When experts talk about sex after 55, it tends to be a gloomy prognostication. After all, they point out that older men have an increased risk of erectile dysfunction, lower libido, reduced sexual sensation, a harder time orgasming, and more difficulty getting going for another round. Consider them pessimists.
Sure, “things don't work as well, but men can continue to be sexual, and happily so, well into their 90s,” says Abraham Morgentaler, author of The Truth About Men and Sex: Intimate Secrets from the Doctor's Office, associate professor of urology at Harvard Medical School. Here's your guide to staying sexual active for, well, ever.
As you age, maintaining an erection is the number one difficulty. Most men will have to deal with this problem at some point according to the Massachusetts Male Aging study that found that 52 percent of the men surveyed reported having ED. The older the men were in the study, the more likely they were to experience it, making incidence of this condition equal about 10 percent for every decade (i.e., 40 percent of men reported it at 40, 50 percent at 50, and so on). Complete ED, where a man can never achieve erection, increased from 5 percent at age 40 to 15 percent at age 70.
So what can you do about it? A fair amount, actually. Eating well and staying in shape and keeping yourself generally healthy has a direct correlation to the health of your penis. According to the Mayo Clinic, causes of ED are most often physical and include:
• Heart disease
• Clogged blood vessels (atherosclerosis)
• High cholesterol
• High blood pressure
• Metabolic syndrome (a combination of conditions including high blood pressure, high blood sugar, excess fat at the waist, and abnormal cholesterol levels)
• Chronic kidney disease
• Parkinson's disease
• Multiple sclerosis
• Injury to penis, spinal cord, prostate, bladder, pelvis
• Certain prescription medications
• Drug use, including tobacco and alcohol
• Sleep disorders
Another sex-sapping culprit is one you've heard plenty about: low testosterone. Low levels of this hormone may affect erection quality, sex drive, sensitivity in the genitals, and ability to have an orgasm. It can also lead to loss of muscle mass and general feelings of reduced vitality and energy. Morgentaler says that about 30 percent of men over age 45 have low enough levels of testosterone to cause symptoms.
Declining testosterone is natural. On average, levels drop 1 percent per year after age 30 or 40, according to the Mayo Clinic. The impact this has on sex varies; not every man with low levels of testosterone experiences changes in his sexual abilities or energy. There is also plenty of debate over what precisely qualifies as low-T.
The Danger of Comparisons
As men get older, the inclination to compare their sex lives with others increases, says Michael Ian Rothenberg, sex therapist and clinical sexologist in private practice in Winter Park, Florida. This is a problem. “Walking into a meeting or walking into the gym, [men] tend to make comparisons between themselves and other men,” says Rothenberg, “and this all becomes part of the performance anxiety that people experience.”
Whether a man is distressed that he can’t do what he used to, doesn’t do what other men do, psychological comparisons are among the most common reasons for ED. "What happens is the past comes into the room and the future comes into the room and it blocks the ability to be present, where sexual pleasure is going to take place," says Rothenberg.
In a similar vein, men who find themselves involved with younger partners might need to evaluate the impact of that dynamic on their sex life. May–December romances can magnify sexual challenges, says Melanie Davis, a sexuality education consultant based in central New Jersey. Younger partners aren’t going to have as great an understanding of an older body, including erectile issues, discomfort with certain positions, and medical conditions, says Davis. She adds that scars, wrinkles, or medical implants, such as pacemakers or hip replacements, simply don't garner the same reactions from older partners that they do from younger ones.
Although your mind probably goes right to the "Little Blue Pill," there are many ways to treat sexual problems related to aging.
Medications like Cialis, Levitra, and Viagra can do wonders for erectile dysfunction, working for about 70 percent of ED cases. If those don't fix the problem, self-injections of medication into the penis or a suppository of medication into the urethra (the tube in the center of the penis) are other options. Beyond medications, vacuum pumps, penile implants, or surgery can also help.
Low testosterone is less often the answer to problems with erectile dysfunction but, if a man does have especially low levels and is experiencing sexual symptoms, it's worth discussing testosterone-replacement therapy with a doctor. There are, however, quite a few risks. These can include acne, enlargement of breast tissue, testicle shrinkage, and lowered sperm production, increased risk of blood clots, and increased growth of existing prostate cancer.
As for problems with sexual functioning that have a psychological or emotional component, a sex therapist can help. The solutions that come from sex therapy will be personal but Rothenberg says that mindfulness training is a common piece. This helps men combat comparisons to others or stress about prior or future sexual encounters by teaching them to focus on the pleasure they are having in the present, rather than what's happened before or what they want to do next.
Sex therapists also help their clients learn different ways to be sexual. This can be as simple as having sex in the morning, when testosterone levels tend to peak, or more complicated explorations of new ways to have sex, such as mutual masturbation or role play. Talk therapy is another common component of sex therapy. "If there's disorder in your mind, you can't expect to find order in your world or in your bed," says Rothenberg.
If you're struggling to understand what it means to be sexual at this stage, you may want to try to find a sex educator. These professionals don't diagnose or treat sexual problems, but offer very specific, actionable ways of learning more about your sexuality or sex in general. One topic Davis says she often covers with older individuals is the relative unimportance of hard erections and orgasm as requirements for good sex. "The best solution is to realize that your erection is your least exciting thing about you as a sexual person," says Davis. Getting education about these misconceptions could include learning more about arousal and sexual stimulation. For seniors, Davis recommends checking out Safer Sex for Seniors, an organization that provides all kinds of sex info tailored for an older audience.