Aging & Health A to Z
Care & Treatment
Treatments can be very simple and effective. The choice of treatment depends on the underlying cause of the problem.
Women around the time of menopause, and men as they get older, experience a drop-off in sex hormones such as estrogen, testosterone, and others involved in sexual response.
Women are now rarely prescribed estrogen replacement therapy because of the danger of stroke, blood clots, and cancer when estrogen is given to women after menopause has already occurred. Instead, pain during sex caused by vaginal dryness and thinning can be effectively and easily treated with vaginal creams or tablets that contain estrogen, or an “estrogen ring” that gradually releases the hormone into vaginal tissues and is replaced every few months. Side effects are rare and mild and the estrogen stays in the area it is applied so it has no systemic (whole body) effects. Although these treatments improve the health of vaginal tissue, they do not have an effect on your feelings of sexual desire (libido) or satisfaction.
For men, loss of libido may improve with testosterone (the male sex hormone) treatment, though this is accompanied by some risks so must be considered carefully. A popular method of administration is in a patch or gel that is applied to the skin. It can also be injected. However, testosterone can cause liver or prostate problems and raise red blood cell counts, so anyone taking it should have a blood test to check their liver function and blood counts before starting, and then every six months while treatment continues. Your prostate should also be checked periodically because testosterone can stimulate its growth. Water retention may also occur with testosterone supplementation.
Drugs for Erectile Dysfunction (impotence)
Several good drug and non-drug treatments are available for impotence. Discuss each of them with your doctor and choose the one that will best suit you and your partner.
Pills: Three medicines that are taken by mouth are now available: sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). These drugs are taken as pills before sex and usually work within one hour. Tadalafil has a longer potential of action than the other two products. Without sexual stimulation, there is no response. A dangerous but uncommon side effect, priapism, refers to an erection that lasts for more than four hours. You must get emergency medical attention if this occurs. If you are taking nitrates like nitroglycerin for a heart condition, you must not take any of these drugs because of the risk of fatally low blood pressure when they are taken in combination. Other side effects may include headache, short-term color blindness, or upset stomach.
Injections into the penis: One injectable drug, alprostadil, is now on the market in the United States. When alprostadil is injected into the penis with a very fine needle, it is able to produce an erection that lasts up to an hour and is sufficient for sexual intercourse. Since the pills to treat impotence appeared on the market, however, this injectable product is much less commonly used. However, for men who are unable to take the pills because of a heart condition or some other reason, alprostadil injections are a valuable option. The injections may cause side effects such as bruises, local pain, or scarring from repeated administration. This treatment may also cause priapism in rare cases.
Vacuum pumps for erectile dysfunction: Vacuum pump devices are also effective treatments for impotence. The penis is inserted into a plastic cylinder and a vacuum pump creates negative pressure inside the cylinder. This causes blood to engorge the penis and make it rigid. The erection lasts for about half an hour. Side effects such as pain, swelling, bruising, and painful ejaculation have been reported.
Medication changes: Your doctor will review your medications and identify any that may hinder sexual response or performance. A dose reduction or alternative medication can often improve the situation.
Treatment of underlying medical conditions: If you have a treatable medical or psychological condition, such as an infection, diabetes, heart or circulatory disease, arthritis, or depression, treatment or improved management of the condition may resolve the sexual difficulty.
For example, if a man with diabetes becomes impotent because of blood vessel problems in his penis, better management of the diabetes may improve local blood pressure and resolve the erectile dysfunction. Similarly, better pain control for someone with arthritis – using pain pills or other approaches – may provide the relief needed to relax and enjoy sexual activity.
Vaginal lubricants: A wide assortment of non-prescription vaginal lubricants (for example, K-Y jelly or Astroglide) is available at local pharmacies. These can be effective for reducing or eliminating pain resulting from vaginal dryness.
Talk therapy or counseling: Your primary healthcare provider may be able to help you with your sexual concerns or you may be referred to a therapist or counselor who is specially trained to help people with sexual problems through talk therapy. The therapist will identify your difficulties, suggest approaches that will encourage you and your partner communicate your needs and desires, and offer ways to enhance understanding and honesty within your relationship.
Simple behavioral changes may make a difference. For both men and women, longer foreplay is usually necessary with advancing age. More direct gentle stimulation of the genitals can also improve response. In fact, just having regular sex can help maintain vaginal tissues and improve lubrication. In particularly difficult situations—for example if one member of a couple is ill—the therapist may be able to suggest solutions that will please both partners. For example, if one partner has painful arthritis, a change in position may be enough to allow an enjoyable sexual experience.
It is important to understand the changes your partner is experiencing with increasing age. By learning about the challenges and concerns of your significant other, you can avoid misunderstandings and disappointments. For example, if a husband takes longer to achieve an erection, his wife—who may have her own insecurities about her increasingly gray hair and wrinkles—may conclude that he no longer finds her attractive. Similarly, vaginal dryness in a woman, while normal and extremely common, may be wrongly interpreted as lack of interest.
Many couples may find that sexual intercourse is no longer necessary to express their loving feelings for each other. Hugging and kissing, caressing, and manual or oral stimulation are forms of intimate lovemaking that may be completely satisfying for both partners. For older people who do not have a sexual partner, masturbation may be a healthy option to satisfy a still active sex drive.
- you use alcohol or tobacco
- your hormone levels are normal (This will require blood tests.)
- general health, blood pressure, and responses of your penis are normal.
Updated: May 2012
Posted: May 2012