It is true that the changes in a man’s sexual response, which may first have become apparent in middle age, continue, but not all of these are disadvantageous. In common with other physical functions (sight, hearing, physical strength, and so on), your sexual response alters as you grow old. Just as there are wide variations between men in the reduction of their physical functions, so too there is a very wide variation in the changes in their sexual response. As you grow older, you may notice that you get an erection less frequently when you fantasize about sexual situations or when you see an erotic picture or object. You may find that it takes longer for you to obtain an erection when making love and that your penis needs a few minutes of direct stimulation by masturbation or by your partner’s hand or mouth before it becomes erect. You may find that for short periods, which usually last for less than a week, you fail to get an erection. Men who are obsessed with their ‘performance’ may see this as the end of their sexuality, but they should know that this is not true. You have not become permanently impotent: you will start getting erections once again.

Viral hepatitis is also more common among homosexual men, and may cause permanent liver disease. Viral hepatitis occurs in two forms, type A and type B. The disease may be associated with jaundice or may be almost symptom less, but men who have been infected can be detected by blood tests. A study in the U.S.A. showed that homosexual men were twice as likely as heterosexual men to have had viral hepatitis type A; and the acquisition of the disease was associated with frequent oral-anal contact. A study in Britain showed that about 5 per cent of homosexual men attending a genito-urinary clinic had been infected some time previously with viral hepatitis type B, and the prevalence was fifty times greater than among heterosexual blood donors.

The second problem, that of age, affects homosexuals more than heterosexuals. Among heterosexuals a lasting relationship is usual although, of course, separation or death may terminate it, and one or other partner may have transient relationships with others. Among homosexual men permanent relationships seem less common, and many homosexuals place a premium on youth. As a man grows older his body becomes less attractive and he has to work harder to find a partner, becoming more at risk of punitive action by the police, when he frequents known homosexual cafes or lavatories.

In recent years, especially in Western nations, many women have rejected this double standard of sexuality. Adolescent girls, particularly, have become more active sexually, and so have adolescent males. Both sexes have more casual sex, in which there is no commitment, and they enjoy sex with a greater number of partners. The result has been an increase in the spread of sexually transmitted diseases, particularly gonorrhoea. This is because at least 50 per cent of women infected by men with gonorrhoea develop no symptoms, and consequently do not know that they have the disease. But they have and can spread it to infect their next sexual partner.

Another reason why the sexually transmitted diseases are spreading is because people are increasingly mobile. Work may take a person to a place where he (or she) has few friends. People increasingly take holidays in other countries.

In these unfamiliar places it is easy to make an acquaintance in a pub, a hotel, or a club, to have an exciting sexual experience – and to become infected with a sexually transmitted disease.

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If he is a sensitive lover he realizes that his sexual dysfunction is diminishing his partner’s sexual pleasure. To delay his orgasm he asks her to ignore him while he tries to bring her to the edge of orgasm. Then, he reasons, he can insert his penis into her vagina in the hope that she will come before he does. Usually it does not work because her obvious arousal is a signal to him and he cannot stop himself coming prematurely.

This is the essence of his problem. He cannot prevent himself reaching the stage of sexual arousal when an orgasm is inevitable.

The second scenario is for the man to reduce his sexual anxiety by reducing his sexual activity. He argues that if he does not have sex, he will not ejaculate prematurely and will not feel he is a sexual failure.

The third scenario is one in which he becomes increasingly anxious, but he is uncertain what to do and is unable to talk with his sexual partner because of his inhibitions. To avoid increasing his anxiety he becomes impotent.

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Certain general measures may also help to improve a low sperm count. These are for the man to drink and smoke less, to wear loose underpants (so that the testicles are no longer held up close to his crutch), and to know the best time during the woman’s menstrual cycle to have intercourse for a pregnancy to occur.

Until about 1970 infertile couples whose inability to have a child was solely due to the husband’s very low sperm count or to his complete lack of spermatozoa were able to adopt a child relatively easily. Since 1970 this has changed in most developed nations. The numbers of children available for adoption have dropped very considerably, so that a delay of up to five years is usual before a suitable baby is found. This is because women avoid pregnancy by using efficient contraceptives and because legal abortion is more readily available. Ten years ago a young unmarried woman who became pregnant and did not wish, or was not able, to marry the man who made her pregnant, either sought a dangerous (or a safe, but expensive) illegal abortion, or had the baby. Many women preferred to have the baby and most surrendered it for adoption. Today, with legal, safe abortion, fewer unmarried women continue with the pregnancy and of those who do most keep the baby. Society has ceased to be so censorious about unmarried mothers and the sanctions against them have diminished.