Ишемическая болезнь сердца-Ischemic heart disease

The slowing of the sexual response with age may be good news. Many men find that it takes them longer to come so their partner can orgasm first, even if it’s a feat they rarely achieved in their younger days. Ruth, now in her sixties, says she experienced her first multiple orgasm in her fifties. ‘In our younger days I rarely managed an orgasm during intercourse at all. Now that Keith takes a bit longer it gives me time to relax and really enjoy it. I can have two orgasms before he’s had one!’ On that subject, some men over the age of thirty-five report that they have been able to develop the ability to have multiple orgasms.

Although it is less obvious than other effects, sperm production gradually declines with age but it doesn’t disappear altogether, and while testosterone levels fall gradually from your mid-fifties, there is not the sudden drop in hormone levels that women get. Even though it might not cause any sexual difficulties, men find their erections are less rigid. As you get older, you might find you need more active stimulation of the penis to get it up. This is not in itself a problem, unless a man’s partner has not previously taken an active role in lovemaking, like orally or manually stimulating him. The prospect of either partner changing their sexual techniques after years and years can be very daunting.

Experimentation can be a very foreign concept.

*149\17\9*

One of the most common sexual difficulties for women is not being able to reach orgasm — all of the time, or some of the time. Perspective is also important here. If you have been led to believe the myth that sexual success means an orgasm with every sexual encounter, then you will believe you have a problem if you fall short of the 100 percent. Anxiety to achieve an orgasm can be self-defeating because the more anxious you are, the less likely you are to get there. This is the female version of performance anxiety.

Sexual technique makes a big difference. It can be embarrassing to admit that you think your sexual skills might need some sharpening. Whenever you bring up the subject of improving sexual technique there are some who criticize the emphasis on performance. Now while I’ll be the first to admit that technique isn’t everything, there is a lot to be said for the elements of sensuality and tactile finesse. While some people are what you’d call ‘naturals’ much of this can be learned or at least improved upon. The ham-fisted jump on, do your thing and go to sleep approach is hardly the formula for a lifetime of mutual sexual bliss. Similarly, people who are sexually inhibited and self-conscious may never be able to relax enough to discover their sexual potential. Sensate focus exercises can help here too. So can some of the reputable sex manuals and self-help videos. It’s been interesting over the last few years to see these move from under the counter of the local bookstore or down in the dark, back corner of the video library to the front shelves. They can show you anything from communication skills to different arousal techniques and intercourse positions you might not have thought to try. Above all, they are often a great way to start conversations between partners about sexuality and give you the opportunity to find out aspects of each other’s attitudes and needs you may never have discussed.

A common theme in many of the letters I receive is the concern that the woman is not able to orgasm during penetration. Now this is perceived by the correspondents as a sexual problem. One typical letter said, ‘My wife and I have been married for nearly a year and we still have a lot to learn about sex. We are both worried that she cannot seem to have an orgasm when I have my penis inside her, no matter how long I can last. I figure I must be doing something wrong.’ Once it is pointed out that this is in fact the normal course of events, that many women usually need something else like stimulation of the genitals with their; partner’s fingers or mouth (before, during, after or instead of intercourse), or the ‘woman on top’ position, then it needn’t be seen as a problem. Mind you, some men find it difficult to accept that a penis is not an essential for a woman to be sexually satisfied.

*129\17\9*

Couples can run into problems if they feel uncomfortable talking about sex with each other. This makes it very hard to let each other know about anxieties and frustrations, and virtually impossible to work out what sorts of changes or alternatives to intercourse might suit you both for a while (like oral sex or manually stimulating each other without vaginal penetration). For many men and women a massage can be a satisfying way of sharing intimacy. If you can’t talk to each other about sex, it’s so easy for the messages to get mixed up and everyone gets their wires crossed. As an example, a new father who doesn’t know that his partner’s libido is likely to turn off for a while could easily interpret her lack of interest as a rejection, and withdraw from her emotionally. This sets up a vicious cycle as his partner interprets the withdrawal as lack of support. It’s also important to realize that sexual needs will change with time.

Even when the vagina has settled down, there are a number of factors that restrict our expression of sexuality after a baby arrives. The main ones are very obvious. The first thing most people will tell you is that they are just too tired. The demands of waking during the night, feeding every few hours, and ploughing through mounds of washing are simply exhausting. I think we sometimes underestimate the impact of pregnancy and delivery on a woman’s body functions, and the time it takes to recover. A colleague of mine had her third baby a few months ago. One morning recently we were talking about sex in general and fantasies in particular. She took a deep sigh and looked wistfully into the distance. ‘You know, right now my idea of the ultimate fantasy is to get into my pyjamas, slip in under the eiderdown … on my own … and go straight to sleep without a single interruption until morning.’ A few women I spoke to said that sex after dark was almost impossible for a while simply because they were so tired. ‘Sometimes it’s like there’s this conflict inside you. You go to bed and you think of the enjoyment you would get from sex versus the need your body has for sleep. Your body just says «There’s no argument, I’ll take the sleep!»

*108\17\9*

Some couples will choose to accept infertility and not have children. For others the need is so strong that they are prepared to do whatever it takes to overcome it, including fertility tests, operations and the prospect of repeated disappointments.

For these would-be parents it is absolutely essential to know exactly what they are in for before they make the decision to go ahead. That means understanding what the tests involve and how the whole process is likely to affect them both. All of the major fertility clinics have access to counselling services to help out with this. One of the issues that needs to be sorted out very early in counselling is whether one or both partners is secretly blaming the other for their inability to conceive. Whatever the cause, a conception of any sort needs to be a team effort. Harboring resentment against your partner for their ‘inadequacy’ will stand in the way of that. The other objective is to make sure that both partners have realistic expectations of success. It is not easy to strike a balance between optimism and caution when so much is at stake.

*88\17\9*

Sexual relationships generally go through predictable phases. There’s the initial exchange of signals of mutual attraction, the thrill of the chase, the ‘getting to know you’ phase of increasing emotional intimacy, the ‘it feels so good when he/she touches me and I think I’d like more’ phase and then the ‘will I or won’t I?’ phase. Nowadays this is often followed by the negotiation phase when subjects like safer sex, contraception and ground rules for the relationship are sorted out. After a while a state of familiarity develops. Somewhere along the way, one or both partners feel it’s time to make a commitment to the other person.

Of course some people have no problem with the decision at the time. Encouraged by a burning desire to spend every waking and sleeping moment with that one other person and an intoxicating awareness of being on the threshold of a sexual experience at the mere thought of their brand of toothpaste, it can be hard to imagine ever wanting to be with anyone else, or a compromise that would be too great.

Commitment means different things to different people but, technically speaking, it is a set of promises or obligations that restrict your freedom of action. Exactly what those restrictions are will vary from relationship to relationship and will evolve over time. They might include things like letting each other know where you will be each day, agreeing not to have sex with anybody else, referring to each other before accepting invitations, or sharing financial decisions. The obligations you place on each other will need to change as you both change, if you decide to live together, to buy a house, to have children.

*68\17\9*