En español | With all the advertisements you see on television for performance enhancing drugs for erectile dysfunction (ED,) you'd think every male on the planet had trouble rising to the occasion. Not so. Here's everything you need to know about this and other performance issues men encounter as they get older.
See also: How sex changes for men after 50.
1. ED is common, but not inevitable. Erectile Dysfunction is "the inability to achieve or maintain an erection sufficient for satisfactory sexual performance," according to the American Urological Association. Huh? If you're not sure what that means, that's because it's pretty vague. Simply put, ED means that a man who's sober (no alcohol or other erection-impairing drugs) cannot raise an erection during sex of any kind.
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Just how common is it? Landmark studies by University of Chicago researchers found that one third of men aged 50 to 64 suffer from ED. That figure jumps to approximately 44 percent for the 65 to 85 age group. So while ED is quite common in older men, more than half never develop it.
2. Some changes, however, are inevitable. Starting around age 50 (for some men, earlier), erections change — in some gradually, in others more quickly. Men lose the ability to raise erections solely from sexual fantasies. Direct fondling is necessary to raise them. When erections appear, they rise more slowly and are not as firm as they were when you first fumbled with condoms. And minor distractions, such as an ambulance siren, may cause wilting. These changes alarm many men, who jump to the conclusion that they must have ED. But if you can still raise an erection during masturbation, you don't. You have erection dissatisfaction.
Post-50 erection changes are normal and inevitable. But some lifestyle factors can postpone or even temporarily reverse them: falling madly in love, getting in shape and making love earlier in the day when you have more energy.
Unfortunately, other factors exacerbate erection dissatisfaction: anxiety, alcohol, many other drugs, relationship problems and making love when fatigued, i.e., late at night after a long day and a big dinner with wine.
Anxiety is particularly pernicious. It triggers the fight-or-flight reflex that sends blood away from the central body, including the penis, and out to the limbs for self-defense or escape. Less blood in the central body means less blood available for erection. Erection dissatisfaction is upsetting, but try to accept it. It's normal. If you become anxious, erections become less likely.
Good ways to minimize anxiety: a hot shower before sex and during lovemaking, deep meditative breathing, a slow pace and lots of sensual touch all over.
3. Healthy lifestyle minimizes risk of ED. Erection depends on blood flow through the penis. Anything that impairs it increases ED risk: smoking, diabetes, high cholesterol, high blood pressure, heart disease, being overweight, little regular exercise, more than two alcoholic drinks a day and fewer than five daily servings of fruits and vegetables. Avoiding these risk factors does not prevent post-50 erection changes, but it preserves erection function and helps prevent ED.
4. Drugs are worth trying, but can't work miracles. Erection drugs improve erections in around two-thirds of men, so they don't work for one-third. They do not produce porn-star erections. Over time, many men need larger doses. But as dosage increases, side effects become more likely, notably, headache and nasal congestion. Finally, the drugs have no effect on arousal, so men may raise erections but not feel particularly interested in sex. Many men feel disappointed with the drugs. Fewer than half refill their prescriptions.
5. Erections aren't everything. Believe it or not, you don't need an erection to have an orgasm. In an erotic context filled with kissing, cuddling, fondling, massage, oral and sex toys, a man with a semi-erect or even flaccid penis can enjoy orgasms as intense as any he ever experienced during intercourse.
6. Erection dissatisfaction can enhance lovemaking. The dark cloud of erection changes has a silver lining. Young couples often have problems because young men become aroused faster than young women. Young men are often all finished before young women have even become aroused. Post-50 erection changes slow men's arousal so their erotic pace more closely matches that of a woman. A slower pace allows plenty of time for kissing, cuddling and whole-body massage, all essential to most women's enjoyment of sex.
When erection dissatisfaction develops, some men decide that's it, sex is over. Others accommodate and continue to enjoy lovemaking as long as they live. The choice is yours.
Michael Castleman answers sex questions for free at GreatSexAfter40.com
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