Men's Secret Sex Problem

En español │The CD is over, and the candles have burned low. You're feeling great. You're enjoying sex, just as you always do: the closeness, the give and take, the heat. But now you'd like to finish — and it ain't happenin'. You step up the rhythm. Nothing. What's going on? You spent your 20s trying not to, and now … you can't. 

Don't worry. You're not alone. Plenty of guys 50 and older experience difficulty with orgasm and ejaculation, says Dr. Louanne Weston, a sex therapist. One study found the problem affects as many as 16 percent of men in their early 60s, 23 percent of men ages 65 to 74, and 33 percent of men 75 and older.

The good news is that these difficulties can usually be resolved. The first step is to understand what's behind the issue. The likely culprits include:

Aging. "As men age, they notice that their penis needs more stimulation to trigger ejaculation," says sex therapist Dr. Dennis Sugrue. "This is normal, but often disconcerting." Aging also weakens the pelvic floor muscles, whose contractions trigger an ejaculation. When these muscles weaken, semen dribbles out and orgasms may provide little pleasure.

Medical conditions. Neurological conditions (diabetes, paraplegia, multiple sclerosis) might damage the nerves that control orgasm. Surgery for benign prostate enlargement has no effect on orgasm, but it eliminates ejaculation.

Drugs. Antidepressants are notorious for impairing sexual performance. Alcohol is most associated with erectile dysfunction, but in some men, it causes orgasm problems. Other drugs may also contribute, such as pain relievers (Aleve, Naprosyn),  anti-anxiety (Xanax, Valium), and numerous blood pressure and psychiatric medications, among others.

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Stress. Sex therapists say that several emotional stressors may be associated with the problem: anger at one's lover, fear of pregnancy or sexual infections, or fundamentalist upbringing. "I've seen ejaculatory problems linked to strict Catholic, Protestant and Jewish upbringing," Weston says. "It's not the religion. It's the fundamentalism."

"Delivery boy" attitude. Lovemaking involves giving and receiving pleasure, but some men believe their only job is to give it. "When a man pays too much attention to his partner's experience and not enough to his own, he loses erotic focus, which can interfere with orgasm and ejaculation," says sex therapist Dr. Marty Klein.

What can you do?

First, consult your doctor. Your physician should investigate possible infections, drug issues, or pain or neurological problems. For antidepressant-induced problems, ask about switching to one that is less likely to impair sexual performance.

Practice Kegel exercises. These simple, discreet exercises tone the pelvic floor muscles, intensifying orgasm and strengthening ejaculation. Ask your doctor for instructions or look online for tutorials.

Value your erotic context. Young men can function sexually under almost any circumstance. But after 50, the context becomes increasingly important. Identify the optimal sexual situation for you, and work with your partner to find it.

Value your own pleasure. You're more than a delivery boy. You, too, deserve erotic satisfaction and have every right to ask for the stimulation that produces it. If you still have vaginal intercourse, it may not provide enough stimulation for ejaculation. "You may need vigorous manual or oral stimulation," Klein says. "If so, ask for it."

Coach your partner. Show your partner exactly what works for you, and coach your partner to provide it. You may feel bashful about demonstrating something that's usually private. But doing so not only teaches your lover what you need, it also involves self-revelation, which deepens the intimacy in your relationship.

Breathe deeply. It relaxes the nervous system so that erotic stimulation can trigger orgasm and ejaculation.

Focus on fantasies. Recall the sexual fantasies that have turned you on in the past. Elaborate on them. They need not include your lover. They just need to excite you. Or try X-rated videos.

Use lubricant. Sexual lubricants make the genitals more sensitive to touch, and often help men with performance problems.

Consult a sex therapist. If self-help doesn't provide sufficient relief, sex therapists can usually help men resolve any issues. To find a sex therapist near you, visit the American Association of Sexuality Educators, Counselors and Therapists, the Society for Sex Therapy and Research or the American Board of Sexology.

 Journalist Michael Castleman has written about sexuality for 37 years and currently publishes GreatSexAfter40.com.