Andrew Siegel MD 7/4/2020 HAPPY INDEPENDENCE DAY!
This is an encore entry, one of the best received of the 500 or so blogs that I have composed over the years. While “What to Expect When You’re Expecting” is a popular book that prepares its readers for pregnancy, there is no “Manual of Man” that explains the changes that might be expected as time marches on. So, I crafted this general guide to expectations of man part function, derived primarily by thousands of patient interactions, having spent more than 30 years on the urology front lines. Furthermore, I am a sexagenarian,** keenly observant of subtle changes that I have witnessed, (although I must say that I am holding my own).
** A person who is 60-69 years old
Although written tongue-in-cheek, the underlying basis is entirely factual. I have arbitrarily broken this down by decade with the understanding that these are general trends and that any given individual may vary significantly from others in his age group, depending upon genetics, lifestyle, luck and other factors. There are 30-year-old men who are completely “unmanned” and 80-year-old men who are veritable “studs,” so age per se is certainly not the ultimate factor.
Image by Gerd Altmann from Pixabay
“But the wheel of time turns, inexorably. True rigidity becomes a distant memory; the refractory period of sexual indifference after climax increases; the days of coming are going. Sexually speaking, men drop out by the wayside. By 65, half of all men are, to use a sporting metaphor, out of the game; as are virtually all ten years later, without resort to chemical kick-starting.” …Tom Hickman, God’s Doodle: The Life and Times of the Penis.
GUIDE TO SEXUAL FUNCTION BY DECADE
It is shocking how ill prepared and uninformed we are about the process of aging. The best we can do is sit back and observe changes as they unspool. Father Time can be unkind and does not spare sexual function. Although sexual difficulties are not inevitable, with each passing decade there is an increasing prevalence of the problem. Present in some form in 40% of men by age 40, with each decade thereafter an additional 10% join the ED (erectile dysfunction) club. All aspects of sexuality decline, although sexual interest and drive suffer the least depreciation, leading to a swarm of men who are eager, but frequently unable–a most frustrating combination.
Age 18-30
Your sexual appetite is mighty and sex often occupies the front burners of your mind. It requires very little stimulation to achieve an erection—even the wind blowing the right way might be enough to stimulate a rigid, gravity-defying erection, pointing proudly at the heavens. The sight of an attractive woman, the scent of her perfume, merely the thought of her can arouse you fully. You get erections even when you don’t want them…if there was only a way to bank these for later in life! You wake up in the middle of the night sporting a rigid erection. When you climax, the orgasm is intense, forceful and powerful. When you arise from sleep, it is not just you that has arisen, but also your penis.
It doesn’t get better than this…you are an invincible king… a professional athlete at the pinnacle of your career! All right, maybe not invincible…you do have an Achilles heel—you may at times ejaculate rapidly because you are hyper-excitable and sometimes in a new sexual situation you may have a bit of “stage fright” brought on by your all-powerful mind dooming the capabilities of your perfectly normal plumbing.
Age 30-40
Changes occur ever so slowly, perhaps so gradually that they are barely noticeable. Your sex drive remains vigorous, but not as obsessive and all- consuming as it once was. You can still get quality erections, but they may not occur as spontaneously, as frequently and with such little provocation as they did previously. You may require some touch stimulation to develop full rigidity. You still wake up in the middle of the night with an erection and experience “morning wood.” Ejaculations and orgasms are hardy, but you may notice some subtle differences, with your “rifle” being a little less powerful and of smaller caliber. The time it takes to achieve another erection after ejaculation increases. You are that athlete in the twilight of his career, seasoned and experienced, with the rapid ejaculation of yonder years occurring much less frequently.
Age 40-50
After age 40, changes become more obvious. You are still interested in sex, but not nearly with the passion of two decades earlier. You can usually get a decent-quality erection, but it now often requires more touch stimulation and the rock-star rigidity of years gone by has given way to a “firm” penis, still quite suitable for penetration. The gravity-defying erections don’t have quite the upward angle they used to. At times, you may lose the erection before the sexual act is completed. You notice that orgasms have lost some of their kick and ejaculation has become feebler than previously. Getting a second erection after climax is not only more difficult, but also something that you may no longer have much interest in. All in all, though, you still have some game left.
Age 50-60
Sex is still important to you and your desire is still there, but is typically diminished. Your erections are still respectable and functional, but not the majestic sights they once were, and touch is often a necessity for full arousal. Nighttime and morning erections become fewer and further between. The frequency of intercourse declines while the occurrence of losing the erection before the sexual act is complete increases. A more dribbling-quality ejaculation occurs with diminished volume and force, begging the question of why you are “drying up.” Orgasms are less intense and at times it feels like nothing much happened—more “firecracker” than “fireworks.” Getting a second erection is difficult, and you find much more delight in going to sleep rather than pursuing a sexual encore. Sex is no longer a sport, but a recreational activity…sometimes just reserved for the weekends.
Age 60-70
“Sexagenarian” is quite the misleading word…more apt a term for the 18-30 year-old group, because your sex life doesn’t compare to theirs—they are the athletes and you the spectators. Your testosterone level has plummeted over the decades, probably accounting for your somewhat diminished desire. Erections are still obtainable with some coaxing, but they are not five-star erections, more like three stars, suitable for penetration, but not the rigid flagpoles of yonder years. They are less reliable, and at times your penis suffers with “attention deficit disorder,” unable to focus and loses its mojo prematurely, unable to complete the task at hand. Spontaneous erections, nighttime, and early morning erections become rare occurrences. Climax is not so climactic and explosive ejaculations are a matter of history. At times, you think you climaxed, but are unsure because the sensation was frankly un-sensational. Ejaculation is down to a mere dribble. Seconds?…no thank you…that is reserved for helpings on the dinner table! Sex is no longer a recreational activity, but an occasional amusement.
Age 70-80
When asked about his sexual function, my 70-something-year-old patient replied: “Retired…and I’m really upset that I’m not even upset.” You may still have some lingering sexual desire left in you, but it’s a far cry from the fire in your groin that you had when you were young. With physical coaxing and coercion, your penis can at times be prodded to rise to the occasion, like a cobra responding to the beck and call of the flute of the snake charmer. The rigidity of erections has noticeably dropped, with penile fullness without the rock-hardness that used to make penetration such a breeze. At times, the best that you can do is to obtain a partially inflated erection that cannot penetrate, despite pushing, shoving and manipulating. Spontaneous erections have gone the way of the 8-track player. Thank goodness for discovering that even a limp penis can be stimulated to climax, so it is still possible for you to experience sexual intimacy, although the cli-“max” is more like a cli-“min.”
Age 80-90
You are now a full-fledged member of a group that has an ever-increasing constituency—the ED club. Although you as an octogenarian may still be able to have sex, most of your brethren cannot; however, they remain appreciative that at least they still have their penises to use as spigots, allowing them to stand to urinate, a distinct competitive advantage over the womenfolk. Compounding the problem is that your spouse is no longer a spring chicken and because she has likely been post-menopausal for many years, she has a significantly reduced sex drive, vaginal dryness, and perhaps medical problems that make sex downright difficult, if not impossible. If you are able to have sex on your birthday and anniversary, you are doing much better than most. To quote one of my octogenarian patients in reference to his penis: It’s like walking around with a dead fish.
Age 90-100
To quote George Burns: “Sex at age 90 is like trying to shoot pool with a rope.” You are grateful to be alive and in the grand scheme of things, sex is low on the list of priorities. You can live vicariously through pleasant memories of your days of glory that are lodged deep in the recesses of your mind, as long as your memory holds out! When and if you do get an erection, you never want to waste it!
Wishing you the best of health and a wonderful holiday weekend,
Always bring homework!
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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery. He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States. His latest book is Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families. This blog is excerpted from the Sexual Function section of Prostate Cancer 20/20.
Video trailer for Prostate Cancer 20/20
Preview of Prostate Cancer 20/20
Andrew Siegel MD Amazon author page
Prostate Cancer 20/20 on Apple iBooks
PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families is now on sale at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours).
Dr. Siegel’s other books:
PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food
MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health
THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health
Tags: Andrew Siegel MD, male sexual function, Prostate Cancer 20/20, sexual expectations with aging
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