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Sunshine for busy executivesMost people working in corporate offices, spend long hours within the confines of concrete buildings. Some business sectors like IT and manufacturing even have their employees working in night shifts. What we don't realize is that, in such a setup, our bodies do not get adequate dosage of sunlight. Lack of exposure to sunlight is responsible for a range of diseases and health conditions. The body requires sunlight just as much it requires food for its nourishment. Long hours of work in glazed business buildings under artificial lighting, deprive the body of this most basic need, thereby creating a deficiency of the vitamin D group. This deficiency then goes on to create several imbalances in the body, and contributes to diseases. Besides these, Vitamin D deficiency can also cause general muscle weakness, muscle and bone aches and pains and osteoporosis, due to the inability to utilize calcium. The best source of Vitamin D is natural sunshine, and that's why it is called the sunshine vitamin. Vitamin D can be had in the supplement form too, but it is still no match for natural sunlight. In a paper titled 'Vitamin D Deficiency' published in The New England Journal, M F Holick writes that, arms and legs should get exposure to sun for 10-15 minutes every day. "The amount of vitamin D produced depends on the intensity of the UVB in the sun and many other factors. Darker-skinned individuals may need 5-10 times more exposure than a fair-skinned person, in order to make the same amount of vitamin D." Tap that sunlight Early morning is the best time to get out in the sun. There's no better time to get that walk, than in the morning. Park your car a little away from the office building if possible, and walk to your office in the sun. When you take a tea break in the evening, head outside, instead of going to the in-house cafeteria.
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.   
Woman, look below your face too!Skin problems are not restricted to the face alone. There are several places where there could be problems. You don't have to grimace and bear it always! Moles: A mole is formed when the skin grows out in a crop or cluster. Moles can be quite harmless. At times, moles are also precursors to serious melanomas. If your mole suddenly grows big or changes colour or starts to bleed, see your dermatologist right away. He will advice a biopsy to rule out anything serious. It is always safe to be in the clear! Rosacea: This is an irritating skin condition that is brought on by specific triggers. It is usually manifested as red spots on the face, flushing or small red eruptions on the face. This condition has multiple triggers, the most common one being the sun. With no cure being available for rosacea, avoiding the triggers like sun, alcohol and extreme temperatures is the only solution. For moderate to severe cases, topical or oral antibiotics are prescribed. Depending on the severity, laser treatments that zap the blood vessels that cause the flushing can also be opted for. Ingrown hair: Too much of waxing and shaving results in the hair growing haphazardly. It results in hair curling up and growing up backwards. It can be a painful condition, especially if it gets infected. Wipe the skin with a cloth dipped in warm water to soften the skin so that it can grow freely. If the pus has already found its place, dab a bit of benzyl peroxide on it. Stretch marks: When your skin stretches with rapid weight gain, as in pregnancy, the result is unsightly stretch marks. Stretch marks, though a proud and happy achievement, can be an embarrassingly reality too! Treatment for them is possible when they are still fresh and pink. Applying a vitamin A or retinoid based cream regularly helps reduce the visibility of the stretch marks by making the skin more pliable. White spots: White spots can be anything from PMLE to Vitiligo. Polymorphous Light Eruptions are the typical whitish spots that come up on the exposed parts when you are out in the sun too much. It occurs due to the damage to the melanocytes by the harsh rays of the sun. In some cases, there are antibodies that the body produces against the melanocytes that go around killing the melanocytes in random places. This causes large white spots at random locations on the body which typically spread. So use a sunblock every time you step out into the sun. If you find the spot growing in size, consult your dermatologist. He may determine whether it is vitiligo. Vitiligo has no cure, there are oral medications available, which along with the sunrays help restoring some color to the skin. Birthmarks: These are pigment cells that are overgrown. Most birthmarks fade over time. However, if yours starts growing and changes to a dark brown color, get yourself checked by a skin specialist. Chances are that it could be a melanoma. Birthmarks are usually harmless and do not require removal except for cosmetic reasons. However certain medical conditions like melanoma also warrant their removal. Varicose veins: When blood in the legs isn't unable to pump up against gravity or if the valves of the leg veins are faulty, the blood starts stagnating in the leg. This causes the legs to swell and the veins to look prominent. This painful condition occurs in obese people, at times in pregnancy and in people with jobs that requires them to stand all day. Resting with the feet above chest level is a solution for mild to moderate cases. In severe cases, the solution is laser treatment. Scars: As a child, you burnt your leg by accidentally placing it on the hot silencer of daddy's bike? You may still have a scar to remind you of that incident! Scars happen after an injury to the skin's collagen and elastin. If scarred, you may have to live with it. However, there is no reason why the new injuries have to have reminders for life. Skin discolorations, keloids or pockmarks from acne attacks, whatever the scar, there are multiple creams and laser options available to treat them. Age spots: Also called Liver spots, they have nothing to with either your age or liver. They are caused when your skin produces extra melanin to cope with your sun exposure. Alternate application of a bleaching cream like hydroquinone and an exfoliating cream like a retinoid based cream can help lighten the spots. Do this under your dermatologist's guidance only. Other options include chemical peels and microdermablasion. Lasers are last option treatments for stubborn old spots. Eczema: This is a long-term skin disease, also known as atopic dermatitis. Most common symptoms include dry and itchy skin, rashes on the face, inside the elbows, behind the knees, and on the hands and feet. Currently, there is no single test to diagnose eczema, so doctors rely on information about you and your family. Treatment options do not include cure, only immediate relief from the inflammation and itching can be obtained. Hives: Hives are the red and sometimes itchy bumps on your skin. They usually appear as an allergic reaction to certain foods or drugs. People who have some form of other allergy are more likely to get hives than people who don't have any allergy at all. Other causes include infections and stress. Hives usually go away on their own, but if you have a serious case, you might need medical help. Skin is the largest organ of our body. It is the protective barrier between our body and the outer harmful world full of bacteria, viruses and other dangerous microbes. Hence, it becomes extremely essential that caring for our skin should find top spot on our health care list.
A baby - proofed guide to childcareCaring for kids is an important task. Everyone wishes to nourish kids in a loving and caring yet protective atmosphere. Initial stages of development call for more care and attention. Health, hygiene and safety at home and outside are important when it comes to kids. Here are a few helpful tips to all the parents: Nurture your infants with massage. Learn a right way or get it done from a professional. It is a great therapy to make muscles strong and bond with the baby. Prolonged crying bothers parents a lot. Usually continuous crying for long hours is suggestive of colic or stomach ache. It is the most common problem in kids, the reason being immature gastric system. Do not panic. Keep medicines at hand and give them as per instructions by your kid's doctor. Toddlers often insist on being carried even when they know how to walk well. Make sure to hold them comfortably. Diapering a baby is a skill that must be mastered especially when the baby is fidgety. Holding baby in right position flat on the back simplifies the task. Parents adapt to doing the job effortlessly with practice. Transition period of swapping from breastfeed to bottle known as weaning is a tough task for most of the babies. Consider gentle weaning strategies advised by the doctors. Do not be abrupt. Go slow! Some Safety Tips: Cap and lock the medicines, detergents, chemicals etc. in containers keeping them far away from the children. Bathingwater should be always checked before bathing the baby. Do not leave kids alone near water tub or any water source alone. Avoid leaving baby in a highchair to prevent injuries such asbaby climbing out, falling, or sliding. Lock up all the knives, matches, and plastic bags away from children to prevent poisonings, bleeding injuries, burns and suffocation.
Teenage troubles for autistic kidsTeenage brings along with it a lot of physical and psychological problems. Your body undergoes a lot of changes, the way the world looks at you is changing and you are not in the position to accept all this. Teenage is one of the most painful periods in one's life.  For an autistic child teenage can be compared to living a nightmare day in and day out. Here is a look at the problems of teenage from an autistic kid's point of view: Social Interaction The ability to interact socially is absent in autistic kids. They are loners who prefer to be left alone and undisturbed in their own worlds. Such a child is a natural target for bullying and ragging by other kids of his age group. At times even if the autistic child wants to come out and make friends, he is not able to do so due to lack of the required skills. Teenage is a period where you need at least one friend to confide in. It can be an extremely difficult phase when you are all alone. Puberty This is the dramatic time in life dilled with hormones and emotions. Your body undergoes lots of changes and you are confused about so many things. You don't know whom to ask or whom to turn to for guidance. Autistic children do not have the maturity to understand this phase. Special issues for autistic teens and sexuality include: Knowledge of physical changes in body. Knowledge of 'good' and 'bad' touch. Ability to communicate about a 'bad' touch or action. Keeping 'safe' distance from others. Handling menstrual cycles. Avoiding 'self-touch' in public. It can be a phase of emotional turmoil for the parents. They need to work closely with their child's special teachers to chalk out a plan that will be best suited to the child in handling puberty successfully. Self-help skills Simple self-help skills like hygiene can be a challenge for teenagers with autism. Improper motor skills, compliance, and sensory problems may interfere with a teen's progress. The proper training of hygiene and grooming can help to add these elements into the daily routine. The right approach is to simplify each task into simple small steps. The positive reward system is a great source of encouragement, as positive motivation always help the teenagers. Higher Functions Autistic teenagers are socially awkward. They lack the power to comprehend and process complex social cues which includes sarcasm, body language, humor, emotional responses and facial expressions. What complicates the problem is that the autistic child lacks empathy and hence may appear rude. Such kids are likely to be teased a lot in school settings.
Crossing the smoke screenWhy should someone quit smoking? Smoking is probably the worst sedentary lifestyle habit that we pick up. Quitting smoking changes everything right from the way you feel, taste and smell, your breath smells better and even your cough goes away. Quitting smoking cuts down the risk of cancer, stroke, neuropathy, heart disease and breathing disorders like bronchitis, pneumonia, and emphysema. Not just that, quitting saves money too... just one of the many financial rewards of quitting. Quit Smoking Tips Write down the reasons you want to quit for, and how it will benefit you: for e.g. live longer, feel better, family safety, save money, smell better, find a soul mate easily, etc. You know what's bad about smoking and you know what you'll get by quitting. Read the list daily. Ask for help from your family and friends. Help and support of family and friends without being judgmental helps a lot. You need their support when you become irritable and even irrational while you withdraw from your smoking habit. Set a Deadline. Set a quit date when you will extinguish forever. Prepare a plan. Talk with doctor and take his support and guidance. Exercise. Exercise helps relieve stress and recovers body from damage caused due to cigarettes. Start slow and increase up to 30 to 40 minutes. Begin to breathe. Daily deep breathing for 5-15 minutes will help cleanse the respiratory system and provide more oxygen repairing the damage caused to respiratory system and help cope with withdrawal symptoms. Do not quit abruptly. Cut down on cigarettes gradually. Plan everything about number of cigarettes you will smoke each day till the quit date, reduce the number each day. Buy single cigarette at a time. This helps a great deal to limit smoking. Change brands. This way you won't enjoy smoking as much. Undertake social commitment. Keep your packet of cigarettes with someone else, so that you have to ask for them each time you want to smoke. This way you'll feel guilty about asking and hence smoking; hence lowering the number of times you smoke. Find a mate who is trying to quit. This will boost the morale and keep up the positivity. Try finding a quitting chat room. Learn what triggers desire to smoke - like stress, the end of a meal, arrival at work, entering a bar, etc. Avoid these triggers or if that's impossible, plan alternative ways to deal with the triggers. Now, after you have read this, sit down and write your own list suitable to your personality and way of doing things and create your own plan for quitting.  
Expression forbidden! - Human emotionsSome people have a perpetual 'bee in their bonnets'! They maintain a demeanor and a mask which is virtually impenetrable. They are generally highly competent and efficient and occupy high positions of authority. They believe in living life set to a routine, and the worst part is that they expect others to adhere to it as well! God help those who have a boss like that, as their immediate liberty is at stake, and unless they are honing to be perfectionists, life is going to be a series of disasters with Captain Ice around! Nothing wrong with perfectionism per se, but when someone is a hard task master then he could well earn himself the epithet of being "a crashing bore," especially if he doesn't allow others to express themselves properly. Take a more intimate scenario - Mr. Bright Harry meets tepid Sally. The sparks fly only on Harry's side with Sally stonewalling his every effort to get to know her mind, body, and soul. A tough ask for poor Harry, as he is yet to touch first base with Sally. Know what? They have been married 5 years and she seems to be fond of him, yet has never as much admitted it to him. Quite frankly, the two could pass off for siblings rather than 'man and wife.' Why are some people such rotten spoilsports, especially where emotions are concerned?  It may well be a natural mindset for some to have an emotional guard up and emote, or have an emotional connect only with certain types of people. Fair enough and good show, we say! After all one can't be wearing one's emotions on a sleeve or you end up been taken advantage of. That's a mask that most 'tough guys with soft centre' wear anyway. Nowadays with the rules being somewhat relaxed with men been given liberty and allowances to display their gentler feminine emotional side, we find men going over the top with the sheer display of emotional expression. One is at sea wondering which one was worse off-the tough, cynical cop look or the "let me weep my heart out for you" kind of contrived emotion. That apart, it is bad enough for us having to contend with a person who has difficulty with expressing himself properly. We don't mean articulation or even well-developed linguistic ability - we mean being able to be spontaneous and congenial and a little forthcoming and nice to be with sort of an emotional person. So, unless someone has a romantic angle towards this guy (there are weirdoes all over the world, who go asking for it!) or girl, he is going to be feared, hated, despised, unloved, and uninvited by everybody. So why do people behave like they are going to be flogged for even attempting a ghost of a smile or a cheerful greeting to a fellow co-worker? Why do some people find it difficult even to open up on a psychiatrist's couch? The Mask The most common reason for Mr. or Ms. Grumpy is that they have probably been emotionally brutalized in their formative years by an authoritative parent and this has caused them to lock themselves up double quick in a shell and throw away the key. Now, that can be tough and extremely painful. It is a prison of their own making through which nobody can see that once bright-n-chirpy personality frozen, much like the curse of the wicked witch in those fairy tales we read. The person is dying to let his emotions out and let people see who he is, but since very little light escapes out due to the tough mask and veneer, that it is an uphill task. Then the sheer anger at not being understood, subconsciously plays havoc and then he gets to be the more demanding boss at work or that sullen wife or lone stranger staring in to nothingness on the park bench. These are the people that have a series of relationship disasters as their defence mechanisms are too solid to be penetrated. Some people may be naturally distant, and for them the finer and higher emotions probably don't register as much as they do in the average person. These guys are cut out for careers ranging from lighthouse keepers to morgue attendants to hangmen, where being emotional has no place. There are still others who swing the other extreme by showing so much of emotion that it is scary for others to take them on. Their emotional side is so overwhelming and demanding that it is actually a clever subterfuge on their part to drive people away as they subconsciously do not want people to get to know their real side. They generally don a mask of humor and good cheer and are great fun to be with. In reality, they are alone and scared and perhaps hurt emotionally. So, they feel safe to display emotions to masses rather than individuals. These people make good evangelists and rock stars as they can safely display and get an emotional discharge without running the risk of a one-on-one emotional exchange where they are afraid they would be hurt. If you encounter such a person who looks askance at you displaying your emotions, then it is better for you to talk things out and maybe put things in perspective. Of course, this all depends on whether you are emotional enough to maybe give someone a chance by understanding what drives them to do the things they do. Let me assure you the ice will thaw if the intention is genuine and well meant.
Have that chocolate without any guiltYou may find this hard to believe, but chocolate is actually good for your health. Hold on, before you faint. Let's first get to the crux of the matter. Chocolate can actually be good for you if you eat it in moderate quantities. So what about all the bad effects of chocolate that people always talk about? Let's fume them all one by one:  Chocolate causes dental caries: Dear mummy, dental caries (cavities) are caused due to poor oral hygiene and consumption of foods rich in fermentable carbohydrates. When these carbohydrates are left in the tooth for a long time, they release an acid. This may damage the tooth enamel and cause tooth decay. In fact, chocolate contains tannin which actually prevents cavities from forming. So next time, dear mommies, let your child enjoy a small piece of chocolate. You can also join them in the treat.  Chocolate is loaded with fats and sugar:Yes, chocolate comprises of both saturated and unsaturated fats, but a majority of themare in the form of oleic acid and stearic acid. Now, oleic acid (present in olives) and stearic acid are good to lower the blood cholesterol levels. Also, the fat that is found in chocolate is added later, after the chocolate has been processed. So the higher content of cocoa in any bar ensures that there is less fat in the chocolate. So, what about the sugar?Sugar is bad, but the darker variety of chocolate has less sugar compared to the regular sweet chocolate. Dark means higher cocoa content and hence no room for other fillers likes cocoa butter, sugar, nuts, etc.  Chocolate contains no nutrients: On the contrary, it is rich in antioxidants.What is the work of an antioxidant? They scavenge the body of free radicals, which roam in body and cause ageing and diseases. Antioxidant flushes these free radicals out of your body. So, if you want to stay young, bite on a piece of chocolate once a week. Secondly, diets rich in antioxidants have been proven to lower the incidences of heart attacks, strokes, cardiovascular diseases, hyperlipidemia, and arthritis. Hence, I stand by the bar full of antioxidants;it's actually good for you.  Chocolate contains caffeine: Caffeine content in chocolatesis low as compared to your tea, coffee, or cola drinks. Now, having counted the amazing health benefits of chocolate, it is important to tell you which chocolate is healthy for you. The one which is in its purest form - thebittersweet one, which is high in cocoa content, is the clue to your healthy bar. So next time you crave a dessert, indulge in a small piece of chocolate to satisfy your sweet tooth and forget that guilt.  
Beating the weight loss plateauThere comes a stage when you stop losing any weight in spite of strict exercise and diet regimen. This is called as weight loss plateau. When calorie intake is reduced along with exercise, the energy required is obtained from stored fat which eventually leads to weight loss. This rate of weight loss slows down and eventually stops once body reaches its set point of metabolism. This set point varies from person to person. So what can you do next? Here are some easy ways to get the weighing scale budging: Modify diet pattern: Metabolism slows down with lowering calorie intake. To reset metabolism, you need to have an adequate amount of calories. This can be done by including fruits and vegetables, whole grains, and proteins in diet. More energy is needed to burn proteins than carbohydrates or fats. Eat within half an hour or hour after exercising. Add proteins and carbohydrates to diet. Sip water: Increase total water intake in a day. Drink water before, during and after exercise and throughout the day. Change the workout: Change the exercises you do daily. Muscles get accustomed to a routine workout. Switching exercises and continually challenging helps burn more fat and build lean tissue. Change the type and time or duration of exercise. Try cycling instead of running if you have been doing it for long. Running, swimming, dancing, and Pilates too are good options. Skipping and brisk walking help in burning calories too and break the plateau. In the gym, change the exercise or number of repetitions. If you have been working on machines for long, try weight training or floor exercises. Take rest: Adequate rest is essential for the body to rejuvenate. Muscles, tendons, and ligaments get slight internal and external injuries which can be healed by rest. Proper rest helps repair and regenerate the tissue and makes them strong. Make these changes and get the needle on that weighing scale to budge.
All you need to know about angioplasty!Why would you need coronary angioplasty? The walls of the arteries are being constantly lined with a fatty material called plaque. This plaque increases in certain conditions like atherosclerosis. When the build-up is too high, the artery gets blocked and the subsequent tissue receives very less or no blood, causing it to die. The plaque at times may be dissolved by medicines but if it is too big, medicines prove ineffective. This is manifested outwardly as a heart attack. This is the time when the doctor would recommend the coronary angioplasty as a treatment for you. How is it done? A thin catheter with a deflated tiny balloon at one end is inserted into the affected artery. Once the exact location of plaque build-up is reached, the balloon is inflated causing the plaque to get pushed against the artery wall and creating free space for the blood to flow. A small mesh called a stent may be placed to hold the artery in place. Some stents are coated with medicines that prevent the scar tissue formation following the angioplasty procedure. The procedure may be done as an emergency or it may be planned. If it is a planned procedure: You will have to get hospitalized and stop eating or drinking 6 to 8 hrs before the procedure. Once the procedure is done, the doctor would prefer you staying in the hospital overnight to watch for any adverse events that may happen. What happens after the surgery? The surgery lasts for 1 to 2 hours and you would be allowed to go home the next day. You will be advised not to undergo vigorous and strenuous exercises and to rest adequately. Most people are fit to return to work a week after the surgery.
How to communicate with a patient who has a strokeThe first and the most important thing to communicate with the patient, is to give undivided attention. Give attention to his activities, gestures, his facial expressions through which he may try to communicate so his feelings could be understood. Eye contact is also important but the patient having stroke may look at you square in the eyes but he may not respond to your conversation. While communicating with the patient you should always stand in front and tune out all the other sights and sounds in the room. Maintain full silence around the patient in the room, turn down the volume of the television, radio and ask other people in the room to be silent. You may communicate with the patient by making contact by touching the hand, chin, cheek or areas which are not affected by stroke. As the side which is affected by stroke, does not have any sensations. You may communicate with the patient through his family member by telling the family member to communicate with patient by saying, "Look at my face"; through this we can gain the patient's concentration. You should always speak clearly with the patient in a normal soft volume. Express your ideas in simple terms, form simple sentences, do not use complex words. You may repeat the sentences or an important term again. For example to ask if the patient wants tea, repeat the word 'tea'. More complex thoughts can also be similarly conveyed and repeated. You may also use hand gestures with clarification like doing Hello by waving your hand or through your hand action, you may ask questions like, How are you? Are you ok? What do you want? Through this both caregiver and stroke patient can benefit. You may ask your patient to point out whatever he wants or if he needs anything. And gradually he will develop the habit of pointing the daily items like television, newspaper, remote, eyeglasses radio, drapes an uncomfortable foot, the patient can indicate any pain or headache. Through this communication we can make the patient learn, use mechanical lifts to get in and out of the bed, and with the help of the attendant by demonstrating the patient how to use it. Sometimes when the communication does not work, take a break, give it time and try again, do not get frustrated and reassure the patient that yes, he or she can do it. Good communication with the patient is very important as they cannot speak their basic wants and needs clearly. The patients suffered a stroke also have slurred speech. There is a deviation of the angle of mouth. They are mostly bed ridden and could not carry out the routine activities.
Busting misconceptions about homosexualityIn the past few years, homosexuality has become a subject of public discourse in India. Thanks to gay pride marches and the Delhi High Court's historic ruling decriminalizing same-sex intercourse in 2009, more people today are willing to accept homosexuality as normal. However, there are still a large number of people who are still confused about whether homosexuality is normal. Homosexuals are people who get attracted to people of the same gender. Gay is a term used for both male and female homosexuals, but some prefer the term 'lesbian' when it comes to women homosexuals. Some misinformed people consider homosexuality as a purely decadent western phenomenon which is far from the truth. Homosexuality finds its place in recorded history throughout the world. So is homosexuality abnormal? A few decades ago a gay person would have ended up on a psychiatrist's couch where attempts would have been made to re-orient him/her towards the heterosexuality. However, as the American Psychology Association notes, "No, lesbian, gay, and bisexual orientations are not disorders. Research has found no inherent association between any of these sexual orientations and psychopathology. Both heterosexual behavior and homosexual behavior are normal aspects of human sexuality." Some scientists are trying to find a genetic link to homosexuality. Results so far have not established a definite link. A whole lot of factors could play a role in deciding sexual orientation - genetic, hormonal, developmental, social, and cultural. One cannot safely conclude that being "gay" is in one's genes and is therefore, hereditary. Legalizing gay marriages Same-sex marriage is legally recognized in several jurisdictions within the United States. As of April 2013, nine states—Connecticut, Iowa, Maine, Maryland, Massachusetts, New Hampshire, New York, Vermont, and Washington—as well as the District of Columbia and three Native American tribes[1]—have legalized same-sex marriage, representing 15.7% of the US population.
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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