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CORRECTING SEXUAL PERFORMANCE PROBLEMS: SEX AND AGING

We generally make one of two possible mistakes in our assumptions about the sexual changes of growing older: we either underestimate or overestimate the effect that the normal aging process has on sexual response. The fact is that clear and predictable changes in sexual responsivity begin as early as the mid-thirties. This certainly does not mean that you are over the sexual hill by your fortieth birthday; enjoyable and effective sexual response can be maintained throughout your life. However, it is essential that you and your mate be realistic and sensible about the facts of sex and aging.
As they age, men require more direct and more lengthy stimulation of the penis to get erect. Furthermore, the erection may not be quite as full or as hard as in prior years. Correspondingly, aging women may require more direct and more lengthy stimulation of the breasts and clitoral area to become aroused. There may also be less vaginal lubrication during arousal than in prior years. Once aroused, both men and women require increased direct stimulation of the sexual areas to trigger orgasm as age advances. The orgasm response may be somewhat less intense than in younger years—very relaxing and satisfying, but less explosive.
To understand sex and aging, it is helpful to understand the effects that hormones have on both male and female sexual response. The effects of the male hormone testosterone were discussed in the Sex Drive section. As the testosterone level drops with each advancing decade past age thirty-five, sexual responsivity slows down in the ways just described. But even though the level of this hormone diminishes as we age, our sexual hormones do not disappear. Most men and women continue to have ample testosterone to fuel sexual response throughout life.
The sexual consequences of aging are somewhat more complicated for women because of the abrupt hormonal changes that occur during menopause. During menopause (which typically occurs sometime around age fifty), there is a sudden decrease in the primary female sex hormone, estrogen. Decreased estrogen does not directly lessen sex drive, arousal, or orgasm response in women. It is therefore often said that there is no physical reason for a woman's sex life to be negatively affected by menopause.
So how is your sex life, from a biological perspective? If you suspect or know that some physical or chemical factor is negatively affecting your sexual response, don't give up; get more information about your condition and the possible medical treatments available to you. Recent medical advances have made possible the accurate evaluation and successful treatment of many organically caused sexual problems. Pelvic angiography can assess the degree of circulation to the pelvic area. It is also possible to determine penile blood pressure as a means of evaluating whether a biological problem underlies erection difficulties.
Medical aids can enhance blood flow to the penis, and surgical procedures can often restore or aid sexual response. One such procedure involves grafting new blood flow pathways to the penis to aid erection. Another surgery involves the insertion of a penile prosthesis into the penile cavities to allow for the simulation of a natural erection. These surgeries are safe, medically sound, and most often effective in enhancing the sex life of any partners who are otherwise open and loving in their efforts to maintain intimate connections through all the years of their life together.
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TAKING ESTROGEN

With the onset of menopause, many women suffer from hot flashes and night sweats. Arlene March, 56, a Los Angeles psychotherapist, says she started getting hot flashes 5 years ago. “I’d be working,” she recalls, “and suddenly feel intense heat all over my body. I’d break out in a sweat. I’d have to stop work. Then Dr. Mishell prescribed estrogen pills, and I’ve not had a day of discomfort.”
Some women experience a drying and thinning of vaginal tissues in the absence of estrogen, making sex painful. They also might suffer urinary tract infections and incontinence. Estrogen therapy often helps.
Among the physicians consulted, the most cautious was Dr. Morris Notelovitz, founder of the nation’s first Menopause Center, at the University of Florida, and head of the Women’s Medical and Diagnostic Center in Gainesville, Florida. He says each symptom needs a different treatment and advises that genital tract problems be given estrogen treatment for a couple of years at most. He also urges special measurements of the bones before prescribing estrogen therapy for osteoporosis.
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WOMEN’S HEALTH

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