One bone condition becomes increasingly common as a person grows older. This is the thinning of the bone substance, so that the bone becomes more brittle and fractures more easily. The disease is called osteoporosis (or thinning bone). It is more common among women than men and it occurs earlier in life in women. You may break your forearm or, more seriously, fracture the neck of your thigh bone. Most of these fractures occur because you tripped over something in your home, or because you turned too suddenly and lost your balance. The disease can be checked by keeping active (which prevents the bones losing calcium) and by taking extra calcium, especially at night (as this is the time the calcified substance of the bone is lost). As well as these measures, avoid tripping! Make sure that your house has no loose carpets, that stairs are well lit and have hand-rails, and that you do not have little stools or tables scattered round. Make sure that you can get into and out of your shower or bath easily and safely, because more old people seem to fracture their hip in bathrooms than in other rooms.

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As so many men are affected by one or more of these conditions, they require discussion. In this chapter I shall discuss the adjustment to middle age, obesity, and high blood pressure. Coronary heart disease, which is common and disabling, is discussed in the next chapter.

In a society which emphasizes achievement, particularly financial success, and which worships the work ethic, middle age signifies a time when most men have reached their peak in terms of promotion and decision-making. To the man who has dreamt of high achievement, the reality of his lower status may be a cause of anxiety. He has not achieved what he hoped he would, and his remaining working years stretch dully, routinely, towards retirement, which itself holds no real attraction.

Traditionally, in most cultures, middle age brought a man respect. He was perceived by others as having wider experience, more skills, and greater wisdom than younger men. He was consulted by others, and was relieved of many routine duties. As his strength decreased, his position and influence in society increased. He kept his self-esteem. Today, the brilliance of youth is stressed and increasing age is discounted – you become an ‘oldie’ by 30 and a ‘wrinkly’ by 50. Advertisements on television and in magazines equate youth with success in sex and work; middle age is equated with declining powers. It is seen as a period when a man needs medicaments, when his teeth are false, and when he should be arranging affairs for his nearing death. In middle age, he is not even given the tentative respect that youth gives to old age.

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During treatment, you have to stop drinking alcohol, as this seems to lead to relapse; and, obviously, you must not have sexual intercourse, because you may infect your partner. Until the discharge ceases you should wash your hands after passing urine or defecating and should wash your genitals each day with soap and water, and dry them with a towel which nobody else uses.

You will also be given treatment. Today penicillin is the most efficient killer of gonococci, although increasing numbers are becoming relatively resistant to penicillin, so that higher and higher doses are needed to cure the disease. The reason for resistance is not clear, but it may be due to the abuse of penicillin, given in inadequate doses for inappropriate, or trivial, disorders over the past twenty years. By 1977, in many nations, between 20 and 40 per cent of all cases of gonorrhoea had become relatively resistant to normal doses of penicillin. It has also become increasingly obvious that the more simple the treatment the more effective it is. This has meant that new strategies have had to be developed.

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The woman straddles the man and puts his penis in her vagina. Once it is inside she does not move, for the object of this training period is to let the man learn the feeling of his penis in a non-demanding, non-threatening female vagina. The couple are learning to communicate. It is likely, at this early stage of therapy, that if the woman starts thrusting with her pelvis, the man will ejaculate. If he begins to feel he is going to come, he tells her and she gently lifts herself off his penis and uses the squeeze technique to reduce the urge. She can then remount him and sit motionless on him, so that he learns he need not fear he will ejaculate once his penis is in a vagina. Masters and Johnson claim that after three sessions of the female-superior coital position most men will be able to keep their penis in the woman’s vagina for 15 minutes without ejaculating. The relearning process is becoming effective.

After a few experiences of motionless vaginal containment, the man learns to thrust just sufficiently to maintain his erection but not to bring him to orgasm.

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In the first weeks of pregnancy many women are nauseated and a few vomit. These uncomfortable conditions are self-limiting and by the 15th week of pregnancy usually have ceased, but during the time they occur, the expectant father can help. Nausea is most common in the morning (hence its other term, ‘morning sickness’)- Its effects may be reduced if the woman is given some food, such as toast, and a drink before she gets up. The man who expects his wife to make breakfast for him, can, when an expectant father, make breakfast for her, and bring it to her so that she can eat it slowly in bed. Fatty foods and fatty smells aggravate nausea, so that a considerate expectant father will avoid asking for such foods during his wife’s early pregnancy. Women with nausea are often advised to eat small meals often, and if the man expects a large meal on his return home, may aggravate the nausea as the woman has to cook it and watch him eat. Be considerate, and adjust your eating habits to hers.

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