As I write this, I’m pushing 70. That’s the younger side of old as demographers define it. But sexually, I’m elderly—and familiar with the changes that afflict aging men, notably gradual erection loss. This problem is more prevalent than many men admit. Fortunately, with a few adjustments, elder sex can feel as fulfilling as ever—maybe even better.
Surprise: Few Elder Men Take Erection Drugs
If elder men can raise erections, they usually owe them to Viagra, Cialis, or Levitra. However, for many (most?) men over 65, the drugs turn out to be a disappointment:
- No more than 20 percent of men over 60 have tried erection medication, let alone become regular users. The CVS Pharmacy chain tracks the demographics of its prescription drug sales. Among the minority of elder men who have tried Viagra, men over 60 account for only around one-third of sales. Most users are in their forties or fifties.
- The pharmaceutical industry has exaggerated the drugs’ effectiveness. In pre-approval trials, they claimed benefit—that is, firmness sufficient for intercourse—in around 70 percent of users. But several recent studies conclude it’s closer to 50 percent, with effectiveness declining with age, especially after 60. So the drugs help only a minority of elder men.
- The drugs improve blood flow into the penis but do nothing for libido and arousal, which become increasingly problematic for men over 65.
- Pre-approval trials called the drugs’ side effects minor, uncommon, and transient. Post-approval studies have documented persistent annoying side effects in around 40 percent of users. Side effects increase with dosage—and most men over 65 must take high doses. As a result, only around half of all men refill their prescriptions and only a minority of elder men.
- Even when men over 65 love erection medication, they are typically involved with women around their age, who develop post-menopausal dryness and vaginal tissue thinning (atrophy) that can make intercourse uncomfortable or painful even with plenty of lubricant.
Bottom line: Most men over 65 bid farewell to erections and penis-in-vagina intercourse and opt for other pleasures; mutual genital hand massage, oral sex, and toys.
Healthy Lifestyle Helps—Until It Doesn’t
Meanwhile, for 43 years, I’ve been a journalist specializing in health and sexuality. Studies abound showing that later-life sexual function decline can be delayed with a healthy lifestyle: daily exercise, no tobacco, a plant-based diet, sleeping eight hours a night, and no more than two alcoholic drinks a day. I’ve done my best to live that way, and thought (naively) that I was immunized against the sexual ravages of Time. Alas, no.
As sexual elder-hood hit me below the belt, I stamped around the house, cursing Fate. My wife of 47 years said, “For God’s sake, Mike, you’ve been writing about this for eons. You know what’s happening and why. Get a grip.”
Eventually, I did. And like millions of older men before me, I discovered that erotic changes don’t necessarily scuttle sex. Yes, erection loss can be unnerving, but here’s the upside: Men don’t need erections to enjoy great sex and marvelous orgasms. This bears repeating: In an erotic context, with a supportive lover, men with semi-firm or even completely flaccid penises, can still experience great fun between the sheets capped by satisfying orgasms.
The Hyde Study
Before the Food and Drug Administration approved Viagra in 1998, the conventional wisdom was that that older couples simply stopped having sex, so researchers didn’t focus on it. But since Viagra, over the past almost 20 years, elder sex has become a hot topic, and two recent Australian studies show that older men’s situation, while not horrible, isn’t pretty.
In one study (Hyde 2012), Australian aging researchers surveyed the health and sexuality of 3,274 mostly white, independent-living men age 75 to 95 (average age 82). Respondents’ demographics—education, smoking, alcohol use, single vs. partnered, etc.—differed a bit from the U.S. but not by much, so the findings can be reasonably extrapolated to Americans:
Problem Whole Group (3,274) Partnered (857)
Lack of interest 48% 24%
Erectile dysfunction (ED) 49% 66%
Premature ejaculation 15% 26%
Difficulty ejaculating 39% 43%
Performance anxiety 20% 37%
Low testosterone 7% not determined
Compared with the whole group, erection problems were considerably more prevalent among men with regular sex partners. This is not surprising. It’s easier to raise erections during masturbation than partner sex. In solo sex, you only have yourself to please. In partner sex, the man’s needs and desires must mesh with the woman’s, and things get complicated and erections suffer.
The same was true for both premature ejaculation and difficulty ejaculating. Men having only solo sex have better ejaculatory control than those who have partner sex.
Despite general awareness than men’s sexual function declines with age, a considerable proportion of these men were still upset about it.
Finally, a good deal of direct-to-consumer advertising pitches older men on testosterone supplementation and many physicians are happy to prescribe it. But in this sample, only 7 percent actually had “low T,” and among those who did, the hormone deficiency was associated with only one sex problem, lack of libido. Testosterone level had nothing to do with erection, orgasm, or ejaculatory control.
The main causes of this sample’s sex problems were not psychological problems or relationship issues but rather chronic health conditions: obesity, arthritis, cancer, diabetes, heart disease, sleep disorders, and high blood pressure.
The Martin Study
As part of the Adelaide Male Aging Study (Martin, 2012), a different group of Australian researchers asked 271 men, age 65 to 80, about their health, libido, and erections.
- Low desire was a major problem, reported by 89 percent of single older men, and 33 percent of those with partners.
- ED was a major problem, reported by 91 percent of the men—mild-to-moderate ED, 54 percent, moderate-to-severe ED, 37 percent.
Risk factors for ED included: anxiety, depression, diabetes, insomnia, cancer, smoking, obesity (especially pot belly), high blood pressure medication, more than two alcoholic drinks a day, and obstructive sleep apnea (OSA).
Surprisingly, OSA, little investigated for ED, was the health problem most closely associated with it. OSA results from either a loss of muscle tone in throat tissue, or obesity-related excess throat tissue. People with apnea (mostly men) exhibit persistent snoring interrupted by choking silences that temporarily shut down airflow into the lungs. The breathing interruption sets off biological alarms that rouse the person, which restores airflow. But OSA disrupts sleep and reduces the amount of oxygen in the blood. Erection depends, in part, on normal blood oxygen. Apnea reduces it and contributes to ED.
The Slippery Slope
Together, the two studies show:
- Testosterone deficiency is not common in older men. Like many physicians and public health officials, I would argue that low T is over-diagnosed and over-treated.
- Exemplary lifestyle habits extend sexual function up to several years, but ultimately, they don’t protect elderly men from libido decline and erection loss.
- Having a partner works wonders for men’s desire. Compared with single men, those in relationships had much more libido. But relationships also have downsides—greater risk of ED, premature ejaculation, difficulty ejaculating, and performance anxiety.
You’re Never Too Old to Enjoy Great Sex
So somewhere between half and 90 percent of men over 65 suffer some level of ED. That's depressing. However, elderly couples who wish to remain sexual can still enjoy great sex and orgasms—if they make a few simple erotic adjustments:
- Don’t take it personally. In the vast majority of older men, libido, and erection function decline. That’s life.
- Stop focusing partner sex on intercourse. Many (most?) older men can’t get it up sufficiently to slip it in. Even if they can, many (most?) post-menopausal women find intercourse increasingly uncomfortable even with lubricant. So most elder couples who remain sexual evolve their lovemaking away from penis-vagina intercourse.
- Instead of intercourse, orchestrate your lovemaking around leisurely, playful, whole-body touch: kissing, cuddling, mutual total-body massage, genital hand massage, oral sex, and sex toys (with plenty of lubricant).
- Enjoy being more in sync. Young men heat up much faster than young women, often finishing before their lovers have even warmed up to genital play. Older men take longer to become aroused—like women. So older couples become more erotically in sync, which enhances sexual and relationship satisfaction.
- Finally, men don’t need erections to have marvelous orgasms. In an erotic context—lingerie, candles, music, whispered endearments, and an enthusiastic lover—with enough penile massage and/or fellatio, men with semi-firm or even flaccid penises can still have earthquake orgasms.
Many older men respond to age-related sexual changes by retiring from sex, especially when erection drugs don’t work. If that’s how you decide to proceed, it’s your call. But I’m in my late sixties, and I can happily testify that without drugs, with the adjustments just mentioned, elder sex can feel as fulfilling as ever—maybe even better.
I would love to hear from older men and women involved with them. What can you add about the real sex lives of men over 65?
Surprisingly few older men use erection drugs
New York Times, March 28, 1998, “U.S. Approves Sale of Impotence Pill. Huge Market Seen.”
New York Times, Dec. 4, 2005. “Sales of Impotence Drugs are Declining.”
Banner, L.L. and R.U. Anderson. “Integrated Sildenafil and Cognitive-Behavior Sex Therapy for Psychgenic Erectile Dysfunction: A Pilot Study,” Journal of Sexual Medicine (2007) 4(4, Pt 2):1117.
Chia, S.J. et al. “Clinical Application of Prognostic Factors for Patients with Organic Causes of Erectile Dysfunction on 100 mg of Sildenafil Citrate,” International Journal of Urology (2004) 11:1104.
DeBusk, R.F. et al. “Efficacy and Safety of Sildenafil Citrate in Men with Erectile Dysfunction and Stable Coronary Artery Disease,” American Journal of Cardiology (2004) 93:147.
May, M. et al. “Erectile Dysfunction, Discrepancy Between High Prevalence and Low Utilization of Treatment Options: Results from the Cottbus Survey,” British Journal of Urology International (2007) 100:1110.
Melnik T. and C.H. Abdo. “Psychogenic Erectile Dysfunction: Comparative Study of Three Therapeutic Approaches,” Journal of Sex and Marital Therapy (2005) 31:243.
Mulhall, J. et al. “Importance of and Satisfaction with Sex Among Men and Women Worldwide: Results of the Global Better Sex Survey,” Journal of Sexual Medicine (2008) 5:788.
Pickering, T.G. et al. “Sildenafil Cittrate for Erectile Dysfunction in Men Receiving Multiple Antihypertensive Agents: A Randomized Controlled Trial,” American Journal of Hypertension 17:1135.
The studies of the sex lives of men over 65
Hyde, Z. et al. “Prevalance and Predictors of Sexual Problems in Men Aged 75-95 Years: A Population-Based Study,” Journal of Sexual Medicine (2012) 9:442.
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.