The B.C.C. is a tumour arising from the cells of the basal layer of the epidermis. The abnormal cells leave their normal position and invade the dermis. It is a relatively innocent cancer, as it does not usually invade blood vessels and spread to distant sites. If left untreated, however, it will quietly spread to the surrounding skin and erode underlying tissues, such as bone. Hence, in the past, these cancers have been called ‘rodent ulcers’.

Causes. Unlike most S.C.Cs, B.C.C.s are not usually preceded by an obvious pre-malignant lesion. Although prolonged sunlight exposure is an important factor in their causation, other factors must be involved also. B.C.C.s are much more common in sunny climates and in light-skinned individuals, and two-thirds occur on the head and neck. However, one-third occur in relatively protected sites, such as on the body, eyelids, and behind the ears. It is therefore thought that regional factors must also be involved.

Features. Patients often describe how they have noticed a spot which, although it is not troubling them, does not go away; it may bleed or crust over, but will never quite heal. The appearances are varied. Most typically, it is a small pearl-like nodule with fine blood vessels overlying it. Sometimes it looks like a very small erosion of the skin, or an ulcer. Overlying it. there may be a small crust. Occasionally it appears like a red scaly plaque with o scalloped margin.

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These are the most troublesome and common of the intermediate symptoms of the menopause. Vaginal dryness is itself the cause of pain during sexual intercourse and many of the recurrent bacterial infections. Without oestrogen, the lining of the walls of the bladder and urethra shrink and become thinner and drier. They are more likely to crack and split, and become vulnerable to infection. Within three years of the menopause, 10—20 per cent of women may visit their doctor with these problems; amongst women eight years or more since the menopause, the figure is up to 50 per cent. It may be embarrassing, but there’s a lot of it about. As with hot flushes, you are not alone, and if only women felt able to talk about these things more they might feel less isolated in their discomfort and embarrassment. Surprisingly, few women realise that these complaints are connected with the menopause at all. They just think it is all due to getting older and that nothing can be done about it; but, as with all the symptoms that are due to lowered levels of oestrogen at the time of the menopause, something can be done about it.

Vaginal dryness and soreness are very common problems for women in their fifties. The walls of the vagina respond to the presence of oestrogen, and as the level of the hormone falls, they become thinner and drier and less elastic. The vagina itself becomes shorter and narrower, and the cervix secretes less mucus. Noticeable symptoms that result from this can be dryness, pain during sexual intercourse, bleeding during intercourse, and a higher risk of bacterial infections. If HRT replaces the lost oestrogen, the vagina can be restored to a healthy state, and there is no reason why you should not continue a fulfilling sex life for as long as you and your partner want to.

Symptoms of pain, discomfort and embarrassment involving the bladder and urinary tract are felt by a great many women to be part of the misery of the menopause.

‘I hadn’t wet myself since I was a small child. Suddenly one day I coughed fairly violently, and with a horrifying sense of shame and embarrassment, I knew I had done at 55 what I hadn’t done since I was about four. Then it started to happen more often, whenever I coughed or laughed or sneezed. At first it was a little trickle, then it became so bad I had to wear sanitary towels most of the time – just in case. A friend of mine who works in a chemist’s shop said she knew of many women who bought sanitary towels for this purpose, and who could not bring themselves to buy incontinence pads.’

The urethra (the canal with carries urine from the bladder to outside your body) is yet another part of you that contains ‘oestrogen receptors’ and so it responds to the presence of oestrogen by remaining firm, strong and healthy. After the menopause, the walls of the urethra become thinner, more prone to infections like cystitis, and the muscles don’t work so well. These changes can cause pain on passing water, and a gradual lessening of bladder control. Complaints such as urgency (needing to pass water with very little warning); frequency (needing to pass water frequently); nocturia (needing to pass water during the night); and stress incontinence (passing urine when you sneeze, cough, laugh or take vigorous exercise), all usually improve significantly after a few weeks of HRT (provided there is no underlying infection or other problem). Up to 30 per cent of post-menopausal women suffer from these complaints, and may need to remain on HRT long-term if the symptoms are not to return.

If you have a continence problem of any sort and don’t like to talk to your doctor about it, you may find the surgery has a special Continence Nurse. Her job is to help people achieve continence wherever this is possible, or to manage incontinence if this is inevitable. You will find her helpful and sympathetic, and full of practical suggestions to improve your particular problem, whatever your age.

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The use of psychological therapies to treat PMS, various types of depression and menopausal symptoms such as hot flushes is based on the view that mental processes can play a significant role in the development and maintenance of these conditions and symptoms. Therapists treating women with PMS have used coping-skills therapies to alleviate the condition. These therapies have three main components. First, individuals are taught to examine their ways of responding to stressful situations. The second phase involves rehearsing new coping strategies that are based on a major re-think of the way they respond to stressful life events. In the third phase, women test their coping responses in the stressful situations that previously gave rise to their PMS and depression. Training programs, which sometimes incorporate relaxation skills, generally involve ninety-minute sessions once a week for eight to ten weeks.

In the case of Nina, aged forty, who had had unrelenting PMS for much of her adult life, coping-skills therapy helped her to identify cues associated with her irritability and feelings of tension and fatigue. She became aware that her approaching menstrual period generated feelings of having to ‘get things done’ in anticipation of her ‘bad days’ when even small things required an enormous effort. Instead of allowing these feelings to dominate her activities, causing overloading and a self-fulfilling exhaustion, she trained herself to develop a plan of action. ‘Don’t concern yourself about the bad days, just about what you have to do today,’ she told herself. ‘Keep the focus on the present.’ After several months she considered her PMS to be much less of a problem.

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There are two kinds of sleep which alternate four to five times each night:

* Non-REM sleep: brain is relaxed, but body is active

* REM sleep: brain is actively dreaming, but body is relaxed

During REM sleep, a lot is going on besides dreaming, and rapid eye movement is only the tip of the iceberg. In a man, although he is completely relaxed and unable to move even one muscle, one part of his body, the penis, is moving, becoming hard and erect. This is one of the most important discoveries made in the sleep laboratory, and has led to a very rapidly progressing field in the treatment of impotence.

It has been confirmed again and again in sleep laboratories that men have erections in the dream state during REM sleep. Hence they have several erections a night, corresponding with the several episodes of REM sleep. This is called dream erection and is completely automatic, furthermore, most of the time the dreamer is not aware of the erection. Most men will tell you that they experience a morning erection when they are just waking up from a dream.

Why do men have these dream erections? Do they serve any purpose? No one has so far been able to give a good reason;

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