactive, unfit doctor wrote an amusing account of his own diagnosis of diabetes type II. He described his build as classic Neanderthal: ‘Meaty limbs, heavy shoulders and a stout pelvis topped by a sagging gut.’

Some years earlier he had developed headaches and begun waking up with a hangover. Even after he cut his alcohol consumption ‘to the bone’, hangovers persisted. Last summer, his energy levels slipped fast and he started getting dizzy spells. At the same time he noticed ants around the base of the toilet. ‘In lieu of thinking, I poisoned the nest,’ he wrote.

The ants were attracted by the high level of sugar in his urine. This is standard. Ants love sweet urine. Many a man who has relieved himself in the garden and later noticed a congregation of ants on the wet patch has gone on to be diagnosed with diabetes type II.

The doctor also noticed a faint odour reminiscent of apple brandy exuding from his body. One hot night in February he realised he shouldn’t be passing so much urine. At his practice he tested himself and confirmed his fears. His blood sugar was sky high. His own general practitioner put him straight onto medication for diabetes and high blood pressure, which is commonly associated with diabetes.

With the identification of his nasty medical surprise, parts of his life suddenly made sense. He became aware of many symptoms because treatment resolved them suddenly. The acetone odour went away, but the vertigo and malaise remained.

He resolved that the disease wouldn’t have him. He wouldn’t, he said, sit on his behind like other diabetic patients, who console themselves with beer and chips and wait for the government’s help. He took charge and within 6 weeks had normalised his blood sugar and was beginning to feel his energy levels climbing. Apart from medication, this condition can be managed by eating simple, healthy food and exercising. Exercise helps the body’s insulin work better, not only during the activity, but also for 12 to 24 hours afterwards.

Management is a life-long commitment and includes regular testing of sugar levels. As the invigorated Neanderthal doctor wrote, this experience taught him just ‘how sneaky chronic diseases can be’.

TEST YOURSELF

Are you older than 50?

Are you overweight?

Do any of your close blood relatives have diabetes?

Do you belong to an ethnic group that has a high risk of diabetes (e.g. are you Aboriginal, Chinese, Indian, Maltese or Polynesian)?

Have you had any of the following symptoms on a regular basis:

severe thirst?

frequent urination?

unexplained weight loss?

blurred vision?

extreme tiredness?

* Test from Melbourne’s International Diabetes Institute.

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You know that rosy glow of new romance, that swirling euphoria of being in love, that period of intense passion? Well, it’s got a new name: in popular American psychology circles they call it ‘limerance’ and are identifying people who are addicted to it.

These so-called ‘limerance junkies’ go from relationship to relationship seeking the perfect partner and are unable to settle down into anything lasting and committed. They are hooked on the bliss of obsessive infatuation and with each new person delude themselves that it is real love.

Age is no impediment for those who seek these fabulous feelings of early romance, and extramarital limerance is rife. Sadly, for all players limerance is always a time-limited experience. Typically, the limerant male is not interested in food or sleep: he can stay up all night talking and yet be full of energy the next day. He feels 20 years younger and is euphoric, and emotionally, his feet don’t touch the ground.

The main desire during limerance is to merge. Interest is completely focused on the loved one, and all critical faculties are suspended. During limerance, men show only their best side, and their partners do the same. Nasty habits or difficult feelings are hidden away. Even if they do arise, they are dismissed as quaint or idiosyncratic. Behaviour that would normally offend is passed over in the glow.

Limerance is so powerful that it ensures conflict is avoided at all costs. If a beloved arrives late or forgets an arrangement, she is seen as adorably muddle-headed. If she leaves her clothes lying on the floor it is admirably bohemian.

Within about 6 to 12 months, however, limerance begins to fade. Then if she is late, he feels furious. The mess in the bedroom begins losing its charm. Differences in desire and sex drive become apparent and the real challenge is to find a balance. Typically, a couple struggling with the loss of limerance say that the very things that attracted them now drive them crazy.

She’ll say, ‘He was so laid-back and carefree. I come from a really stitched-up family, so I enjoyed his relaxed attitude. Now it irritates me. He never takes anything seriously.’

He’ll say, ‘I’m not so sure I like the way she wants everything organised all the time. She’s so tidy and particular it gets on my nerves.’

Although limerance is a period of heightened arousal and obsession, it can also be a time of considerable anxiety. The limerant man is very anxious to please, to make an impression and to be adored, but he has to cope with unpredictable elements. He wants the experience to be marvellous but he is not sure how to make it happen or how to make it last.

For some men, this anxiety is a spur. It arouses and excites them. For others its impact is negative and adversely affects their performance. The ‘high’ of limerance is said to be due to the release of arousing brain chemicals. These ‘feelgood’ neurotransmitters include acetylcholine, which produces an amphetamine-like rush; dopamine, which induces a feeling of wellbeing; noradrenaline, which brings on feelings of pleasure, joy and the ability to conquer the world; phenylethylamine, which creates heightened excitement; and serotonin, which maintains a generalised feeling of emotional security.

The altered state induced by this intoxicating chemical mix is often mistaken for love. It may just be a biological mechanism to get two people together: in reproductive terms it lasts long enough for the woman to become impregnated and perhaps for a baby to be born. Then the man can be off again, to ensure the diversity of the species.

Limerance can last weeks, months or a year. If obstructions are placed in the way of the lovers, it can last even longer. Extramarital limerance can endure for years as long as the straying couple don’t spend too much time together.

As it fades, the partners begin to reveal their real selves. They are tired of being flexible and patient and little arguments and irritations begin to erupt. Conflict is inevitable in any relationship, and real love can only begin when limerance begins to die off.

When this happens, the couple becomes aware of discrepancies in their previously perfect sexual compatibility. A mismatch of desire may emerge as sexual activity drops down to its normal level.

Take this piece of advice on sex from a baseball coach to his team: ‘If you put a bean in a jar every time you make love during your first year of marriage, and take a bean out every time you make love in the years that follow, don’t be surprised if you still have beans left in your jar a few years down the track!’

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Give or take a week, something happens to human eyes when they reach the age of 43,5. It happens without warning and affects most normal eyes in Australia. Suddenly, people who have been able to read without glasses all their life find themselves struggling to see small print. They’ll be in the car and be unable to read the names in the street directory or they’ll be in a restaurant and have to concentrate hard to see what’s on the menu.

Instead of holding a book at a comfortable distance, they notice they are now holding it at arm’s length and even then are finding it hard to read. They are commonly heard asking for more light, and they find it especially hard to focus close up when they are tired: a tired body means tired eyes, which are too weary to take on the extra strain of reading small print.

The 40s is the spectacle decade. Most people who have avoided wearing glasses for reading now find themselves buying a pair off the shelf at the newsagent or booking themselves in for an eye test.

While this vision change is a perfectly natural part of the ageing process, some people can stave it off for a few years. Ultimately, however, it will happen to them too. Relaxed and rested on holiday, they might find they can read the morning newspaper on the beach without glasses, but once they get out of the bright light, it may not be so easy.

Some ophthalmologists say this phenomenon uncannily kicks in at 43,5. It’s called presbyopia, from the Latin for ‘old sight’, and is part of a process that usually begins in the third decade of life.

In this process the crystalline lens, which sits just behind the pupil in the eye, gradually becomes less flexible. This lens is responsible for adjusting the focus from a distant point to a near point. Tiny little muscles push and pull on this lens to adjust its curvature and make it refocus in a process known as accommodation.

Children have an excellent capacity for accommodation even if they are long-sighted. Their lenses are fluid and highly flexible and the muscles in their eyes are strong.

With age, the lens inevitably hardens and muscles eventually become fatigued. By the time a lens reaches its 40s, it is harder and muscles have to do extra work to make it accommodate, although it can still provide good distance vision.

People’s lenses continue to harden until they are in their late 60s. As hardening progresses, stronger and stronger glasses are required to compensate for it. By the age of 70, the process has stabilised as no more accommodation is possible.

In their 70s and 80s, some people experience what looks like a reversal in this process. They begin to realise they can read without their glasses. Often adult children remark on how odd it is that, after depending on spectacles for 25 to 30 years, their mother now has better sight and is able to sew and read without them. Unfortunately, this usually means the mother is developing cataracts that will eventually have to be removed.

Some eye doctors say one of the best measures of body ageing is the person’s ability to focus. By measuring how much focusing power is lost, they believe they can tell how well the person has aged.

If I have a 70-year-old patient who looks 60, I will try and treat them as if they were 60. Vision is linked to general health,’ says one ophthalmologist.

When they hit their 40s many people resist getting glasses in the incorrect belief that the glasses will make their eyes lazy and lead to further deterioration. While there is no reason to rush to get spectacles, there is little point delaying too long.

Eventually, they will need help with reading. There are alternatives for those who don’t want to wear glasses for personal reasons. While research into a laser option continues apace, there are the options of bifocal contact lenses and monovision.

Bifocal contact lenses are specially weighted at their base so they hold their position in the eye and are correctly placed for reading.

With monovision, vision is corrected in one eye only. Although they are usually unaware of it, most people have one dominant eye. To create monovision, the nondominant eye is identified, and a contact lens is placed on it to give it reading vision. This eye then becomes blurred for distance vision. The person then uses the dominant eye for general vision and getting about in the world and the nondominant eye for reading. The price for this is the loss of binocular vision, which can only occur when both eyes work together.

Some people can’t tolerate different vision in both eyes and some grow used to it and find it effective. Several well-known public figures who prefer not to wear glasses for vanity opt for monovision.

There are laser centres that will modify one eye to create monovision. Some eye specialists don’t push this option because they believe it is better to have both eyes set for normal vision.

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By solving one problem crucial to men, modern medicine has inadvertently created a new problem for many women.

In the past 5 years, thousands of men have been able to regain their potency using one of a number of new treatments. Men who had resigned themselves to celibacy are suddenly ready to resume a full and healthy sex life.

While this development has thrilled many, it has caused numerous women anxiety and stress. They have felt unprepared for the change in intimacy. After years of sexual inactivity, suddenly their husbands have become potent again. Suddenly, sex is on the agenda. For women who have not experienced intercourse for some time and for women who have been through the menopause, this can be a daunting prospect.

A woman’s response to her partner being on treatment will often depend on how she finds out about it.

It is common for men who are planning to use treatment not to tell their partners. In some cases, their erectile difficulties are not physically induced but are related to their relationships, and they try the treatment as a ‘quick fix’. The problem with this approach is that the deeper issues are ignored.

Although treatment can be excellent, in some situations it can be destructive. There are documented cases in which treatment has exacerbated rather than solved relationship problems. It is understandable that a man might not want to disclose the fact that he is receiving treatment when he is at the beginning of a relationship. After 25 or 35 years of marriage, however, a man’s desire to hide from his wife the fact that he is receiving treatment may be an indication that the relationship is in real difficulty.

Men rarely seek advice about how women will cope with their new potency. It is something many of them don’t even consider.

Most men who use injections, for example, are 50 or over, and they find that with the injection their erection is much harder than it used to be and may last for up to an hour. For many women – especially older women – this may be too much. Being of a menopausal age, they have their own physiological issues to deal with and may be coping with a thinning of the vaginal membranes, dryness and low libido.

Recognising that both partners need to be prepared to recommence intercourse, the company that manufactures Caverject injections began supplying, on request, a free booklet for women whose partners used the product.

The booklet gives women detailed advice on how to cope with their partner’s new potency. It was produced because all the attention was on men and re-establishing their erections and no-one was focusing on how their partners would cope.

Injection therapy provides the possibility of ‘fast sex’, which just doesn’t work for women. With injections a man doesn’t need to be aroused. He can inject himself at any time and produce a robust erection. He doesn’t have to go through any build-up or arousal. Imagine where this leaves his partner.

The booklet recommends that intercourse be undertaken slowly and patiently. It also gives women a detailed description of how the injections work and an explicit account of how females become aroused.

The booklet explains that sexual inactivity can lead to a slowing of the arousal mechanism in women. Even 15 to 20 minutes of foreplay may not be sufficient to arouse a woman if she is anxious, overtired or under stress.

Anxiety can have a devastating effect on female arousal. With their husband all ready to go, many take even longer to become sexually involved. Couples planning to use treatment need a little practice to feel completely relaxed.

For comfortable intercourse at any age the woman needs to be in charge of the three Ps: pace, position and penetration of intercourse. She needs to help her partner by giving him feedback about the pace at which sexual activity proceeds, the most comfortable position for intercourse and the depth and type of penetration.

The older a woman is, the longer it takes for arousal to occur. Lubrication is diminished and takes longer to appear. She may need more stimulation to have an orgasm and find that her orgasms are not as strong as they used to be.

It is a good idea for men and women never to assume they know what their partner likes. Good lovers learn what turns their partners on by asking them, not by reading their minds.

While many women need advice on how to cope with the new potency, some need none at all. They are simply delighted at the restoration of an activity that can be so pleasurable and enriching.

One of the major reasons women go to menopause clinics is that they are experiencing difficulties with sex, such as pain, dryness or loss of libido. Previously, by the time they had been treated, their libido had returned and they were ready for sex, their ageing husbands were not up to it. Now they are!

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