When you were in your early 20s, you would probably swear off sex for a year before you’d admit—to yourself or to anyone else—to having any problems with sex. Pain during intercourse? Hey, that was part of the learning experience. But it probably happened because you were so eager to get to it that you didn’t think or care that your partner wasn’t ready. And your partner was probably too shy to tell you.

How times have changed! You’re older and presumably wiser and more willing to admit to those times when your body doesn’t do what you expect it to do, which includes during sex. Some problems you may have are pain during intercourse; priapism, a very dangerous condition in which your erection doesn’t subside; or blood in your semen. All are signs of potentially serious underlying health problems.

If you have blood in your semen, it’s possible that you have prostatitis, which is an inflammation of the prostate; or perhaps a minor blood vessel has broken. Though it is rare, priapism is an emergency problem. Priapism may be a result of a clot that is preventing the blood from leaving the penis after sexual activity, or it could be due to a problem with your spinal cord.

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Although they are polar opposites, it’s not uncommon to have diarrhea that’s followed by constipation and returns to diarrhea again a few days later. In fact, I see this back-and-forth syndrome occur with some frequency in men and women in their 40s. Besides diarrhea and constipation, you may also have abdominal cramping, bloating, and flatulence.

This condition is generally known as irritable bowel syndrome, or functional colitis.

If you think you have irritable bowel syndrome, you shouldn’t worry that there’s something wrong with your digestive system, because most often stress and particular foods such as dairy products and those that are high in fat are the culprit, especially if you have a history of abdominal problems that dates from your late teens and early 20s.

Generally, irritable bowel syndrome is an annoying condition that can be treated. If, however, you notice a sudden loss of weight or your health in general begins to deteriorate, you should see your doctor.

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Description and Possible Medical Problems

If you’re under 50 with a heart rate to match, it means you’re in excellent health and physically fit. If, however, you have a history of heart disease and you’re taking beta-blockers—which deliberately slow the heart rate—as long as you have no other symptoms, you don’t have to worry.

A slow heart rate in an elderly relative is cause for concern, however. Also, a slow heart rate may be discovered only in the course of an exam for possible heart failure, especially when it’s accompanied by shortness of breath or a sudden fall.

Treatment

If an elderly relative has a heart fate under 50, her doctor will use an electrocardiogram and echocardiogram (see pages 239-241 for a description of these tests) to evaluate the health of her heart. If the slow heart tate is not caused by beta-blockers, she may need to have a pacemaker surgically placed.

A pacemaker is a small device that keeps the heart beating. After a pacemaker—a small generator that measures about four inches square—is placed under the collarbone with local anesthesia, it normally takes less than a week to fully recover from the procedure; the pain is usually minimal and can be treated with aspirin or Tylenol. Pacemakers are totally safe; their batteries almost never need to be replaced, and they have been responsible for saving thousands of lives. Contrary to popular belief, you don’t have to have had a heart attack to require a pacemaker, though people who have had a heart attack still receive the majority of pacemakers to forestall potential problems with the rhythms of the heart.

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Description and Possible Medical Problems

One of the biggest concerns of doctors who treat a large number of elderly patients is preventing the development of bedsores. The first sign of a bedsore is usually a break in the skin, so if an elderly relative is confined to bed, it’s important that any break in the skin—especially on the buttocks or heels—receive medical attention. A bedsore can develop due to poor nutrition or immobility. If an area has constant friction and pressure on it—in the case of a person who is bedridden—the skin can become frail. The skin can then quickly break down and the sore can spread down to the bone and cause a bone infection called osteomyelitis. The infection can also spread into the bloodstream and cause a bloodborne infection of bacteria known as septicemia.

Treatment

The best treatment is prevention of the bedsore by helping a bed-bound patient to move around and change position in bed several times a day.

For an existing bedsore, there are a variety of treatments. The most important treatment is excellent nursing care. An alert nurse will help keep pressure off the area; a special mattress made of foam or sheepskin or a special airflow bed can also help.

Once a bedsore develops, the area must be kept impeccably clean with saline solution and sterile packing materials. Bedsore care will also depend on the general health of the patient.

If the bedsore has caused an infection, your elderly relative will need to receive intravenous antibiotic therapy. If the bedsore contains areas of dead skin, the doctor will need to remove the dead skin surgically. This procedure, which is not painful, is called a debridment.

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If you find you are unable to move your tongue around easily, you may have a tumor. If the tumor is benign, you may not have noticed it as it’s grown, since a benign tumor can take years to develop. Some people may even dismiss the growth as a normal sign of aging.

A benign tumor usually starts out as an almost imperceptible lesion that is lighter in color than the tongue. It tends to grow slowly over the course of several years. Though it may occasionally bleed, it won’t hurt.

A benign tumor can turn into a malignancy, however, so your physician will want to examine it regularly.

If the growth has appeared suddenly, it’s likely the tumor is malignant, and it can quickly spread to other parts of the mouth and body. Like a benign tumor on the tongue, a malignant tumor is not painful, and in its early stages it resembles a benign tumor. However, it grows quickly and can become ulcerous and bleed frequently. A malignant tumor can also stiffen the tongue to the point where it is almost impossible to eat and talk. The cause of a malignant tumor on the tongue is usually a long history of pipe, cigar, or cigarette smoking.

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