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Stay in shape and have a healthy, natural sex life into your golden years, doctors say.

Sex is the first step in creating a new life. When people grow older, having children is no longer a motivating factor in a sexual relationship. But that certainly doesn't mean that it has to come to an end. A sexual relationship can live on long after the children are grown.

Below, three sexual health experts discuss sexual issues of particular interest to the elderly man.

Can elderly men engage in sex? Can they physically do it and is it healthy for them?

DAVID KAUFMAN, MD: I think the most important thing I can do today is dispel the myth that as men get older their sexual abilities decrease. That is absolutely not true. There's really no physiologic or anatomic reason why a healthy man who takes good care of himself, and who doesn't have attendant medical problems, shouldn't be able to have a very fulfilling and active sexual life.

When men come to a physician who specializes in taking care of older patients, as a geriatrician would, do they come out and say that they're having problems with sexual function? Is it something that a doctor should address?

PATRICIA BLOOM, MD: I train a lot of young physicians, and I always encourage them as part of the initial assessment, to ask about sexual function. Some patients will bring it up, but they may not. They may be embarrassed about it and afraid to bring it up. So I think it's very important for the doctor to ask about it, to establish a baseline.

What sort of questions should a doctor ask?

PATRICIA BLOOM, MD: Is the person sexually active? If so, are there any problems? If they're not sexually active, is it because they're having a problem, or is it because they don't have a partner? Try to find out what's going on. Elderly men are able to engage in sex. And, in fact, some surveys show that even as much as a quarter of men over the age of eight-five or ninety are still sexually active.

So there's really no age limit?

PATRICIA BLOOM, MD: No age limit. We know Picasso fathered children in his nineties.

How does an elderly man come to a sexual therapist? Are they referred? Do they come on their own? And when you meet with them, what is it that you try and accomplish?

DAGMAR O'CONNOR, PhD: They're usually referred either through professionals or through friends, or they've been doing research in books. So there are many referral sources.

What we're trying to ascertain when they come in is, is the problem psychological or physical? If it's a psychological problem, I can address it. I have found that there are personality profiles attached to all sexual dysfunction. A man who is a premature ejaculator is also somebody who walks fast and talks fast and is never in process, he's always at the endpoint, doing something else. A man who has psychological impotence usually has difficulty expressing his anger. When he gets angry, he withdraws and holds that back. What do I do for him? I tell him to work with his anger; we work with expression of his feelings.

Do personality profiles change over time?

DAGMAR O'CONNOR, PhD: Only in that the body changes. I remember seeing a man who was seventy-two-years-old, and he came in to see me, and he said he had difficulty with erections. I said, "How long is your foreplay?" He said, "Always ten minutes." I said "How about twenty? Takes a little longer to get aroused when you get older." Next week he came back and he banged on my door, and said, "It worked! It was wonderful. Not only that, I came twice in one night, and I haven't done that since I was fourteen."

So educating older people about how sexual function changes can be very useful?

PATRICIA BLOOM, MD: If elderly people understood the changes in physiology which make sexual cycles somewhat different, they would be very comforted.

DAVID KAUFMAN, MD: A very significant part of my job when I discuss sexual problems with older men is to reassure, and let them know that what they're experiencing is okay. It's not only the sixty-five-year-olds or the seventy-year-olds, but it's the twenty-five-year-olds and the thirty-year-olds who need to understand these changes. We all know that men are supposedly at their sexual peak at age eighteen, and after that, changes happen. Some people are able to go with the tide and acknowledge those changes, but in some cases it causes profound problems. Just hearing an acknowledgment and a reassurance from a physician makes my job very easy in a tremendous percentage of these patients.

Until recently, we believed that the vast majority of sexual problems were psychologically-based. But as medicine improved and as we understood the etiologies and the physiology of sexual arousal, we have learned that there are many physical and medical problems that can cause sexual dysfuction, and these problems can be treated.

Now, having said that, I have never seen a patient with a medically-based sexual problem that doesn't have a psychological overlay. That's how we work; that's how we're built. Whether it is caused by vascular disease or neurological disease, you only need to have the problem once, and the next time you are in a similar situation, you will be thinking: Is it going to work this time? I think that even though there are clear-cut medical explanations for sexual dysfunction, there is always a psychological component. And if that's not addressed concurrently with the medical problem, we've really only done half of our job.

What are some of the most common psychological or relationship-based sexual problems that you find?

DAGMAR O'CONNOR, PhD: A man who suddenly finds that his wife is not available, and he's now proclaiming to her that he's going to go to other women. Certainly it may cause a lot of problems in the marital relationship. Many men believe that their duty in their sexual relationship is intercourse. There's a large amount of women who are not orgasmic with intercourse, who are not so interested in intercourse, especially older women, who have discomfort. So there becomes a friction in their relationship. And that can be a problem.

PATRICIA BLOOM, MD: I actually heard an interesting twist on that. When you get into the far reaches of the age spectrum, when you're talking age ninety, there are at least three women for every man. And there may be four or five women for every man. So you might think, oh, that's nirvana for the man. But I actually heard a man say that he feels like he's been turned into a sex object with all these women.

In terms of physical problems, are men who have experienced heart attacks at risk of recurrent attacks when they have sex?

PATRICIA BLOOM, MD: A kind of equivalency that I've heard is, if you can walk up two to four flights of stairs, that's about the same level of physical activity as having intercourse. Of course it depends on the nature of the intercourse. But if you can do that without having chest pain, then probably you'll be okay.

And then, of course, you should talk about potential modifications. I remember one patient of mine who had angina, and I kept trying to encourage him to use a different position. "Let your partner do the work. You be on the bottom." He'd say "Oh, Dr. Bloom!" But really, you can talk about different positions and which positions expend more energy.


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