“The first time a man experiences problems with his erection after years of normal function it can be like a punch in the gut. For most men, their sexual performance is a matter of pride. Men equate their erections with masculinity—their manhood.”
– Michael Bates, MD
Are you wondering how to deal with erectile dysfunction in a relationship? I write frequently about erectile difficulties, because this is an issue that my readers and audiences ask me about all the time. You can find plenty about staying sexual despite erectile dysfunction in my books, articles, and webinars. But I realize that a woman writing about erections may not strike you as having the same credibility as the same information coming from a man, especially a man with a medical degree.
Michael Bates, MD, is a retired OB/GYN physician who, with his wife Carolina, directs the website X’s and O’s, a resource center and retailer for folks over 50. In “How To Help Your Partner With Erectile Dysfunction (ED),” Dr. Bates suggests these steps for supporting a partner with ED and figuring out what options will help you remain a sexually vibrant couple:
- Communicate. Start an honest conversation about the change in your sexual pattern as a couple.
- Go to his doctor together to determine the cause of his ED. Run the tests to discover or rule out medical conditions that can cause erection problems. Discuss his medications that may have sexual side effects.
- Learn about medical options: medications, suppositories, injections, pumps, implants.
- Try non-medical solutions, such as vibrators and penis rings.
- Explore non-penetrative ways to arouse and satisfy each other, aka “outercourse.” *
Read Dr. Bates’s article here.
Visit X’s and O’s.
* My most popular workshop and webinar is “Great Sex without Penetration,” which helps you enjoy hot sex without PIV (penis-in-vagina). As a special gift for reading this far, email me and ask how to view this 90-minute webinar for just $35 instead of $55.
June has been declared Adult Sex Ed Month (#AdultSexEdMonth) by Ms. Quote
(@GoodDirtyWoman on Twitter) who blogs at A Good Woman’s Dirty Mind. This idea caught on, and this month, hundreds of posts designated #AdultSexEdMonth from sex educators and bloggers appeared all over the Internet. View the list with links here.
In my world — advocating for senior sex and educating about older-age sexuality — every month is Adult Sex Ed Month. This month has been particularly fruitful.
This month, I participated in a Huffington Post Live event titled “How Old Is Too Old To Have Sex?” with fellow panelists Ashton Applewhite, Walker Thornton, Sidney Schwab, and Ken Solin, hosted by Abby Huntsman. Of course the answer to the question in the title is obvious to us (though not obvious to Abby, until we raised her consciousness), but you’ll find the discussion interesting even though you know the answer! Watch it here:
The annual conference of the American Association of Sexuality Educators, Counselors
and Therapists conference always makes my brain swell with new information and ideas from sex educators who are trailblazers in the field. Counselors, therapists, sex educators in community or medical settings, and other people who care about your sexual knowledge and enrichment gather to learn from the leaders. Then people like me come home and spread it around – to people like you.
As always, it was impossible to attend all the sessions of interest, and there’s no way I can share all of the 25 pages of single-spaced notes that I took on my laptop, no matter how many blog posts I write. But here are some highlights and tips that are especially relevant to our age group:
- Some sexual issues are psychological; some are medical or physiological. But even when it’s a medical issue, a sex therapist can be important to help you work with whatever is going on. Medical sexual issues affect your sense of self and your relationship. “Any pharmacotherapy for sexual dysfunction should occur within the context of sex and relationship therapy.” (Ricky Siegel)
- One more good reason to quit smoking: Nicotine has been shown to decrease blood flow to the penis and increase venous outflow from the penis — in other words, less ability to get and maintain an erection. (Ricky and Larry Siegel)
- Women with vulvar or vaginal pain have a difficult time getting the pain diagnosed and treated effectively. Possible causes of pelvic pain are varied, and with the wrong diagnosis (or no diagnosis!), the wrong treatment follows. Look for a three-pronged approach: a sexual medicine physician, a pelvic floor physical therapist, and a certified sex therapist, such as used by the Summa Center for Sexual Health in Akron, Ohio. (Kimberly Resnick Anderson)
- Pelvic floor physical therapists are trained to do internal evaluation of the pelvic floor muscles — evaluating muscle function, strength, tone, and any points of tenderness. Regular physical therapists are not trained to do this. (Amy Senn)
- Men with low libido: Anxiety, mood, relationship, and religious factors affects libido. “First know what’s going on in the relationship before throwing medication at it.” (Larry Siegel)
- “Nerve sparing” prostate surgery is “a bit of a misnomer.” Erectile nerves on the outside of the prostate are very difficult to see and avoid during surgery. “The prostate is deep in the pelvis, and they go pushing around with stainless steel instruments. If cauterizing instruments are anywhere near nerves, it damages them for life. Nerves recover from the pushing and pulling – it takes a long, long time. Nerves go into shock and stop sending message to blood vessels to relax and let blood in.” (Anne Katz)
- “Sexual arousal requires healthy blood flow for everything else to work. Otherwise, nothing happens. Take a 15 minute walk with your partner before sex. It will prime the pump.” (Ellen Barnard)
- After treatment for female genital cancer, using a vibrating wand internally will reduce scar tissue. “Vibration directly to the scar tissue starts breaking up that scar tissue, allowing it to expand, become more comfortable, and allow penetrative sex if we want it.” (Ellen Barnard)
- After cancer treatment, start getting to know “what is”: “What feels good? What doesn’t feel good? What’s numb? What’s painful? How does arousal happen? What does it take? How does orgasm happen and feel? When during the day do I have energy?” (Ellen Barnard) You need to learn this for yourself before you can teach your partner. (JP: This applies to aging in general, also.) A Woman’s Touch has excellent educational brochures for both men and women online at no cost, for example, Healthy Sexuality After Cancer. Visit www.sexualityresources.com, see the Educational Brochures link in the upper left hand corner of the menu bar for a complete selection.
The huge news this month for me as a senior sex educator was an invitation from Cleis Press to write a book for them: The Ultimate Guide to Sex after Fifty! I’m thrilled to have a new book to write on my favorite topic, and I’m proud to be part of the fabulous Ultimate Guide collection of sexuality guidebooks. You can be sure you’ll hear more about my new endeavor as it unfolds.
Meanwhile, if there’s a topic you want to be sure that I cover in this new book, please either post it as a comment here or email me. I love to hear from you. I’m too busy to promise to answer all your questions in detail, but I try to acknowledge your email and point you in the right direction. I admit sheepishly that I have about 400 unanswered emails waiting. If one of these is yours, I thank you for your patience! (I do give private, educational consultations answering your questions by phone or Skype for a modest fee — email me for more info about this.)
Urologist Dudley S. Danoff, MD, FACS, is the author of Penis Power: The Ultimate Guide to Male Sexual Health (Del Monaco Press, 2011). It’s an upbeat and even entertaining guide to the complexities, myths, facts, and vagaries of owning a penis (or, in my case, liking penises and being endlessly fascinated by them). Dr. Danoff covers how they work and what’s going on when they don’t work—psychologically as well as physiologically.
My male readers often write me with age-related questions about their penises: what’s a “normal” change with age vs. what’s a medical problem, how they can deal with erection difficulties, how to negotiate new needs and issues with a partner. “We are tragically ill-informed about the penis,” says Dr. Danoff, and he aims to change that.
Although this book is not specifically aimed at our age group, all of it applies to us, and I guarantee you’ll say, “I didn’t know that” several times as you read, even if you’ve owned a penis for 50, 60, or 70 years.
Q: What is your big message to our older men?
Sex is good for you. It maintains overall physical strength and cardiovascular health, and most of all, it keeps you invigorated. A man’s penis is there to serve him from puberty to old age.
Q: What are the most common misunderstandings that men age 60+ have about their penises or about their sexuality in general? What do you wish all men knew as they aged?
A: By far, the most frequent complaint I hear from men is that they do not have the same level of sexual desire they used to have. It takes longer to get an erection, it takes longer to ejaculate, it takes longer to get aroused again after they make love, and their erections are not as firm. These conditions are all predictable changes that occur as men get older.
Attitude is the key to penis longevity. My super-potent patients tell me that sex gives them as much joy at 70 as it did at 20. Some say the sex is even better! Equal pleasure can be obtained from occasional, prolonged intercourse with one orgasm as with frequent, rapid intercourse with multiple orgasms.
All men, as they age, deserve active, healthy sex lives as long as they remain physically fit. Do not expect to do at 60 what you did at 40. Adjust your sexual activities as your body changes, just as you adjust other activities. Look upon the adjustment as both a new challenge and a new opportunity.
As you age, learn to use your mind and imagination to make up in creativity what you may lack in physical strength. As long as you are able to breathe, move your extremities, maintain relative control over your bodily functions, remain alert enough to identify the date and day of the week, and sustain a positive mental outlook, you can continue to exercise your penis power indefinitely.
Q: What would you say to many men age 60+ who tell me that they don’t get good information or direction from their urologists when they report undependable or nonexistent erections? They are commonly told, “Well, you’re older now,” or “It’s ED,” without a medical workup to see whether some underlying condition is causing the ED.
A: Find another urologist who is knowledgeable about erectile dysfunction and is willing and able to thoroughly evaluate you. A comprehensive evaluation, including a full cardiovascular evaluation, by a qualified urologist is essential. Endocrine issues, such as low testosterone or unrecognized diabetes, can then be treated, and erectile dysfunction will improve. Knowledge is power. There are many treatments on the urologic menu for erectile dysfunction, but first you need a proper diagnosis to identify the underlying cause. Treatment is both available and effective in almost all cases and will result in satisfactory erections.
Q: Many men would rather sever their own leg than admit to a doctor that they are experiencing erectile difficulties. Why is it important to see a doctor before self-treating with drugs or other assists?
A: Many serious medical conditions that are first manifested by erectile difficulties go unrecognized. It is absolutely essential to get a full evaluation by a qualified urologist in all cases of erectile dysfunction in order to determine the presence or absence of some serious (or not so serious) medical problem and treat it accordingly. For example, if low serum testosterone is found, testosterone replacement therapy can give spectacular results. Under no circumstances should a man self-treat his erectile dysfunction with over-the-counter preparations without first determining the presence or absence of an underlying medical condition that is correctable.
Q: How can women enhance their partner’s and their own sexual pleasure when erections and intercourse are not the main events?
A: Most importantly, do not think old! Sexual pleasure is all about attitude. If your mind is strong and your partner’s mind is strong, intimacy and sex without vaginal penetration can be enormously pleasurable. The key is not to lament what you have lost. Be grateful for what you still have and make the most of it. Age is not a deterrent to great sex. Rather, it is a challenge and an opportunity.
If you keep your enthusiasm, you can compensate for or even delay the effects of aging. You do not stop having sex because you are old—you get old because you stop having sex! Talking candidly with your partner about aging is the best way to find a solution for maintaining a healthy sex life.
Q: What else do you want women to understand about their male partners?
A: Older men are just as penocentric as younger men are, even though capacity may be diminished. I would encourage older women to become more “penis oriented.” Older women who are penis oriented have more fun and also have better marriages, more faithful partners, and greater personal fulfillment in all aspects of their lives. If you believe that each partner has the mutual responsibility to satisfy the other’s needs, then it follows that you will hold up your end of the bargain as a woman by making your partner’s penis one of your top priorities.
Being penis oriented does not imply a belittlement of female sexuality. It simply means learning to understand and accommodate an older man’s penis needs by approaching that task with all of the pride and skill that you would bring to any other endeavor. I assure the older woman that if you take the steps to become informed, you and your man will reap rewards you have only dreamed about.
Images are from Penis Power: The Ultimate Guide to Male Sexual Health by Dudley Seth Danoff, MD. ©2011 Dudley Seth Danoff. Reprinted by permission of Dudley Seth Danoff. Copies of the book are available at your local bookstore or may be ordered through Amazon.com.
a man with erectile dysfunction, there are many options. Most ED in men below
the age of 45 or so is psychologically based. The drug companies would like to
sell these men Viagra, Cialis or Levitra, but the real solution is
psychological counseling and/or sex therapy.
as men age, physical reasons cause more ED. Drugs for blood pressure, or type II
diabetes, psychotropic medications like Zoloft, Prozac, Sertraline all carry
the risk of reduced libido and also affect erections. So what are men in this
situation to do? One great option is the vacuum device.
erection devices are designed to lengthen and strengthen the penis so that
blood will flow into it. The best vacuum devices can create an erection hard
enough for penetration for many men whose erections are no longer automatic. You
can enjoy them as part of couple foreplay to heighten your mutual pleasure.
Rapport Classic is a 2-½ inch clear plastic tube of good quality. The whole
length is just over 8 inches. At one end is a manual pump to take the air out
of the tube. At the other end is a part that fits snugly to the tube and for
insertion of the penis. Surround the penis with a large amount of gel lubricant
for a good vacuum seal. (Both the Revive
and the Rapport come with a tube of surgical gel lubricant, which works very
inserting your penis, you use a supplied cone to load a cock ring onto the
Rapport. Then insert your penis and use the manual pump to exhaust the air.
This draws your penis up into the tube. At the same time, the extension of the
penis creates an internal vacuum that forces blood into the penis, making it
firm enough for vaginal penetration.
the penis is long and stiff enough—and before it begins to be painful and even
damaging—you push the cock ring off the tube and down to the base of the penis.
The cock ring is now holds the blood in the penis, keeping it hard. Press a
button on the pump to release the vacuum, and take away the device. You are
left with a good erection.
is all much more difficult to describe in words than it is to accomplish. The
Rapport comes with a DVD video that makes the whole thing clear, obvious, and
simple. The Rapport was provided to me by Uand Me Time.
Encore Revive is similar to the Rapport and works much the same way, with two
main differences: The Encore Revive comes with both a manual pump which you use
either one-handed like the Rapport or two-handed for more leverage, and with a
battery powered pump. It also has a cock ring release that makes the final step
almost automatic and releases the vacuum pressure at the same time. It also has
a release valve if you decide not to complete the process.
video shows how to use the Encore Revive and why it works:
the Rapport and the Revive are available online at a a
wide variety of prices. (Links here to Amazon seem to have the best prices.) Both come with a large assortment of cock rings in sizes
from very tiny to very large. A little experimentation will find your best size.
trying both the Rapport and the Revive, my vote goes to the Encore Revive. But
that is a very personal preference. I like the battery powered pump. Using the
manual pump required more mental attention and I could not focus as much on the
sensations in my genitals because of the manual effort to achieve a high level
of vacuum. But, as they say, “That’s just me.” Another person may have a
different reaction. Either one of these devices could really improve the sex
life of a man who has tried simpler solutions and not been satisfied.
talked about these vacuum devices as though they are only to be used to lead to
intercourse, but actually they also work very well for masturbation. The
erections are strong and allow for a lot of pleasure.
of these are very different from the “fireplug” type of vacuum gadgets often
sold in sex toy stores. The quality of construction and performance of these
two devices is much better than the fireplugs, and not much more expensive.
These items are, as the manufacturers like to remind us, “Medical Grade.” That
means they are well constructed and will last much longer. Also don’t be afraid
of the word “medical.” You don’t need a prescription to buy one.
are several other brands of similar devices which I haven’t yet tested. The
advertisements suggest that they all work essentially the same way but the
pricing on the others was also quite a bit higher. None of these other manufacturers
responded to my inquiries.
erection devices are not the same as men’s sex toys that stimulate the penis by
emulating the feel of a vagina, such as the Fleshlight or the Tenga Egg (which
I reviewed here).
with sexual issues for over thirty years. Many of his clients are age 50-80,
when good sex is important, and dissatisfaction may lead to loss of shared
intimacy that can threaten the total relationship. David specializes in helping
women who are not experiencing sexual satisfaction and men with non-medical and
medically-related erectile dysfunction or other issues. Visit his website here.
Please see Dr. Pittle’s review of the Hitachi Magic Wand and the Tenga Egg.
(I am sad to tell you that my friend, sex therapist David Pittle died December 2017. We value his sex toy reviews. Read his other reviews here.)