in shape and have a healthy, natural sex life into your golden
years, doctors say.
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
sexual health experts discuss sexual issues of particular interest
to the elderly man.
men engage in sex? Can they physically do it and is it healthy
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.
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
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
of questions should a doctor ask?
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.
really no age limit?
MD: No age limit. We know Picasso fathered children in his nineties.
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?
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.
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.
profiles change over time?
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."
older people about how sexual function changes can be very useful?
MD: If elderly people understood the changes in physiology which
make sexual cycles somewhat different, they would be very comforted.
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.
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.
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.
some of the most common psychological or relationship-based sexual
problems that you find?
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.
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
of physical problems, are men who have experienced heart attacks
at risk of recurrent attacks when they have sex?
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.
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
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