Archive for March, 2013

Sexual Health at 40

March 3rd, 2013 No comments

Sexual Health at 40.

Is growing older a process of stress and sexual decline or of being stress free and being sexually active? Aging and stress, stress and aging — these two human conditions, when paired, can profoundly affect the quality of life.

Genetic basis of Aging and Neurodegeneration:

When events go awry, molecular processes take place that, over time, can lead to neurodegenerative disease. At the root of the problem is a fundamental process: protein folding. Since proteins are the predominant products of gene expression and provide much of the shape and functionality of the cell, their proper synthesis, folding, assembly, translocation, and clearance are essential for the health of the cell and the organism. When proteins misfold, they can acquire alternative proteotoxic  states that seed a cascade of deleterious molecular events resulting in cellular dysfunction. When these events occur in neurons, the consequences can be devastating. Alzheimer’s disease, Parkinson’s disease, amyotrophic lateral sclerosis, Huntington’s disease, and other neuropathies involve the cytopathological appearance of intracellular and extracellular protein aggregates in the brains of affected persons. It is increasingly clear that the relevant event in these neurodegenerative diseases is a toxic gain-of-function mutation associated with the appearance of oligomers and other toxic aggregates consisting of the ?-amyloid peptide, ?-synuclein, superoxide dismutase, and huntingtin, respectively. The way in which these toxic species form, the processes that determine their persistence or clearance, and the molecular basis of their toxicity are critical to the mechanisms of these diseases.

Cohen et all in a land mark study  proved that The association between the life span and the cellular stress response is suggested by the insulin-signaling pathway’s requirement for heat-shock factor 1 (HSF-1), the activator of the heat-shock response that induces the expression of molecular chaperones (a large class of proteins that assist in protein folding  and thus guard against misfolding) during stress. Consequently, the inhibition of HSF-1 function also increases polyglutamine aggregation, resulting in toxic effects that decrease the life span of  C.elegans. Conversely, overexpression of HSF-1 suppresses polyglutamine-mediated toxicity and extends the life span. Collectively, these observations provide support for the hypothesis  that graceful aging depends on the cell’s ability to counter the effects of stress by maintaining protein folding, which in turn permits appropriate protein function.

Cohen et al, showed that activation of the insulin-signaling pathway suppresses the toxicity of aggregates Of amyloid  ß, a peptide formed in the  neuronal tissues.


These investigations  showed that in suppressing the toxicity of aggregates, the insulin-signaling  pathway  activates   two

downstream pathways, both of which affect the fate of an aggregation-prone protein. Each pathway is triggered by a transcription factor: HSF-1 or abnormal dauer formation 16 (DAF-16).  The authors  showed that HSF-1 promotes disaggregation by elevating the levels of protective molecular chaperones, whereas DAF-16 enhances the formation of

large, inert aggregates from toxic oligomers.



 A Model of Age-Related Protection against Proteotoxicity.

The insulin-signaling pathway is triggered in C. elegans by a receptor called DAF-2. It has a profound effect on aging — a mutation of  daf2 can result in a doubling of the life span of this organism, and similar results have been observed in mice. DAF-2 represses two downstream pathways: one is commandeered by the transcription factor HSF-1 and the other by the

Transcription factor DAF-16. (Transcription factors are proteins that “turn on” specific  genes.) A recent study by Cohen  et al. shows that both HSF-1 and DAF-16 provide protection against proteotoxicity of the amyloid ß  peptide, an aggregation-prone peptide that can spontaneously form small toxic aggregates. The default pathway, regulated by HSF-1, identifies and breaks apart toxic aggregates. When the HSF-1 machinery is overloaded, however, a molecular apparatus regulated by DAF-16 grinds into gear, resulting in the formation of less toxic high-molecular-weight aggregates.


Psychological impact  of Aging and Sexual Health

Masters and Johnson  proved that the loss of sexuality is not an inevitable aspect of aging, and the majority of healthy people remain sexually active on a regular basis until advanced old age. However, the aging process does bring with it certain changes in the physiology of the male and the female sexual response, and these along with a number of medical problems that become more prevalent in the mature years, play a significant role in the pathogenesis of the sexual disorders of the elderly. The typical patient over 40 has only a partial degree of biological impairment, which has, however, been escalated into a total sexual disability by a variety of cultural, intrapsychic, and relationship stressors. Fortunately, these problems are frequently amenable to an integrated psychodynamically oriented sex therapy approach that emphasizes the improvement of the couple’s intimacy, and the expansion of their sexual flexibility

Endogenous Sex Hormones and Metabolic Syndrome

in Aging Men  a landmark study done by Majon Muller, Diederick E. Grobbee, Isolde den Tonkelaar, Steven W. J. Lamberts, and Yvonne T. van der Schouw proved that Sex hormone levels in men change during aging. These changes may be associated with insulin sensitivity and the metabolic syndrome.

THE METABOLIC SYNDROME represents a constellation of lipid and non lipid risk factors of metabolic origin and is closely linked to a generalized metabolic disorder called insulin resistance in which the normal actions of insulin are impaired . The syndrome is most important because of its association with subsequent development of type 2 diabetes mellitus and cardiovascular disease. The pathogenesis of the syndrome is multifactorial, but obesity and sedentary lifestyle and factors in concert with diet and still largely unknown genetic factors interact in the occurrence of the syndrome.

Androgen Deficiency, Aging and  Male Sexual Health

Decline of both testicular and adrenal function with aging causes a decrease in androgen concentrations in men . Epidemiological evidence has shown that sex steroid hormones are related to type 2 diabetes and CVD in men. Although the mechanisms underlying the association between endogenous sex hormone levels and both diabetes and CVD are not entirely understood, it has been postulated that low levels of total testosterone, bioavailable testosterone, SHBG, and dehydroepi- androsterone sulfate (DHEA-S) are associated with unfavourable levels of several strong CVD risk factors, such as lipids and blood pressure, which are components of the metabolic syndrome, and insulin levels. It is proven beyond doubt that endogenous sex hormones and metabolic syndrome are linked as proven by a large-scale cross-sectional study  which was  done to investigate the relation of endogenous testosterone, SHBG, DHEA-S, and estradiol (E2)  with metabolic syndrome, as defined by the National Cholesterol Education Program (NCEP), in middle-aged and elderly men.

Testosterone acts on the male brain to promote sexual desire and arousal. With increasing age there is a varying degree in reduction of Free Testosterone which is the bioavailable male hormone, and this is why the possible responsiveness of neurones in the relevant areas of the brain, such as locus ceruleus, the brain stem-centre  for testosterone dependent arousal mechanism. These changes contribute to the age related decrease in sexual interest and to some extent erectile function. There are age related changes in the various aspects vascular and smooth muscle tissues related to erectile process, including a increased sensitivity to inhibitory (ie contractile ) signals in the erectile smooth muscle.


The Impact of Aging on Sexual Function and Sexual Dysfunction in Women: A Review of Population-Based Studies  By Richard Hayes  and Lorraine Dennerstein proved that  the role of hormones in the effects of aging in women’s sexuality is less clear and has not been extensively studied. The effect of menopause is complex involving not only physiological changes eg( reduced vaginal lubrication due to reduced estrogen levels), but also an end to women’s fertility, social attitudes about the role of post menopausal women, that vary across cultures and a transitional phase with increased vulnerability to depression. Most Indian women do not express their concerns and most of the diabetic women are all depressed. The levels of testosterone in women also decrease with aging and this also affects their sexual functions.

Scientific interest in the impact of aging on women’s sexual function and dysfunction has increased in the half century since Sir Alfred Kinsey described age-related changes in women’s sexual activities. However, a range of methodological issues limit the conclusions that can be drawn from many published studies in this area.

Aging encompasses a range of processes that have the potential to affect a woman’s sexual function. Hormonal and physiological changes take place throughout a woman’s life. These changes are particularly pronounced during puberty, menstrual cycles, pregnancy, postpartum, and the menopausal transition. Relationship factors including the presence of a partner, the partner’s age and sexual function, the length of the relationship, and a woman’s feelings for her partner may change as a woman ages. The importance of sex in her life and level of distress she feels if she suffers from sexual dysfunction may also differ as a consequence of her age. Given that so many changes take place in a woman’s life as she ages, it can be challenging to separate out which factors affect which aspects of her sexual function and to what degree. One of the major deficiencies in the literature is that many of the relevant determinants of sexual function are not measured or analyzed to separate out their effects.


New definitions of sexual dysfunctions have been developed which include personal distress as part of the definitions for vaginismus, desire, arousal, and orgasmic disorders. Sexual inactivity increases with age, but it may also be a response to sexual difficulties.



John H.J. Bancroft, M.D. in his editorial  on Sex and Aging states  that,  As compared to studies in men studies in women have emphasized the effect of relationship factors and mental health which increasingly are proven to be more important predictors of sexual  well being than the physiological  factors of sexual arousal and response. For many women, being in a relationship, the quality of the relationship, and their partner’s sexual problems are more important than their sexual responsiveness. Women also differ from what they find rewarding after  having sex. Some are motivated principally by the desire of intimacy, whereas for others the desire for sexual pleasure and orgasm is equally important. This different motivational patterns may be affected in different ways by aging.


Despite of high prevalence of sexual problems at aging, a fact remains at most patients don’t talk about it nor do their physicians ask about it. A simple question which I advise to  the physicians to ask all their patients above forty is this :Do you have problems in making love ? .. This shall open a pandora’s box.

Given the age-related decline in sexual function, one might expect that sexual difficulties or dysfunctions would increase with age. This does not appear to be the case. The prevalence of most sexual difficulties or dysfunctions changes very little with advancing age, and sexual pain disorders appear to decline. An age-related decline in sexually related personal distress might help explain this. Certainly, the importance of sex does appear to decline with age.


At present day scenario, a man of 40 is not at all considered old. The life expectancy has increased by many fold and unless one is in his late 60s, no one considers himself old. Infact Life begins at 40. This is a universal fact that men hardly feel themselves aged unlike women. As after 40 the graph of life is all descending, men become conscious of this and starts acting more like a man in his twenties.

In my opinion,  we are all aware that sex and pleasure is a state of mind and not present in genitalias, so visualise yourself as a sexual being and  feel good about your body Dress sexily for each other, try out newer things in bed to enhance your libido, bring in variety in every initiation of your sexual act, go on dates and trips with your partner, show spontaneity, never take your spouse for granted, give your spouse time not gifts, never criticise, complain or compare your partner and never make him have any pressure to perform and always say yes to sex.

As we get older, the way in which media portrays one could be forgiven for thinking that sex is the province  of the young. This is not true. The Menopause, The controversial Andropause  are not a matter of concern , infact its a liberation time, because for women, its now the time of their life when they need not worry about contraception, unwanted pregnancy etc and men  by balancing their metabolic syndrome, regular exercise, balanced diet, erotic intelligence and undying passion and romance can be sexually confident.

Sex is not a activity, it’s an IDEA. If we have complicated ideas we tend to complicate Sex. Whatever be your age, weight, these are just numbers and Sex has no expiry date. Aging is graceful in a monogamous relationship, which is like a garden and polygamous relationship is like a jungle. To remain Sexually healthy one must learn to cultivate his/her garden. Truly Rishi Vatsayana in Kamsutra said that Sex is to be used and not abused.

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