Regarding aging and intimacy

As our bodies age and our relationships evolve, men and women experience different changes to their libido and self-esteem. Here, Dr. Helfgott and Dr. Palmer explain some of the unique considerations for both genders in regard to intimacy.

Michele Helfgott, MD, PPG  Integrative Medicine

If given the choice, which would you choose?

  • grocery shopping
  • car pooling
  • making dinner
  • having laundry
  • having sex with your partner

If your answer is having sex but you are doing all the other things, why? If having sex isn’t what you chose, why? For many women, sex is another thing they have to do. Women need to have intimacy before having sex. For men, sex allows them to become intimate.

What affects the female libido?

Poor self-image, anxiety, depression, a history of abuse or trauma, poor communication, lack of trust, health issues and medications.

Low sexual desire is the most common sexual problem for women before and after menopause. Changing hormones are rarely the only major factors. If the emotional and mental desire for sex isn’t present, all the testosterone in the world isn’t going to restore lost libido.

6 ways to increase sex drive  
  • Eat healthy and exercise
  • Manage and minimize stress
  • Make time for yourself
  • Schedule sex, enhance desire and sensation, change things up
  • Be mindful when you are having sex
  • Enhance the quality of your relationship

If you are having pain during intercourse, tell your primary care provider or gynecologist to get a referral to a physical therapist.


Scott Palmer, MD, FACS, PPG - Urology

Ageism can lead to the incorrect assumption that sexual activity is no longer considered important in the elderly. The majority of men maintain sexual desire well into their 80s. Approximately 20 percent of couples over the age of 75 report sexual activity at least twice a month.

The gradual decrease of functionality of numerous body systems can directly or indirectly interfere with sexual function and performance. Including, but not limited to, cognitive function, flexibility, vasculopathies, cardiopulmonary function and exertional tolerance.

Erectile dysfunction

Incidence shows a gradual increase with age. As much as 40 percent of men at age 40 and up to 75 percent over age 70 report experiencing symptoms.

The risks of erectile dysfunction include:

  • Diabetes Mellitus
  • Cardiovascular disease
  • Chronic renal failure
  • Pelvic surgery and/or radiation
  • Depression
Treatment for erectile dysfunction

Mainstay is medical therapy, primarily the phosphodiesterase inhibitors (Viagra®, etc.). Not recommended for men using nitrate-containing medications, or with high-cardiac risk factors or unstable heart disease. Medical therapy is at least 50 percent effective.

Side effects include headache, flushing, nasal congestion, stomach distress, back/muscle aches and visual changes. Prolonged erection (priapism) reported though likely much rarer than generally considered.

Another form of treatment is Intracavernous Injection Therapy (Caverject, Trimix), which are highly effective.

Low testosterone (hypogonadism)

Defined generally as inadequate levels of the circulating hormone (testosterone), levels of, directly related to, and dependent upon, the "hypothalamic-pituitary-gonadal axis". Prevalence increases with age, with approximately 35 percent at age 45-54 and up to 50 percent by age 85 or higher experiencing the condition.

Symptoms can be relatively specific or general, and therefore difficult to characterize. They include incomplete sexual development, reduced body hair/muscle mass/libido/erections, breast development, loss of testicle size/turgor. More general symptoms include depressed or irritable mood, loss of motivation/energy, poor concentration/focus, worsening glucose tolerance, anemia or sleep issues.


Testosterone Replacement Therapy (TRT) requires ongoing monitoring via regular blood tests. Options include transdermal (gels and patches), injections, buccal and implanted pellets. There’s no oral preparations available currently in the U.S. Potential benefits include improved libido, bone density, muscle mass, erectile function, energy, mood, glucose metabolism and cognition.

Potential risks/side effects include anxiety/Irritability, exacerbation of sleep apnea, congestive heart failure and BPH, elevated RBC (erythrocytosis), stimulation of existing prostate cancer, fluid retention, low sperm count, gynecomastia and testicular atrophy.

Are men their own worst enemies?

Psychological and emotional changes including normative changes with aging can lead to anxiety and frustration. Men must adapt in a healthy, supportive environment, avoid self-criticism and impatience. Males are conditioned to gauge self-worth from performance and achievements. With all the natural changes that occur, patience and a positive mental attitude are a must.

Men should focus on:

  • Quality of relationship with significant other
  • Communication
  • Openness
  • Trust
  • Intimacy
  • Closeness
  • Patience
  • Sense of humor

The goal should be genuine emotional intimacy. It’s important for your partner to be aware of the physical changes that occur, and understand that hypoactive desire and/or erectile dysfunction is almost never related to their desirability.

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