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Social causes. One of the social factors that contributes to sexual problems is alcohol; it affects a man’s ability to achieve and maintain an erection, and a woman’s ability to produce enough lubrication. Many older men and women drink much more than they did in their youth.

Another is the lack of a sexual partner due to death, divorce or separation, and the decreasing opportunities to find another as you get older. Most older women would be restrained by their upbringing from seeking a sexual partner other than within a fairly permanent relationship. One way in which many women choose to keep their sexual interest alive is by masturbation. Some religions do still prohibit it, but contrary to traditional church and public-school thinking, masturbation does not make you either blind or mad, nor is it unnatural, degrading or a form of ‘beastliness’. It certainly isn’t something you should feel guilty about. During the course of their lives, most people masturbate; and although men do it more than women, and younger people more than older people, there is nothing abnormal or unnatural about masturbation at any age. Many women feel it is no more or less satisfying than having sex with a partner, just different. In fact, for women who are unable for any reason to have sexual relations now but who feel they might want to in the future, it is a good way of keeping their ‘sexual apparatus’ functioning well, by maintaining their sexual responsiveness, by producing regular vaginal lubrication with mucus, and by keeping the necessary muscles in good working order. Sexual pleasure is closely linked with how well your vagina is working – a case of ‘use it or lose it’; so if you feel that masturbation is right for you, then don’t stifle this natural urge.

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Emotional highs and lows are common after hysterectomy with many women experiencing tearfulness and irritability. One explanation is the stress of the surgery and the effect of the anaesthetic. In addition, the removal of the ovaries, or their inadvertent damage, will quickly lead to changes in sex hormone levels and, with this, mood fluctuations.

Hot flushes, night sweats and associated sleeplessness may follow close on the heels of a hysterectomy, particularly if the ovaries have been removed. These effects are blamed on rapid changes in the levels of oestrogen, progesterone and other sex hormones circulating in the bloodstream. The symptoms diminish over the space of months or years but they can play havoc with the lives of women and their loved ones until then. Hormone therapy is often regarded as a simple solution to these problems and in some women this appears to be the case. Others, however, cannot tolerate hormone therapy or they may be concerned about possible long-term effects, for example the increased risk of developing breast cancer with prolonged (more than five years) use of hormone therapy.

On returning home, some women expect to resume everyday activities without missing a beat. Unfortunately, pain or other problems may prevent this and partners, children and relatives should be on call to lend a hand. If this sort of help is not available, it may be possible to arrange for assistance from the local council, a nursing service or another organisation. The decision about when to resume driving is important as lives can hinge on it. Emergency braking requires quick reflexes and leg strength. By the time women are able to climb stairs quickly and do the garden, they are usually fit enough to drive.

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Insomnia is not a new disease. The ancient Egyptians remarked that one of the worst things in life is to be in bed and be unable to sleep. The word ‘hypnotic’ comes from the name of the Greek god of sleep, Hypnos. Throughout the centuries, drugs have been available to help with sleeplessness. However, as more and more hypnotic drugs have become available, more and more people have come to suffer from insomnia. It is possible that modern life is more competitive than life in the past, and insomnia becomes a symptom of modern, busy city life. It is also possible that people are more aware that there is a drug for treating insomnia, whereas in the past people suffering from insomnia would have had to put up with it rather than seek treatment Hence this gives an artificial increase in the number of people with insomnia who take sleeping pills.

The drugs. For many years, opium and alcohol were the only remedies for helping insomnia. In 1869, chloral hydrate was discovered and became the first synthetic hypnotic drug. This was widely used at that time and is still used even now. Choral hydrate is relatively short acting; it is marketed in Australia as Noctec, Dormel, and Chloralix.

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