Solutions for common sexual problems

When a widely publicized landmark study of the sexual habits of older adults was recently published in The New England Journal of Medicine, many people were shocked by the results. University of Chicago researchers who asked 3,000 adults nationwide about their sex lives found that the majority of sexually active adults in their 50s, 60s, 70s and 80s were having sex two or three times a month or more—the same rate as people in their 20s, 30s and 40s.

But the survey also found that many older adults are not sexually active—and many who are having sex are not sexually satisfied. Why not? There are various reasons…

MEDICATIONS

Older adults typically take the most medications—and many have sexual side effects.

The biggest offenders…

  • High blood pressure medication. New cases of high blood pressure are often treated either with a beta-blocker, such as atenolol (Tenormin) or propranolol (Inderal), to lower the rate and force of the heartbeat…or a thiazide diuretic, such as hydrochlorothiazide (HCTZ), to stimulate the body to produce and excrete more urine, which helps lower blood pressure.

Trap: Most doctors know that beta-blockers can cause some men to have difficulty achieving an erection, a condition known as erectile dysfunction (ED)—but don’t know that diuretics also can lead to ED.

Best: Ask your doctor why he/she has decided to treat you with a beta-blocker or a diuretic. In some cases, the drug may be the best choice. But if you believe your blood pressure medication is causing ED, ask your doctor if there are other options.

  • Antidepressants. Selective serotonin reuptake inhibitors (SSRIs), such as citalopram (Celexa), sertraline (Zoloft) and fluoxetine (Prozac), can cause sexual difficulties, including ED, delayed ejaculation and decreased sexual desire.

Trap: Among the SSRIs, Prozac has one of the highest incidence rates for sexual difficulties—but it is frequently prescribed because it has a good track record…is available in a generic form, which is less expensive than a brand-name antidepressant…and is likely to be covered by insurance.

Better: Talk to your doctor about taking an SSRI other than Prozac. If you still have sexual difficulties after switching SSRIs, consider taking half the dosage and adding bupropion (Wellbutrin), an antidepressant that rarely causes sexual side effects. (In some cases, people who take bupropion alone experience a worsening of anxiety disorders.)

CHRONIC ILLNESS

Chronic diseases, such as heart disease and cancer, are more common among older adults—but they don’t necessarily have to derail sexual activity.

  • Heart disease. People who have recently had a heart attack (or surgery to implant a pacemaker) should generally abstain from sex for six weeks, until their condition is stable. But once a patient is free of angina (chest pain) and his blood pressure is normal, the risk of dying from a heart attack during sex is miniscule. Caution: Consult with your doctor regarding how soon you can safely resume sexual activity if you have recently had a heart attack or pacemaker surgery.

New finding: A study published in the October 2007 issue of the Mayo Clinic Proceedings found that peak heart rate during intercourse in men with chronic heart failure was lower than during their normal daily activities, and not a risk factor for heart attack.

  • Cancer. In a 2007 study by Australian researchers, 80% of the partners of cancer patients said the diagnosis negatively impacted their sexual relationship.

Examples: A cancer patient may feel less sexually attractive if chemotherapy causes hair loss. A man may develop ED after surgery for prostate cancer.

What to do: If cancer is diagnosed, the patient and partner should talk to a doctor about their sexual relationship—asking questions and having them answered in an unrushed atmosphere. According to research, this approach usually leads to positive sexual experiences—in spite of cancer.

  • Stroke. If you or your partner has been sexually incapacitated by a stroke or other neurological illness, such as Parkinson’s disease or dementia, consider other forms of physical intimacy, such as hugging, kissing and touching each other.

Also try: Men with ED that is caused by neurological damage should see a urologist to consider a penile implant (an inflatable or semi-rigid device that is implanted inside the penis), which often leads to a satisfactory sex life.

ERECTILE DYSFUNCTION

Thirty-seven percent of the men in the national survey reported difficulty achieving an erection—and 14% took over-the-counter medications, supplements or prescription drugs to improve sexual function.

Trap: Don’t simply treat yourself for ED. This condition may be a symptom of heart disease or diabetes, two conditions that impede circulation, including circulation to the penis.

Better: If you develop ED, consult a doctor to see if you have an undiagnosed medical problem. If you do, your doctor can treat the problem and recommend an approach to ED that is right for you.

LUBRICATION

Thirty-nine percent of the women in the national survey reported a lack of vaginal lubrication, which makes intercourse painful.

My advice: Use a lubricant. If your partner is using a condom, try a water-based lubricant (such as KY jelly, Astroglide or Liquid Silk)—not an oil-based lubricant, which can damage latex condoms.

A THERAPIST CAN HELP

If you’ve discussed your sexual problem with your primary care physician but he does not have a solution, you and your partner may want to see a sex therapist—a psychologist, counselor or social worker with an advanced degree in human sexuality. A sex therapist offers insight, reassurance and at-home exercises designed to improve intimacy, sexual performance and sexual satisfaction.

To find a qualified sex therapist near you, contact the American Association of Sexuality Educators, Counselors and Therapists,
804-752-0026, www.aasect.org.