05. THE GENITAL REGION

MALE GENITAL REGION | PROSTATE DIFFICULTIES | FEMALE GENITAL REGION

The genitals of both sexes are of great interest in later years. What can be expected as normal sexual activity after fifty seems almost a hidden question and an understanding of male and female physical problems is difficult to obtain.

Examination of the Male Region

Examination of the external genital system in the male re­quires only privacy, a well-lighted room which can be darkened, and a small flashlight

1. Examine the head of the penis for any reddened irritation or pus, after the prepuce skin is pulled back. Also observe any discharge of pus from the urethra, when the penis is squeezed gently. These findings possibly indicate internal infection of the penis or prostate.
2. Examine the entire skin of the penis and scrotum. Note here, any open sore, whether or not it is painful. These skin findings include the possible chance of syphilis, the Ducrey bacillus chancroid, an early cancer of the penis, boil-like infections or large sebaceous cysts (blackheads).
3. Examine the scrotal sac, which holds the testicles, in a dark room, by stretching the scrotum over the lens of a flashlight. Feel any painless enlargement in the scrotum above the testicles, through which light passes easily. Light transparent enlargements in the scrotum may mean hydrocele or water cysts.
4. Examine the testicles within the scrotum. One testicle is normally higher than the other, but notice any pain in either testicle with gentle palpation or squeezing. Note also any apparent shrinkage or any firm enlargement in one or both testicles. Such findings might indicate the presence of testicular tumors, atrophy, or infection.
5. Examine the urinating ability. Determine if there is a lengthened period of time required before urination begins, and compare the force of the urinary stream with earlier years. Note also any burning during or just after the act of urination. Hesitant urination and weakened or burning urinary stream may mean prostatic difficulties.

Diseases of the Male Genital Region

The male genitals are beset with a definite group of difficul­ties. Some of them are common in both young and old, but most of these troubles occur after the age of fifty. They may arise from infection, the physical state of the genital organs, malig­nant and non-malignant growth, erection difficulties and uri­nary problems due to prostatic disease.

Infection of the Penis. Infection at the end of the penis often occurs because the fore-skin cannot be retracted to expose the head of the penis for cleaning. This contracted and narrowed fore-skin, called phimosis, keeps the head of the penis wet, con­taminated, and an ideal breeding ground for infection.

Infection of the penile skin may be due to scratching from fungus, louse, or bacterial infection. The dark, moist skin of the penis and groin invite not only infections common to skin all over the body, but also the fungus infections which seek damp, dark skin areas in which to breed.

Fig. 105. A penile sore usually brings up the question of venereal disease. However, the penis may be afflicted with skin diseases found anywhere on the body. It is only logical to wash hands before, as well as after, touching this organ.

A widely known infection inside the penis is gonorrhea, often called by other names. This infection can be acquired at almost any age, but usually from just one source—sexual relations with an infected person. The disease produces copious amounts of pus draining out of the urethra, starting about a day after sexual intercourse. The pussy discharge and accompanying burning urination last about one week, but will respond rapidly to the physician's administration of the proper antibiotic.

Chancre of Syphilis. Syphilis, the venereal disease, down through the ages has been heralded by the chancre, a shallow, ulcerated, painless sore on the penis, which lasts two to three weeks. It develops about two weeks after sexual intercourse with an infected person, as a small pimple or boil, which soon breaks down into the shallow painless ulcer. Syphilis is then a systemic disease, with the causative spirochete circulating in the blood, in the salivary secretion, and in other parts of the body, and a blood test will show a positive serology to establish the definite diagnosis of syphilis.

Drugs now available are extremely effective in the treatment and cure of this disease, when properly administered by a physi­cian, but repeated checks are desirable to determine the effect­iveness of treatment.

Chancroid-Ducrey Infection. Chancre-like sores on the penis and other parts of the body, often thought to be syphilitic in nature, are sometimes caused by non-venereal types of bacteria and organisms such as the Ducrey bacillus. There are other infective types of penile sores, sometimes closely resembling chancres, but not due to any particular bacteria, and thought possibly the result of simple chronic irritation.

Cancer of the Penis. Malignant growths of the penis are not common but they do occur occasionally and usually after the age of fifty. They appear most often on the head of the penis and are sometimes thought caused by chronic irritation from the contracted fore-skin of phimosis, mentioned previously. Cancers can start in a very unsuspicious manner, and are usually blamed on some coincidental and trivial accident. They may also be mistaken for syphilis or some simple infection, because in this region, cancers may look like sores in any other region of the body. Like all cancers however, they differ in one respect—they do not heal. They may also be somewhat painful, have a tend­ency to bleed and to enlarge rapidly.

Cancer of the penis differs from many other cancers in one important distinction. It travels extremely fast and can spread throughout the body at a very early stage. Therefore, any sore on the penis, should be seen by the physician. This is especially true after the age of fifty, because it is only through very early diagnosis that effective treatment of cancer of the penis can be obtained.

Cysts, Hydrocele, Spermatocele. Hydrocele and spermatocele, commonly called water cysts, occur frequently in the male geni­tal tract. They are felt in either side of the scrotum as a smooth, balloon-like enlargement, which slowly may enlarge to the size of a lemon or orange. Although these cysts are usually painless,

Fig. 106. Hydrocele or water cyst of the spermatic cord presents a smooth, soft enlargement above the testicle. In a dark room, light shines through it easily, distinguishing it from other scro­tat difficulties.

they frequently become a nuisance because of their size and location about the testicles.

The so-called water cysts, in the scrotum on the cord of the testicles, can easily be identified in the following manner: In a dark room, a flashlight is placed against the back of the scrotum, so that its rays shine through the scrotum. Water cysts will illuminate readily, whereas, the solid testicles or possibly other growth, appear as dark, non-illuminated masses.

Hydrocele is not a condition leading to malignancy or serious disease. A needle may be used to drain the enclosed fluid of the cyst for temporary relief, but afterward, the fluid nearly always reforms to fill the cyst again. The cysts are readily removed by simple surgical operation for lasting and satisfactory results.

Testicle Diseases—Absence, Pain, Tumors. Absence of the testicle at any age is nearly always a physical defect, present since childhood. It is usually an undescended testicle, which has re­mained unnoticed in the abdomen. Many men with just one external testicle have fathered several children, and have noticed no lack of virility through the absence of one testicle.

The atrophic, smaller size of one testicle, often noticed in adult men, is most often the result of serious virus infections in childhood—especially mumps. The smaller sized testicle remains the same throughout life, but has no significance so far as male hormone, virility, or sexual ability is concerned. The affection of both testicles in this manner, however, usually renders a man sterile.

Pain in the testicle is quite common, because it is a very sensitive organ, and trauma or other pressure causes immediate and severe pain. The sudden onset of unexplained severe pain of the testicle however, usually heralds an infection within the testicle or its tract, the epididymis, especially if accompanied by a mild blood discharge from the urethra. The infected testicle some­times produces a bloody discharge, and its severe pain is mark­edly increased by any pressure, jarring or slight trauma. The pain forces the patient to drop his work and seek effective treat­ment. After diagnosing the difficulty, the physician may pre­scribe antibiotics, ice bag coverage, and occasionally incision and drainage in a surgical manner.

Tumor growth of the testicles, other than water cysts, are not very common after the age of fifty years. Most growth of the

Fig. 107. Scrota I hernia is simply a large ordinary hernia in the male. The protruding hernia mass, often the intestine, descends into the scrotum which may become the size of a football.

testicles that are cancerous in nature, are found during early youth and adolescence but there is no guarantee, that a growth of the testicle will not occur in the later years of life. Because of this, any growths or enlargements of the testicles, whether they be painful or not, should command an early visit to the physician for an examination.

Scrotal Hernia, Rupture into the Scrotum. Long-standing hernias or ruptures frequently descend into the scrotum and create enlargement of the scrotal sac. When standing or strain­ing, the mass appears to fall outside of the lower abdomen, underneath the skin, and find its way into the scrotum, which then may balloon-up to the size of an orange or more. Usually these enlargements return to the abdomen when lying down, or when pressure is placed under the enlargement in the scrotum.

Hernia is an age-old condition that has been treated by numerous means. The simplest thing to do is to wear a truss, but they are often exceptionally cumbersome, frequently quite painful and usually limit the physical ability through necessary tightness of the truss.

A truss will not heal a hernia, and any such claim is mislead­ing. It is common to find men who have worn a truss twenty or more years in an attempt to "fix" their rupture, but they finally realize the hernia has been slowly enlarging all along. Only a few who wear a truss for hernia, are satisfied with the end results.

Other treatments for hernia have been injections of various waxes and sands into the hernia itself. This form of treatment has had occasional success, but more often produces undesirable results or makes the hernia condition even worse. Fortunately, these practices are almost extinct today.

Surgical operation for rupture is most satisfactory. There is complete healing, complete comfort, and a strengthened body wall usually follows the hernia operation. It is thought, that within six months of a surgical hernia repair, the repaired re­gion will have grown stronger than the same region of the average person. These operations are not completely fool-proof, but it is by far the most satisfactory treatment available for hernia.

Erection Difficulties. After the age of fifty, varying with the individual, erection of the penis, and sexual activity, are not as frequent as in earlier years. Unusual episodes through the years, such as accidents may also affect this function considerably.

As a result of trauma, scar tissue can form on the penis and a painful erection called Peyronie's Disease may result. The scar tissue along one side of the penis will not stretch, and creates a curve in the penis of such magnitude that intercourse is diffi­cult or impossible. The scar tissue in these cases is very dense, and is similar to the scar contraction sometimes seen in the palm of hard-working men. Because the scar tends to contract, and has no ability to stretch, erection difficulty becomes very great and requires considerable medical skill for any kind of satis­factory treatment.

An erection that is normal except that it is painful and un­related to sexual function is known as priapism. This difficulty is often seen in the later years of life, and is usually due to some body disease which affects the nervous system, the blood, or the penis itself. The treatment of priapism demands careful and complete physical examination to determine, if possible, the bodily disease responsible for this and perhaps other conditions.

Prostate difficulties

Infection of the Prostate. Most prostate infections are in­curred during youth in the active sexual years and are caused

Fig. 108. The prostate gland has a minor sexual and hormonal func­tion. The urine must pass through the prostate gland as through a worm hole in an apple. An infection or growth may close this narrow channel.

by gonorrhea and similar infections. However, in later years, prostate infections are more often due to focal points of infec­tion, such as the teeth or tonsils. When the prostate gland har­bors infection, it tends to spread, not only into the urinary tract, but to the rest of the body as well. In youth, or in later years, prostate infection is very stubborn and difficult to eradi­cate completely. It is often the underlying cause of arthritis and headaches, and complete cure of this infection becomes very important.

Treatment of prostate infections cannot be accomplished by drinking large amounts of water, flushing the kidneys or other simple remedies. The complete cure of these infections is often very difficult and time consuming, even for the experienced phy­sician who must direct the patient through many weeks of scheduled treatment before effective cure is certain.

Growths of the Prostate. One of the most common and trou­blesome difficulties for males beyond the age of fifty is non-

Fig. 109. The prostate gland's tendency to enlarge with age can cause great difficulty with urina­tion. Because the narrow urinary channel runs through the prostate, pressure from an enlarging growth may completely blockade the urine's outlet. Surgical removal cures the condition.

cancerous enlargement of the prostate gland which creates urinating difficulties known the world over. Developing gradu­ally from an unknown cause, the symptoms begin as a slow start­ing stream of urine, which becomes greatly weakened and at times even dribbling. There might be a full minute or more of waiting before urination commences, and the weak urinary stream is only a faint shadow of the forceful stream of urination known in youth.

The enlarging prostate not only obstructs the urinary flow, but also makes nearly impossible complete emptying of the blad­der which, like a half emptied glass of water, is refilled quickly. This makes frequent urination necessary, sleep is interrupted possibly five to ten times a night. With each urination, however, only a small portion of the urine present escapes from the over­filled bladder and the urge to urinate quickly returns. Several aids of doubtful value, in common practice to encourage urinat­ing ability, include the psychological benefit of running water from a nearby faucet and sitting in a tub of warm water.

Prostate growth difficulties often follow an uneven course, worse one day than another, but progressive worsening may eventually find these people unable to urinate at all, and a state of semi-emergency arises. At this stage a mechanical drainage of urine from the bladder must be done by introducing a small tube through the urethra into the urinary bladder, to provide an orifice for the escape of the entrapped urine.

The permanent cure of prostate hypertrophy, calls for the mechanical removal of the prostate tissue which is squeezing and obstructing the urinary channel. This operation, called pros­tatectomy, is usually done directly through the urethra itself, by means of a slender electrical cautery specially devised for this purpose. Removal of the prostate gland, properly done, restores urinary function as known in youth. This operation does not interfere with sexual relations, so far as erection of the penis is concerned, but it does usually render a male sterile. As most prostate gland operations are done after fifty or sixty years of age, sterility is usually not of great concern.

Fig. 110. Once the prostate gland is removed, the urinary stream again becomes forceful.

Cancer of the Prostate Gland. Cancer of the prostate gland behaves exactly like non-cancerous enlargement of the prostate, and is treated in essentially the same manner—removal of the gland. Cancer, however, which has a characteristic feel to the finger, and a distinguishing appearance under the microscope, can spread to other sections of the body, just like any other cancer. There is divided opinion about the prevalence of pros-tatic cancer, but some authorities state that nearly one-half of all males over sixty develop cancer in the prostate, of a low degree of malignancy.

The treatment of prostate cancer in addition to its removal, includes the use of hormones effective in slowing these growths considerably. Obviously such treatment is very technical and can be obtained only through a physician familiar with prostatic diseases.

FEMALE GENITAL REGION

Examination of the Female Genital Region

This examination is best carried out lying on the back with the knees well bent and held wide apart. With good light and a large hand mirror, the external vagina and its component parts can be visualized easily.

Fig. 111. Much of the female genital system, excluding the vagina, is within the abdomen. Only the vaginal entrance is visible externally, with­out the aid of instruments.

1. Examine the skin of the vulva, the labia majora and minora, surrounding and enfolding the entrance of the vaginal vault. Note any irritation, redness, ulceration, or sore on these skin structures, along with areas of drying, leathery whitening or skin cracking. These possibilities may mean leukoplakia or cancer of the vulva.
2. Feel the labia themselves, and note any one-sided ball-like enlargement under the skin, creating a bulge which may possibly be sore. An enlargement here may be a Bartholin cyst.
3. Look closely at the condition of the urinary exit, the dimpled-like opening just inside of the entrance into the deeper vagina. Observe any polyp-like reddened or bleeding growth about it. The possibility here is a urethral polyp or caruncle.
4. Examine closely the entrance of the true, or deep vagina. An irritated blanched and cracking skin, covered possibly with a coating of pus or streaked with blood, is the appearance of vaginitis when it occurs.

Fig. 112. External female genitalia include only the unimportant skin folds about the vaginal entrance. The urinary tract exit is visible recessed into this region. Most diseases of the external genitals are not serious.

1. With a hand separating the labia on each side, strain with great effort as in child birth or at stool, and note any balloonlike or other structure from the vagina coming into view. Such structures may be a fallen bladder, called a cystocele, a fallen uterus, called a prolapsed uterus, or a fallen rec­
   tum, called a rectocele.
2. After gentle soap and water cleaning of the vagina and hands,  insert one  finger  into  the vagina and  feel  the rounded cervix, high in the vaginal vault. Normally, the tissue here is soft and smooth, and any grossly rough, irregular or bleeding areas may include the possibilities of cancer or cervicitis.

Diseases of the Female Genital Region

This study considers female genital diseases in the post-meno-pausal period. Some of these conditions however, are found in pre-menopausal women at a considerably younger age because some diseases do not respect the menopause as a barrier or pre­venter of disease.

Leukoplakia of the Vulva. This is a disease seen during and after the menopause in which the skin surrounding the vagina has a distinctly, dry, whitened, and abnormally thickened ap­pearance. The skin seems to shrink along with contraction of the vaginal entrance itself. Itching is very prominent in this skin, and invites scratching which only increases the soreness of this area.

Leukoplakia seems to be associated with a decrease of female hormone in the body after the menopause, and it continues its irritating course until properly treated. It is definitely con­sidered a pre-cancerous condition, and frequently does turn into cancer. The only efficient treatment for leukoplakia is surgical removal, a simple and satisfactory treatment resulting in perma­nent cure.

Fig. 113. Growths of the vulva may be benign or cancerous. Though not common they should be shown to the physician without delay.

Cancer of the Vulva. Cancer of the vulva, or external vagina, is not the most common cancer in the genital tract, but it is one cancer that can be detected by the patient in its early stages be­fore it has spread to other regions. Most of these cancers develop

in areas of leukoplakia which have been itching and irritated for a long time. The onset of cancer may be quite painful in the vulva, presenting a slight bloody discharge and the feeling of a raised lump or ulcer; this can be seen easily with a mirror.

Cancer of the vulva, which often burns when touched by urine, is usually not found until after the age of sixty years, and though the seeking of treatment is commonly delayed in these patients, early surgical care can often promise cure. At no age should treatment of cancer be postponed, because a very simple treatment necessary today, might easily be exchanged for a night­mare of trouble tomorrow.

Bartholin Cyst. Fluid-filled enlargements on one side of the outer vagina, result from the small Bartholin glands which be­come blocked up. Often caused by infection, these cysts may approach the size of a walnut with little or no pain. However, when filled with pus, such cysts may be excruciatingly painful, and make walking or sitting extremely uncomfortable. These cysts are not cancerous in nature but do have great nuisance value. Their presence is readily detected, known to be abnormal and productive of much cancer fright.

Surgical removal of such cysts is a simple, adequate, and permanent cure for this difficulty.

Fig. 114.  Bartholin Cysts are fluid filled enlarged glands of the vaginal orifice. When infected, they can be exquisitely painful.

Urethral Caruncle or Polyp. A rather common difficulty, the urethral caruncle looks like a small polyp which is blood-red, very tender and sometimes apparently infected. It seems to be coming out of the urinary exit and frequently suggests the appearance of a cancerous condition.

Urethral caruncle is a non-cancerous condition, frequently left alone with no harm, but easily removed with cautery or minor surgery. Any attempt to treat this or any similar sore in this region should be undertaken only by a qualified physician, otherwise very unhappy results can easily be obtained.

Vaginitis. A generalized irritation of the entire vaginal outlet, with a discharge, itching and considerable soreness, is a vaginitis commonly found in the post-menopausal vagina. It is possibly

Fig. 115. The normal saggital female pelvis shows the uterus, bladder and rectum all high and normally placed.

due to the menopausal cessation of estrogen, the female hor­mone, and is frequently associated with a slowly discharging infection of the vaginal canal.

The customary care of such difficulties is the promotion of cleanliness, the administration of vitamins and possibly small amounts of estrogen hormones.

Fallen Bladder, Cystocele. Downward displacement of the urinary bladder is usually a result of childbirth and is rarely seen in women who have had no children. It appears as a bulg­ing at the vaginal opening when straining or standing and there is often a loss of urine with straining such as laughing, coughing, sneezing or lifting. Cystole usually feels like an uncomfortable bearing-down sensation in the vaginal region and is noticed for the first time many years after childbirth has become a forgotten

FEMALE-FALLEN BLADDER (CYSTOCOELE)

Fig. 116. Cystocele, or fallen bladder, means a urinary bladder whose supports are weakened, allowing it to fall backward and downward into the space normally reserved for the vagina.

event. When infection is also present within the bladder, a burning with urination is noticed.

Lying down gives temporary quick relief for the symptoms of a fallen bladder, but permanent relief is obtained only through surgery. The operation which replaces the bladder to its normal position and gives it the support it needs to remain there is commonplace, easily performed, and usually results in satisfac­tion for the patient.

Fallen Womb, Prolapse of the Uterus. Prolapse of the uterus

Fig. 117. Prolapse of the uterus is a uterus whose supports are so stretched and weakened that it falls into the vagina and some­times to the outside.

is fairly common in the post-menopausal period and is also a result of child-bearing plus hard physical work. Inherited weak­ness of the tissues possibly aids in bringing about this condition, but it is rarely seen in women who have not borne children.

Childbirth, by stretching, and sometimes tearing the pelvic and vaginal tissues produces a "hole" in place of a tube for the vagina. Afterward, hard work may push the uterus down and through this non-supporting defect in the floor of the pelvis. Then sensations of bearing down, falling out, backache, vaginal pain, and a discharge are frequently present. Externally, on straining, a bulge of smooth, moist tissue can be seen and felt at the outlet of the vagina, and it may continue to the point that an orange sized mass protrudes and hangs out on straining or standing. Irritation, ulceration and bleeding of these tissues often follows.

Lying down allows the fallen womb to retract within the vagina and return nearly to its normal position. Permanent re­lief from prolapse of the uterus, however, is accomplished only through removal of the uterus or suturing it back into normal position along with the surrounding structures, such as the bladder and rectum.

Although prolapse of the uterus is a most annoying and rather disabling condition, it is not a serious situation that threatens life. The diagnosis and treatment for each patient must, of course, be determined by a physician of experience in this field since position of the womb may vary considerably.

Rectocele (Herniated Rectum). A rectum that bulges forward and out through a weakened wall of the vagina also presents the sensation of "something falling" out of the vagina. It is nearly

pletely to straining pressure from the rectum, and bulges for­ward out through the vaginal entrance.

The rectum, no longer contained within its ordinary sur­roundings, empties only with difficulty, and the increased strain­ing activity of the daily movement continues to worsen and enlarge the rectocele. Such a condition is not, considered serious or life threatening, but it does have great nuisance value and is most uncomfortable.

Surgical repair of the vaginal wall, with replacement of the rectum to its normal position will effect complete relief from rectocele.

Cancer of the Uterus. The uterus is one of the most common sites for the development of cancer. The open end of this organ, called the cervix, is visible at the top of the vagina, and is by far the most frequently involved cancer site in the uterus.  The

Fig. 119. The uterus is one of the most common sites of human cancer. Least common in the Jew­ish race, over 90 per cent of its incidence occurs in women who have borne children. It is best de­tected early, through routine peri­odic examination.

cause of cancer, though unknown, appears related to irritation, and thus ninety percent of these cancers occur in women whose uteri have borne children and suffered the trauma of childbirth. Cancer of the uterus is usually painless. Its most common warning signal is vaginal bleeding between the menstrual peri­ods, or after the menopause, when bleeding is always abnormal. All races seem to be afflicted with this form of cancer, with the exception of the Jewish race, which for some unknown reason seems to escape affliction with this disease.

Happily, the uterus is in a semi-exposed position, where it can be seen, diagnosed and treated early by complete surgical removal, or adequate x-ray therapy. Diagnostic smear tests for cancer are now available everywhere, allowing women interested in their health, to keep ahead of cancer in this region, or to dis­cover it in its infancy when its treatment is relatively easy.

The Menopause, Change of Life

The menopausal period for each women marks the time of her life when function of the ovaries slows down and the men­strual flow ceases. This is a normal change following the repro­ductive life and ordinarily takes place in the late forties or the early fifties.

The menopausal life introduces a period free from certain responsibilities such as childbirth and its associated tribulations, but it also presents temporary physical discomforts due to the withdrawal of the female hormone to which the body has been accustomed. These discomforts vary considerably from person to person, but they may include hot flashes, muscle twitchings, sleepless nights, mental irritation, unreasonable fears and ex­treme nervousness. Regressive changes also may occur later in the genital region, including irritation and infection.

Most women go through the menopause with little difficulty, but about 10 to 15 percent need medical treatment, ranging from mild sedation to female hormone replacement. Such treat­ment is most desirable, as it relieves disabling symptoms and allows a woman to live her normal day. It should also be known that treatment of the menopausal state neither prolongs this period nor merely delays a day of reckoning; it simply allows a difficult period to pass along gracefully. Menopausal change dis­comforts can exist eight to ten years, years which would other­wise be completely lost to many women without the simple medical relief available everywhere.

It is true that many difficulties encountered in this period also occur at other times in life, and may not be caused by the meno­pause in every instance. For this reason the change of life is an ideal time for a complete physical examination to discover and treat other difficulties as well as menopause symptoms. It is far too frequent that tragedy is invited into a household in the form of cancer or similar disease because its warning symptoms were brushed off as just being due to the change of life. Also dis­couraging is the way "old age" difficulties following the meno­pause are allowed to progress unnecessarily. It is known that hormone withdrawal results in a thinning out of the bone struc­ture, frequently about the major joints. This softening of bones often presents joint pains thought to be simple arthritis, and the result is a slowing down of joint function along with muscle atrophy, ligament fixation, and eventually the restricted, hesi­tant and guarded movement of the body, so often seen in the senior years of life.

Adequate treatment of the menopausal state then seeks to establish the entire physical condition and to correctly direct treatment wherever needed. This includes administration of replacement hormones and vitamins for the prevention of the more commonly expected diseases and disabilities of the latest years of life.

Sexual activity after the menopause

Does the menopause mean the end of physical sexual ability? To this important question, the answer is no. The menopause simply means a transition period which ends a woman's child-bearing ability but not her sexual ability; she may continue to experience the pleasures of sexual relations to the end of her years. The menopause is also nature's safeguard for the protec­tion of the human race. The bearing of children and the hard task of raising them is allowed only to the young and most physi­cally able; it would be difficult indeed for women of sixty and seventy years to begin the ardors of new motherhood and the menopause guarantees that this will not happen.

Varying in length from one-half year to several years, the menopause technically means a decrease in function of the ovaries with a cessation of the menstrual period. During this period, about one third of all women experience difficulty de­scribed as hot flashes, dizziness, irritability and crying spells.

Happily, treatment for this difficulty is simple and easily ob­tained.

There is no real male menopause, as women know and experi­ence it, but both sexes experience a gradual diminution of sexual vigor to the extent that other body functions diminish. Thus sexual ability, visual ability and other physical abilities are gradually lessened but rarely do they completely fail. People in their sixties do not ordinarily expect or want their sexual desires and abilities to be the same as at the age of twenty, but they can expect them to be present and active according to their way of life.

Sexual relations are of great interest to most people, but they are not equally appealing to all. Like playing tennis, some of us will be absorbed with sexual matters until the age of 100, but most of us lose interest somewhere along the line after our "flaming youth." Losing interest in sex, however, and develop­ing tastes for other facets of life, such as golf, reading or stamp collecting, does not mean that sexual abilities are lost; they are only set aside.

A normal development, after the age of fifty, is a displacement of the passionate and demanding physical sexual relations of youth for a deeper and more endearing marital relationship, revolving more about family activities, interest in children and grandchildren, and more communal thought in the hereafter.

Enduring, satisfying and happy social relations, after fifty as well as before, are built not only upon sex, but far more upon the solid virtues of faithful and unselfish marriage. As written by another—

Sing, for faith and hope are high— None so true as you and I— Sing the lover's litany; Love like ours can never die!
Rudyard Kipling,
"The Lover's Litany"

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