Ask Dr. Annie K: Sex and Aging

My husband, who is 78, can’t climax. He has the desire but loses the urge after a short time. He has had ed for several years but could still finish up to the last year or so. Is this age related? Any hope?
– Anonymous

Love+Medicine

 

Thank you for this great question. I assure you that many of my readers are interested.

This is a condition called Delayed Ejaculation (DE) or Anorgasmia. The erection is there but no climax. The answer to your first question, whether it is age related is yes. About 1/3 of men your husband’s age have problems reaching climax.

Let’s take a look at the science behind the male sexual response to understand what is going on. It is a cascade of events originating in the brain but involving the entire body. One system relaxes the body allowing for blood flow to the penis (erection), the other follows up with contractions necessary for ejaculation. These processes are sweetly choreographed to reach the big O.

What can cause DE?

Drugs – It is well known that antidepressants cause sexual dysfunction. Here are some others:
Alcohol
Diphenhydramine (Benedryl)
H2 blockers (Tagamet, Zantac, Pepcid)
Hydrochlorothiazide
Atenolol
Opiates
Furosemide (Lasix)
Triamterine (Maxzide)
Estrogen
NSAIDs (Ibuprofen)
Pseudoephedrine (Sudafed)
Finasteride (Propecia, Proscar)
Lipid-lowering agents
Digoxin
Levodopa (Sinemet)

Heart Disease – The arteries of the penis are often the first to show atherosclerosis.

Weak Pelvic Floor – These muscles weaken as we age.

Infection – Urinary tract infections, STDs and prostatitis.

Endocrine Conditions – Diabetes, hypothyroidism, low testosterone levels.

Psychological and Spiritual Factors – Anxiety, depression, relationship issues.

Consultation with a primary care physician AND a urologist are recommended to rule out these and other medical conditions. They may provide treatment options as well. Studies are limited but there are promising reports of acupuncture as a treatment for DE.

Sex is different as we age – biology we have to accept. I like to describe it as a quieter sex. Just as hot but more simmering than full boil. Pleasure comes equally from giving and receiving. Orgasm may not be the goal every time. Going through the natural changes and seeing them as normal may bring you closer as a couple.

 This is advice for all my sexually active seniors:

  1. Get in shape.
  2. Make love early in the day, when testosterone levels are highest.
  3. Eat healthy – What is good for your heart is good for your penis.
  4. Maximize oral stimulation.
  5. Fantasize about sex.
  6. Do Kegel exercises.
  7. Use your imagination.

Age is not a disease. Do everything you can to OPTIMIZE the functioning of your body and mind. In answer to your second question, there is definitely hope!

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13 comments

  1. I am so happy to have found your blog. I want to recommend a book “All Night Long” How To Make Love to a Man Over 50 by Barbara Keesling, Ph.D. It helped me to get over any shyness I ever had about trying things to give my husband pleasure, especially since he cannot seem to climax. He is a scientist and has done a great deal of research into sexuality. You are the expert. It would be great if you could explain the prostate to your readers as a center of pleasure for men.

    1. Thank you of the book recommendation!
      When we think about the prostate it is usually in regards to urinary retention and cancer. Many men, both gay and straight, find pleasure in prostate stimulation. It is considered analogous to the G spot in women. It can illicit a great sense of pleasure and can be an alternative for men unable to climax otherwise. Anal penetration and stimulation of the area between the testicles and the anus (perineum) are both erogenous zones with thousands of nerve endings. There is a wide spectrum of what we find erotic, which makes life interesting for all of us, wherever you are on this spectrum. Find your comfort zone.

  2. Hello Anne K,
    I spotted your email in the Parade Magazine.
    Curious….
    I make little short bread cookies and Imodge podge
    On the jar
    “Love Medicine”
    I would love to send a jar to you.

  3. Hi Anne, I am 67 and having some problems even getting an erection. Orgasms are a thing of the past. I take Duloxetine – 60 mg once a day. I’m thinking of stopping because I think duloxetine is the problem. I’d appreciate a referral if you know a doctor in the Chicago area. Thanks.

    1. Hi and thank you for your comment. I received my sexual medicine training at Loyola University in Chicago. I suggest you call the Sexual Wellness Clinic there at 888-584-7888. They are an old well established clinic with a stellar reputation.

  4. As much as all your points are, I believe, accurate regarding sex & aging, the elephant in the room is diminished hormones. I would love to correspond further in this regard. I would to hear what your experience with yourself and your patients says. I think it is detrimental to say otherwise. It leaves one to think that there must be something wrong with me, because everyone else is having all this great sex. My wife and I are in our early 60’s. We travel to STL from Cleveland for HRT from Dr. Kathy Maupin. Like I said, I’d love to correspond to see how your information compares with my understanding. Because of HRT (for both of us), we are having our best sex ever (we’ve been married 35 years).

  5. My spouse has been taking Zoloft for about 20 years. Overtime she is lost any sexual desire. I believe that her weight gain and hair loss are contributed to this drug as well. I’ve asked her to talk to her doctor about considering another medication but she is afraid to. What can I do? I kind of feel trapped.

    1. Some people decide the benefit of the medication is worth it at any cost, even with life-altering adverse effects. This is a decision each of us must make for ourselves. I’m sure hair loss, weight gain and loss of libido can be depressing for anyone. If there is one thing she needs from her doctor, it’s the ability to ask questions, communicate openly and seek alternatives constantly in this ever changing landscape of modern medicine.

      A medical workup to rule out another cause for the side effects should also be done (such as hypothyroidism).

      As a cancer survivor I understand her fear of change, of not wanting to “rock the boat” but there may be other options for her to lead a more healthy, enjoyable life.

  6. I am a 71-year old male. I have had a really good sexual relationship with my wife for about 45 years, and we have two adult children.

    Now erectile dysfunction has set in and I cannot do anything sexually in bed anymore at all. I am unwilling to inject anything into my penis or to have a penile implant of any kind. I have a vacuum device which doesn’t do anything for me. I have tried Viagra and similar drugs with no success, and am now on Androgel.

    I am still romantically interested in my wife, but she has a “that’s all over, I have moved onto other interests” sexual attitude. I have not had a climax in over two years and miss this greatly! My excellent doctor says there is nothing that can be done about my ED.

    I read about all the exciting things for couples sexually, but I cannot do any of them! Does there come a time in a man’s life when it is all over sexually, when he cannot get erect or climax?

    Thank you.

    1. As I posted in Sex and Aging, the importance of ruling out all physiological, psychological and spiritual causes of ED cannot be understated. It sounds like you have a good doctor who has explored all of these causes.

      One avenue you did not mention is hormone treatment, or low testosterone. Ask your doctor about this option and perhaps look for a sexual health clinic in your area.

      Remember sex without climax is still sex… It can still be very creative and pleasurable.

  7. Hi Dr. Annie,

    My wife likes to have sex only once a week on the weekends, and I think it is just usually for me. She often doesn’t care to orgasm. I’m 61 and seem to wake up with a hard on most mornings. I travel during the week and seem to get aroused staying in a hotel. So I often will play with myself once or twice while out of town. I just really enjoy pleasuring myself for some reason. I orgasm rather quickly, much quicker than when we have sex. Is this normal and acceptable behavior or do I have a problem?

    1. Dear Concerned reader,

      First of all your habits and behavior are total normal, adaptive and great for a 61 year old! Masturbation can often be more intense and quick than sex with a partner.

      Secondly, look at your relationship and find where you share common ground in your dreams and passions. That is where good sex comes from.

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