“Sex is like air; it’s not important unless you aren’t getting any” — John Callahan
Dr. Muhilan Parameswaran
Consultant Urologist
MBBS (India), FAGE (Manipal), MRCS (Edin), M.S (Malaya). Board Certified Urologist (M’sia), FRCS (Urology) (Glaslow), FellowLaparascopic Surgery (India), Fellowship in Urology (Austria)
It’s true that sex isn’t going to stay exactly the same as you age. But the changes that take place aren’t all negative. Most people have more time and know their partners well that sex can be fun especially without worrying about pregnancy.
Erectile Dysfunction vs Loss of Libido
For us guys what slows us down and stops us from having a good sex life as we get older is either erectile dysfunction or loss of libido. These are both very different things, the first (erectile dysfunction) is usually caused by issues with the blood flow or nerves, where we want sex but it just doesn’t work. It’s a bit like trying to put a marshmallow into a coin slot. Usually after a thorough check up I can help this group fairly easily.
It’s the loss of libido or low sex drive that is tough. For a good sex life, a few things must come together. Your brain says I want sex preferably right now, sends the signal down the nerves (the wiring), the stronger the signal the more the blood flow into the penis, the better the erection.
Loss of libido is a failure of the first part where your brain or you are just not that interested in having sex. It can be a person specific issue or a general issue.
Person specific issues can’t be treated by medication, most of the time I will only do counselling with a little medication for a boost. The problem here is your brain has no interest in having sex with that particular person, anyone else no problem.
Usually happens in couples who have a lot of personal problems which can really turn the brain off! Prolonged period of time where you did not have sex with the person, often seen after a prolonged period of illness or pregnancy where your brain no longer things of your wife as a sexual partner but as a friend or family member. When these things happen, your brain will no longer get excited and release the appropriate stimulus to get an erection.
I usually do a simple assessment which includes some blood work and questions which quickly rule out a erection problem, than the treatment is based on counselling and initial medication to kick start your sex life. After the first two or three successful attempts things (at sex) usually revert to normal as now your brain has learnt that sex with this person is fun so let’s do it some more, hence your sex drive will immediately improve.
General issues with low libido are a bit less common. What this means is in general your brain is not interested in having sex with anyone. No matter how interesting he or she is! Let’s go over some common issues which are a mix of life style or medical issues. A common thing with all the topics below is that the end point is fatigue or low testosterone levels.
Lifestyle
In young men the commonest cause is lifestyle. Basically, you are so tired you just aren’t in the mood for sex. A simple blood test will tell me that your hormone levels are normal, clinical assessment will confirm your nerves and blood vessels are intact. Without a good 7-8 hours’ sleep on a regular basis and some form of exercise your brain will not respond to circulating testosterone to give you the sex drive you need. Stress either at work or home, especially stress of a continuous nature which happens daily will cause a hormonal and chemical imbalance which will lower your sex drive as well. Prolonged lack of activity with your partner will cause your brain to no longer consider your partner of sexual interest further lowering your desire for sex.
Treatment is difficult as a pill is not going to help. It’s about you deciding what’s important and adjusting your life. Medication can help smooth this process. The next commonest reason is low testosterone levels.
Low Testosterone Levels
This happens naturally with age, levels start to decline after 40, with certain medications like high blood pressure pills, diabetic and cholesterol medication, social drugs, excessive painkiller use, alcohol abuse and in people who have a lot of abdominal fat.
In rare cases you may have testicular or brain abnormalities that stop you from producing testosterone.
The commonest complaint here is that you just are not interested. You come home, go to bed and fall asleep! That’s it.
I am usually able to help you fairly easily if you fall in this category as there some medical issues to fix and most of it can be managed. Treatment is based on fixing the underlying cause if any and improving testosterone levels either naturally or with medication.
In short, low libido is not something you have to live with, it treatable . Depending on the cause often without medication. The good news is improvement in libido is usually associated with an improvement in your overall health either due to the lifestyle changes you have made or because we have fixed the underlying medical issues.
Sex is an integral part of life, missing it is really not fun at all.
“Some things are better than sex, and some are worse, but there’s nothing exactly like it.” — W. C. Fields
