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.
Erectile dysfunction can be a cardiovascular health alarm going off, finds a German study reported in Circulation: Journal of the American Heart Association. ED should take you to the doctor’s office and a cardiovascular workup, never ignored. It can be the first sign of atherosclerosis, which can show up in the penis several years before the onset of cardiovascular disease, because arteries in the penis are smaller.
According to an article by Thomas H. Maugh II in the LA Times,
Dr. Michael Bohm, a cardiologist at Germany’s Saarland University, and his colleagues studied 1,519 men from 13 countries who were involved in a study of two drugs to treat cardiovascular disease. The men were also queried about their ED at the beginning of the study, two years into it and at the end at five years. A full 55% of the men had ED at the beginning of the trial, nearly double the normal incidence of about 30% in the population at large.
The team reported that, in the five years of follow-up, men with ED were 1.9 times as likely to die from heart disease, twice as likely to have a heart attack, 1.2 times as likely to be hospitalized for heart failure and 1.1 times more likely to have a stroke. The risks increased with the severity of the ED.
This study is one more of many that point to the need not only to consult a doctor about ED but also to make sure a cardiovascular workup follows.
In writing Naked at Our Age, I hear from many men with ED who are justifiably concerned and exploring medical diagnoses and solutions. But I also hear–often from women whose spouses have developed ED–about men who will not go to a doctor, will not discuss it with their wives, and often withdraw from sex and intimacy altogether. Others may ask their doctor for Viagra or Cialis without ever investigating the cause of the ED.
About.com sex educator Corey Silverberg brings up another part of the problem — doctors aren’t trained to talk about sex,and it’s hard to get a useful conversation going about it. True, Corey, but our lives may depend how hard we try.
Don’t ignore ED and don’t just treat the symptoms with drugs– find out what’s going on. Please.
I invite your comments.
Older women stop having and enjoying sex sooner in their lives than men do, a study in the British Medical Journal found. That’s because the medical community has no idea how to help women maintain their sexual health and pleasure after menopause without the use of potentially dangerous hormones. Women don’t have any “little blue pill” to make things work better when their bodies have given up.
But the truth is, there are simple answers:
1. Live a “Good Sex Lifestyle” which includes daily exercise, a healthy diet full of fruits, veggies, nuts, whole grains and healthy fats and free of white sugars and flours, low-to-moderate alcohol intake, and daily doses of chocolate, Omega-3 oils and lots of Vitamin D. Healthy women enjoy good sex much longer than those in poor health.
2. At menopause and later, care for your vagina. Moisturize her daily or more with a good moisturizing lubricant (no glycerin), and massage her inner walls two to four times per week for five to ten minutes, with either a well-made vibrator or a partner’s fingers or penis. For more details, see our Vaginal Renewal™ program.
3. Have at least one orgasm per week, with yourself or a partner, it doesn’t matter. Keep those nerves functioning properly and remind them what pleasure feels like. If it’s hard to have orgasms, use a vibrator. Men use tools all the time, why shouldn’t you?
4. Get enough sleep, keep your stress under control, and keep a positive outlook. Your body will thank you for it, and your mind will be able to think sexy thoughts without distraction.
5. Think sexy thoughts, often. Fantasize, reminisce, create erotic stories in your head (or on paper), talk about sex, plan for sex, and make it a priority. Nurture your sex life, and it will love you back for many years to come.
– Ellen Barnard, MSSW is a sex educator and co-owner of A Woman’s Touch Sexuality Resource Center, which offers education and products to support healthy sexuality for everyone, with a focus on older adults and those living with cancer. She can be found at http://www.sexualityresources.com/.
I think Ellen’s information is vital, and I hope you’ll pass this link to your friends, colleagues, lovers, wives, and mothers. If more mid-life and older-age women knew these self-help strategies for enhancing their sexuality, there would be more satisfied smiles on their faces! — Joan Price
About three years ago, I was contacted by a producer of The Daily Show with Jon Stewart about appearing on a segment about the rise in STDs among sexually active seniors. The segment didn’t get produced at that time because they wanted to include sexually active elders, preferably unattractive and smarmy who didn’t use condoms, who were willing to let a camera and interviewer follow them on their how-to-pick-up-a-sex-partner-escapades.
I knew TDS would ridicule these elders and the whole notion of older-age dating and sex, but I wanted to be a part of the show because I thought I could bring some dignity to the topic.
After months of trying to locate their wild elders (who were likely smarter than I was and wouldn’t agree to be ridiculed by The Daily Show), the producer gave up on the segment — or so I thought.
I went on to be interviewed on the topic of unsafe senior sex by ABC Nightline, which did a fabulous, educational, and respectful segment and included a long interview with me, featuring comments from readers on this blog, in fact.
You know what happened last night if you were watching Comedy Central. On April 9, 2009, The Daily Show aired “Dirty Bird Special” about unsafe senior sex and dating, which featured an 82-year-old horndog (“lookin’ for it wherever I can get it”) who doesn’t believe his genital warts are contagious (“warts are my penis”) and hasn’t used a condom in 40 years, although he’s getting more “tail” now than in his youth.
Although part of the segment showed vivacious Miami elders dancing, dating, and having fun, the interviewer — who admitted that thinking of seniors having sex produced “gagging sensations” — was intent on making even social dancing and dating seem seedy, ridiculous, and icky. And I hate to tell you what they did with the segment about safer-sex education at a Jewish community center. You’ll have to view it yourself .
I thank Sue Katz for drawing my attention to this show with her superb blog post about it.