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Format: 04/16/2014
Format: 04/16/2014


Pittsburgh Post-Gazette: Healthy sex life might need a little nudge as we get older

Thursday, June 4th, 2009

By Pohla Smith

Pittsburgh Post-Gazette

UPMC surgeon Thomas Jaffe has done penile implants to correct erectile dysfunction in otherwise healthy septuagenarians looking to resume normal sex lives.

Sex therapist Connie Lappa helped an 80-year-old man with medication-resistant, diabetes-related ED and his slightly younger wife learn alternative means of giving one another sexual pleasure. The result: He bought her a vibrator, and Ms. Lappa said, "to her surprise she had her first orgasm of her life."

So is there an age limit for having an active sex life?

"If there is, we should all be lucky to live so long," says Neil Resnick, the geriatrician and gerontologist who directs the Institute on Aging at the University of Pittsburgh. "In other words, there is no age at which sexual desire is lost. Sex is affected by ... a lot of things. But provided everything is normal [physiologically and psychologically], then the answer is 'no.' Sex drive and sexual capabilities are both maintained."

Physiologically speaking, women can maintain a comfortable, enjoyable sex life more easily than men.

"Men may lose the ability to get and maintain an erection. Women don't have that physiological limitation," said uro-gynecologist Halina Zyczynski, director of the Women's Center for Bladder and Pelvic Health at Magee-Womens Hospital of UPMC.

Still, there are some problems as women pass through menopause and production of estrogen diminishes. Many, though not all, older women have drier, less pliable vaginal tissue, a problem exacerbated by lower production of lubrication during sex. Both can cause uncomfortable or painful intercourse.

Some also report a lessening of sex drive, but that's a symptom that also can be caused by medications, psychological issues like depression or stress and/or relationship problems. That symptom has multiple solutions.

But there are easy treatments for the lack of lubrication and a tight vagina.

For lubrication, there are quite a few over-the-counter products. Some are water-based; others have bases of petroleum, natural oils or silicone.

"Assuming they don't cause allergic reaction ... they address the problem for the moment in terms of lubrication," Dr. Zyczynski said. "But they don't change the skin and the problem of dryness."

Prescriptions containing estrogen, however, can rejuvenate that skin and restore some of that elasticity. The estrogen comes in various forms, including topical creams, a silicone ring with a 90-day supply of estrogen cream and estrogen vaginal tablets. "They're all variations of treating the same problem, which is [the need for] estrogen," said Dr. Joanne Oleck, director of urogynecology and pelvic reconstructive surgery at Allegheny General Hospital.

Not all men lose the ability to have erections, but in general, they do undergo a series of changes in their sexual organs.

"A lot of testicles grow smaller ... [which] has to do with the ability to make semen," Dr. Resnick said. "It is what it is. They're smaller, softer than in youth, but most don't care how big a testicle is. ...

"The effective level of testosterone goes down, but not sufficiently so that it will eliminate sexual drive or erections.

"Erections are slower in age and less rigid with age, and some of that has to do with the blood supply with erections. It all has to do with the opening up of valves, pipes and plumbing. ... It takes more stimulation to get an erection and it's not as firm, but at no age in absence of disease or drug interaction, no matter how old, he ought to be able to get and maintain an erection and be sufficient if the woman has sufficient lubrication."

The erection will be of less duration and having an encore performance will take longer, he added, "but that's easy to adapt to."

But Dr. Zyczynski and Ms. Lappa say it may not be easy for the man's partner to adapt to.


To read more, visit the Pittsburgh Post-Gazette web site.

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