Normal Changes in Women

Erectile Dysfunction in Men

Older men experience a delayed reaction to sexual stimuli. They require a longer time to achieve an erection, and the erection is often less firm than it was at a younger age. Male orgasm takes longer to achieve and has a shorter duration than at a younger age. Ejaculation is less forceful and a smaller volume of seminal fluid is released. Loss of erection occurs quickly after orgasm. In general, the time between orgasms increases, and orgasm may not occur with every episode of sexual intercourse. Diabetes, depression, and cardiovascular disease contribute to impotence in men, even at a young age. Prostatectomy (removal of excess prostate tissue) normally does not cause problems with achieving an erection because newer surgical techniques do not cause the nerve damage that was common in the past. Medications such as sildenafil citrate (Viagra) or tadalafil (Cialis) are effective for many individuals suffering from erectile dysfunction.

Illness and Decreased Sexual Function

Illness of one or both partners is a common reason for decreased sexual function. Many disease processes interfere with normal sexual function, as do many of the medications taken to treat illness. Incontinence does not interfere with sexual relations but may cause some people to avoid sex because of possible embarrassment. Treatment can at least control if not completely cure incontinence problems. Joint pain resulting from arthritis can interfere with sexual activity. Cardiac problems are likely to interfere with normal sexual activity, although this is more from fear than from actual danger. The actual risk for death resulting from sexual intercourse is low, but older persons who have experienced a heart attack should discuss their concerns with a physician. Stroke need not prevent sexual activity. Sex is not likely to cause another stroke, although modification in position or use of assistive devices may be needed to compensate for any residual weakness or paralysis. Neither hysterectomy (removal of the uterus) nor mastectomy (removal of a breast) changes sexual functioning, although loss of these organs may make the woman feel less desirable or make her fear that she will be viewed that way. Counseling may be required to help women with these concerns. Depression can decrease sexual interest and lead to decreased response to intimacy.

Alcohol and Medications