William Aiken
As a man ages there are certain inevitable changes in sexual function that take place. These changes are considered a normal consequence of the ageing process.
The well-informed man should be aware of these changes so that he is not alarmed at their occurrence and does not mistake them for symptoms of a disease process or disorder. Moreover, awareness of these age-related changes in sexual function should mitigate against the older man having unrealistic expectations regarding his sexual prowess.
Desire and orgasm
Male sexual functioning may be examined by artificially compartmentalising it into aspects dealing with desire, arousal, orgasm, ejaculation and satisfaction.
Sexual desire or libido refers to one's interest in and desire for sex as well as frequency of sexual thoughts and fantasies. Sexual desire in both men and women is partly related to circulating levels of free testosterone in the bloodstream, which influences certain areas of the brain concerned with behaviour. That is, a certain background level of testosterone is necessary for normal sexual desire.
In a highly-evolved and sophisticated organism such as a human being, however, in which multiple and complex social interactions are taking place, there are many other important factors which impact on sexual desire and may supersede the influence of testosterone. For example, psychosocial pressures such as job deadlines or financial insecurity may result in a loss of libido.
Stage of relationship, relational conflict, negative attitudes toward sex, sexual dysfunction in a partner, unsatisfying past sexual outcomes, negative body image and poor self- esteem may adversely affect libido.
Decline in libido
From the late 20s onwards, men experience a slow progressive decline in free testosterone levels. It has been observed that there is a general decline in libido with increasing age in men, and this is entirely normal.
Sexual arousal in men is manifested by the unmistakable occurrence of an erection.
Sexual stimulation resulting in an erection may either be psychic/imaginative in which thoughts, fantasies and visual stimuli result in an erection through the transmission of nerve impulses from the brain down the spinal cord, or it can be from direct stimulation of the penis, or a combination of both. As a man ages, psychic stimuli alone no longer readily results in an erection but more direct penile stimulation is required to achieve it. Moreover, erections are not as hard or turgid but are nevertheless hard enough for penetration.
Penile sensation also diminishes with advancing age and consequently more direct stimulation is generally required to achieve the same level of arousal when compared to someone who is younger and orgasm and ejaculation are usually more difficult to elicit.
The time interval after ejaculation in which the man is unable to get an erection, known as the refractory period, progressively lengthens as men get older, resulting in a reduced ability to engage in intercourse with the same frequency as when they were younger. Failure to obtain an erection in these circumstances is, therefore, not a sign of erectile dysfunction but is rather a consequence of ageing. Considerable variation in the refractory period does, however, exist in men of a given age.
The volume and projectile force of the ejaculate generally declines with advancing age as does the intensity of orgasm. Also, it generally takes longer for ejaculation to occur despite direct penile stimulation which is related to the diminished penile sensation mentioned above.
Despite the decline in several aspects of male sexual function with increasing age, sexual satisfaction is very often maintained or improved in long-term relationships when the non-sexual aspects of the relationship such as communication at a deep level, emotional support, trust, acceptance and companionship are given emphasis.
Dr. William Aiken is the head of urology at the University Hospital of the West Indies and president of the Jamaica Urological Society; email: yourhealth@gleanerjm.com.
