Sexual Difficulties

Sexual difficulties in middle age are just as natural to the aging process as a change in hearing, vision, or physical strength. While it’s important to understand why most men over 40 experience some form of sexual difficulty, it’s more important to understand that sexual difficulties in middle age (and beyond) can be managed.

So what's going on?

Remember when your hormones kicked into high gear during puberty? Now they’re downshifting. Decreased testosterone levels can cause a drop in your sex drive, erectile dysfunction and other sexual difficulties.

There are other health factors to consider. If you have diabetes, high blood pressure, arthritis or another chronic condition, your sex life may be affected. Oftentimes the emotional effect of a chronic condition can impact sexual health, too. Stress, anxiety or depression may even cause sexual difficulties in men (and women). Medications administered to treat these conditions can also add to the problem. Alcohol, tobacco and lack of exercise are common factors in men experiencing sexual difficulties.

There are many causes of ED and it is thought that 70% of cases have physical causes and 30% psychological causes although often there are both physical and psychological reasons for the condition.1

While it may be difficult to pinpoint the exact cause of a sexual disorder, a competent urologist can determine how to treat these common conditions:

  • Erectile dysfunction (ED) 
    Of the several types of sexual difficulties, ED is the most well-known because it is the most widespread.2 ED is characterized by the consistent inability to sustain an erection sufficient for sexual intercourse or the inability to achieve ejaculation, or both. There are several treatment options available including drugs, hormone injections, surgical repair or implants, sensate focus, vacuum devices and psychotherapies. Learn more about ED here.
  • Ejaculation disorders
    • Premature ejaculation
      Premature ejaculation is a common complaint, especially in younger men. It’s described as the inability to delay ejaculation until it is mutually desirable by both partners. Even though the description is somewhat subjective rather than strictly clinical, there are techniques patients can learn to control their ejaculations.
    • Inhibited or retarded ejaculation
      Defined as ejaculation that is slow to occur, inhibited ejaculation is often psychologically based and can be treated with therapy.
    • Retrograde ejaculation
      Retrograde ejaculation occurs when the ejaculate is forced back into the bladder rather than through the urethra and out the end of the penis at orgasm. Depending on the cause, the treatment usually consists of changing an existing medication regimen or prescribing a new medication. If surgery or diabetes is the underlying cause, the condition may not be correctable.
    • Learn more about ejaculation disorders here.
  • Inhibited sexual desire
    Inhibited desire, or loss of libido, refers to a decrease in desire for, or interest in sexual activity. The condition can be treated whether its cause is medical or psychological. Learn more here.

There are other less common penile disorders such as balanitis, phimosis, paraphimosis and penile cancer. All of these conditions can be treated.

There are steps you can take right now to overcome a sexual problem:

  • Make an appointment with a healthcare provider
    The doctor will take a full medical history, perform a physical exam and conduct tests to determine the nature and extent of the problem and the best way to treat it.
  • Communicate with your partner if you have one.
    Psychologically based sexual difficulties can be significantly eased by talking to your partner about your concerns.
  • Educate yourself.
    The more you know about your specific condition, the better informed you’ll be when you discuss causes and treatment options with your doctor.

2 It is estimated that half of all men over 40 experience ED occasionally and 20 million American men are chronic sufferers, particularly older men as ED increases with age.