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Sunday May 12, 2013

Sex and the elderly male

The need for love and sexual intimacy does not decrease with age. Nevertheless, with ageing, the body undergoes certain changes that may have significant effects on sexual health.

THE World Health Organization (WHO) has defined sexual health as the state of physical, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.

Sexual activity has its benefits. This includes improved mood by increasing endorphins in the body, which in turn will boost self esteem and prevent depression. It also strengthens the immune system, and coupled with the aerobic benefits, promotes longevity and enhances quality of life.

Due to advances in science and medicine, the average lifespan of men and women have increased. With increasing age, there is a misconception that sex dies a “natural” death. This was dispelled by a study conducted by the National Council of Aging in the United States, where it was reported that 71% of men in their 60s and 57% of men in their 70s engaged in sexual activity at least once a month.

The need for love and sexual intimacy does not decrease with age. Nevertheless, with ageing, the body undergoes certain changes that may have some effects on sexual health.

Sexual problems in elderly men

Erectile dysfunction

Diseases like diabetes and high cholesterol may cause clogging of the blood vessels supplying the penis. This will decrease blood flow and result in poor rigidity.

Diabetes may also affect the nerves innervating the penis and cause poor erection.

Besides the nerve and blood vessels, hormones (testosterone) also play an important role in maintaining a good erection.

Testosterone deficiency syndrome

Testosterone hormone production reduces with age. The decline is at an average rate of 1% per year after the age of 30. When there is low testosterone levels in the body, a man will inadvertently have poor libido, desire, as well as poor erection.

Ejaculatory disorders

Testosterone deficiency may also affect sperm production, resulting in low semen volume. Other ejaculatory disorders include retrograde ejaculation, anejaculation and painful ejaculation.

Retrograde ejaculation occurs when semen, which would normally be ejaculated via the urethra, is redirected to the urinary bladder. Diseases like diabetes, which may affect the nerve supply, as well as weak pelvic floor muscles (due to ageing), may cause these ejaculatory disorders.

Premature ejaculation (ejaculating too fast) may also be seen among the elderly, but the incidence is almost the same as younger men.

Slower response to stimulation, shorter orgasm and longer refractory period

The time needed for the body to rest before it is able to achieve orgasm again (refractory period) is longer. Young men may be able to achieve orgasm within minutes after the last ejaculation, but for elderly men, the waiting period may be a few days.

Treatment matters

As it is with all other health matters, lifestyle and behavioural modifications are important. Exercise, cessation of smoking, eating a balanced diet and maintaining a healthy weight are important measures to take.

Diseases like diabetes, hypertension and high cholesterol will need to be well controlled as well.

For erectile dysfunction, the options of treatment include phosphodiesterase-5 inhibitors, intracavernosal prostaglandin (injection of medication into the penis), vacuum erection devices and penile prosthesis (implanting rods or inflatable cylinders into the penis).

In testosterone deficiency syndrome, replacement of testosterone will be able to restore libido, desire as well as erection. Testosterone replacement can come in the form of tablets, gels, patches, and injections. Besides sexual health, the overall well being of the man will also improve with such treatment.

Treatment for ejaculatory disorder is a lot harder as the outcome is not so good. For retrograde ejaculation, medications like pseudoephedrine may help. Certain medications like tamsulosin, which may cause retrograde ejaculation or anejaculation, should also be stopped.

For anejaculation, electroejaculation and electrovibration stimulation devices may help. Whatever it’s worth, retrograde ejaculation and anejaculation are harmless and does not prevent one from achieving orgasm.

Finally, good open communication lines with the spouse or partner will do wonders. If there is slow response to stimulation, there is no need to rush. Focus on foreplay instead. If one has climaxed, but the partner isn’t ready for the sexual experience to end just yet, the focus should be on meeting the partner’s needs or on activities that don’t require an erection.

Although elderly men may face sexual health issues, these can be treated effectively. Continued sexual enjoyment into later life requires a degree of adjustment to changes in the body, mind, relationships and life circumstances.

A positive attitude towards older people’s sexuality and relationships is a vital part of promoting positive sexual health throughout people’s lives and ensuring that people of all ages are able to access appropriate sexual health advice, support and services.

> Assoc Prof Dr Christopher Ho Chee Kong is a urologist/sexual medicine physician. This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public. The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Datuk Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist. For more information, e-mail starhealth@thestar.com.my. The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care.

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