Preserve your sexuality by living a healthy life
DEAR DOCTOR K:
I'm a man in my 70s. I still enjoy sex, but it's different than when I was younger. What changes are normal?
As a man in the last half of his life, I would like to be able to tell you that nothing changes. However, even in healthy men, sexuality changes over time. It's usually a gradual, almost unnoticeable process that usually begins in a man's 40s.
The sex act can be broken down into stages. Most are affected by aging.
Sexual desire or libido: The sex drive requires the right mind-set and enough testosterone, the male hormone.
The intensity of the sex drive tends to wane with age. Levels of testosterone begin to drop after age 40. Most men over 40 still have more than enough testosterone to function sexually.
But the sex drive is not just about testosterone levels. A man's mind finds certain aspects of another person's appearance or behavior attractive, or not. And when relationships become strained, a person who used to be sexually attractive can become less so.
On the other hand, having an abnormally low testosterone level probably trumps the influence of the mind on sexual desire. People who used to generate sexual desire, and still should, may not because the testosterone isn't there.
Arousal. Arousal begins with erotic thoughts and sensory stimulation. These excite the nerves that go to the penis, and that leads to an erection. Here's how it works:
The penis is filled with a spongy tissue. When the sponge is dry, it collapses. When it's wet, it swells. Stimulation of the pelvic nerves signal the arteries of the penis to widen. Blood rushes into the spongy tissue. Stimulation of the nerves also causes the veins carrying blood away from the penis to narrow. So more blood is entering the penis and less is leaving. As a result, the penis swells, causing an erection.
There are several reasons why it becomes harder for men to have an erection as we age:
-- Penile responsiveness to sensory stimulation slows with age.
-- Penile blood flow may decrease as men grow older, even if they stay healthy.
-- The nerve signals that cause erections are more difficult to sustain.
Plateau. The prostate and seminal vessels begin to discharge fluid to prepare for ejaculation. This phase does not change with aging.
Ejaculation. Certain muscles contract, propelling semen forward. Orgasm usually occurs with ejaculation. These muscular contractions of orgasm become less intense as we get older. Also, semen volume and sperm counts decline.
Refractory period. The penis can't respond to sexual stimulation during this phase. It lasts from 30 minutes (in younger men) to three hours (in older men).
I know my description of male sexuality is kind of dull. However, you may have noticed that sex itself is not.
Healthy men can remain sexually active and satisfied throughout life. The best way to preserve sexuality is to reduce your risk of chronic diseases. A healthy lifestyle is the road both to a longer life and to better sex.
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)
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