For a start it is controversial whether high cholesterol is a problem in people over 70 years of age. A study called “Cholesterol and mortality: 30 years of follow-up from the Framingham study” was published in the Journal of the American Medical Association in 1987. Cholesterol levels were measured in 1959 men and 2415 women aged between 31 and 65 years of age, who were free of cardiovascular disease and cancer. You may be shocked to know that the study showed there was no increased death rate in people with high cholesterol over the age of 50. So if you make it to 50 years of age, you are not more likely to die of a heart attack if you have high cholesterol than people who have normal or low cholesterol, according to this study. In the study there was a direct association between low levels of cholesterol and increased death.

Researchers at the San Diego School of Medicine found that high cholesterol in people over 75 years of age is protective, instead of harmful. They also stated that low cholesterol is a risk factor for heart arrhythmias, or heart rhythm irregularities. A study in the European Heart Journal recruited 595 people with coronary heart disease who had a total cholesterol level of 4.1mmol/L or less; they were compared with a group of 10 968 people with heart disease who had a cholesterol level above 4.1mmol/L. The study found that the risk of cardiac death was the same in both groups. Therefore, there was no protective benefit to having a low cholesterol level. The study found that “the most frequent cause of non-cardiac death associated with low total cholesterol was cancer”. What is the point of worrying about getting your cholesterol down when it won’t help you to live any longer? Elderly patients are more susceptible to side effects caused by statin drugs. One reason for this is that older people are more likely to take several medications, making drug interactions more likely to happen. Statin induced muscle soreness (myopathy) is more common as we get older, the more other medications we take, the more other diseases we have, and during postoperative periods. All of these factors are more prevalent in the elderly. Muscle pain makes people less likely to exercise; therefore they miss out on the cardiovascular benefits it provides.

Statins without a prescription

In 2004 a low dose version of the cholesterol lowering drug Zocor became available without a prescription in the UK. The theory behind this move was to make statins more widely available to the public, in order to prevent heart disease in at risk individuals. Dr John Reckless, chairman of Heart UK believes statins are safer than aspirin, and “rather more people do need statins than are currently getting them”.

Statins can of course have serious side effects, and this move will place an unnecessarily high number of people at risk. They should never be used by pregnant women because they can cause limb defects. Professor Tom Sanders is a nutritionist at King’s College, London, and nutrition director for Heart UK. According to Professor Sanders, “At the age of 40, your risk of having a heart attack is below one in 1, 000, so any reduction is really quite miniscule in terms of benefit”. Unfortunately, being able to buy Zocor over the counter reinforces the idea that we can eat what we like and never exercise, and a pill will undo the damage.

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There is evidence that the quality of marriage for the woman may improve after vasectomy (Adler, Cook, Gray et al., 1981). On the other hand, there is a measurable regret for some men which leads to requests for reversal (Howard, 1982).

Mr G. is a fireman and one of those men who described his vasectomy as a ’small job’. He then reassured himself by saying it was a difficult part of life at last put behind them and that they could relax. Sex was the same and the family complete. The doctor felt a strong hint that discussion of the matter should now be completed, and it was for the time being. Later Mr G. relaxed and was able to say how much more time he had at home, particularly because ‘we don’t seem to need so much sex now, and anyway the children need so much of our time’. Some time later the discussion returned to contraception. ‘Did it take long to decide about a vasectomy?’ ‘No. She said . . . . , well, we agreed that I would do my bit, and it didn’t matter who was done.’ There was a long silence. ‘I wonder if your wife would have decided so quickly about being sterilized herself?’ After a pause he replied, ‘You know, in a way, I thought more about it afterwards. It took me several months to get used to it. At first I thought I was bound to go off sex, but it is no good getting cross about it.’ Mr G. became visibly upset, and it was necessary to arrange a follow-up consultation later, which had a satisfactory outcome.

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They had tried on so many occasions but her husband’s penis just would not go in.

The doctor was able to do a smear quite easily, probably because there had been some introital stretching with their attempts at intercourse, and she tried to reassure her that there did not appear to be a physical block in her vagina. However, she felt that more time was needed to explore this woman’s difficulties, and she referred her to a special psychosexual clinic.

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• Be warm, friendly and physical towards your lover. Let him know you want to hug, kiss and cuddle him—but that you don’t expect intercourse now.

• Tell him that you want him to hold you, that you need him. Communicate directly, but gently. You might say, for example, “I want to be close to you. Please touch me. I don’t need you to use your penis, I just want us to lie here together and be close.”

• Do not tell your lover that intercourse doesn’t matter. If he believes you, he may question just how much you liked intercourse before. And if he doesn’t believe you, he’ll say to himself, “She thinks I’m so fragile that she can’t tell me the truth anymore,”

• Sometimes a couple unconsciously gets into arguments so they’ll be angry and won’t want to have sex. Try to avoid this self-defeating trap, and if you think your partner is falling into it, point it out.

• Don’t assign blame for the problem. Don’t say, “Ifs your problem, you fix it.” Remember, the problem affects both of you. And the solution needs to come from both of you, too.

Oversympathetic Response

Women whose husbands suffer potency problems may develop sexual problems themselves. Of 151 such women, more than 60 percent reported sexual problems in a study done at Loyola University’s Sex Clinic. Only 8 percent of these women reported that their sexual problem developed before their husband’s. The author, Domeena C. Renshaw, M.D., notes that most of the men had an erection problem for anywhere from two years to as much as a decade before they went for help. Early treatment of an erection difficulty may prevent many women from developing sexual problems of their own.

Most of the women did not blame their husbands for the sexual problems. They were, says Dr. Renshaw, “supportive, sensitive and concerned.”

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Now recognized as a crucial ingredient in sexual arousal, dopamine is ultimately responsible for evaluating the many sensory stimuli you encounter in the course of the day. As that information—which is comprised of what you see, hear, smell, taste, and touch—is perceived by your brain, the dopamine system rewards you with heightened sensory states.

Nestled deep in the brain stem, dopamine is the so-called pleasure chemical messenger that makes us feel good. However, the brain is very stingy with dopamine, only releasing it from its cells for brief moments. When the neurochemical is discharged, it plugs keyholes, called receptors, on other cells. Once it has done this, dopamine is picked up by transporters and is stored and conserved for future use. Normally, the release of dopamine is pulsed on and off as needed. But, in some men, the discharge of this brain chemical is less frequent than it is in others. When this happens, the man is said to have a low libido. In other words, he just doesn’t seem very interested in having sex.

Serotonin has a different role. A calming neurotransmitter, it has a significant effect on mood, aggression levels, what foods we crave, and how much of them we eat. Too little of this chemical can result in sleep disorders, rage, and food binges. Too much, however, isn’t good either —it can have a decidedly negative effect on your sexuality. As we saw in Chapter 8, drugs which promote the release of serotonin can cause a decrease in sexual desire.

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A recent study of fifty thousand men aged forty to seventy-five found a 39 percent decrease in heart disease risk in those who took at least 100 IU of vitamin E daily. This showed that the substance works to prevent build-up of fatty deposits (plaque) on arterial walls. The same deposits can decrease blood flow to the penis.

Another study, from the University of Texas Southwestern Medical Center in Dallas, divided forty-eight men into six random groups. They were given either a placebo or vitamin E capsules in dosages of 60, 200, 400, 800, and 1,200 IU daily for eight weeks. Blood cholesterol levels were checked before and after the study. Those men who took 400 IU had substantially less oxidation of LDLs—and therefore less likelihood of it sticking to artery walls—than that of any other group.

Studies also show that it is necessary to use supplements in order to get the full benefit of vitamin E, since it’s impossible to get adequate quantities from food alone. The RDA is currently 10 mg for men and 8 mg for women—enough to prevent a deficiency, but hardly sufficient to provide full antioxidant protection. Most of my patients who adhere to low-fat, heart-healthy diets never take in enough of the supplement through diet alone. That’s because it’s found primarily in high-fat foods like nuts, seeds, vegetable oils, and mayonnaise.

The best way to ensure that you’re getting enough E daily for penile protection is with a supplement of at least 400 W (one milligram equals 0.91 IU). But since high doses of the vitamin may interfere with the clotting ability of the blood, check with your physician first if you are taking blood-thinning medication.

A powerful antioxidant that not only prevents damage on a cellular level, vitamin C can also reverse free radical injury. Researchers have long noted the critical role that this substance plays in the prevention of atherosclerosis, once again helping both the heart and the penis. It does so by reducing both cholesterol and fat levels and increasing the permeability, as well as the strength of, all capillaries, the smallest blood vessels in the body.

In addition, research points to a much lower death rate among men who take vitamin C supplements compared to those who took in adequate dietary amounts but no additional supplementation. One study, at the University of California at Los Angeles, observed the correlation between vitamin C intake and death rates of more than eleven thousand people. As a group, the more vitamin C the men consumed, the fewer deaths they suffered—particularly from heart disease. Another large study at UCLA demonstrated that men who took 300 to 400 mg of vitamin C daily had 15 percent fewer deaths from heart conditions, and lived six years longer than those who didn’t.

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Sandy’s reaction was based on her own narcissism; she fully expected a peer to have as much control over his own body as she did hers. When I informed her about the new oral medications for ED, she was skeptical. “I don’t see how that can change anything for us,” she stated emphatically. “He needs help, but I’m not going to be the one to tell him where to get it. I’m sorry to sound so unsympathetic about it, but now he’s not so appealing to me. It’s like all those muscles he’s been building are fake.”

Then there is the perspective of Angela, a thirty-three-year-old whose six-month relationship with Pete was marked by his ED right from the start. “I know it might sound odd,” she told me, “but Pete’s condition didn’t bother me that much; in fact, it drew me to him. I felt sorry for him and I was happy to be sympathetic. And despite his problem, he did everything he could to satisfy me sexually. I mean, it was a good situation for me—and he certainly didn’t seem to mind. But now that this pill is available I’m uncomfortable. I don’t want to change what we have.”

In this case, Angela’s narcissism is fed through her role of caretaker. It’s not surprising that she feels threatened by something that can supplant that role and remove her position as sexual superior.

Single women, whether they are just beginning a new relationship or have been seeing a man for a while, should be aware of the new medications. While it’s probable that ED has not yet touched their lives, it’s just as likely that, at some point, it will. But at the same time, they need to take a look inside and ask themselves what they really want from a relationship.

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