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A major misconception is that a decline in sexual function with advancing age is


The majority of couples remain sexually active throughout life, with only 15 percent of men and women experiencing sexual problems. Things may not be the same as they once were, but there is no reason for the elderly not to remain sexually active.

Sexual dysfunction is often neglected. Much has been written about sexual dysfunction — also called erectile dysfunction — in men, but problems occur in women as well. Unfortunately, few health care providers attempt to identify or treat sexual difficulties. Both physician and patient may be embarrassed to raise the issue, which is a big mistake.

Dr. David LipschitzIn both men and women, loss of libido and an inability to become aroused are frequent features of sexual dysfuncton.

Recent advertisements imply that from age 30 onward there is an inexerable decline in testosterone with advancing age in men. Marketers almost overnight have given this the notorious name of “low T.” Apart from loss of libido or sex drive, low T is blamed for depression, insomnia, increasing weakness and decreased exercise tolerance. Needless to say, there are many causes for these nonspecific symptoms. However, the only universal symptom of low testosterone is decline in libido. Testosterone does not affect arousal, and deficiency does not cause an inability to have an erection.

The actual number of men with testosterone deficiency is very small. Many men with values in the lower limit of the normal range now receive replacement therapy with testosterone. Unless loss of libido is a major issue, this approach is questionable, as hormone replacement therapy is not without its problems.

Women also have small amounts of the male hormone testosterone. In combination with low levels of estrogen, reductions in testosterone can affect libido in women.

In some circumstances, physicians may measure testosterone level in women, and small replacement doses can be very beneficial.

Vaginal dryness and resulting pain with penetration account for most of the sexual dysfunction that occurs in women. The usual cause is hormonal loss associated with aging. This can be treated readily with hormone replacement therapy, estrogen creams and lubricants. Sexual problems also can occur because of weakness of the vaginal wall, caused by multiple pregnancies. Sometimes the uterus can prolapse (fall down and protrude through into the vagina), making an active sex life difficult. These problems are amenable to surgical correction.

Problems in men are more easily identified, because ED is defined as an inability to develop or maintain an erection.

Why does it occur? Well, first comes arousal, so libido is important. A message must then go from the brain to the penis for an erection to develop. For this to happen, the nerve supply to the penis must be normal. If the message is received, an erection occurs when the penis fills with blood. So ED can occur because of a lack of libido, or interference of the nerve or blood supply to the penis.

These days, billions are spent on medications to treat erectile dysfunction. The most frequently used one is now generic. These drugs do not cause but facilitate an erection, and are of no value without adequate libido and arousal. Sadly, for most older men, the presence of vascular or nerve problems makes these drugs ineffective.

At the end of a long visit, and as I am about to say goodbye, not uncommonly a patient will ask me, “By the way, Doctor, do you think Viagra will help me?’ I have become so aware of this problem that, in the appropriate setting, I always ask about sexual issues. And if there is a problem, it is important to engage both partners in the discussion.

Regrettably, an alternative word for ED is impotence — lack of power and weakness. It often causes couples to become more separate, never touch and sleep apart. In counseling, any couple who has sexual dysfunction, the critical importance of intimacy, closeness and touch must be emphasized. Concentrating on intimacy, kissing and loving must always be the initial step in solving the problem.

Dr. David Lipschitz is the author of the book “Breaking the Rules of Aging.” To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at More information is available at: DrDavid

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