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Make no bones about this - Men have osteoporosis tooOsteoporosis is a condition in which the bones of the body lose their strength gradually and become thin and brittle. This is most commonly seen in women who have attained menopause. The reason being the decrease in the hormonal levels, particularly estrogen. Studies reveal that 20% of sufferers are men. Falling levels of testosterone are one of the causes for men developing brittle bones. Men's bodies convert some amount of testosterone into estrogen, which is very essential in maintaining the bone mass. Genetic deficiency of the enzyme that helps the conversion of testosterone to estrogen also is a major factor for men developing osteoporosis. Calcium and vitamin D play an important role in developing the bone mass and in helping the bone grow. Exercising helps too. When you exercise, the muscle gets pulled and the bone responds by growing. Too much of indoors and sedentary work may make men get the less of all three and it eventually leads to weak bones and osteoporosis. Studies reveal that 20% of sufferers of osteoporosis are men. Certain medications like anti-seizure drugs, drugs for prostate cancer and steroids have side-effects that make it impossible for the body to use vitamin D. Using them for a long time reduces the bone mass density and leaves the bones brittle making them easily prone to fractures. Smoking is a vice that has to be quit for more reasons than one. An analysis of several major studies on the effects of smoking shows that smokers have a 55% higher risk of hip fractures and low bone mineral density than non-smokers. Nicotine has also shown to have a direct effect on bone cells. A long list of medical conditions like diabetes, rheumatoid arthritis, and digestive and blood disorders can take a toll on your bones. Long term medications for the same also have side-effects on the bones. How to prevent osteoporosis? Exercise- As young boys, men have usually been exposed to a lot of bone building exercises through sports. This helps in building up on the bone strength and comes in handy in the later years. A brisk walk for 30 minutes 5 times a week and moderate impact exercises help in maintain the bone mass and reduce the thinning of bones. Calcium intake- The daily calcium needs for men is the same as women. Hence, the dietary recommendations remain the same too. 1,000 mg of calcium a day from ages 19 to 50 and 1200 mg of calcium a day if you're over 50.Along with this, make sure you get the required dose of vitamin D too, so that the calcium you eat is absorbed properly. The standard recommended dietary allowance is 400 IU. Some doctors advise to increase the intake to 800 IU. Regular medical checkups will help you to know beforehand about the risk factors and the necessary precautions you will need to take.Osteoporosis in men is as much a reality as in women. However, there are ways to avoid it too. Awareness about the condition and about the ways to prevent it can help keep osteoporosis at bay. Bone mass matters. It could mean the difference between a hip fracture later in life - or keeping an active, high-energy lifestyle.
Weight gain and prostate cancerOne of the hormone therapies involves increasing the production of LH-RH. Luteinizing Hormone-Releasing Hormone (LH-RH) is a hormone which is produced by your body. This lessens the production of testosterone. The drug given induces the generation of this hormone. One of the side effects of this therapy is weight gain. Along with this, breast pain, hot flashes, nausea, and growth of male breast tissue might occur. Apart from hormone therapy side effects, the presence of fatigue can also stop a patient from regularly exercising, thus, resulting in gaining weight. However, it is important that this weight gain is averted as the chance of cancer returning is a possibility. You can keep your weight in check by following these tips: Ask your doctor if your hormone therapy can lead to weight gain. If you receive an affirmative answer, then ask for a diet chart to be followed. You can also keep a food and activity journal to get an idea of how your body is reacting to the treatment. Inculcate physical activity in your schedule. This will not only help to reduce fatigue, but also keep at bay the chances of becoming constipated or feeling nauseous. Medical studies have shown that cancer patients must have at least 2-1/2 hours of moderate physical exercise per week. Have about 2.5 cups of fruits and vegetables every day. Also, shift to whole grain food items. You should also consume at least a cup of legumes, for example, beans, to keep up your protein levels. It is best to opt for lean protein snacks like yogurt and chicken. You must stay adequately hydrated during your treatment. Drink about 10 to 12 glasses of water everyday. Do not consume excessive amount of sweetened beverages like coffee and cola. Have a small portion of nut and nut seeds. If you feel distressed due to the therapy, go for a massage. These have been proved to reduce anxiety and stress caused during the treatment of cancer. Most importantly, keep up with your appointments with the doctor and convey the bodily changes that you may notice. Have an optimistic outlook towards the treatment and do not repress any emotional disturbance. Weight gain in men who had been previously healthy often leads to depression regarding weight issues. Being proactive and focusing on keeping your weight under check is the key here. You could also approach a psychologist if you have been feeling low. The LH-RH therapy is also known as Androgen Deprivation Therapy (ADT). This therapy leads to a weight gain of around 9 pounds within a year of starting treatment. You can make sure that your weight is controlled by altering your lifestyle and getting adequate physical exercise everyday.
Pregnancy and HIVMothers with higher level of viral load have been found to deliver infected babies. However, no amount of viral load can be safe as infections can occur any time during pregnancy. A high level of precaution is necessary during this phase. Mostly infection occurs during delivery but that's not the only way through which it can spread. HIV-infected mothers should not breast-feed, as virus can transmit through breast milk too. Antiretroviral medications are used to reduce chances of transmission of HIV. Keeping delivery time shorter can reduce the risk of transmission. Most of the times babies born to positive mothers are positive for HIV. Babies infected with HIV will have antibodies made in their system and will continue to test positive. But if babies aren't infected, the mother's antibodies in baby's blood will eventually disappear and babies will test negative after about one to one and half year. HIV positive women should consider possible problems with antiretroviral medications for HIV before getting pregnant. Talk to the doctor about choice, indications, and contraindications of these drugs. There's a risk of missing doses due to nausea and vomiting during early pregnancy, hence giving HIV a chance to develop resistance. Some doctors prefer the practice of stopping or modifying medications during pregnancy to lower the risk of birth defects. Short course of treatments can help eliminate or reduce risk of transmitting HIV to a newborn; but, short treatments increase the risk of resistance to the drugs used too. There is a risk of birth defects due to antiretroviral drugs during the first 3 months of pregnancy. Pregnancy does not worsen mother's HIV disease, but any HIV positive woman planning to get pregnant should discuss treatment options thoroughly and all the pros and cons with her doctor.   
The post-delivery bluesA baby being born is cause for celebration. Especially in a country like India, where the family ties tend to be close, there is a festive atmosphere at home. However, sometimes the mothers may not share the same enthusiasm. This wave of negative emotions in the middle of what is clearly a happy occasion can be confusing for the new mother. Interestingly these feelings are not abnormal, as many new moms face postpartum depression, which is also called baby blues. It is an emotional reaction that begins a few days after delivery and lasts not more than 2 weeks. What are the symptoms of postpartum depression? Feelings of anger or irritability. Lack of interest in the baby. Lack of appetite and sleep disturbance. Crying and sadness. Irritability or hypersensitivity. Feelings of guilt, shame or hopelessness. Loss of interest, joy or pleasure in the things you used to enjoy. Possible thoughts of harming the baby or yourself. What are the causes of postpartum depression? Postpartum depression can occur due to a combination of factors. Hormonal changes: Changes in the level of hormones can leave you feeling tired, sluggish and depressed. Changes in your blood volume, blood pressure, immune system and metabolism can contribute to fatigue and mood swings. Emotional factors: Feeling overwhelmed with the new arrival in the family, and taking care of the baby day and night, may leave you sleep deprived, overexerted, and anxious. New mothers also feel that they look less attractive after pregnancy. You may feel that people around you are concerned with the baby more than you, and that you are being neglected. All these emotional factors may lead to postpartum depression. Other factors: Issues like breast feeding, financial strain, and relationship troubles can also contribute to postpartum depression. How does one deal with postpartum depression? Take complete rest and sleep for sufficient hours Spend quality time with your husband Go for healthy diet Take morning or evening walk for fresh air Try to follow yoga or other exercises Share your feelings with your husband or friends Do not overexert Join some groups for new moms Go for individual therapy or counsellors Remember, postpartum depression is not an incurable problem. It is just a temporary state of mind, which can be overcome if you are sufficiently aware of the problem.                
Avoiding nappy rash - A few words of adviceNappy rash is a skin condition that takes its name from the nappy in which a baby is wrapped. It is a reddish rash, or tender skin around the buttocks and inner thighs of babies, which occurs due to prolonged wetness from either urine, or stools, or both. Nappy rash may be in the form of an unusually tender bottom on a child, or an inflammation around the genitals, and inner thighs, or folds of the skin. It generally occurs in really small babies, less than a year old. Most times, nappy rash is not a very serious condition, provided care is taken. No matter what type of nappy you use, whether promising complete dryness, or absorbent nappies, your baby is likely to develop 'nappy rash' at least once. The rash can make the baby feel uncomfortable, and cranky as a result. Steps to avoid nappy rash: Always ensure that your baby's bottom remains dry by changing nappies at regular intervals. Use a mild medicated baby soap which will help in keeping the skin around the inner thighs and buttocks soft. Give your baby some nappy free hours. You will be the best judge to know when she is likely to have comparatively dry spells, which can allow the skin and parts below the waist some breathing space. Regular bathing should take care of most rash related problems. Use an emollient, or medicated soap for bathing. Sometimes, nappy rash is a result of a thrush or yeast infection. The baby's resistance at these times is low so that it allows the yeast to thrive in the form of ugly red patches. Always show a medic to rule out the possibility of bacterial infections. Anti-fungal creams should also take care of normal nappy rashes.    
Stress - Even kids cannot escape!Often when we feel overwhelmed with stress, we go back in the past and reflect. We miss our golden days of childhood.We think of those days with fondness, miss the free and carefree times. We feel like becoming kids again. But the truth is that at no age are we free of stress and worries. It is just that with time, we move on to newer situations and every new stressor seems worse than the previous one. Children stress out too, some more than the others. Stressors Simple things like a test in school, a Physical Training class or poem recital could mean a lot of stress for the little ones. The desire to meet the expectations of parents or teachers also creates tremendous pressure on the children. They are eager to do well at all the times and the smallest failures can upset these kids immensely. Peer groups are difficult to manage. In childhood, the social maturity is not sufficiently developed to handle day-to-day conflicts. Trivial fights or comments from classmates and friends can lead to a long-lasting impact on the vulnerable minds. They get easily influenced by their friends. Elder siblings also play a major role. Some act as mentors, some as bullies. Some cause damage unknowingly, some are plain indifferent. Life is full of new things and childhood is a fast-track learning lesson. Every other day, there is something new a child has to do. Meet a new kid, learn a new subject, try to dodge a ball differently or ride a bicycle without side wheels; there is too much to learn. These cause anxiety and may make the child nervous. Performance pressures, technology, precocity, media influences, etc. are some of the other factors that add to the stress in childhood. Signs Watch out for subtle changes in moods and behaviour. With adults, it is easier to identify the stress and hence rectify it. But with children, it is quite a challenge. Most of the children are themselves unaware of the stress they are facing, they don't understand why they are feeling sad or angry or fearful. They are just not at ease. Inordinate crying or screaming is a common sign. Being withdrawn, aloof and quiet is another way by which kids express their tensions. Physical signs can be seen in basic physiological changes - in sleep patterns (oversleeping or inability to sleep), eating habits (not eating or eating too much), frequent aches and pains, especially digestion disturbances and headaches, etc. Managing childhood stress Pay attention to your child. Listen to what he/she is saying, but also try to listen to what he/she is not saying in words, although only in action. Help the kids open up to you, spend quality time with them and talk to them about everything under the sun. Be well connected with their school teachers and parents of their closest friends. If the need be, please don't hesitate to reach out and seek professional help from psychologists and child counsellors. "One of the luckiest things that can happen to you in life is, I think, to have a happy childhood." - Agatha Christie  
The male ego: Fragile male self-esteemIn a world where men are constantly competing with one another, adding a woman to this dynamic changes the perception for majority of men. The fact that a woman is doing better than a man can largely affect relationships at a personal and professional level. Simple things like opening a door for men or even pulling a chair for him can make him feel self-insufficient. The whole concept of a woman doing something/anything better than him brings down his self-esteem. In a relationship the roots go deeper and men who are making less money or not doing as well as their partners have a more fragile self-esteem. The mental insecurity that a woman may be a better provider for the family and has more potential than he does, changes the dynamic of his relationship, while for women this does not seem to be the case. Fragile self-esteem alters your everyday determination and persistence. Without being determined, the only way to go is downwards. When self-esteem is affected by women doing things that he can do, men seem to take it in a negative manner and lower their self-esteem. Small examples of this in our day to day life are - driving your own car as compared to having a driver, being physically weaker than a woman, etc. Men are creating rules to ensure that women who are considered lower than them cannot perform or do better than them. Systems and frameworks are made which ensure that situations never come up where a "lower person" does better than a man can, all out of the fear that they can't perform! From the day we are born to the rest of our lives, we are drilled with the fact that men are better, stronger, and smarter than women. So when situations arise where she is doing or has done better than you, the male self-esteem is questioned and, most of the time, drops. Being the person you are meant to be, you would automatically create a system by your choice and influence it to reduce the possibility of any other to be able to achieve what you have, in turn increasing your self-esteem. However, when the other overcomes or surpasses this obstacle, your self-esteem will be hit hard causing a drop in your self-esteem like the stock exchange does on its bad days. Self-esteem is a very personal topic and completely dependent on the situations you have encountered across your life. However, when majority of these are leaning in one direction then there is no question of failure. Consider a world dominated by women, What would happen to your self-esteem? Do you think you would survive in this kind of world, a world in which all your thoughts are limited by restrictions and rules you have to adhere too, to ensure things like your family name is kept out of shame. So let us all do as the women have been doing for centuries, embrace it, and learn to maintain our self-preservation and esteem irrespective of our surroundings. This may sound hard but let us work towards a world where women and men are equal. Don't let your self-esteem be affected by your surroundings, if you know your surroundings are not the best for the future.
Exercise, a healthy way to deal with hypertensionYou have not exercised for a long time. You took it easy when it came to physical activity. Now that you are diagnosed with high blood pressure, you will do anything to control it. Even exercise! Exercise, weight management, and a healthy diet are important ways to help prevent high blood pressure and lower the blood pressure that is already high. Benefits of exercise for people with hypertension include: Improve blood and oxygen circulation in the body Promotes sound sleep Improves stamina and endurance Keeps heart healthy Reduces stress and promotes mental health Exercise enhances the effectiveness of medication So how much should one exercise? An exercise session of atleast 30 minutes per day is important. Get started Start slowly and increase gradually. Start with 10 to 15 minutes of exercise and increase it, as youget comfortable. Choose exercises you enjoy and will do consistently. Avoid sudden vigorous activities; they can cause injuries and hamper the routine. Warm up Warming up helps the body adjust slowly from rest to exercise. A warm-up will reduce stress on the body muscles, increase heart rate and respiratory rate, and body temperature slowly. It will also decrease soreness of muscles. Best exercises for lowering blood pressure Stretching: It is the best. It relaxes and helps prepare the body and muscles for activity and prevents injury and muscle strain. Stretching regularly will make you flexible and improve motility. Aerobic exercise: This helps to improve circulation to the entire body. It improves heart function. It gives maximum benefits to the heart. They also help to reduce heart rate and blood pressure by improving breathing pattern thus lowering blood pressure. Walking, swimming, jogging, and skipping are all aerobic activities. Do aerobics for at least 30 minutes three times a week. Strengthening exercises: These include exercises that have repeated muscle contractions till the muscles are tired. These include side balance crunch, climbing a rope, and push-ups. Join a gym. Here are some  exercise guidelines for a better exercising routine in the gym:  Schedule a fixed time for exercise. Find a buddy to exercise with you. Select an exercise that you like. Make variations to avoid getting bored. Boredom can make you stop exercising. Start slowly and increase gradually, especially if you do not exercise regularly. You should wait for an hour after eating before you exercise. Ten minutes of warm up and ten minutes of cool down sessions are must Keep a record of daily exercise.
The age of nutritionAdvantages of Healthy Eating: Increased mental acuteness Resistance to illness and disease Higher energy levels More strong immune system Faster recuperation times Better management of chronic health problems Eating Obstacles for Seniors:  Lifestyle changes: Lifestyle changes can be an eating obstacle. For example single seniors may not know how to cook or may not like eating alone. Activity level: Seniors often cut back on activity for physical and medical reasons. Weight gain can result from the decrease in calories burned. Metabolism: Every year over the age of forty, our metabolism slows down. This means that even if you continue to eat the same amount and kinds of food as when you were younger, you're likely to gain weight because you're burning fewer calories. In addition, you may be less physically active now. Taste and appetite: The senses of taste and smell diminish, so one may be inclined to season one's food more heavily than before even though seniors need less salt than younger people. One may struggle with loss of appetite due to lifestyle, loneliness or a medical condition. Health Issues: Physical ailments and prescription medications, become a daily exercise, and ends up often negatively influencing appetite. Digestion:Due to changes in your digestive system, you generate less saliva and stomach acid as you get older, making it more difficult for your body to process certain vitamins and minerals, such as B12, B6 and folic acid, which are necessary to maintain mental alertness, a keen memory and good circulation. Emotional Factors: Emotional factors such as loneliness and depression can affect your diet. For some, feeling down leads to not eating and in others it may trigger overeating. Specific Nutritional Recommendations for Seniors: Some important guidelines for seniors include Reduce sodium (salt) to prevent high blood pressure, Monitor fat intake in order to maintain healthy cholesterol levels Consume more calcium and vitamin D for bone health Eat more fibre-rich foods to prevent constipation Cut back on sugar and on dry foods Ensure getting recommended amount of important vitamins and minerals Increase water intake, and Perform regular physical activity Eating well as you age is easier than you think: Focus on good carbohydrates. Opt for whole grain nutrition (brown rice, whole wheat bread, rolled oats, barley, and millet), not refined "white" products, such as white bread, white rice, or products made with white flour. To manage weight and maintain optimum health, focus on eating efficiently. This means choosing foods that maximize nutritional value, not calories. Whole, natural, fresh foods such as fruits and vegetables, whole grains, nuts, legumes, healthy sources of protein (poultry, fish, eggs, and tofu) and dairy products that contain calcium constitute efficient eating. Highly processed and refined foods usually contain more calories and fewer nutrients. Raw equals roughage! Aim to eat at least one daily serving of your fruits and vegetables raw. This not only preserves their nutritional value, it's an easy way to eliminate constipation. Steaming is the best way to cook vegetables; it preserves nutrients. Light sauting is next. Bone up on calcium. All dairy products are not created equal. Milk, cheese and yogurt retain their calcium content; cream cheese, cream and butter do not. As part of a healthy senior diet, choose fat-free or low fat dairy products. Choose first-rate fats. Get your "good" fats from oils such as olive oil and sunflower oil, avocados and avocado oil, nuts and seeds. Keep it moist. In addition to drinking enough water each day, aim to consume foods with high water content. Staying properly hydrated flushes toxins from your body, relieves constipation, helps keep your joints flexible and your mind clear. High water content foods include melons, grapes, cucumbers, onions, apples, cabbage, and, of course, soup.
A quick guide to high blood pressureWhat is blood pressure? Blood pressure is the force or pressure exerted by blood on the walls of arteries while flowing through it. What is normal? A blood pressure value of 120/80 mm Hg is ideally said to be the normal. The upper value (systolic) reads the pressure when the heart beats (squeezes to pump the blood). The lower value (diastolic) computes pressure at rest in between the heartbeats when the heart refills with blood. What is hypertension or high blood pressure? The condition in which the pressure of blood in the arteries is persistently high.More the pressure, harder the heart has to work to pump the blood. The prolonged and too high blood pressure (BP) raises the heart's work persistently and can lead to grave damage to the arteries. This eventually leads to uncontrolled high blood pressure raising the risk of heart disease, stroke, and kidney disease in the long run.A blood pressure above 130/90 mm Hg is said to be high. What are the symptoms of hypertension? Hypertension can go unnoticed without any symptoms and thus remain untreated for years altogether. Thus, it is also called as silent killer sometimes. What causes hypertension? The cause of hypertension is unknown in most of the cases. Sometimes, hypertension occurs secondary to kidney disease or adrenal gland disease. Who are at risk of getting high BP? The risk of developing high blood pressure is more in people above the age of 45, those who have close relatives already suffering from hypertension, and who have history of diabetes, Many people consistently have blood pressure above normal, yet not so high to be called as hypertension (130-140 /80-90). These people are at more risk of developing hypertension. Is salt and blood pressure are related? Sodium content of salt causes water retention thus putting more burden on heart and raising blood pressure. So watch the foods you eat for sodium content and stick to a low-sodium diet. Stress and high blood pressure Stress can increase the blood pressure, but no scientific facts to suggest that it causes hypertension. Stress can lead to addictions, poor diet, lack of sleep which can indirectly contribute to high blood pressure and heart disease. Obesity and hypertension Obesity strains heart and raises the risk. Losing every kilo makes a huge difference. Alcohol  Alcohol can surely raise blood pressure and limiting it mandatory. Pregnancy and hypertension High blood pressure during pregnancy is called as gestational hypertension. It can cause serious complications like preeclampsia. It can harm both the mother and baby. It can compromise oxygen flow to the baby. The blood pressure normalizes after child's birth. Medicines and hypertension Some medicines, like pain killers, birth control pills, steroids, flu medicines etc. can cause the blood pressure to rise. Be careful with the medications. Avoid over-the-counter medications and take doctor's advice before consuming any medicine. "White coat" phenomenon Some people show high blood pressure in doctor's clinic due to nervousness. This is called as white coat phenomenon. These people are at risk of developing high blood pressure. Kids and hypertension Kids who are obese and have a family history are more at risk. How to control high blood pressure? Eat healthy: Eat more fresh fruits, vegetables, whole-grain foods, low-fat dairy products, and nuts. Say no to sweets, saturated fats, and excess salt. Exercise: Regular physical activity lowers blood pressure. Atleast 150 minutes of exercise per week is essential. Activities like brisk walking, swimming, cycling or gardening, all count. Reduce stress: Add yoga, meditation, deep breathing. All have proven to lower the blood pressure and keep it normal. Hypertension is usually a chronic life-long condition. It's very essential to take medications, make lifestyle changes and regularly monitor blood pressure. Keeping it under checkwillreducethe potential riskof heart disease, kidney diseases, and stroke.
Is sex linked to self esteem?Man is a curious creature, full of quirks and contradictions. Sexual intercourse, something that most people consider an intimate and private experience, is spoken about in hushed tones and often, with some discomfort. We don't reveal or talk about our sexual desires, as readily we discuss our salary packages or food habits. This is quite ironic seeing how sex is an important gauge for a person's self esteem and also an indicator of his/her social desirability. The very thing that we do under covers, we somehow choose to "keep under cover". The Link between Sex and Self Esteem: Self esteem is an important factor that determines the mental & physical well-being of an individual. All of us have a craving to be understood, liked and appreciated; and these form the equivalent of our basic needs on the inverted pyramid- Food, clothing and shelter. For a human being to flourish and prosper, consumable food, without the mental food of appreciation, is not enough; and sexual intercourse or an intimacy with the opposite sex, is one way of validating that need. Sex therefore, ceases to be just a physical need instilled by nature for the perpetuation of the species, but goes into the larger emotional cum psychological dimension of self actualization and realization. Though some of us might be embarrassed to broach the topic of 'whether or not we are getting enough', the truth is that every human seeks to achieve his sexual potential, even while he or she might, not be aware of it. Most of us have the ability to get the foods matching our taste preferences onto our plates, but with sex, this could be a little difficult, since sex, is a complex subject with a lot of social, moral and religious links. The truth is evident in the number of marriages (the very cornerstones of civil society) that fail on the basis of sexual compatibility, either by setting unrealistic sexual expectations or by not owning up to, or even identifying, one's sexual needs. This has repercussions on the psyche and self-esteem of a person, and this is especially true in the case of men in particular, as they may feel completely inferior for not being able to attract a sexual partner matching his desires. In some people, this also leads to a case of self-loathing, for having sexual needs which a partner doesn't understand, or much worse, needs which are considered taboo and sinful (Homosexuality, Anal Sex, Group Sex, Fetishes, etc.) These complex emotions can wreak  havoc on a person's self-esteem, by creating severe internal conflicts and serious self-doubts. Now socially, sex can either liberate a person, or hold him prisoner. At times, the unfulfilled needs may get repressed and banished to the shadows, only to be played out later, in the form of sexual adventurism and crime. Just one look at the sexual crimes in our society today, and we can clearly understand just how healthy our collective self esteem is! The very society that frowns upon prostitution, is actually responsible for creating it, though everybody would like to pretend otherwise. The crux of the matter is that "sex" and "self esteem" are closely related; and one should not shy away from addressing any issues one might face regarding one's sexuality. Physical love is necessary for the survival of a relationship and one needs to make time and efforts to successfully create one's own sexual space. The positive effects of a good sex life can be seen in an increased work productivity, fewer illnesses and an increase in one's overall efficiency. Some people are haunted by sexual guilt and confusion and when they keep it all locked up, they suffer from unexplained physical pains and feel 'down in the dumps' mentally. Another problem with appreciation from the opposite sex, is the addiction to  external validation. Some people feel utterly worthless until they receive positive feedback about their looks or abilities on a regular basis. This can be downright devastating, as in these cases, there is a great dependence on external factors for one to feel good. While no one denies the "feel good factor" of sexual appreciation, it is up to each one of us, to decide just how much of control one must be giving to external factors, to determine our personal self-esteem. The appreciation may be theirs, but the esteem is entirely of the self and only the self can decide how much of appreciation and sex is enough.
Sex after 40Sexual changes in normal aging after 40: Erection takes longer time Require manual stimulation, particularly by partner Erection may subside during foreplay or coitus Decreased frequency of nocturnal erection Pre-ejaculatory fluid decrease or absent Ejaculation less forceful Seminal fluid volume decreases or absent Frequency of desire for sexual release decreases with age. Aged couples learn to cope with their own sexuality. Some are happy with foreplay and self masturbation, others insist on more usually it is the male. Frequency of sexual intercourse between 20-95 years : Sexual intercourse decreases with age as the study shows. Decreased during 5year interval after 34 years Weekly frequency: 30 - 34 years 2.2%; 60 - 64 years 0.7%; 65  - 74 years 0.4%; 75 - 79 years 0.3% Do we need to change this pattern with Viagra? I would say yes - sex can be  joyful till the last days. Nobody needs to be impotent now. Home devices like rubber bands, ribbons are also used to hold the blood back in the penis when the erection is not adequate. Vacuum pump to draw blood into penis with an application of a ring after erection is also found suitable by some. Active intervention by drugs (both allopathy, ayurvedic and unani) have been successfully developed. They may be applied topically (minidoxil), inhaled (amyl nitrate) inserted into the urethral passage, injected into the corpus cavernosa or taken orally (Sildenafil, Tadalafil, etc.). Finally if all fails silastic rods can be implanted in the penis to give permanent erection. The joy of living lasts a life time.
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