Sexuality is an integral part of the personality of everyone. It is a basic need and aspect of being human that cannot be separated from other aspects of life. Men may have 4 phases of sexual response. They can experience sexual desire, and move from sexual arousal to orgasm and satisfaction. The goal of sexual activity for men is personal satisfaction which manifests as physical satisfaction with orgasm and emotional satisfaction by feeling intimacy with a partner.
Do you agree that older people no longer want sex? The misconception and myths about sex in the aging men was not commonly talked about. Many older men remain sexually active through their middle or late old age at 60s to 70s, which is largely related to sexual activity of an earlier age at 40s to 60s. There are also those who stop sexual activity while they are in their 50s or 60s, which can be due to different biopsychosocial factors. Some studies suggest a decline in sexual interest during andropause. The society’s attitude towards sex among elderly and religious perception can be part of the challenges.
What are the sexual changes that elderly men might experience due to ageing?
- May take longer to have an erection. The increase latency for erection and ejaculation may be good for female partner who needs more time to reach orgasm.
- Need more stimulation and more time. This can be due to decreased sensitivity to stimulation.
- Less rigid erection compared to younger days.
- Loss of force of ejaculation.
- More easily losing an erection after an orgasm.
- Increase in the time interval from orgasm to when a man can have the next erection. The resolution phase or returning to pre-excitement phase decreases in time span.
- Easier in delaying orgasm.
- Decrease in sexual urge.
- Decrease in production of male hormones. Factors that decreases testosterone production include aging, physical or emotional stress, obesity, insulin resistance (related to diabetes mellitus), heavy alcohol or opioid (a type of painkiller) use.
- Decrease in production of sperm.
What are the possible physical and psychosocial factors associated with sexual problems among the elderly men?
- Physiological changes such as hormonal changes
- Medical problems (for example diabetes mellitus, hypertension, hyperlipidemia and heart disease) and their medications
- Erectile disorders
- Physical fitness for sexual intercourse
- Lifestyle becoming less active
- Feeling anxious because of aging
- Changes in marital phases
What is the relation of sex and the heart in older men?
Men who have sex at least twice a week were less likely to develop heart disease compared to men who only had sex once a month. If you can walk up a flight of stairs briskly, you have enough cardiac output to engage in sexual activity.
Studies show that less than one of every 100 heart attacks is related to sexual activity. For a healthy 50-year-old man, the risk of having a heart attack in any hour is about one in a million, sex doubles the risk but its just two in a million. For men with heart disease, the risk is 10 times higher, but even so the chance of having a heart attack during sex is just 20 in a million which are pretty safe.
What is the impact of enlarged prostate on elderly sex?
Older men maintain their interest in and enjoyment of sex and sexual activity, unless that enjoyment is impaired by physical disabilities. Sex remains an important aspect of the lives of BPH (benign prostatic hyperplasia) patients even in older age groups. BPH symptoms, as well as BPH treatments, may adversely affect sexual function. Medications used in benign prostate enlargement such as finasteride may affect the active form of testosterone hormone called dihydrotestosterone.
There are two main types of sexual dysfunction that are closely related to the severity of lower urinary tract symptoms (LUTS) in BPH. They are erectile dysfunction and ejaculatory dysfunction. While sexual activity is known to decline in older men, those with severe LUTS at any age experience more difficulties. The sexual activity of a man with severe LUTS in his 50s is reduced almost to the level of a man 20 years older without LUTS. There is also a strong correlation between severity of LUTS and reduced volume of ejaculate. The more severe the LUTS, the greater the reduction in ejaculate. Pain and discomfort on ejaculation, although less frequent, is bothersome to the men affected.
What about effects of medications on sex in elderly men?
More than 60% of the elderly are on medicines for cardiovascular disease such as hypertension and coronary artery disease. Among those reaching 80-year-old, 40% are on hypertensive medicines such as thiazide diuretics and beta-blockers which can cause erectile dysfunction in elderly men.
More than 80% of the elderly are on sedative medications to help their sleep, especially benzodiazepines which can decrease the sexual urge among elderly and are found to decrease affection among elderly men. Other medications that can affect sexual function in men include antidepressants. On other hand, some medication used in patients with Parkinson’s disease can cause an increase in libido and sexual function.
What are the treatment options for elderly men with sexual dysfunction?
Male sexual problems increase with age and are common among andropause men due to lack of testosterone. Declining levels of testosterone have been associated with changes in sexual functioning. This can be physically and emotionally distressing and socially disruptive. Many options of treatment available. A basic evaluation from history and full examination with lab testing will be carried out to identify possible causes of men with sexual dysfunction.
The cause of male sexual dysfunction is often multi-factorial and multi-dimensional, therefore treatment may involve hormone therapy in men with sex hormone deficiency such as androgen, non hormonal medications to improve blood flow to penis, addressing medical illness, adjustment of medications, lifestyle changes, sexual counselling and psychosexual therapy for individual. Testosterone hormonal treatment (local application with gel and/or systemic in the form of injection) has been shown to improve sexual desire and satisfaction.
Sex among the elderly men when the end is near
Sexual relationship is healthy and can be fun for the elderly men, and to accept that sex is normal at old age. Adjusting to changes such as with prolong foreplay during sex, learn variations in the erotic techniques of stimulating the partner, encourage the use of lubricant (due to change of skin texture with aging), changing position, non-intercourse sexual relationship like heavy petting can be helpful in many aging couples. Communication among elderly couples is also important.
Be the wise elderly. A positive lifestyle creates a meaningful old age. Many older men remain sexually active through their later years, which men rate this as important. Physiological changes with aging and disease and the treatment of disease will impact on sexual function. The presence of good health, good relationships and life stressors will all impact on continued sexual activity with age. Challenges in physical illnesses and marital demands can be managed by the elderly.
Enjoy a healthy sexual relationship beyond the age of 60, and do not feel embarrassed to discuss any of your sexual problems with doctors.