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Coping with Erectile Dysfunction

Is a Prescription the Right Thing for You?

iStock 000023629100SmallAs a geriatrician, I believe that seniors are entitled to have healthy, satisfying sex. I frequently see patients who fall in love and develop new relationships later in life. Yet, unfortunately, our society is age biased. We forget that older people have sexual needs and desires. I hear that most physicians don’t even ask senior patients if they’re sexually active. For some seniors, sexual issues may not be at the top of the priority list during a visit to the doctor. Others may be hesitant or simply embarrassed.

Let’s take a look at a very common issue that affects the sexual lives of many men (and, therefore, their partners): erectile dysfunction (“ED”). The term ED refers to a condition wherein a man cannot obtain or sustain an erection long enough to have sexual intercourse.

ED can have many different causes:Physical symptoms related to conditions such as diabetes, heart disease, neurological diseases, chronic alcoholism, and others that can decrease blood flow.

  • Psychological and emotional issues, including stress and depression, can contribute to ED.
  • Performance anxiety: the stress of getting or maintaining an erection can inhibit erection.
  • Lack of testosterone can affect libido.
  • Medications, including antidepressants, may actually be the underlying cause of ED.

Is it normal to experience ED as you age? The truth is, there is no “normal.” The trick is to know your own body, to be familiar with what’s “normal” for you, personally, and to watch for changes in the way your body functions. It’s certainly helpful to have a close relationship with your primary care provider who can help you understand what’s going on and find the best solution for your situation. If you’re experiencing ED, it’s possible that there’s a causal problem—a systemic issue, such as coronary artery disease—that needs to be addressed. Sometimes, when the underlying problem is resolved, the ED is corrected as well.

iStock 000019213140SmallAnd other times, there’s really no problem at all. I once had a male patient with coronary artery disease and diabetes who had recently re-connected with a woman he’d been close to 30 years before. He came to me concerned about ED and hoping to get a prescription so he could “perform” adequately. We had a long discussion and I gave him samples of a medication to try. But, along with the meds, I asked him a critical question: is your partner ready for sexual activity, or could this damage the newly-rekindled connection? As it turned out, he never used the samples. Instead, he brought his lady friend in to see me and talk about the situation. While he was thinking that sex was important to her, she really wasn’t interested in that at all. Their courage and willingness to talk about the situation opened up a whole new happy dimension to their relationship and alleviated a great deal of pressure and stress for both partners.

Which brings up an important point: there are many satisfying ways of being physically intimate that don’t require sexual intercourse. Touching is important; physical contact is important. But it does not always (or even ever) have to “go there.” Find out what your partner really wants. And tell your partner what you want. You might surprise each other.

All that said, pharmaceutical assistance can be exactly what’s required in certain situations. There is a class of drugs called phosphodiesterase (PDE) inhibitors (known by the brand names, Viagra, Cialis, and Levitra) which increase blood flow to the penis when it’s needed. Each of these drugs affects people differently. Again, it’s really important to talk openly with your physician about your needs so we can prescribe the right medication for you and your lifestyle.
There are possible side effects to these medications, including headaches, backaches, other muscle aches, facial flushing, and upset stomach. The following potential side effects are more serious and require immediate medical attention:

  • Precipitous drop in blood pressure
  • Sudden blurred vision with dizziness or ringing in the ears
  • Priapism—an erection (usually a painful one) lasting more than four hours

Now, these drugs are not “magic pills” that will solve everything. Some separate but related dynamics:

  • What many people don’t realize is that, while drugs can enhance a man’s ability to achieve and maintain an erection, they don’t do a thing to enhance desire, pleasure, or orgasmic experience. There’s much more to a gratifying intimate encounter than just the physical ability to get the job done.
  • These medications do not cure ED—they only temporarily create a condition wherein an erection becomes possible.
  • These drugs are not birth control. If you’re having sex with a fertile female partner (and don’t intend to father a child), birth control is still required!
  • While we’re focused primarily on men’s issues here, it bears noting that the female partner’s libido and ability to achieve orgasm are not necessarily addressed by the male partner having an erection. Both partners’ needs and desires should be taken into consideration.
  • I’d be remiss if I didn’t mention sexually transmitted diseases, including HIV/AIDS. If you are planning to have an encounter with a new sexual partner, you need to talk about safe sex and take preventive measures. STDs do not discriminate based on age—they can affect anyone.

Everyone should be having good sex—not just young people! If you have concerns about ED or other issues related to your sexual health, please don’t hesitate—talk to your physician.

Senior Health Articles