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People seem to want and need to be close to others. As we grow older, many
of us also want to continue an active, satisfying sex life. But the aging
process may cause some changes.

What Are Normal Changes?

Normal aging brings physical changes in both men and women. These changes
affect one’s ability to have and enjoy sex with another person. Some
women enjoy sex more as they grow older. After menopause or a hysterectomy,
they may no longer fear an unwanted . They may feel freer to enjoy
sex.

Some women do not think things like gray hair and wrinkles make them less
attractive to their sexual partner. But if a woman believes that looking young
or being able to give birth makes her more feminine, she may begin to worry
about how desirable she is no matter what her age is. That might make sex less
for her.

A woman may notice changes in her vagina. As she ages, her vagina shortens
and narrows. The walls become thinner and also a little stiffer. These changes
do not mean she can’t enjoy having sex. However, most women will also have less
vaginal lubrication. This could affect sexual pleasure.

As men get older, impotence becomes more common. Impotence is the loss of
ability to have and keep an erection hard enough for sexual intercourse. By age
65, about 15 to 25% of men have this problem at least one out of every four
times they are having sex. This may happen in men with heart disease, high
blood pressure, or diabetes-either because of the disease or the medicines used
to treat it.

A man may find it takes longer to get an erection. His erection may not be
as firm or as large as it used to be. The amount of ejaculate may be smaller.
The loss of erection after orgasm may happen more quickly, or it may take
longer before an erection is again possible. Some men may find they need more
foreplay.

Many drugs can induce acute headache, including ,
antihypertensive agents (beta blockers, calcium channel blockers,
angiotensin-converting enzyme ACE inhibitors, and methyldopa), dipyridamole,
hydralazine, sildenafil, histamine receptor antagonists (e.g., cimetidine and
ranitidine), NSAIDs (especially indomethacin), cyclosporine, and antibiotics
(especially amphotericin, griseofulvin, tetracycline, and sulfonamides).

Drug-induced aseptic meningitis, a rare occurrence, has numerous possible
causes, including NSAIDs, antibiotics (e.g., ,
sulfasalazine, , ciprofloxacin, isoniazid, and penicillin),
intrathecal drugs and diagnostics (e.g., antineoplastic agents such as
methotrexate and cytarabine; gentamicin; corticosteroids; spinal anesthesia;
baclofen; repeated iophendylate for myelography; and radiolabeled albumin);
intraventricular chemotherapy; intravenous ; vaccines (polio;
measles, mumps, and rubella; and hepatitis B); and some other drugs, such as
, muromonab-CD3, and ranitidine.⁴³

The clinical presentation of drug-induced aseptic meningitis is the same as
that of viral meningitis. Cerebrospinal fluid findings are the same as those in
viral meningitis, except for a neutrophil predominance; however, in cases
induced by intravenous immunoglobulin, eosinophils are present.

Numerous other types of headache have been identified. The more common of
these are briefly discussed.

First or Worst and Thunderclap Headaches

The term first or worst refers to severe headache of a type the patient has
never experienced before, which may be the first episode of a primary headache
such as migraine or cluster or to the worst headache the patient has ever had,
which can be caused by numerous primary and secondary
disorders.⁵

Headache in Subarachnoid Hemorrhage

Headache is present in 90% of cases of subarachnoid hemorrhage
(SAH).⁶² The classic headache is sudden, severe, and continuous,
often with nausea, vomiting, meningismus, focal neurologic findings, and loss
of consciousness.

Thunderclap Headache

A sudden severe headache with maximal onset within 1 minute without evidence
of SAH is termed a headache.⁶³ A small percentage of
patients with thunderclap headache will have aneurysms, cerebral
vasospasm, cerebral venous thrombosis, carotid artery or vertebral artery
, pituitary apoplexy, occipital neuralgia, and possibly Erve virus.
Most cases of thunderclap headache are primary disorders: benign thunderclap
headache, so-called crash migraine, and benign orgasmic headache.

People seem to want and need to be close to others. As we grow older, many
of us also want to continue an active, sex life. But the aging
process may cause some changes.

What Are Normal Changes?

Normal aging brings physical changes in both men and women. These changes
affect one’s ability to have and enjoy sex with another person. Some
women enjoy sex more as they grow older. After menopause or a hysterectomy,
they may no longer fear an unwanted pregnancy. They may feel freer to enjoy
sex.

Some women do not think things like gray hair and wrinkles make them less
attractive to their sexual partner. But if a woman believes that looking young
or being able to give birth makes her more feminine, she may begin to worry
about how she is no matter what her age is. That might make sex less
enjoyable for her.

A woman may notice changes in her vagina. As she ages, her vagina shortens
and narrows. The walls become thinner and also a little stiffer. These changes
do not mean she can’t enjoy having sex. However, most women will also have less
vaginal lubrication. This could affect sexual pleasure.

As men get older, impotence becomes more common. Impotence is the loss of
ability to have and keep an erection hard enough for sexual intercourse. By age
65, about 15 to 25% of men have this problem at least one out of every four
times they are having sex. This may happen in men with heart disease, high
blood pressure, or diabetes-either because of the disease or the medicines used
to treat it.

A man may find it takes longer to get an erection. His erection may not be
as firm or as large as it used to be. The amount of ejaculate may be smaller.
The loss of erection after orgasm may happen more quickly, or it may take
longer before an erection is again possible. Some men may find they need more
foreplay.

As a who has counseled heart patients for more than thirty
years, Wayne Sotile, PhD, knows exactly how much they worry about sex after a
heart attack.

And if theyre not anxious, believe me, their partners anxious, he
says.

Couples worry about triggering a second heart attack, or even that a patient
could die in the bedroom. But Sotile and cardiologists tell WebMD that
sex isnt nearly as risky as many patients believe. With a touch of
, heart patients can once again enjoy sex after a heart attack.

Why Fear Sex After a Heart Attack?

While fears of another heart attack or dying are common, patients have also
told Sotile that theyre afraid of their partner if they die
during sex. As director of services for the Wake Forest
University Healthy Exercise and Lifestyle Programs, Sotile is also a special
consultant in behavioral health for the Center for Cardiovascular Health at
Carolinas Medical Center in Charlotte, North Carolina.

Female patients have told Nieca Goldberg, MD, a cardiologist and chief of
Womens Cardiac Care at Lenox Hill Hospital in New York City, about concerns
about increased heart rate and sweating during sex after a heart attack. They
fear triggering heart attack symptoms.

According to Goldberg, depression also sidelines many patients, especially
women.

Women have higher rates of depression after their heart attacks, she
says.

Men are also prone to problems that cause them to put sex on the back
burner. Randal Thomas, MD, a preventive cardiologist and director of the
Cardiovascular Health Clinic at the Mayo Clinic, says, A persons life is
essentially thrown upside-down. They see their frailty and how close they came
to dying, and it can lead to a lot of psychological issues and need for
recuperation.

Some patients give up sex after a heart attack, and theyre too embarrassed
to talk to their doctor about it. Goldberg encourages you to bring
up the subject if your doctor doesnt.

Your doctor should talk to you about sex. With all the high-tech procedures
that we do for people to get them back into the community, I also think that we
have to ensure them a high quality of life, and sexual activity is part of
that.

When Can You Resume Sex After a Heart Attack?

Most people can safely resume sexual activity a couple of weeks after a
heart attack, if they have no serious , cardiologists say.

In fact, the chance of another heart attack during sex is so low that its
not worth worrying about, says James E. Muller, MD, a researcher who published
a 2000 study, Triggering of Cardiac Events by Sexual Activity, in the
American Journal of Cardiology.

The absolute risk is very low and should not be a consideration for those
with stable coronary disease, he says.

Sex is generally physical activity, and some doctors have even said its
the equivalent of walking up a flight of steps, Goldberg says. Its not as
vigorous an activity as some people perceive.

Patients may not even need an exercise stress test first to check how much
physical activity their heart can handle according to Thomas. In general,
patients can resume sex after a heart attack if they are able to walk a couple
of flights of stairs, if theyre able to walk on a treadmill, or do
moderate-intensity activity without any chest discomfort or without any severe
shortness of breath, says Thomas.

Sex after a heart attack is safe even after successful bypass surgery or
angioplasty in which stents are placed inside arteries to keep them open,
according to Goldberg. However, bypass patients may need additional time to
recover from their surgical wounds.

Certain high-risk patients do need to be more cautious, however. If theyve
developed complications from a heart attack–for example, heart failure or
dangerous heart rhythms that make them prone to heart attack, cardiac arrest,
or faintingthey may need additional treatment. Until these treatments work to
reduce their cardiac risk, they should ask their doctor when it will be safe to
resume sexual activity.

The TV commercials make it all seem so simple: He can’t get an erection so
he pops a pill. The next thing you know, his partner is cooing about how her
guy is back to his old wild and romantic self.

What the commercials don’t show you: The painful distress a woman can
experience when her man suffers with erectile dysfunction (ED).

“Women internalize things — they tend to blame themselves first,
thinking it’s because they have done something wrong, or that they are no
longer attractive to their partner. In fact, the first thing a woman thinks
when a man can’t get an erection is that it’s her fault, and nothing could be
further from the truth,” says Andrew McCullough, MD, director of sexual
health and male infertility at NYU Medical Center in New York City.

ED, or erectile dysfunction, is medically defined as the inability to
achieve or sustain an erection long enough for sexual intercourse. Virtually
all men experience some erection failures at certain points in their lives. It
can be the result of stress, depression, or sometimes even for no reason at
all. For some, the problem becomes chronic. When it does, a diagnosis of ED is
made. According to the American Foundation for Urologic Disease, it’s a problem
that affects about 18 million men in the U.S. alone.

Although many women — and men as well — continue to view ED as a sexual
issue, in truth, the most common causes are undiagnosed physical conditions
such as diabetes, high cholesterol, or even the earliest stages of heart
disease. Even more often, it can be the result of certain used to
treat these conditions, particularly some high blood pressure drugs.

Unfortunately, experts say a lack of education about the causes of ED are
frequently behind a woman’s self-blame, as well as her increasing anxiety, and
sometimes, even feelings of hurt and anger when the problem occurs.

“Most women usually start with a line of questioning that often has some
anxiety or hurt to it. She may suspect her partner is having an affair, or that
he just doesn’t find her desirable anymore, so she begins to hint around at
these ,” says Sallie Foley, MSW, a professor at the graduate
school of social work at the University of Michigan and co-author of Sex
Matters For Women.

Often, says Foley, a man suffering with ED will interpret her questions –
and her hurtful attitude — as an attack on him, so he pulls back.

“She then this pulling back as a that she
has done something wrong, and so she retreats even further,” says
Foley. As she does, increasing levels of anxiety or depression can set in,
along with suspicions about what’s going on with him, as well as a continued
belief that there is something wrong with her.

The end result: The couple can stop communicating altogether — not only in
the bedroom, but in all aspects of their relationship. And that, say experts,
can only make problems worse for both partners.

“The one thing a woman should never do is withdraw because that is a
formula for relationship disaster,” says McCullough. When one partner pulls
away, he says, the other withdraws as well, and “this kind of dance goes on
where you stop touching each other, then you stop talking, and before you know
it you are not communicating at all.”