Yet, there are "realities" of aging. When women reach menopause, a fall in estrogen levels leads to vaginal dryness and thinning of the vaginal wall that can make sex uncomfortable. After surgical treatment of the prostate for cancer or benign prostatic hyperplasia, men might have erectile dysfunction. Men and women are at higher risk for a range of illnesses that can affect sexual performance and interest, from arthritis to high blood pressure and heart disease.

While it's important to be aware of how the aging process can affect sexuality, it's equally important not to view sexual problems as a natural part of aging. If people in their 50s and older experience a noticeable decline in their desire for sex or fail to become aroused, they should seek medical help. While sex tends to be associated with youth or having a family, it is much more than that. Sex fulfills our basic need for a close connection with another person. There is no good reason why people can't remain sexually active throughout their entire lives. Sex can mean much more than intercourse. It encompasses many different ways of showing affection and sharing intimacy.

The AARP/Modern Maturity Sexuality Survey, a survey of nearly 1,400 adults 45 and older, shed much-needed light upon sexual behaviors and attitudes among this segment of the population. Here are some major findings:

• While the majority of men and women said that satisfying sex is important to their quality of life, they see relationships as more important than sexual activity.

• The "partner gap" is one of the most obvious factors affecting sexual activity. While roughly 80 percent of men and women 45 to 59 years have partners, only 58 percent of men and 21 percent of women 75 and older have partners.

• Reported sexual activity declines with age for men and women, as health declines and many lose their partners. However, 64 percent of men and 68 percent of women who have sexual partners are extremely or somewhat satisfied with their sex lives.

• Out of all those surveyed, only 10 percent of men and 7 percent of women report they are now or have in the past taken any medicine, hormone or other treatment to enhance sexual performance. Among those who have done so, a majority reported improvement in their sexual satisfaction and relationship with their partner.

This last finding suggests many men and women 50 and older are not seeking help from their physicians for sexual problems. If you are in this age group, realize that you are not alone and that help may be available.

There are many positive aspects of intimacy in the 50s and beyond. Empty nesters can now concentrate on their relationship and become romantically re-acquainted. Taking vacations and exploring new interests together are viable now that careers and children are no longer the focus. Singles in their 50s can bring new stimulation and excitement to their lives with a new partner.

Also, there are advantages to being older. According to a study by the National Institutes of Health and The Ford Foundation, women ages 50 to 59 were a third less likely to have pain during sex and half as likely to report anxiety or non-pleasurable sex. Men ages 50 to 59 did not have any more performance anxiety than men ages 18 to 29. The following tips are beneficial antidotes to the often inevitable physical realities of growing older.

• Communicate with your partner. Talk about pleasing each other. Discussing changes in sexual response, erectile dysfunction or a loss of sex drive helps deal with the problem.

• Take your time. Men and women may need more manual stimulation or foreplay. Also, find ways to adjust to changes. Women in menopause may need to use a lubricant.

• Find a doctor with whom you can be candid. Don't be embarrassed to ask for advice and possible medication to enhance intimacy.

The information about circumcision in this handout may help you make your decision. After you have read the handout, talk with your doctor about any concerns you have. The decision about whether to have your son circumcised should be made before your baby is born.

What is circumcision?
During a circumcision, the prepuce of the foreskin, which is the skin that covers the tip of the penis, is removed. Circumcision is usually performed on the first or second day after birth. It becomes more complicated and riskier in infants older than 2 months and in boys and men. The procedure takes only about 5 to 10 minutes. A local anesthetic (numbing medicine) can be given to your baby to lessen the pain from the procedure.

Are there any benefits from circumcision?
Studies about the benefits of circumcision have provided conflicting results. Some studies show certain benefits, while other studies do not. The American Academy of Pediatrics (AAP) says the benefits of circumcision are not significant enough to recommend circumcision as a routine procedure and that circumcision is not medically necessary. The American Academy of Family Physicians believes parents should discuss with their son's doctor the potential benefits and the risks involved when making their decision.

A recent AAP report stated that circumcision does offer some benefit in preventing urinary tract infections in infants. Circumcision also offers some benefit in preventing penile cancer in adult men. However, this disease is very rare in all men, whether or not they have been circumcised. Circumcision may reduce the risk of sexually transmitted diseases. A man's sexual practices (e.g., if he uses condoms, if he has more than one partner, etc.) has more to do with STD prevention than whether or not he is circumcised.

Study results are mixed about whether circumcision may help reduce the risk of cervical cancer in female sex partners, and whether it helps prevent certain problems with the penis, such as infections and unwanted swelling. Some studies show that keeping the penis clean can help prevent these problems just as well as circumcision. Infections and unwanted swelling are not serious and can usually be easily treated if they do occur.

What are the risks of circumcision?
Like any surgical procedure, circumcision has some risks. However, the rate of problems after circumcision is low. Bleeding and infection in the circumcised area are the most common problems. Sometimes the skin of the newly exposed glans becomes irritated by the pressure of diapers and ammonia in the urine. The irritation is usually treated with petroleum ointment (Vaseline) put directly on the area. This problem will usually lessen after a few days.

Cancer: In some cases, cancer can have a direct impact on sexual functioning if it affects hormone production or an organ involved in sex itself, such as the prostate, penis, ovaries, cervix or vagina. Treatment for most forms of cancer, not just those affecting sexual and reproductive organs, can make people feel uncomfortable about their bodies and sexually unattractive. Chemotherapy and radiation therapy are intense treatments that can cause more illness and discomfort than the cancer itself. Patients often experience unpleasant side effects such as fatigue, nausea, hair loss, skin irritation and weight changes. Surgery for cancer, such as removal of a breast or testicle, is often disfiguring and can affect a person's sexual self-image.

Diabetes: People with diabetes can develop diabetic neuropathy damage to nerve tissues caused by decreased blood flow and high sugar levels. This damage can interfere with sexual response.

Stroke: Along with causing problems with motor function and control, stroke can affect a person's body image. A stroke survivor may not be aware of one side of the body; the mouth may droop; feeling on the paralyzed side may be different; and speech may be garbled and emotions hard to control. The patient also may be afraid that sexual activity could bring on another stroke. Stroke survivors and their partners need to work together to overcome these physical and emotional issues.

What causes Peyronie's disease?
Scar tissue under the skin of the penis causes the curve. No one knows why the scar tissue starts. Some men with Peyronie's disease have had a penis injury that causes scar tissue. The scar feels like a ridge or a row of tiny bumps. The scar can keep getting worse during the first few years, making the penis curve more and more. You might notice this more during an erection. After a few years, the scar usually stops getting worse, but it doesn't go away.

What can I do about the curve in my penis?
There is no cure for Peyronie's disease. Medicines like Potaba or vitamin E help some men. Potaba is a prescription medicine. Your doctor will tell you about it. If you take vitamin E, don't take more than your doctor tells you. Too much vitamin E won't help your penis. Too much vitamin E or Potaba can hurt your liver. Potaba can also make you nauseous or take away your appetite.

Can surgery help?
Surgery might help men who have pain during erection or men who can't keep an erection long enough to have sex. During the surgery, a prosthesis (something to make the penis firm) is put in the penis. The prosthesis helps make the penis straighter. It also helps erections last longer.

Can anything else help?
No, although new treatments are being tested. Some of the medicines being tested are put into the scar tissue in shots. Another medicine being tested is a lotion containing the drug verapamil. Verapamil (2 brand names: Calan, Isoptin) may help break down the scar tissue and allow new tissue to grow.

The Merck Manual of Diagnosis and Therapy uses three phrases that can be helpful in judging whether a difficulty you're experiencing is actually a problem with sex:

• Persistent or recurrent: It isn't an isolated or occasional event but persists a long time.

• Causes personal distress: It upsets you and causes unusual anxiety.

• Causes interpersonal problems: It hurts your relationship with your sexual partner.

The latter two categories are the most important. Many people may experience levels of desire or changes in function that don't cause distress and do not impact their relationships. These changes would not then be considered a problem. However, these same changes may be very stressful for other people or couples and would be considered a sexual problem. Problems vary from person to person.

Another complicating factor is that most sexual problems cannot be traced to one specific cause. Rather, they result from a combination of the physical and the psychological. Proper sexual functioning depends on the sexual response cycle, which includes:

• An initial mindset or state of desire.

• The flow of blood to the genital areas (erection in men and swelling and lubrication in women) in response to arousal.

• Orgasm.

• Resolution, or a general sense of pleasure and well-being.

A breakdown in one of the cycle's phases can be responsible for a sexual problem, and that breakdown can stem from a variety of causes.

Role of diabetes, smoking and other problems

According to the American Medical Association, sexual problems often result from physical conditions such as:

• Diabetes

• Heart disease

• Neurological disorders (such as stroke, brain or spinal cord injury, or multiple sclerosis)

• Pelvic surgery or trauma

• Side effects of medications

• Chronic disease such as kidney or liver failure

• Hormonal imbalances

• Alcoholism and drug abuse

• Heavy smoking

• The effects of aging

Psychological causes might include:

• Stress or anxiety at work

• Concern about performance, marital or relationship problems

• Underlying mental disorders such as depression and anxiety

• Previous traumatic sexual experience

These sets of causes often "play off" one another. Certain illnesses or diseases can cause people to feel anxious about their sexual performance, which, in turn, can make the problem worse.

Undescended testicles are common in male babies. Up to 30 percent of boys born early and 5 percent of boys born on time have at least one undescended testicle. If your newborn baby has an undescended testicle, it will usually move down on its own in the first few months of life. If this doesn't happen after 3 or 4 months, it may need to be treated by a doctor.

How will I know if my baby has an undescended testicle?
Your doctor can tell whether your baby has an undescended testicle by checking the baby's scrotum. If your doctor can't feel the testicle inside the scrotum, it's called a "nonpalpable" testicle. A nonpalpable testicle might be inside the abdomen, too small to feel or not there at all. It's important to find out which one is the reason. Unfortunately, an x-ray can't tell if a nonpalpable testicle is inside the abdomen. Doctors usually have to do surgery to find out.

Why does an undescended testicle have to be treated?
There are 2 reasons to treat an undescended testicle. First, undescended testicles may not make sperm. Testicles are in the scrotum because the temperature there is cooler than it is inside the body. A cooler temperature helps the testicles make sperm. A man's ability to make sperm can be lost in early childhood if the testicle doesn't drop down into the scrotum. A baby boy with an undescended testicle can start to lose the ability to make sperm by 12 months of age. Getting the testicle down into the scrotum early in life can help him have a better chance of having children when he grows up.

Second, an undescended testicle is more likely to develop a tumor. Testicular cancer affects one of every 2,000 men with undescended testicles. This rate of testicular cancer is higher than the rate in men whose testicles have dropped naturally. When the testicle is inside the scrotum, a man can easily feel his testicles to check for a tumor, or he can be checked by his doctor. This way, any tumor can be found early, when the cancer is easier to cure.

How is an undescended testicle treated?
Treatment for an undescended testicle depends on where it is. Babies with a testicle that can be felt in the groin (the area where your thigh meets your body) often get an operation called orchiopexy (say: "or-key-oh-peck-see"). Babies who have this operation usually go home the same day. The operation is done through a small cut in the groin. It takes about 1 hour. Most babies get better very quickly.

Another treatment is a hormone called hCG. Your doctor might give your child hCG in a shot. HCG helps the testicles make male hormones. A higher level of male hormones might move the testicle down into the scrotum. This treatment is best if the testicle is already close to the scrotum.

If you are an adult with an undescended testicle, moving the testicle to the scrotum probably won't improve your ability to make sperm. So, in adult men an undescended testicle is usually just removed. Doctors often don't do anything about an undescended testicle in men older than 40. If you are an older man with an undescended testicle, your doctor can help you decide what to do.

How should I take sildenafil?
Follow your doctor's instructions. Usually, a man takes 1 tablet 1 hour before he plans to have sex. You should not take more than 1 tablet in 24 hours. The medicine comes in tablets of 25 mg, 50 mg and 100 mg. Most patients start with 50 mg.

Even if you take sildenafil, you still need physical and mental stimulation and desire to have an erection. If your first dose of Viagra doesn't help, call your doctor. Your doctor may want to change your tablet strength.

What are the side effects?
Sildenafil has some common side effects:

• Headache
• Flushing (face and upper body turning red and warm)
• Stomach upset
• Runny nose (sniffles)
• Vision changes (things look blue)

Headache is the most common side effect. Vision changes are the least common. Talk to your doctor if you have any side effect that bothers you

Can everyone use sildenafil?
No. You shouldn't use this medicine if you take any of these forms of nitroglycerin or any other nitrates:

• Isosorbide mononitrate (brand names: Ismo, Monoket, Imdur)
• Isosorbide dinitrate (brand names: Isordil, Sorbitrate)
• Sublingual nitroglycerin tablets or spray (brand names: Nitrostat, Nitrolingual Spray)
• Transdermal nitroglycerin patches or paste (brand names: Minitran, Nitro-Dur, Transderm-Nitro)

If you use sildenafil and get chest pains, be sure to tell the paramedics, nurses or doctors at the hospital that you use it and how long ago it was that you last took a tablet.