Dirty old men or sexy senior citizens?

People are living longer today than ever before. As the population ages, many senior citizens are burdened with chronic illnesses, but many others remain healthy and active. When researchers study aging, they distinguish between changes caused by disease and those caused by aging itself. It’s important to do this. It has taught us, for instance, that men who take good care of themselves can prevent many of the illnesses that make less prudent men old before their time.

Initially, research on aging focused mainly on major illnesses such as heart disease, diabetes, arthritis, dementia, cancer, and others. But while big-ticket items are still getting the priority they deserve, researchers today are expanding their investigation to other critical issues, such as sexuality. Several new reports have recently shed light on sexuality and seniority especially among aging men.

Male sexuality

At any age, sexual activity is an instinctive, automatic part of human behavior. But the biology behind that behavior is quite complex. It requires both an appropriate mindset and sufficient amounts of the male hormone testosterone. Sexual desires surface in puberty, when testosterone levels rise; although ardor tends to wane with age, most men produce enough testosterone to maintain libido throughout life.

In fact, last year, an Australian study clearly linked the level of testosterone with how often a man over 75 had sex. Zoe Hyde of the University of Western Australia and colleagues surveyed more than 2,700 men, aged 75 to 95, for their study, published in the Annals of Internal Medicine. They asked questions about health, relationships, and sexual activity. “The older the men were, the less likely they were to be sexually active, but sex remained at least somewhat important to a fifth of men aged 90 to 95 years, refuting the stereotype of the asexual older person,” they wrote.

Changes due to age

Sexuality is complex, and scientists don’t understand all the factors that contribute to sexual function in young men, let alone what is responsible for the changes that occur with healthy aging. Still, it’s clear that the hormones, nerves, and blood vessels responsible for male sexuality all change over time. That change is usually a gradual, almost imperceptible process that begins in middle age. In the average man, levels of testosterone fall by about one percent per year beyond 40 many older men still have enough testosterone to function sexually. But while these older men retain an interest in sex, it’s generally a far cry from the preoccupation with sex that’s so common in youth. Although interest is retained, desire tends to wane; many older men think about sex, but don’t have the drive to put theory into practice. And even when the spirit is willing, the flesh may be weak; male sexual performance typically declines more rapidly than either interest or desire.

Most men experience decreased sexual responsiveness with increasing age. Erections occur slowly, and most men in their 60s report that their penile rigidity is diminished and harder to sustain. The muscular contractions of orgasm are less intense, ejaculation is slower and less urgent, and semen volume lessens. Sperm count declines. Although healthy men can father children well into their senior years, their reproductive efficiency can’t match younger men’s.

Changes due to illness

In men who stay well, all these changes add up to a gradual, partial decline in sexual activity. But in some men, the shift is more abrupt and complete. Erectile dysfunction (ED) is closely linked to age. Only five percent of men under 40 years of age experience ED, but the prevalence rises steadily with age. About 44 percent of men in their 60s have ED, and the problem may affect up to 70 percent of men over 70.

Because ED is so common in older men, many assume that it’s part of the normal aging process. It is not. Instead, ED reflects the impact of chronic diseases that become increasingly prevalent with age. The most important are atherosclerosis and hypertension, which affect blood vessels, and diabetes, which strikes both blood vessels and nerves. In addition, stress, depression, and anxiety about adequate sexual performance can reduce sexual activity and satisfaction at any age. So, too, can marital strife, poor communication, poor sexual technique, and boredom; many of these problems become more common with age. Still, both partners in a relationship can expect to experience intimacy and sexual activity in maturity; if these expectations are not met, both partners should explore the problems that may be responsible and the remedies that may be available. Important, too, are the medications that many older men require; numerous drugs can interfere with sexual function, including many used to treat high blood pressure, heart disease, anxiety, and depression.

Sexual surveys

Although you’d never guess it from watching American TV’s late-night talk shows or TV ads for ED pills, or even Mae West (“A hard man is good to find”), erectile dysfunction is not the only measure of successful male sexuality. Two recent surveys of sexuality in older men paint a more nuanced picture.

An American survey evaluated 1,455 men, 57 to 85 years of age. Nearly 84 percent of men under 65 reported sexual activity with a partner during the year prior to the survey, but the figure fell to 67 percent in men between 65 and 74, and to 39 percent between 75 and 85 years of age. But among sexually active men, most reported at least two to three encounters per month throughout the three age groups. There was little decline in sexual interest between ages 57 and 85, with over 70 percent of men maintaining interest. Confirming Shakespeare’s insight (“Is it not strange that desire should so many years outlive performance?”), however, ED became more common over the years. In all, 14 percent of the men reported taking medication or supplements for sexual dysfunction.

A Swedish survey evaluated 225 70-year-old men. Among the men living with a partner, 66 percent reported sexual intercourse within the previous year; of these, 31 percent reported sexual intercourse one or more times per week. More than half of all the 70-year-old men reported that sexuality contributed to happy relationships.

Keeping it up

In this age of Viagra, many men, young and old, respond to sexual dysfunction by downing a little blue pill or one of Viagra’s newer rivals. Indeed, the ED pills have been a tremendous boon to male sexuality, psychological health, and relationships. But men with sexual dysfunction should always work with their doctors to identify underlying causes of the problem and when the issue is ED, it’s particularly important to identify and treat or correct cardiovascular risk factors, including abnormal cholesterol levels, high blood pressure, diabetes, tobacco abuse, obesity, and lack of exercise. In fact, ED is a powerful predictor of future heart disease, even in men who have no cardiac symptoms.

Although treatment can help remedy sexual dysfunction, prevention is surely the best medicine. A 2003 Harvard study of 31,742 men between 53 and 90 emphasizes the preventive power of avoiding tobacco, getting regular exercise, staying lean, and avoiding excessive alcohol.

Sex and age

Sexuality is an important part of life, but its role changes over time. Sex is necessary for procreation, which preserves the life of the species. And a healthy lifestyle is the best way to preserve sexuality in seniority.

Most men remain interested in sex as they age, but many experience a diminished urge for sex and altered sexual function. Despite these changes, healthy men should expect to retain the capacity for sexual activity and satisfaction throughout life.

There is a recent Finnish study, which suggests that regular sexual activity itself may help preserve erectile function as men age. Many men will welcome that finding, but more research is needed.

At present, the best way to preserve sexuality is to preserve health; a good diet, regular exercise, and a healthy lifestyle. Good health habits are also the most effective ways to reduce the risk of developing chronic diseases and requiring the medications that so often impair sexuality.

Dirty old men? No! Sexy senior citizens? Yes! –Tyrone M. Reyes, M.D. (The Philippine Star)