Care & Treatment
Treatments can be very simple and effective. The choice of treatment depends on the underlying cause of the problem.
Both men and women experience a drop-off in sex hormones such as estrogen, testosterone, and others involved in sexual response with age. This usually happens for women around the time of menopause.
Women used to be prescribed oral estrogen replacement therapy after menopause. However, oral estrogen therapy may not be appropriate for some women because of the danger of stroke, blood clots, and cancer. Instead, pain caused by vaginal dryness and thinning during sex can be effectively and easily treated with vaginal creams or tablets that contain low doses of estrogen. An “estrogen ring” can be prescribed as well. The ring gradually releases estrogen into vaginal tissues and is replaced every few months. Side effects are generally rare and mild. Since the estrogen stays in the area it is applied, it has no systemic (whole body) effects. Something to keep in mind is that these treatments improve the health of vaginal tissue, but they do not have an effect on your feelings of sexual desire or satisfaction.
Women who don’t want to use topical estrogen may find some symptom relief with non-hormonal vaginal moisturizers (such as Replens), or by using lubricants during intercourse. However, the moisturizers do not reverse vaginal thinning.
An alternative for women who do not want to use topical hormones is the oral medication ospemifene. This medication was approved by the U.S. Food and Drug Administration (FDA) in 2013 to treat moderate to severe pain during intercourse caused by vaginal changes. However, there is no information yet on its long-term safety. Negative side effects include hot flashes and increased risk of thromboembolism (blood clots).
Testosterone is the primary male sex hormone, but its use may also help women. Patches may help with the decreased desire associated with aging, but there is limited information on the long-term safety of using patches for women. There is a new treatment (flibanserin) for low sexual desire disorder in women before menopause. However, its role in increasing libido in women after menopause is unclear (older women were not included in the research studies).
For men, loss of libido may also improve with testosterone treatment. However, this is accompanied by some risks, so it must be considered carefully. A popular way of taking testosterone is by using a patch or gel that is applied to the skin. Testosterone 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 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 make it grow. Water retention may also occur when taking testosterone.
Medications for Erectile Dysfunction (Impotence)
Several good medication and non-medication treatments are available for impotence. Discuss each of them with your healthcare provider and choose the one that will best suit you and your partner.
Medicines that are taken by mouth are now available. These include sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis), and avanafil (Stendra). These medications are pills that are taken before sex and usually work within one hour. Tadalafil has a longer window of action than the other products. With these medications, you will not have an erection without sexual stimulation.
Injections Into the Penis
One injectable drug, alprostadil, is now on the market in the United States. 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. This injectable product is much less commonly used now that there are pills to treat impotence. However, alprostadil injections are a valuable option for men who are unable to take the pills because of a heart condition or another reason. 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 swell in the penis and make it rigid. Then a constriction ring traps the blood to maintain the erection, which lasts for about half an hour. Side effects such as pain, swelling, bruising, and painful ejaculation have been reported. It is important to remove the constriction ring after 30 minutes. This device is not recommended for men on anticoagulant therapy or with a history of bleeding disorders.
Your doctor will review your medications and identify any that may get in the way of sexual response or performance. Common causes are related to the use of antidepressants, antipsychotics, antihistamines, antihypertensive agents, and antacids. Reducing doses or using alternative medications can often improve the situation.
Treatment of Underlying Medical Conditions
You may have a treatable medical or psychological condition such as an infection, diabetes, heart or circulatory disease, arthritis, or depression, all of which can impact your sexual health. Treatment or improved management of these and other conditions may resolve sexual difficulty.
For example, a man with diabetes may become impotent because of blood vessel problems in his penis. In that case, better management of the diabetes may improve local blood pressure and resolve the erectile dysfunction. Similarly, better pain control for someone with arthritis may provide the relief needed to relax and enjoy sexual activity.
There is a wide assortment of non-prescription vaginal lubricants available at local pharmacies. For example, K-Y jelly or Astroglide. These can be effective for reducing or stopping 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 to communicate your needs and desires, and offer ways to enhance understanding and honesty within your relationship.
Simple behavioral changes may make a difference. 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. There may be particularly difficult situations, such as if one member of a couple is ill. In that case, 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 them both to have an enjoyable sexual experience.
It is also 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, your partner may take longer to achieve an erection or may have their own insecurities about growing older. The lack of an erection may even lead one's partner to conclude that they're no longer seen as "attractive." Similarly, vaginal dryness is normal and extremely common, but it 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 sexual activity that may be completely satisfying for both partners. For older people who do not have a sexual partner, masturbation can be a healthy option to satisfy a still active sex drive.
Updated: October 2017