Most older men suffer not ED but erection dissatisfaction. Starting around age 50 (often earlier among smokers and, or, diabetics), erections change. In some men, the process is gradual, in others, it happens more quickly. Either way, older men loose the ability to raise erections solely from sexual fantasies. Direct fondling of the penis becomes necessary. When erections appear, they rise more slowly and do not become as firm as they were during men’s thirties and forties. And minor distractions may cause wilting—the doorbell or an ambulance siren. These changes alarm many men, who jump to the conclusion that they must have ED. If you can still raise erection during masturbation, you don’t. What you have is erection dissatisfaction.
Post-50 erection changes are normal and inevitable. But some lifestyle factors can postpone or even temporarily reverse them: falling madly in love, getting in shape (see below), and making love earlier in the day when you have more energy.
Unfortunately, other factors exacerbate erection dissatisfaction: anxiety, alcohol, many other drugs, relationship problems, and making love when fatigued—late at night after a long day and a big dinner with wine.
Anxiety is particularly pernicious. It triggers the fight-or-flight reflex that sends blood away from the central body, including the penis, and out to the limbs for self defence 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. And when men become anxious about it, erections become less likely.
Good ways to minimise anxiety: a hot shower before sex, and during lovemaking, deep meditative breathing, a slow pace, sensual touch all over—which is the kind of sex most women say they prefer.
Erection dissatisfaction can actually enhance lovemaking. The dark cloud of erection changes has a silver lining. Young couples often have problems because young men become aroused faster than young women. Young men are often all finished before young women have even started to get aroused. Post-50 erection changes slow men’s arousal process 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. Seen in this light, for many older couples, erection dissatisfaction can be a gift.
A healthy lifestyle minimises the risk of ED. Erection depends on blood flow through the penis. Anything that impairs it increases ED risk: smoking, diabetes, high cholesterol, high blood pressure, heart disease, being overweight, sedentary lifestyle, more than two alcoholic drinks a day, and fewer than five daily servings of fruits and vegetables. Avoiding these risk factors does not prevent post-50 erection changes, but it preserves erection function and helps prevent ED.
The drugs are worth trying but don’t expect miracles. Everyone has heard of Viagra, but Cialis is actually more popular because it’s effective longer—24 to 36 hours instead of three to five. Erection drugs improve erections in about two-thirds of men. They don’t work for about one-third. When they work, they do not 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 erections but don’t feel particularly interested in sex. Many men feel disappointed with the drugs. Fewer than half refill their prescriptions.
If you’re no longer having intercourse, you don’t need erections. Most men assume that erections are necessary for sex. No. Couples can have great sex without them. Intercourse becomes problematic for older couples. Men have erection issues and post-menopausal women develop vaginal dryness and atrophy that can make intercourse uncomfortable (or worse) even with lubricants. Many older couples jettison intercourse in favour or of mutual massage, oral sex, and sex toys—and still enjoy hot sex.
Men can have orgasms without erections. That’s right, you don’t need an erection to have an orgasm. In an erotic context filled with kissing, cuddling, fondling, massage, oral, and sex toys, a man with a semi-erect or even flaccid penis can enjoy orgasms as intense as any he ever experienced during intercourse.
The drugs work best in combination with sex therapy. Several studies have shown this. There’s more to satisfying sex than just an erection. The quality of the relationship is crucial, especially if sex has been a sore point or if the couple hasn’t had much for a while.
Erection changes can mark the end of sex or a new erotic beginning. When erection dissatisfaction develops, some men decide that’s it, sex is over. Others accommodate and continue to enjoy lovemaking as long as they live, even if they eventually develop ED. The choice is yours.