Too old for sex?

Long-term medical conditions compound the sexual issues that men and women face during the natural aging process. Heart disease, diabetes, and cancer are just some of the illnesses that can have a serious lasting impact on your sexuality. What’s more, the emotional aspects of an illness often weigh as heavily as the physical ones. One or both members of the couple may experience depression, which is a major contributor to sexual problems.

As you might expect, one sexuality survey done in the US found that healthy individuals are more likely to engage in sexual activity. It also found that 44 percent of people who characterized their health as excellent or very good had intercourse at least once a week. But as health status declined, so did sexual activity. About 33 percent of people with good health and just 20 percent of those with fair or poor health had intercourse this frequently. And many of the respondents reported that better health for either themselves or their partners would improve their sex lives.

When you’re first confronted with an illness, things may look bleak. But many people are able to resume a satisfying sex life after an initial adjustment phase. The first step to overcoming these challenges is to investigate the potential effects of the disease and treatment on your sex life. Today’s article provides an overview of some common conditions and how they affect sexuality in later life. But it is also important to discuss these issues with a doctor. Keep in mind, too, that there are many ways to maintain physical intimacy. Some couples find that they can have a satisfying relationship without intercourse. However, even in the absence of sexual contact, preserving other forms of affection — such as hand-holding and cuddling — is crucial to maintaining a healthy, positive relationship. A wide variety of illnesses can cause or exacerbate sexual problems. Here is a closer look at some of the most common culprits.

From The Bottom Of Your Heart — And Genitals

Your heart is linked to your sexual organs, both physically and metaphorically. When you have chest pain or a heart attack, it’s usually because fatty deposits have narrowed your arteries (atherosclerosis) and the heart tissue is not receiving enough blood. When atherosclerosis strikes the coronary arteries, it’s a good bet that other vessels in your body have met the same fate — including those that serve your genitals. Because the penis needs a rapid influx of blood to achieve an erection, it’s easy to see why vascular disease is the leading cause of erectile dysfunction. Atherosclerosis may also cause female arousal difficulties by preventing sufficient amounts of blood from reaching the sex organs. Engorgement of the blood vessels of the vagina is needed for adequate lubrication and arousal.

After a heart attack, many people fear that the exertion of sex will bring on another attack. In reality, the cardiovascular demands of sex are relatively mild — about the equivalent of walking briskly up two flights of stairs. A study in the Journal of the American Medical Association concluded that chances are only one in a million that a man who had previously had a heart attack would have another during or immediately following sex. Those who engage in regular physical activity are at the lowest risk.

Although your doctor will give you specific instructions when you leave the hospital, most people should be ready to resume normal sexual activity within four weeks after a heart attack. If you’re recovering from bypass surgery, you may have to wait six weeks before having sex, and you may need to avoid positions that could strain your incision.

Likewise, chronic stable angina should not be a barrier to sex if you’re accustomed to doing other things that require the same level of exertion. Some cautions apply, though. You cannot use Viagra, Levitra or Cialis if you’re taking a medication that contains nitrates (such as nitroglycerine); the interaction of these drugs can cause life-threatening drops in blood pressure. People with unstable angina may have to abstain from sexual activity altogether. If you have this condition, consult your doctor before having sex.

Diabetes Bad For Sex

Unchecked, diabetes can be devastating to sexual function. About 35-50 percent of men with diabetes experience erectile dysfunction. The disease contributes to erectile problems in at least two ways: It can impair the nerves that instruct the arteries of the penis to dilate, and it can restrict blood flow to the penis by damaging the blood vessels. People with diabetes often have high blood pressure and high levels of cholesterol and other fats in the blood — all of which may further damage blood vessels and impede blood flow.

Among people with diabetes, erectile dysfunction usually develops gradually over a period of months or years. At first, the erection may not be as rigid as it had been or the erection can’t be sustained. Sometimes, erectile dysfunction is the first sign that a man has diabetes. Carefully controlling blood sugar can help prevent the vascular and neurological complications that contribute to sexual problems. But even with proper treatment, men who have diabetes are three times as likely as other men to develop erectile dysfunction.

For women, the sexual effects of diabetes are more subtle but can be equally distressing. Diabetes can damage blood vessels and nerves, interfering with clitoral sensation and vaginal lubrication, and causing difficulties with arousal and orgasm. The disease may also cause low libido. In addition, high blood sugar contributes to frequent yeast and bladder infections, which can make sex uncomfortable or impractical for long stretches during treatment

Long-Term Sexual Problems

The physical and psychological ramifications of cancer can deal a serious blow to sexual functioning. Cancer’s effects are both direct and indirect. The disease itself can cause fatigue and pain, and the diagnosis may also engender fear, depression, guilt, stress, and poor self-image. Cancer treatments often produce another set of problems. Nearly half of the women who undergo treatment for breast or gynecological cancer have long-term sexual problems. For men, prostate cancer treatment causes erectile dysfunction in about 85 percent of the time, depending on the treatment the man chooses.

• Surgery. In women, surgery that involves the pelvic organs can cause damage to the nerves, diminishing sexual sensation during intercourse. If a woman’s ovaries are removed before she has reached menopause, she is likely to experience sexual problems because of the sudden absence of estrogen as well as testosterone. Breast removal denies women the pleasure of being caressed in this area, and it can have a psychological effect as well. After a mastectomy, many women struggle with body image issues and feel less sexually attractive. For men, surgery for prostate cancer can cut nerves or arteries that are necessary for an erection. Even “nerve-sparing” operations lead to erectile dysfunction at least 20-50 percent of the time. Regardless of the type of surgery used, most men do not regain potency for sex for six to 12 months.

• Radiation. Radiation treatment for prostate cancer can cut nerves or vessels that serve the penis. It may also affect testosterone levels, leading to low libido and erection difficulties. Men who’ve had this therapy may have problems getting or keeping an erection. Women who have had radiation to the pelvis area can develop scar tissue in the lining of the vagina that can cause pain during intercourse. Side effects of radiation treatment — such as fatigue, nausea, vomiting, and diarrhea — are also deterrents to sexual activity.

• Chemotherapy. Many of the side effects of chemotherapy, such as nausea, hair loss, weight changes, and diarrhea, can squelch desire, damage a person’s self-image, and prompt depression. Women may also notice vaginal dryness and pain. Erectile dysfunction is sometimes a side effect in men, but diminished testosterone levels and ejaculation problems are more common. Both sexes report lower sex drive and less frequent intercourse.

Take-Home Message

The bottom line is, whether the sexual problem you have is big or small, there are many things you can do to get your sex life back on track. Communicating with your partners, maintaining a healthy lifestyle, availing yourself of many excellent information available, and just having fun can help you weather stormy seas. –Tyrone M. Reyes, M.D. (The Philippine Star)