Mindful Sex

Tips and techniques from the front lines of couples therapy.

Aging and Male Sexual Desire III: Life-Style Issues

Maintaining sexual desire requires attention to body, mind, and relationship.

  In Part II of this four part series, we discussed physical factors associated with aging that impacts on sexual desire in men. In Part III, we expand the discussion to body, mind and relationship. Maintaining your sexual life well into midlife requires attention to all three domains. 

Medical illness, especially those that impact on vascular health, can affect erectile functioning and desire. This is as good an argument as any for men to adopt a healthy lifestyle. Good nutrition, exercise, stress management, and seeing a doctor regularly are all positively associated with keeping blood vessels healthy and the sexual equipment running smoothly. High blood pressure, hypertension, obesity and diabetes are strongly associated with erectile dysfunction (ED). For example, within five years after the onset of type II diabetes, 60% of the male patients have some form of sexual dysfunction. Diabetes affects both the quality of the blood vessel causing arterial insufficiency. The neurological changes (neuropathy) associated with diabetes also contributes to ED in older diabetic men. The “good news” is that obesity, hypertension and type II diabetes are related to a number of life style behaviors that can be altered. There is the possibility to control negative health outcome and avoid disease. If you have a poor diet, rich in animal fat and processed food, live a sedentary existence as a couch potato, have depression and/or chronic stress in your life you are at risk for premature aging in the sexuality department. 

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There are a wide variety of drugs that have been reported to impair erectile ability and reduce desire. I will mention the major culprits. I suggest checking with your physician if you have concerns. As we age, our metabolism changes (slows) which affects physiologic drug distribution which renders older persons more vulnerable to the side effects of drugs. Among medications, antihypertensive agents and diuretics are primary offenders causing impaired erections. Cardiovascular drugs, cancer chemotherapy agents, anti-anxiety meds, anti-psychotics, and a wide variety of antidepressants, bipolar meds, and numerous drugs of abuse (cocaine, alcohol, narcotics, and amphetamines) have all been linked to impaired erectile function. With diseases such as depression, hypertension and vascular diseases it is difficult to determine the extent to which the sexual dysfunction is the result of the disease or the treatment (medication) as they both impact the sexual response. 

It is important to understand that these physical changes and effects are happening to an aging man with a history and emotions. The interaction between mind and body has strong implications for sexual desire. It is a generalization but true that most men attach self-esteem and worth to their sexual response and performance. Men are conditioned to garner self-esteem via competition, achievement and by succeeding. This has been described as the “boy code” by psychologists. In my practice, I have found men with relatively minor sexual dysfunction to be “high reactors” in that they feel terrible and ashamed about their reduced functioning. They experience it as a diminishment of self. These are men who are likely to withdraw into forms of distraction and self-medication and avoid sexual intimacy. Unable to perform in a way that meets some standard, avoiding intimacy has the effect of protecting them from being threatened and humiliated. These men suffer and the relationship suffers. On the other hand, there are men who have vascular disease, on medications, and strive to accept the loss and do the best they can with what they have. They focus on pleasure and intimacy and stay sexual. It is our response, what we feel, experience, and attribute to the physical changes that determine to a significant degree if we remain sexual. We are emotional creatures (yes, even men!), and how we end up feeling about our sexual response determines our sexual and relationship behavior. If it is all about performance and being a stud, sexual changes associated with normative aging will be fraught with anxiety and loss. Withdrawing from the relationship or other problematic relationship behaviors would then make sense but be self-defeating at the very least. 

Relationship Factors: As a sex therapist that treats couples, I cannot overestimate the importance of a secure, trusting, communicative, and empathic relationship to sexuality as we age (at any age). Anecdotal case material from my 35 years in psychotherapy practice as well as the research speaks to sexual desire as an interactive and relational phenomenon and not exclusively a biologic or physical entity. If you are in good physical health and are accepting of normative age-related sexual changes and you have a partner you feel attracted to and secure with, you can be sexually active into your 80s. Bad news: marital conflict, relationship imbalances, commitment issues, intimacy and communication problems, lack of trust, mismatches in sexual desire, boredom and poor sexual technique are some of the common sources of sexual dissatisfaction guaranteed to reduce the desire to engage sexually. These issues take the zest out of sex and likely lead to the deadening of interest and ultimately avoidance. Long suffering resentments and anger built up over the years as well as feelings of entrapment is the “wet blanket” for sexual desire. The bottom line is that relational satisfaction is closely linked to sexual satisfaction in older couples. 

Sex therapy might be the antidote if tension and conflict characterize your relationship and the sex has become rote, uninspired, and absent. There is help available if you can acknowledge the need and seek out an experienced sex therapist. Study after study regarding sex and aging has noted the strong mediating influence that a “securely attached” relationship has on maintaining the satisfactory sexual relationship as one age. An intimate and securely attached relationship inoculates you from having to abandon sex just because your body and its sexual apparatus have become less functional. In such a quality relationship you are in sync with your partner and can communicate how you need to be pleased (and vice versa). It feels safe to express sexual needs and to ask for different forms of stimulation. It’s like being able to dance the tango smoothly in step. If you are emotionally intimate, secure in your love and attraction to one another, you are propelled to seek each other out sexually and the sex, in turn, pleasurably reinforces your connection. In this dance, mind, body, and relationship are inextricably linked. 

In the final edition of this four part series, I will describe how a particular way of paying attention and being present called Mindfulness can help you negotiate the inevitable changes that getting older brings. Applying Mindfulness to your sex life allows a deeper appreciation of the experience as well as provides the antidote to age-related sexual changes that will occur in time. Stay tuned.

 

Dan F. Pollets, Ph.D. is a licensed clinical psychologist and certified sex therapist. more...

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