I’m a Marine. My PTSD and Other Issues Are Affecting My Sex Life

Winston’s advice: Talk to the physician managing your medications, and ask directly whether any adjustments could improve your sexual function without compromising your mental health.

There are also very effective medical treatments for ED, including oral meds, vacuum devices and injections. If you haven’t already explored those possibilities with a urologist, Winston says that would be a reasonable next step.

Have an open conversation with your wife. Certified sex therapist Marianne Brandon recommends sharing your frustrations and concerns with your wife.

“Try approaching this as a team, rather than just you trying to figure it out on your own,” she says. “The more you struggle alone, the more closed your body and heart will become, and intimacy will feel even more elusive.”

Licensed marriage and family therapist Tameca N. Harris-Jackson says intimacy is about vulnerability, and she suggests a conversation opener such as, “I don’t know who I am anymore. I want to be close to you, but I don’t know how.”

Consider, too, that your wife may be feeling rejected or afraid she’s doing something wrong, says Harris-Jackson, adding, “This [conversation with her] could be the start of something beautiful.”

About that performance anxiety. “When intimacy starts to feel like a test of performance, it creates pressure and anxiety, which can make erections even more difficult,” says Winston.

As sexuality and relationship coach Stella Harris frames it: “Just the expectation of performance is so much pressure.... This becomes a self-fulfilling prophecy. As soon as that becomes a part of your thought process, you’ve kind of already lost.”

If penis-in-vagina sex is your go-to — and it sounds like it is — Winston suggests changing up the script.

“One of the most helpful shifts is to take intercourse off the table, at least temporarily,” he says. “Focus instead on rebuilding physical closeness without the expectation of performance.”

Try a new playbook. Dacker recommends exploring each other’s bodies through a combination of sensate therapy (a way of introducing intimacy without it being about performance) and tantra (being present and aware through breath movements).

Here’s how it works:

• Step 1 is to sit close to each other or hold hands, and when you are touching, think about what kind of pressure, texture or sensation you enjoy.
• Step 2 is to practice nonsexual touch. “This isn’t about arousal; it’s just getting comfortable with touch,” says Dacker. As an example, touch each other’s hand or inner forearm while doing a deep inhale and slow exhale.
• Step 3 is to practice erotic touch — not the genitals but perhaps the chest. Dacker says don’t plan on having sex for at least a month while you explore yourself and each other through touch.

“What we’re trying to develop here is a foundation where his body feels safe and seen,” she explains. “During this process, he’ll also find out what he doesn’t enjoy. What he’ll discover is a whole different system of exploring pleasure and eros.”

When you do have sex. Even though your body has changed and responds differently than it used to, it doesn’t mean you are done being a sexual partner, according to certified sex therapist Shadeen Francis.

What it does mean is that your definition of intimacy might have to expand. While erectile dysfunction impacts the ability to have intercourse, Francis points out that giving and receiving oral sex does not require an erection, nor does exploring the body with hands, mouth and tongue.

Certified sex therapist Chris Fariello, founder and director of the Philadelphia Institute for Individual, Relational & Sex Therapy, says other options include using toys on and with your partner, watching your partner masturbate and watching porn together.

“There is a whole wheel of pleasure to add to your repertoire that could be interesting and that may feel hot, exciting and even orgasmic,” he says.

See a sex therapist. Francis says it can feel overwhelming to figure this out on your own. A sex therapist “can help map out options. Don’t miss out on the opportunity to get the support that people need to have lifelong pleasure available,” she says.

Bottom line. Winston urges you to “think of this as a reset rather than a loss. Intimacy in your 70s can still be deeply satisfying, but it may look different than it did earlier in life. Slower pace, more communication and broader definitions of intimacy often lead to better experiences than trying to recreate the past.”