DEAR DOCTOR K:
My wife and I are in our 70s. Sex is not what it once was. Is there anything “natural” I can do to improve sex? I don’t want to take pills. What’s normal aging when it comes to sex?
As a man in the last half of his life, I would like to be able to tell you that nothing changes. However, even in healthy men, sexuality changes over time. It’s often a gradual, almost unnoticeable process that usually begins in a man’s 40s.
Sex involves different functions. Most are affected by aging:
SEXUAL DESIRE OR LIBIDO: The sex drive requires the right mind-set and enough testosterone, the male hormone.
The intensity of the sex drive tends to wane with age. Levels of testosterone begin to drop after age 40. Most men over 40 still have more than enough testosterone to function sexually.
But the sex drive is not just about testosterone levels. A man’s mind finds certain aspects of another person’s appearance or behavior attractive, or not. And when relationships become strained, a person who used to be sexually attractive can become less so.
That said, having an abnormally low testosterone level probably negates a man’s sex drive, even when he sees a very attractive woman.
AROUSAL: Arousal begins with erotic thoughts and sensory stimulation. These excite the nerves that go to the penis, and that leads to an erection. Here’s how it works:
The penis is filled with a spongy tissue. When the sponge is dry, it collapses. When it’s wet, it swells. Stimulation of the pelvic nerves signal the arteries of the penis to widen. Blood rushes into the spongy tissue. Stimulation of the nerves also causes the veins carrying blood away from the penis to narrow, so more blood is entering the penis and less is leaving. As a result, the penis swells, causing an erection.
There are several reasons why it becomes harder for men to have an erection as we age:
- Penile responsiveness to sensory stimulation slows with age.
- Penile blood flow may decrease as men grow older.
- The nerve signals that cause erections are more difficult to sustain.
PLATEAU: The prostate and seminal vessels begin to discharge fluid to prepare for ejaculation.
EJACULATION: Certain muscles contract, propelling semen forward. Orgasm usually occurs with ejaculation. These muscular contractions of ejaculation become less intense as we get older. Also, semen volume and sperm counts decline.
REFRACTORY PERIOD: The penis can’t respond to sexual stimulation during this phase. It lasts from 30 minutes (in younger men) to three hours (in older men).
Diseases that affect the blood vessels and nerves can disrupt all these functions. For example, atherosclerosis blocking blood flow in the arteries that send blood to the penis is one culprit. Diabetes and pre-diabetes are another example: They damage nerve function, as well as stimulating atherosclerosis.
A healthy lifestyle, which reduces your risk of atherosclerosis and diabetic nerve damage, is the road both to a longer life and to better sex.
(This column is an update of one that ran originally in July 2013.)