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Middle-Age Erection Changes: What Couples Need to Know 

Most middle-aged men don’t have erectile dysfunction, but erections change.

Between age 40 and 50, most men notice that their erections aren’t what they used to be. They no longer rise spontaneously from erotic fantasies or the sight of cleavage. The penis must be fondled. When erections rise, they may be less firm, and minor distractions may cause wilting, even during hand massaging, fellatio, and intercourse.

These changes can be unnerving. Some men jump to the mistaken conclusion that they have erectile dysfunction (ED) and run to their doctors for prescriptions. Others decide that sex is over and retire from it, often to the chagrin of their partners. But most middle-aged erection changes are not ED, and even if ED develops, there are still plenty of ways to enjoy great sex and fabulous orgasms. Here's what every man—and every heterosexual woman—should know about middle-aged penises.

ED means no erections during extended masturbation.

The American Urological Association defines ED as "the inability to achieve or maintain an erection sufficient for satisfactory sexual performance." That’s absurdly vague. If you define “an erection” as what you see in porn, and “satisfactory sexual performance” as porn sex—instant erections that last forever—then most men over 40 have ED. What is ED, really? For practical purposes, it means that a man not under the influence of alcohol or any of the many other erection-impairing drugs cannot raise an erection during extended masturbation.

Most middle-aged men do not suffer not ED, but rather erection dissatisfaction.

If you can raise erections during masturbation, you don’t have ED. You probably have erection dissatisfaction.

Middle-aged men’s erection changes are normal and inevitable. Men who develop them closer to 40 usually have chronic medical conditions: diabetes, obesity, heart disease, high blood pressure. Or they’ve spent decades living unhealthy lifestyles. They smoke, don’t exercise daily, imbibe more than two alcoholic drinks a day, have chronic stress, and eat a diet high in saturated fat, that is, a lot of meat, cheese, and junk food.

Erection changes can be postponed but usually not prevented by embracing a healthy lifestyle, falling madly in love, and making love not late a night (especially after a big dinner with cocktails and wine) but in the morning or afternoon when most men have more energy.

In addition to an unhealthy lifestyle, anxiety—from job and money troubles to family and relationship problems—can be toxic to erections. Anxiety triggers the fight-or-flight reflex that sends blood away from the central body, including the penis, out to the limbs for self-defense or escape. Less blood in the central body means less blood available for erection. Erection dissatisfaction is upsetting, but try to accept it. It’s normal. If you become anxious, erections become less likely.

Good ways to minimize anxiety include a hot shower before sex, and during lovemaking, deep meditative breathing, a slow pace, and lots of sensual touch all over.

Some erection changes are due to the lengthening refractory period.

The refractory period (RP) is the time from ejaculation/orgasm until men can raise their next erection. In teens and young adult men, RP may be less than 30 minutes. But as men get older, it lengthens. By the time men hit 40, it may be several hours or longer. Meanwhile, most men masturbate frequently, many daily, some more than once a day. If men over 40 stroke a few hours before partner sex, they may still be in their RF, which can make it difficult to raise firm erections.

Consider not masturbating for 12 to 24 hours before partner sex. This works best when couples schedule sex in advance. Therapists almost universally recommend this for long-term lovers, but some people prefer spontaneity. Older couples are usually happier with scheduled sex—and for men who masturbate frequently, managing RP can help deal with middle-aged erection dissatisfaction.

Erection dissatisfaction can enhance lovemaking.

The dark cloud of erection changes has a silver lining. Young couples often develop conflict because most young men become aroused faster than most young women. Young men are often all finished before young women have even become interested in genital play. Middle-aged erection changes slow men’s arousal so their erotic pace more closely matches women’s. A slower pace allows plenty of time for kissing, cuddling, and whole-body massage, all essential to most women’s enjoyment of sex—and crucial to firm erections. From this perspective, erection dissatisfaction can actually be a gift.

A healthy lifestyle helps postpone erection dissatisfaction and ED.

Erection depends on robust blood flow through the penis. Anything that impairs circulation increases ED risk: smoking, diabetes, sedentary lifestyle, high cholesterol, heart disease, being overweight, high blood pressure, more than two alcoholic drinks a day, daily consumption of meat and/or cheese, and fewer than five daily servings of fruits and vegetables. Avoiding these risk factors does not prevent middle-age erection changes, but it helps postpone them and ED.

Erection drugs don’t produce miracles.

Erection drugs improve erections in around two-thirds of men, so they don’t work for one-third. In addition, when they work, they don’t produce porn-star erections. Over time, many men need larger doses, but as dosage increases, side effects become more likely, notably, headache and nasal congestion. Finally, the drugs have no effect on arousal, so men may raise chemical erections but not feel particularly interested in sex. Many men feel disappointed with the drugs. Fewer than half refill their prescriptions.

If you no longer have intercourse, you don’t need erections.

There’s another reason men forgo erection drug refills. With age, intercourse usually drops out of the erotic picture. Between men’s erection issues and post-menopausal women’s vaginal dryness and atrophy (tissue thinning), intercourse can become uncomfortable or impossible, even with lubricants. Many older couples jettison intercourse in favor of mutual massage, oral sex, and sex toys. Most men assume that erections are necessary for sex. For natural reproductive sex, yes, but for sexual pleasure, no. Men can enjoy fabulous sex without erections.

Men can have great orgasms without erections.

Men don’t need erections to have orgasms. Different nerves govern erection and orgasm. Even if erection nerves become severed (paraplegia, prostate cancer surgery), orgasm nerves usually remain intact. In an erotic context filled with kissing, cuddling, fondling, massage, oral, and sex toys, men with semi-erect or even flaccid penises can enjoy orgasms as intense as any they ever experienced.

The drugs work best combined with sex therapy.

Several studies have shown this. There’s more to satisfying sex than a hard penis. Relationship issues are crucial, especially if sex has been a sore point or if the couple hasn’t had much for a while.

After 60, ED is not inevitable, but it’s likely.

What proportion of men eventually develop ED? Various studies have come up with different findings, but the best research is an Australian study that tracked several hundred men over 65 for more than a decade. Nine percent developed no ED, 91 percent, occasional ED, 54 percent, mild chronic ED, and 37 percent moderate to severe chronic ED. So ED becomes, if not inevitable, quite likely. That’s the bad news. The good news is that from age 40 to 65, as men get used to coping with erection dissatisfaction, they prepare to deal with more problems later.

Gentlemen, no matter how old you are, no matter how you function, you can still enjoy great sex.


Aubin, al. “Comparing Sildenafil Along Vs. Sildenafil Plus Brief Couple Sex Therapy on Erectile Dysfunction in Couples’ Sexual and Marital Quality of Life: A Pilot Study,” Journal of Sex & Marital Therapy (2009) 35:122.

Banner, L.L. and R.U. Anderson. “Integrated Sildenafil and Cognitive-Behavior Sex Therapy for Psychogenic Erectile Dysfunction: A Pilot Study,” Journal of Sexual Medicine (2007) 4:1117.

Martin, S. et al. “Clinical and Biopsychosocial Determinants of Sexual Dysfunction in Middle-Aged and Older Australian Men,” Journal of Sexual Medicine (2012) 9:2093.

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