8/18/11 update: I’m bringing this older post to the top because it answers so many of the questions about erectile dysfunction that my readers are asking. Michael Castleman is also one of the experts in Naked at Our Age and I respect his knowledge and ability to convey important information simply and compassionately.
So many readers–both male and female–have been asking for information about erectile dysfunction that I asked Michael Castleman, a sex educator, counselor and journalist specializing in men’s sexuality to answer some questions. His interview starts here and continues here.
Q: Explain erectile dysfunction (ED) and why it happens.
MC: Only a small fraction of men from age 45-60 have true ED. A larger but still modest fraction of men over 60 have true ED. True ED is the inability to raise an erection despite vigorous extended hand massage of the penis. True ED is usually the result of a medical problem, either a problem with the nerves that control erection, or more likely, narrowing of the arteries that carry blood into the penis. Like the arteries of the heart, the arteries into the penis can become narrowed by atherosclerotic plaques. Causes of plaque formation: heart disease, diabetes, smoking, high blood pressure, high cholesterol, high-fat diet, sedentary lifestyle. In other words, all risk factors for heart disease are also risk factors for ED. In addition, ED can be caused or aggravated by stress and anxiety, which constrict the arteries and limit blood flow into the penis.
Q: What about men who are capable of erections, but they’re less reliable than they used to be and require more stimulation?
MC: While only a fraction of men over 45 experience true ED, just about every man experiences what sex therapists call “erection dissatisfaction” (EDis). After 45 or 50 or so, men with EDis can still raises erections, but they don’t rise as quickly as they used to. They no longer rise from fantasy alone–seeing an attractive woman or some erotic scene. Men begin to need direct penis stimulation by hand or mouth. When erections rise, they may not look/feel as firm as they were in the man’s 20s. They may also droop from minor distractions, anything from donning a condom to hearing a motorcycle roar up the street.
The good news is that EDis is a normal and natural part of aging. If older erections wilt a bit, hand massage and/or oral stimulation bring them back up again–IF the man remains relaxed and patient with himself. If the man gets stressed and anxious, this reduces the likelihood of a return to fullish erection.
Many (most?) older men are unclear on the distinction between true ED and EDis. Many mistakenly think they have ED when they experience the normal age-related erection changes of EDis. Now EDis can be disconcerting. I’ve been a sex educator for 30 years. I knew all about what happens to erections after 50. But when those changes started happening to ME, I found them unnerving. P.S. Erection medication (Viagra etc) helps treat EDis. In fact, most men who take erection drugs don’t have true ED. They have EDis.
Q: Many men fear that they can’t please a woman without an erection, or they give up on sex altogether. Is an erection necessary for sex?
MC: Of course not. As you know, women’s pleasure organ is the clitoris. Many women prefer cunnilingus to intercourse. Surveys show that only 25% of women are reliably orgasmic from intercourse, no matter how vigorous or how long it lasts. So women know that an erection and vaginal insertion are not necessary or sufficient for sexual pleasure and orgasm. But many men DON’T know this.
Q: How did men’s sexual education skip that important concept that women’s orgasms are based on clitoral stimulation, and that most women don’t need penis-in-vagina penetration for their pleasure?
Most men get most of their sex ed from pornography. Porn is totally penis-centered. Porn actors have monster cocks, which makes normally endowed men feel they’re “too small.” Mainstream porn includes a bit of massage and cunnilingus, but it’s mostly about sucking and fucking, so that’s what men come to believe sex is all about.
I’ve spent my life as a sex educator and counselor trying to persuade men that they’ll have better sex and get better reviews from women if they ditch their preoccupation with their penis and focus instead on leisurely, playful, whole-body, massage-based sensuality. But compared with porn, which is viewed overwhelmingly by men and is by far men’s #1 source of sex ed, the combined voices of every sex expert on earth amount to a little whisper in the hurricane of porn porn porn.
Here’s where I plug my book, Great Sex. Its message to men: If you want great sex, if you want women to sing your praises as a lover, stop trying to imitate porn. In fact, do the opposite of what you see in porn. Not only will she be happier, you will be, too. You’ll enjoy sex more and have fewer sex problems–more cooperative erection and better ejaculatory control.
Angry and/or bewildered readers write me or raise their hands at my talks with tales of doctors who can’t or won’t inform them about sex.
Just a few of the many examples seniors have shared with me:
- One woman described how her oncologist bolted from the room when she asked how her cancer treatment would affect her sexuality.
- A man emailed me that he finally got the nerve to tell his doctor that he could no longer have erections. “You have ED,” he was told, and that was that. I was the one to tell him that ED is a symptom, not a diagnosis, and he needed to get tests run to find out what was going on.
- Several women with vaginal pain reported that their doctors offered them no help other than telling them their vaginas were “normal” and they should just use more lubricant. A referral to a vulvar pain specialist or a pelvic floor therapist would have helped these women enjoy sex again.
- Several men told me that they were never told that treatments for their medical conditions would interfere with their erectile difficulty and that other options were available.
A woman at one of my bookstore talks told a roomful of sympathetic listeners that after a hysterectomy at age 70+, she asked her doctor what she should know about resuming sex. He asked, “Do you have a partner?” “No, she replied. “Then you don’t need to worry about that, do you?”
When I retell this story in different parts of the country on my travels, there’s always someone who says, “I know that doctor!”
I always rush to defend doctors, being a doctor’s daughter and a doctor’s sister, and having had my own life saved and quality of life restored by brilliant medical professionals.
But that doesn’t mean that I think doctors and other medical professionals adequately address senior sex — they do not. I know that their medical training barely addresses sexuality at all, and doesn’t deal with senior sex whatsoever. Unless doctors make an effort to educate themselves (and bless ’em, some do!), they just don’t know what to tell us.
I give my readers and audiences tools for talking to their doctors, for example, saying, “If you can’t help me with this, give a referral to someone who can.”
The worst thing we can do is keep silent about our sexual challenges or mumble and give up.
I invite your comments — your stories about doctors who have or have not helped you regarding your sexuality, and especially what you would like doctors to know about what we seniors/boomers/elders need from them in that realm.
For example, Ron posted to my Naked at Our Age Facebook page (which I hope you’ll visit and “like”!), “Docs need to be up on the sexual side effects of medications and we need to be sure to tell docs we don’t want any meds that somehow reduce our libido or capability.”
“Promise me you’ll keep doing your work,” Robert said, taking both my hands in his and pressing them to his heart, looking deeply into my eyes.
It was three years ago — end of March 2008 — and we had learned that his body was succumbing to multiple myeloma. There were treatments we could and would try, but this conversation marked the countdown to the end, as I think back on it.
He would have one more month of health — fatigued, but able to live the way he loved — going to his art studio to paint, dancing joyfully, and loving me as if his life depended on it (and maybe it did). Then, as treatments failed, his back fractured in multiple places. The extreme pain led him into another world — a world where love was not enough to heal or even ease the physical, emotional, and spiritual pain.
“Promise me you’ll keep doing your work…”
Our profound sexual connection had powered our relationship for our seven, soul-soaring years together. Neither of us had ever had a relationship as sexually exuberant or as emotionally satisfying! Professionally, our spicy hot afternoon delights propelled me to switch writing topics from health and fitness to senior sex. Better Than I Ever Expected: Straight Talk about Sex After Sixty celebrated our love affair. We married in 2006, the year the book came out.
We already knew that our love wasn’t “forever” the way young people think of it. Besides being seniors, we had the challenge of Robert’s diagnosis — at that point — of leukemia and lymphoma. Our wedding celebrated not only our love, but that six months of chemotherapy had sent Robert’s cancer into remission. We were told we might have ten or more good years of health, a magical gift.
But we didn’t have ten years — we had two.
“Promise me you’ll keep doing your work…”
March 2011: Two countdowns shift in my mind. In August, I’ll face the 3-year anniversary of Robert’s death. (When does it get easier?) But before that, in June, I’ll welcome a new book into the world — Naked at Our Age: Talking Out Loud about Senior Sex — the book I started working on with Robert. In fact, you’ll see that he wrote part of the chapter, “Unlearning Our Upbringing: Men’s Stories.”
I think at our age, those of us who dare to live and love fully have this balancing act between the sweet surprises and rewards of living our dreams out loud and the inevitable losses. Robert gave me the right advice: “Promise me you’ll keep doing your work.” It sustains me and brings me great joy — as does sharing it with you!
One of the most helpful chapters in Naked at Our Age (coming June 2011) addresses vulvar/vaginal pain, a complex issue. You’ll read real-people stories from women whose vaginal or vulvar pain prevented them from enjoying penetration, or who learned how to renew their vaginal health, plus information and direction for getting your own pain diagnosed and treated. Although you’ll have to wait for the book, until then, these posts about vaginal/vulvar pain will be helpful, and here is a list of websites that offer more information and/or referrals to knowledgeable professionals:
• American Association of Sexuality Educators, Counselors, and Therapists: http://www.aasect.org/.
• American Physical Therapist Association, Section on Women’s Health: http://www.womenshealthapta.org/.
• American Urogynecologic Society: http://www.augs.org/.
• International Society for the Study of Vulvar Disease: http://www.issvd.org/.
• Mypelvichealth.org: http://www.mypelvichealth.org/
• National Vulvodynia Association: http://www.nva.org/
• OObgyn.net: http://www.obgyn.net/
• Pelvic and Sexual Health Institute: http://www.pelvicandsexualhealthinstitute.org/
• Secret Suffering: Helping Women Cope with Sexual and Pelvic Pain (patient site): http://www.secretsuffering.com/.
• Vulval Pain Society: http://www.vulvalpainsociety.org/.
• Vulvar Pain Foundation: http://www.thevpfoundation.org/
• Vulvodynia.com: http://www.vulvodynia.com/