Mens Health Blog. Medical Blog

The easy answer is that semen is the ejaculate. It consists of sperm plus the secretions from the sex accessory tissues (these include the prostate and seminal vesicles), and is composed of prostaglandins, spermine, fructose, glucose, citric acid, zinc, proteins, and enzymes such as immunoglobulins, proteases, esterases, and phosphatase. Less than i percent of semen comes from other reproductive organs such as the testes and epididymis, which produce sperm.

Semen is not merely sperm; sperm is just a tiny fraction of the seminal fluid. So why the other secretions? In some mammals, sperm removed from the epididymis—having never made contact with secretions from the prostate and seminal vesicles—has proved capable of fertilizing an egg. Many scientists believe the varied secretions that make up semen are there as a buffer, to help sperm survive and remain active, to encourage sperm’s passage in the male and female reproductive tracts, and to minimize environmental shock during intercourse. The presence of sugars such as fructose and glucose may be there to nourish the sperm, to provide energy for sperm’s metabolism on its journey.

And still other secretory products—the zinc, for example, and proteases and immunoglobulins—may exist as disease fighters that cleanse the urethra, repulsing attack by harmful substances in the body that enter the urinary tract.

*12\201\8*

Some men change the direction of their life because pain pushed them out of a situation that had become unbearable. They may not discover a better alternative until after making this break, as we have seen. Other men change because they feel pulled toward something more meaningful: a deeper commitment, a different intellectual interest; more creative freedom; or a calmer way of life. Even so, they too will experience pain. They are giving up something familiar for something unknown. They are taking a risk. Men who have made such moves say the rewards ultimately outweigh the risks. But, they insist, uncertainty and sacrifice are part of the package. If a man who makes a major change ignores either, he will be sadly disillusioned.

“Society has you pigeonholed, and if you want to get out it’s very hard,” says Dr. Harold Lear who, at age forty-seven, scrapped his lucrative medical practice as a urologist to enroll at the University of Pennsylvania for postgraduate training in psychiatry and sexual therapy.

In retrospect, his decision to give up a steady income astonishes even him. “I was always concerned with money,” he says. “I always had to be. And then to decide the hell with it was just incredible!” He actually entered school before being sure the funding he had applied for would come through. For six months he and his wife lived on a very stringent budget, and even borrowed money, until he finally did receive a NIMH grant. Finding an organization to fund him in the first place was difficult, says Lear, who is convinced he got the grant partly because one of the NIMH agencies was fascinated by the fact that “this character had actually quit his practice and was studying without any income whatsoever.”

Before leaving the hospital in Connecticut where he had worked, Lear encountered some dramatic reactions from his colleagues. “Some people were very supportive,” he says, “but others resented me and became very hostile.”

Lear emphasizes that his move into a new field was made only after he had seriously re-evaluated his own talents and interests, and had gotten advice from people whose opinions he respected. His move was prompted partly by the realization that “I was working hard to make money to get away from working hard to make money. And that cycle seemed crazy!” Enthusiastic about his new life, he adds: “I also found that if you’re doing the same thing constantly there is a deterioration. Change is a renewal, and this whole experience has been fantastic. A sheer joy. It’s been the most rejuvenating thing I’ve done since I’ve been in practice!”

Some men who make a mid-life shift turn an avocation or creative talent into a second career. Though previously trained in or dedicated to painting, music, acting, or writing, they generally have had to abandon their creative calling and find other work to support their family. Later, when they feel financially secure, or their children are launched, they may turn again to their art. Often, however, this decision means trimming the budget and simplifying the family’s lifestyle.

When Harding Lemay left his job, at forty-five, as vice president of Knopf publishing house to devote himself to his own writing, he did so in part, he says, because “nothing at work nourished my self-respect or held my attention.” He also found himself becoming increasingly irritable (“I would come home a snarling beast”) after spending his days being nice to people he didn’t like. Describing what finally led him to resign, he says:

There is something every man feels uses the best in him. And I think we become very mean people, men do,

if we’re not living up to what we think we are. If you, don’t like what you do then you don’t like what you are. I’m absolutely certain of that. And if you don’t like who you are, your poor wife and kids pay for it.

That’s what really forced me into examining it, and then saying, “If this is really what I want then I’m not the kind of guy I want to be.” And once a man reaches that point, then I think the next step is almost automatic.

The summer after he quit, Lemay went with his family to their summer home on Fire Island to begin writing his autobiography, Inside, Looking Out. The envy he aroused startled him. “The curious thing was the number of men who came up to me,” he says. “Surgeons, lawyers, advertising men— men who were making much more money than I was, averaging $50,000 to $150,000 a year, and who had magnificent occanfront houses. Out of about 200 families there, I must know 100 men well enough to talk to. And that summer I don’t think there was a man under 50 who didn’t stop me. The conversation usually centered on, ‘How did you have enough guts to do it?’ ”

Sensitive to the fear of taking such a risk that provoked these queries, Lemay stresses that he left his job primarily because he had something “tugging” him away—something more important to pursue. And before making his move he had already written five full-length plays. “I don’t think I would have had enough guts to jump into a new life without having explored it,” he insists. “I don’t think you do it unless you’ve had years of hoping or wanting to. It’s not an easy decision. It really isn’t.”

Although changing careers at mid-life is generally thought to be a choice that only the affluent can afford, or would even desire, there is evidence that many blue-collar workers feel a similar need for renewal and more freedom of movement at this stage of life. In fact, their wish for change is often so strong that they are willing to undergo considerable hardship in order to make the switch. That, at least, is the case with a group of two hundred policemen and firemen in New York City who are training for second careers as professional nurses.

Designed to reduce the personnel shortage in nursing and attract more men to the field, this unique experimental program at Hunter College-Bellevue School of Nursing is federally funded, which means the men do not have to pay for their training. Still, the sacrifices they made to prepare for their mid-life switch are most impressive. Their rigorous schedule requires attending classes 3 nights a week for 2 years, in addition to working full-time. Keeping abreast of their reading and studying cuts into their weekends and sharply curtails time spent with their families. And, most humiliating, these men have had to adjust to moving from a supermasculine career into one considered feminine.

‘The first group that came to us were very brave,” says Professor Louise Jennings, the project’s director. “They were laughed at and called ‘Nancy Nurse’ by their colleagues. But now that they’ve broken the ice, more men in their departments are interested.” (Because the younger men rejected this course initially, the average age of the first class was forty-five; in the second it was thirty-five.)

Generally these men were attracted to the program because they knew employment would be guaranteed when they finished, and because they found the prospect of traveling to different parts of the country appealing. Planning to supplement their retirement pension with income from their new career, they see themselves working in different capacities: in emergency or operating rooms; in industry or schools; or even becoming owners of nursing homes.

Their reasons for enduring this grueling study routine vary, but most say that staying on the job for more than twenty years is much less feasible today than in the past. Policemen stress violence and social change, and firemen underscore health hazards and the physical toll. Wanting to find another work direction for the future, some of these men had already tried various business ventures, without much luck. Others were even willing to spend their own money for training—to become an X-ray technician, for example—but found that full-time study was required. Thus for men without a college education, this opportunity to become a professional nurse was welcome indeed.

“When I heard about this course it was like somebody opened a window in a closed-up room!” said one policeman. “I could breathe. I could see a way out for myself.” In his view the sacrifices that he is making now are well Worth the satisfactions he envisages for the future:

It took a lot to sign up for this course, knowing the reaction we had to face back at the stationhouse. You have to have some guts to go ahead and say I’m going to change my whole conception of what I want to do, how I want to fulfill myself. At one stage of my life, money was the big thing, but I’m not interested in the cash value of life anymore.

Like me, some of the guys are going around the clock. There are days you go to work, go to school, go home to sleep—and start again at 5 a.m. It’s tough, and you’re putting in a lot of time and effort. If a guy wants to change his job he has to have moxie. And if he doesn’t, he’s never going to do it!

I’ve spent seventeen years of my life missing everything. If there was a picnic or a wedding or a christening I always had to say, “No.” I was working. Now I’ll have a job where I can say, “Yes!” And maybe I’ll just work three or four days a week, and home will be wherever me and my wife want it to be. We’ll be free!

*60\93\2*

Generally the generation gap grows even larger when an adolescent rebels in a more radical manner than merely choosing a disapproved lifestyle. Given the many rapid changes in American society, the issues that parents must confront are more complex today than ever before. And since there is no longer a consensus on values, nor any clear-cut guidelines on how to socialize a child toward adulthood, parents often feel inadequate and confused.

These feelings increase at mid-life, when a man discovers that it is far more traumatic to be the father of teen-agers than toddlers. Adolescents no longer rebel simply by drinking too much beer, flunking math, abusing curfews, or taking the family car for a joyride. They smoke and deal dope, get strung out on speed or heroin, shoplift and steal, or run away from home. Some disappear entirely, swallowed up by the underground drug culture or seduced by a religious cult like that of the Reverend Sun Myung Moon.

Steering a teen-ager through such treacherous waters is not easy, especially for this generation of success-oriented men who have often been too busy to pay much attention to their kids even during more placid periods. “These guys know a man doesn’t make the cover of Time magazine because he’s a good father,” said one management consultant bluntly. “They may give lip-service to the sanctity of their family, but the corporate man who is really concerned with his children’s development is rare indeed.” Sometimes men who have been so preoccupied with work that they have largely ignored their children are dynamited out of their indifference only when a tragedy occurs.

“This is a perfect example of a mid-life crisis,” said a New England psychiatrist, pointing to a telephone message marked “Urgent” from a man he described as a highly successful business executive. “My son was hurt in an accident and is dying now. Another child is very upset. Please advise,” the message read. “This kind of man buys advisers when he needs them,” commented the psychiatrist. “He had just recently woken up to the fact that he barely had any contact with his children. And now this.”

Such heart-shatterini? incidents are not Unique. “It’s only when there is a total breakdown in the child and it destroys the family that we do something,” declared entertainer Alan King not long ago, speaking from personal experience. “T saw it all . . . the glue-sniffing . . . the marijuana . . . and I excused it, any excuse,”" he said about his oldest son. Bob, who had gone from bcinc a school troublemaker to using alcohol, barbiturates, amphetamines, and then to becoming a heroin addict at seventeen.

“I’m more aware now,” claimed King at forty-four, acknowledging his failure as a father several years after his son had completed a rehabilitation program and gotten off drugs. “I thought because I was a success at any early age, I knew it all. I knew nothing.” An active philanthropist who had “played a million benefits” and spent many years on the road, he recalls not wanting to discipline his child after returning from his travels. “When I did things with him, it was token, there was no continuity,” he admits. “They are aware when you are playing at being a father. They can smell it. just as they can smell true affection, concern and parental guidance.”7

King discovered that more discipline, consistency, and demonstrative affection are needed at home. “Now everyone kisses,” he says. He also discovered that even though the demands of his career are atypical, many other men fail their children in a similar way:

The average father doesn’t lead my life, but it’s the same thing. He goes to work, comes home, says he doesn’t want to hear about the little problems because he’s had a tough day at the office, puts on the television and then goes to bed. He’s on the road, too!

I sec successful men running companies with hundreds of men; they know how to deal with every situation, how to discipline and reward in the business world. But the biggest business they arc running is their family and they fail at it. When you’ve been through this, you find out how many other parents arc going through it.

King remembers the futility of reminding his son that he had given him “everything,” including luxuries his own immigrant father could never afford. “What he wanted was not the material things but my affection and love,” he now says with painful candor. “What my kid was screaming for was Daddy.”

King heard the scream just in time. Two years later, when he realized that his younger son was heading in the same direction, smoking marijuana and sneaking out late at night, he had his son arrested for drug possession. “I had to stop him, and the only way—it was the last resort-—was to call the police,”" said King, a man who is just beginning to realize at mid-life how difficult it is to be a daddy. “The greatest danger,” he warns, “is that we see what is happening but we don’t want to see it, we don’t want to believe it.”

Alan King is right. Many men in their middle years refuse to see what is happening to their children, refuse to hear them even when they scream. When a youngster gets in serious trouble with himself or with the law, they react, instead, by becoming immovably irate. Rather then face reality or confront the fact that their child, their own flesh and blood, has given birth to an illegitimate baby, stolen a car, become a political activist, or been convicted on a narcotics rap, they often deny the whole event, deny any responsibility for their child’s behavior, by cutting of all communication.

Here is another instance where men of this generation reach an impasse because of impacted feelings. Not only are they inept at handling openly antagonistic confrontations with their own children, but also they frequently cannot accept the fact that their child has in some way failed, or that they themselves have failed as a father. Turning their back, they refuse to acknowledge that here is a situation they cannot solve, a person they cannot control.

“Such critical encounters with rebelling youngsters are enormously humbling experiences” for driving, ambitious men, says sociologist Norma Haan, who has interviewed many mid-life men participating in studies at the University of California’s Institute of Human Development at Berkeley. One man whose daughter had become involved with drugs confessed this was the only problem he had ever tackled that he couldn’t lick.

“He found out he couldn’t order her, he couldn’t bully her, he couldn’t persuade her,” says Haan. “And for the first time he felt really helpless about something that mattered terribly to him.” Frequently such fathers want to cut their children off, in contrast to mothers, who are much less inclined to break the tie, despite their anger. The man’s attitude is that he will refuse to support a child who is doing things he doesn’t approve of.

“Some of them absolutely reject the kid,” says Haan of the men in her study. “They don’t know where the kid is, and they don’t care to know.”

*45\93\2*

Settling Down, Thirty-two to Thirty-nine: During this period a man generally makes deeper commitments to his work and his family. He “joins the tribe,” as the Yale group puts it. One keynote of this period is order: building a nest and working for security. Another keynote is “making it”: moving upward according to an inner timetable about the age when certain goals should be reached. By forty, for example, the executive wants to be earning fifty thousand dollars; the assistant professor desires tenure; and the professional man aims at becoming a senior partner.

One of the most pernicious myths about adulthood is the notion that once a man has established a stable life pattern, it can continue more or less indefinitely—without any major problems ahead. This is simply not true, say the Yale group. No matter how satisfying the life structure created during this period, it cannot possibly fulfill all of the self—and must therefore be enlarged, or radically changed, later.

Another reason for future change is that this structure is inevitably based partly on illusions about the importance of work goals, relationships to others, and what a man truly wants in life. And later on, letting go of these illusions will be vital for further growth.

*31\93\2*

Men of this generation have made a heavy investment in hard work, and at mid-life they are forced to come to terms with what that means. In large part their difficulties stem from a gigantic gap between myth and reality: Taught to expect more from work than it could possibly deliver, they find themselves waiting for rewards at a time when work itself is less rewarding than ever before. Jobs today are more impersonal and pressured than in the past, less satisfying in terms of providing a sense of human worth. Moreover, the rules for playing the game—and winning—have also changed.

“What it takes to get ahead in the organizational structure is almost directly opposite to what we’ve been taught,” claims Shumaker. Working hard and being loyal—basic tenets of the Horatio Alger myth—are not enough. To be successful, he says, a man must be more concerned about his boss’s needs than his subordinates. He must be self-centered, manipulative, and totally committed to his career—sparing almost no time for his family.

Businessmen themselves are gradually becoming aware of this. In a recent survey they agreed overwhelmingly that “pleasing the boss is critical to success” and that “a dynamic personality and the ability to sell oneself” is more important than “a reputation for honesty or firm adherence to principles.”

But if striving and hard labor are not enough to get to the top, neither are they enough to lead a fulfilling life. The trouble is, however, that many men of this generation don’t know how to do anything else but work. In response to disappointments and anxieties on the job, pressures that push them to re-evaluate the meaning of their pursuits, they toil even harder. Many, in fact, become work addicts.

Still largely unrecognized as a sickness, work addiction has only recently been identified as a neurotic syndrome, a syndrome that is peculiarly American and primarily male. Professor Harrison M. Trice of Cornell University’s School of Industrial and Labor Relations describes it this way:

“Like addiction to alcohol or food, addiction to work develops as a means of managing heightened anxieties and tensions, whatever their source. Work addicts become attached to work as an expression of neurotic conflict and obsession. . . . They are not the employees who simply work hard, but rather individuals who work all the time. They live, eat, and breathe their jobs. They stay late at the office, take work home with them, work all weekend and on holidays, and refuse to take vacations.”

What happens to the work addict when his job responsibilities are curtailed, or when his value to the organization diminishes? He becomes anxious and depressed; and then— Catch-22—responds to these feelings by working even more. The neurotic quality of his addiction becomes still more apparent when he is formally demoted or fired: “Separation from work can bring on feelings of worthlessness and inadequacy that reach such extremes as chronic depression and suicide,” says Trice.

Other alternatives, both for men who lose their jobs and those who continue working at jobs where they feel useless, include giving up their aspirations or sublimating them into nonjob activities. However, since these choices are generally repugnant to men who feel compelled to achieve, they more commonly resort to drinking—and the reasons are understandable.

“If you become addicted to work and then become obsolete, what the hell have you got left?” says Trice. “You don’t know how to play. You don’t know how to enjoy leisure. Drinking is pretty easy to learn. You just drink the stuff—it goes down real easily.”

Today an estimated 4.5 million American workers are alcoholics, and physicians and psychiatrists report that countless more men are excessively heavy drinkers. Evidence is mounting which suggests that the responsibility falls directly on corporate shoulders: Alcoholism is caused primarily by job factors, especially the specter of obsolescence, according to a study of drinking pathology conducted by Professor Trice and his colleague, James A. Belasco.

The majority of men they questioned, 82 per cent, had no drinking problem until they moved into a period of competitive career effort and upward mobility during their mid-thirties. Typically, alcoholism began when the older man felt forced to keep up with younger, more recently trained competitors; and it accelerated when he felt increasingly worthless—when his work role was diminished, or his responsibilities reduced.

To put it more bluntly, men become alcoholics when industry treats them like expendable objects. Despite the evidence linking alcoholism to work pressures, however, and despite the cost in sick pay and absenteeism now estimated to total a whopping $8 billion a year—industry has, with rare exceptions, refused to accept responsibility for this huge problem. Moreover, the few corporate programs that do exist to rehabilitate alcoholics almost never cover executives or professionals.

At mid-life when the scramble for success accelerates, the man who has become addicted to work finds himself in a double bind: Even if he doesn’t turn to drink to ease the pressures, he will probably wind up as a coronary candidate. Compelled to ovcrpcrform in his job role, the addict tries to manage his anxiety by pouring all his energies into his work—withdrawing from his family, shunning leisure time, and suppressing his feelings. But he never really escapes anxiety; he merely passes it on to his heart.

Horatio Alger’s disabled offspring, the work addict, is really the psychological counterpart of the Type A man. Unfortunately, however, both patterns are rarely seen as sicknesses in our society because, despite being harmful to the individual, they are valuable to the organization.

*16\93\2*

The most popular label for the curious troubles that afflict men at mid-life is male menopause. Unlike the other phrases, it has a scientific ring.

Taken literally, it is of course a ridiculous concept. Men don’t have a menstrual cycle, we all know that. Nor do they lose their reproductive powers in their forties as women do. We know that, too. Nonetheless, the question of whether or not there is a syndrome known as male menopause has been hotly debated and widely publicized.

Some doctors use the phrase in a metaphorical sense to describe the psychological reactions that trouble men as they age. Others have focused on the_ hormonal issue, suggesting that like women, men in their forties also experience devastating hormonal changes. One influential medical popularizer, Dr. David Reuben, claims that because of the menopause all men will become impotent at this time of life—unless they undergo hormonal treatment. Reuben even predicts that with out such treatment a man’s genitals will shrivel and his breasts enlarge. This is nightmarish nonsense.

The responsible scientific community overwhelmingly agrees that, unlike the female, the male in his forties does not normally suffer from radical hormonal changes. Rather, the decline is gradual and usually too slight to have any effect on his sexual functioning. If he is in good health and not victimized by psychic blocks, a man can continue having erections and enjoying sexual relations well into his eighties.

(It is true, however, that a few men will suffer a sharp drop in hormones later in life, in their fifties or sixties. Considered an illness, not a normal occurrence like the menopause, this “climacteric” can be treated by hormone therapy. More about that later.)

Given these facts, the phrase “male menopause” only confuses rather than clarifies matters. Why then is this absurd and destructive label so popular? Why do some authorities favor a phrase they must qualify as metaphorical only? Why do women welcome a label with such a castrating bite? And why do men so willingly embrace a concept implying they’re on the sexual skids?

The reasons revolve, first, around the profit motive: Male menopause is a syndrome that was originally invented, it has been suggested, by certain pharmaceutical companies to promote the sales of male hormones at a time when the medical community first became enthusiastic about endocrinology.

This in turn resulted in a flood of sometimes lurid literature on the subject inundating the physician’s desk. Since there has always been a tendency in medicine to seek a quick cure for psychological symptoms, some bandwagon doctors were only too happy to buy the sales pitch claiming that a hormone injection could “replace the strength of declining manhood”—and to pass this soothing promise on to distressed patients. Besides, it is much simlper for a doctor to whip out a syringe than deal with a man’s emotional problems.

Obviously this diagnosis of male menopause did not gain wide currency simply because it was promoted by drug companies and endorsed by some physicians. It also had to be popularized through the mass media. But since the phrase itself is alliterative, and the topic provocative and controversial, it makes for highly commercial copy—which is why in recent years so many magazine articles and television programs have been devoted to this subject.

More important, however, most of us have found it to be a comforting catch-all label. A ridiculous phrase to begin with, it helps us laugh when faced with unsettling male behavior— and lightens our anxiety. Also there seems no limit to its usefulness. It’s the menopause, we nod knowingly, when a man in his forties becomes restless and despondent. It’s the menopause, again, when he lies brooding in the hammock, drink-1111: too much Bourbon. Likewise when he buys a flamboyant wardrobe, gives up a high-status job for the simple life, or runs off with a much younger woman. Without doubt, we snicker, it’s the menopause.

This diagnosis appeals to all of us for the same reason doctors find it convenient: It provides a legitimate excuse to avoid dealing with disturbing emotions.

Women seize upon this phrase for support at a time of life when the battle of the sexes often escalates dramatically. Wife or girlfriend, she wants something to blame when her man glowers at her irritably, provokes arguments unjustly, or Haves a trail of adulterous clues. Attributing his strange behavior to some elusive malady not only lets her off the hook us the possible cause of his troubles, but also eliminates the Deed to probe too deeply or face shattering realities: like the fact that he is having an affair or that their relationship is over.

For the woman it is surely less devastating to believe her Ban is sick with the menopause than sick of her.

Moreover, she probably has good reason to use every weapon at her disposal. One of the most common reactions at this time of life is for a man to seek a scapegoat for his problems. Anyone from a secretary to a boss to younger colleagues to welfare recipients will do, but most frequently it is his wife or girlfriend whom he faults. Even otherwise sensible men suddenly grant their mates extraordinary demonic powers during this period.

Subject to such irrational attacks, a woman is likely to become insulting and abusive too. By calling her man menopausal she suggests not only that his sexuality is fading, but also that he is acting like a female. Equally frail and vulnerable. Equally victimized by his body.

What better way to puncture the inflated balloon of male superiority than this? What more scathing denunciation of machismo could there be? After years of being accused by men of bizarre behavior triggered by her hormonal cycles, what sweet revenge for a woman to suggest there is a time of j life when a man becomes as loony and unpredictable as a menopausal female.

Seen in this light, it is understandable why women use this label as an epithet, a way of fighting back when they feel put * on the defensive.

But why do most men readily accept “male menopause” as an apt description of their mid-life predicament? Many every volunteer the phrase, offering their diagnosis with an earnest air of insight and discovery.

Why should the American male welcome such an insulting! label?

The answer is that the insult is mild, and gladly ignored compared to the vast relief a man experiences when he can stamp all the scrambled threads of his life with this simple tag—meant to excuse everything.

It’s the menopause, he sighs as he casually surveys thm chaos he’s created, the misery he’s caused. If his wife is distraught, his girlfriend exploited and his children rebellious, he can now claim it’s not his fault; rather, the fault of an obscure ailment that has suddenly struck.

There are good reasons for welcoming an escape route: Taught to repress his feelings, the American male now in his forties is poorly equipped to handle the disturbing emotions that fracture his inner peace at mid-life. Beamed into power and performance, he regards emotional upheaval as a sign of weakness. And he has become so used to stoic self-control that by now he has often lost touch with his feelings entirely. Deeply buried, rarely revealed, they represent alien territory.

How then to cope with the frustrations and fears so common at mid-life? How to cope with the doubts and depression? Instead of confronting them, a man often finds it easier, more his style, to seek an external solution: make a major move, find another job, grab a younger wife, leap into an affair—all options oriented toward action.

When this need to run and repress prevails he will do anything to avoid dealing with painful emotions. Anything to avoid plumbing his inner self. And this is when he discovers that wearing the menopausal halo pays off.

Being “sick” has definite advantages: It allows him to be considered slightly incapacitated, mildly indisposed, and thercfore not entirely accountable for his behavior. It also provides an excuse to withdraw from the irritating demands of others—and indulge himself instead.

More convenient still, since there is no specific cure available for the male menopause, the diagnosis itself suffices. The phrase implies that mysterious body changes, entangled somehow with the hormones and the aging process, are at the root Of a man’s predicament. Beyond his control then, certainly. All his problems can therefore be magically disposed of with just a label, exonerating him from the difficult task of having to deal with them.

And so the perfect cop-out: If a man is suffering from the menopause, as he might from a virus, how can he possibly do anything but wait to get over it?

In the final analysis, the reason why the concept of male menopause has become so popular is simple: It gives both exes something to blame during the difficult mid-life period.

Women use it as a damning epithet to retaliate for being Blade scapegoats, and men capitalize on being called sick to hide from self-confrontation. In these ways both avoid tangling with disruptive emotions.

Despite its appeal, however, the menopausal label is dangerous and destructive:

•It mistakenly implies that aging inevitably destroys male potency.

•It obscures the real problems that a man must recognize

and work through during his forties. •And, worst of all, it perpetuates the notion that the pain

and confusion experienced at mid-life are symptoms that

mean something is wrong.

*3\93\2*

Those elderly people who are not forced to live in institutions because of illness or destitution have, at some stage, to make a decision about where they will spend their remaining years of life. Should they choose to live in the house or flat they have occupied for years, or move to a smaller house within the community? Should they seek to live in a ‘retirement village’ or complex? Should the concept of ‘almshouses’ be revived?

Whatever decision is made, it is important that the old person makes the choice and that it is not dictated by others. If the choice is to continue to live in the general community, in the person’s own home, or in a flat, the community needs to be pressured to provide appropriate facilities, such as social clubs, access to shops, and community helping organizations, and efforts need to be made to provide the old person with an occupation. A retirement village is usually expensive and only the well-to-do can afford it. The advantage of such places is that services are readily available; illness is not as great a problem, because of the facilities provided; and the environment encourages group activity, giving a much-needed sense of purpose to life. A disadvantage of many retirement villages is that they are relatively isolated and the inhabitants may find it difficult to go into the town centre or to visit friends, without seeking the charity of someone to take them. This can promote a feeling of being cut off from real life and create an artificial, unhealthy way of living. The old idea of almshouses, situated in the town itself, has attractions as these can provide independence for the old person and, at the same time, the facilities and services needed for the person to enjoy his independence without fear of accident, illness, or incapacity.

*376/16/1*

Escape from the crisis of middle age is well advanced when the man accepts that he needs help. With help, he can escape from the dull routine of work, he can widen the range of his activities, he can change direction, and he can have a stimulating sex life. He needs to see that he must talk about his problem. He needs to see that соoperation and sharing are more important than acquisitiveness and competition. He needs help to build up his self-esteem. He needs to see through his dissembling, his fantasies, his deceptions (about himself and about others), and his delusions. He needs to learn about his strengths and to accept his weaknesses.

If he is overweight, he will feel better if he loses some weight. If he drinks heavily, he will feel more awake if he drinks less. If he is slothful, he will become healthier if he takes more exercise – not competitive exercise to ‘beat’ someone, or ‘duty’ exercise to keep himself fit for work, but an active pursuit he enjoys.

These two infections more commonly infect a woman’s vagina, but can spread to her partner’s penis. Both cause a vaginal discharge which is usually itchy and may smell. Trichomoniasis is the name of the infection caused by a tiny animal (a flagellate) which infests the vagina of 10 to 20 per cent of sexually active women, but only causes symptoms in a few. Candidosis (or monilia) is caused by a fungus and infects about 25 per cent of sexually active women, but only produces symptoms in about 5 per cent.

If a man’s partner is diagnosed as having trichomoniasis he should take a course of tablets and should wear a condom when they have sex, until they have both been cured. One course of tablets for 7 to 10 days usually does this. The preferred drugs are metroni-dozole and tinidazole. Recently research has shown that a single large dose is almost as effective as the seven-day course.

If the woman has candidosis, the man may get an itchy penis. Should this happen, treatment with an ointment called nystatin, which kills the fungus, is available.

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An impotent man who is unable to get an erection may believe that his sexual partner, who is usually his wife, is disgusted with his diminished masculinity, talks about his masculine inadequacy to her friends, may seek sexual release with other men, and generally belittles him. The vicious circle of failure to achieve an erection causes anxiety, which is increased the harder he tries, and the harder he tries the more he fails.

A number of men become impotent because of illness or because of the treatment required for an illness. Diabetes often causes impotence, and certain drug treatments for high blood pressure may produce impotence. Alcohol, taken excessively over the years, is often associated with impotence. The reason for this is not clear, but it may be because of liver damage.