24. Factors affecting sexual life, frequency, and erectile dysfunction in the elderly.

Factors affecting the sex life of the elderly

As people age, their libido may decrease and the onset of sexual pleasure may slow down, but it has little impact on the frequency and intensity of orgasms, allowing older adults to still enjoy appropriate sexual activity. However, many physiological, psychological, and lifestyle factors can strongly influence the sexual function of older adults. These factors can be summarized as follows:

1. Psychological sense of loss

Some people believe that as they enter old age, discussing sexual matters will only invite ridicule from their children and others. Deep down, some people consider sex shameful, and believe that sex detached from reproduction in old age is meaningless lust; others equate sexual function with reproductive function, believing that the loss of reproductive ability means the loss of sexual function, and that sexual activity in old age is utterly unattractive.

2. Lack of understanding of sex education

Mistaking normal physiological phenomena that occur during aging, such as the inability to achieve an erection within 24 hours after ejaculation and decreased sensitivity of the reproductive organs, for sexual dysfunction or loss can create an unnecessary mental burden, becoming a psychological inhibitory factor, and gradually leading to a loss of interest and confidence in sexual life.

3. The applicant or their spouse suffers from hypertension or cardiovascular disease.

Because of a lack of understanding about whether these diseases preclude sexual activity and how to maintain a healthy sex life, and concerns that continued sexual activity might cause premature death of the affected partner, some people terminate their sexual relationships. All of these situations can lead to disuse-induced sexual dysfunction.

4. Suffering from diseases that directly affect sexual function

For example, diabetes can affect sexual function primarily through erectile dysfunction, retrograde ejaculation, low libido, premature ejaculation, and impaired spermatogenesis. The incidence of erectile dysfunction caused by diabetes is approximately 37%–60%, thus impacting sexual function.

5. Drug effects

Because older adults suffer from more illnesses, their average medication dosage is significantly higher than that of younger people. When discussing drug side effects, people primarily focus on toxicity to liver and kidney function, rarely considering the impact on sexual function. For example, frequent use of antihypertensive drugs (including diuretics) and sedatives can lead to sexual dysfunction and decline.

6. Drinking alcohol

Long-term heavy drinking can lead to sexual dysfunction, and even small amounts of alcohol can inhibit erectile function in men. The impact of alcohol on sexual function is very significant; after becoming intoxicated, one often experiences sexual inhibition and may even be unable to complete sexual intercourse.

Frequency of sexual activity in the elderly

Moderate sexual activity is very beneficial for older adults. It can make people more energetic and cheerful, and may also improve blood circulation in the prostate, promote smooth secretion, and reduce the chance of developing prostate diseases.

The frequency of sexual activity is a difficult question to answer definitively. It varies greatly depending on individual age, physical condition, spouse's health, living conditions, and habits. However, from an aging perspective, for most people, the frequency of sexual activity gradually declines with age. This decline begins in men around age 35, decreases again around menopause, and then levels off, maintaining a certain frequency into old age. However, individual differences are significant. Some men have almost zero sexual activity by age 60, while others can still maintain a frequency of once a week until age 80.

An analysis of the frequency of male sexual activity revealed the following changes after age 30: 30-35 year olds averaged twice a week, 60-64 year olds averaged 0.7 times a week, 65-74 year olds averaged 0.4 times a week, and 75-79 year olds averaged 0.3 times a week. These findings are not entirely consistent, possibly due to variations in race, region, living conditions, and survey methods. However, the results illustrate three points: First, the frequency of sexual activity decreases with age; second, the ability to have sex is not lost in old age; and third, due to various differences, it is difficult to establish a uniform standard for the frequency of sexual activity across different ages.

So, how should older adults manage their sexual activity frequency? Adjusting the frequency of sexual activity should be based on individual physical conditions, family circumstances, and other practical factors. Currently, most sexologists advocate determining and adjusting the frequency of sexual activity based on how one feels after intercourse. This method is applicable to both young and middle-aged adults and the elderly. You can appropriately increase the frequency of your current sexual activity. If you don't feel tired the next day after intercourse and instead feel energetic and full of vitality, then the frequency is appropriate. Conversely, if you feel fatigued, weak, short of breath, or have lower back and leg pain the next day, then you are having too much sex and should moderate it. Of course, in special circumstances such as illness or fatigue on your part or your spouse, you should reduce or suspend sexual activity for a period of time, based on the existing frequency.

For older adults, maintaining a healthy frequency of sexual activity can be beneficial, appropriately satisfying both their physiological and psychological needs. Appropriate sexual activity can help prevent brain aging and enhance enjoyment and confidence in life.

impotence in the elderly

Reasons why older adults are prone to erectile dysfunction

There are many causes of erectile dysfunction, which can be broadly divided into two categories: organic causes and psychological causes. The proportion of these two types of factors varies at different ages. In young people, psychological factors account for the majority of cases, while in older patients, both types of factors play an important role.

Clinically, many systemic diseases can lead to erectile dysfunction, and these diseases are particularly prevalent in the elderly. For example, hypertension is a common disease among the elderly, and its main impact on sexual function is erectile dysfunction. This is due to the patient's anxiety, fear of sexual activity, and worry that their blood pressure might suddenly rise during intercourse, potentially causing an accident. Another example is diabetes, where up to 57% of patients experience erectile dysfunction. Some diseases prevalent in the elderly may not directly cause erectile dysfunction or cause it less frequently, but medications used in their treatment can reduce sexual function and lead to erectile dysfunction. Other diseases specific to the elderly, such as benign prostatic hyperplasia, Parkinson's disease, and post-prostate surgery, can also cause erectile dysfunction.

In psychogenic erectile dysfunction, the main causes are psychological decline, lack of self-confidence, low self-esteem regarding sex, and insufficient understanding of the physiological characteristics of changes in normal sexual function. These factors create psychological inhibitions, leading to decreased libido and erectile dysfunction. These factors account for a large proportion of erectile dysfunction cases. In particular, pre-existing organic factors, coupled with the influence of unhealthy psychological factors, often make erectile dysfunction more severe and persistent.

There is a type of psychogenic erectile dysfunction called "widower syndrome," which is more common in men over 50. It often results from the wife's long-term illness, leading the husband to avoid sexual contact out of love and care. Alternatively, it can be caused by psychological setbacks and a lack of opportunity to release sexual desire, leading to sexual disuse, such as after the death of a former wife and subsequent remarriage. Another type is "self-doubt-based" erectile dysfunction. This involves misinterpreting normal aging phenomena (such as a prolonged refractory period during male sexual arousal) as erectile dysfunction, leading to heavy mental stress, anxiety, and feelings of guilt towards one's wife. The fear of failure before each sexual encounter ultimately results in erectile dysfunction.

In addition, among the causes of erectile dysfunction in elderly men, some patients are related to changes in their wives' sexual function. Due to a lack of understanding of the characteristics of these post-menopausal changes in female sexual function, husbands may experience aversion, discomfort, or even anger, which can negatively impact their sexual response and lead to erectile dysfunction.

Furthermore, excessive smoking and drinking are also significant causes of erectile dysfunction in men.

Proper treatment of impotence in the elderly

The causes of erectile dysfunction in the elderly are very complex, making treatment difficult and requiring individualized approaches.

Erectile dysfunction in the elderly is sometimes caused by chronic diseases, which are often not curable overnight. Therefore, theoretical "treatment based on the cause" is often ineffective. Treatment of erectile dysfunction in the elderly must be based on practical considerations. For those caused by medication, the dosage may be appropriately reduced or the type of medication changed, if the patient's condition permits. For medications that are optional, discontinuation or alternative treatment methods should be considered.

Whether erectile dysfunction is caused by the disease itself or by medication, psychological factors play a significant role, and psychotherapy is essential. It's crucial to approach the condition correctly and let go of mental burdens; this can be effective for both organic and psychological cases.

Sex education should be strengthened to overcome feelings of inferiority. Sexual intercourse techniques should be improved based on the biological characteristics of changes in sexual function in older adults to prevent and treat sexual dysfunction. At the same time, close cooperation between couples is crucial, not only for older adults but also for treating erectile dysfunction at any age. Some treatments designed to address fertility issues, such as injections of vasodilators at the base of the penis and surgical procedures like implantation, are not applicable to older adults who do not have fertility problems.

Patients with angina can take one nitroglycerin or amyl nitrite tablet before sexual intercourse to prevent angina attacks during intercourse. Nitrite drugs also have a therapeutic effect on erectile dysfunction in the elderly caused by arteriosclerosis, making sexual intercourse more successful.

Some pharmacies sell or circulate folk remedies for erectile dysfunction, which may have some effect on treating impotence. However, since there are many causes of erectile dysfunction, it's impossible for one medicine to cure all ailments. Some medications can improve the underlying condition (such as medications for benign prostatic hyperplasia) and thus improve erectile dysfunction, while others improve it by adjusting the body's overall functions. These medications can all be taken under the guidance of a doctor, but it's not advisable to abuse "aphrodisiacs" containing androgens, as their benefits outweigh their risks.

If erectile dysfunction is caused by a poor environment, sometimes improving the sexual environment can alleviate the erectile dysfunction.

In addition, for those patients with erectile dysfunction who do not respond to treatment, they can be encouraged to use other forms of sexual expression to satisfy their sexual desires for themselves or their partners. This is because older adults should not repeat their younger sexual experiences, but rather strive to enhance intimacy and companionship between elderly couples, alleviate loneliness, boost self-confidence, and promote a happy, healthy, and long life in their later years.