Posts Tagged ‘Addyi’

When He’s Interested and She’s Not: A Common Dilemma of the Aging Couple

October 20, 2018

Andrew Siegel MD   10/20/2018

2018-05-26 16.21.35

Photo taken at Icelandic Phallological Museum, Reykjavik: note that the stallion is braying, stomping and ready in every respect, while the mare seems rather indifferent

This entry is based upon my more than 30 years of experience in the urological “trenches” with innumerable daily interactions with male patients (often accompanied by their spouses). I have observed that much of the time when it comes to sexuality, “men are from Mars and women from Venus.”  I do not intend in any way to be disparaging or offend females, but only to report—as I see it—the not uncommon finding of the discrepant and diverging sexual appetites of the aging male as opposed to the aging female.  When I use the term “aging,” I am not referring only to octogenarians, but also to middle-aged and perhaps even younger couples.

Sex is a vital aspect of human existence—instinctual, hard-wired and a biological imperative. Nature has created the ultimate “bait and switch” in which reproduction (procreation) is linked with a pleasurable physical act (recreation), ensuring mating and, ultimately, perpetuation of the species.

Yet sex is so much more than an act of physical pleasure. For men, it is emblematic of potency, virility, fertility, and masculine identity. For women, it represents femininity, desirability and vitality. For both genders, it is an expression of physical and emotional intimacy, a means of communication and bonding that occurs in the context of skin-to-skin, face-time contact that gives rise to happiness, confidence, self-esteem and quality of life. In addition to sexual health being an important piece of overall health, it also provides comfort, security and ritual that permeate positively into many other areas of our existence. No matter what our chronological age, our need for physical and emotional intimacy never perishes.

Considering that nature’s ultimate purpose of sex is for reproduction, perhaps it is not surprising that when the body is no longer capable of producing offspring, changes occur that affect the anatomy and function of the genital organs.  However, long after the reproductive years are over and parenthood is no longer a consideration, many humans still wish to be able to function sexually.  For men this entails possessing a satisfactory libido (sex drive), the ability to obtain and maintain a reasonably rigid and durable erection, the capacity to ejaculate and experience a climax and, of course, to please their partners.  For women this entails having adequate sexual desire and interest, the ability to become aroused and lubricated, and the capacity to achieve orgasm as well as please their partners.

The aging process can be unkind and Father Time (as well as the ravages of poor lifestyle habits, medical issues and their treatment and other factors) does not spare sexual function.  For men, all aspects of sexuality decline, although sexual interest and drive suffer the least depreciation, leading to men who are eager, but frequently unable to achieve a rigid erection—a frustrating combination.  Age-related changes that affect male sexuality include penile shrinkage, decreased libido, diminished erectile rigidity and durability, more feeble ejaculations (less semen, less force, less arc) and less climactic orgasms.  The male downswing in sexual function usually has a slow and gradual trajectory that is based on many factors, with the progressive decline in testosterone production that occurs with aging (“andropause”) one of the key contributing factors.

For women, all aspects of sexuality decline as well. Age-related changes that affect female sexuality include vaginal and vulval dryness, irritation and thinning, vaginal narrowing and shortening, reduced sex drive, decreased arousal and lubrication, diminished ability to achieve an orgasm and a tendency for painful intercourse. Issues such as urinary incontinence and pelvic organ prolapse can put a further damper on sexual function.  The female downswing in sexual function occurs more precipitously than the male decline—although on the basis of numerous factors, an important one is the cessation of estrogen production by the ovaries that occurs after menopause, typically in the early 50s.

In addition to the physical and hormonal factors that may contribute to decreased sexual activity of the aging couple, there are many other considerations that come into play: After many years of marriage, the novelty factor wears off; priorities change; couples are often busy and fatigued with work, child-rearing and other responsibilities; emergence of urological, gynecological, orthopedic/joint problems, etc., psychological conditions (anxiety, stress and depression having to do with aging, health and other causes); and side effects from medications.   Ultimately, emotional intimacy can become more important to one (or both) partner(s) than physical intimacy.

In the population of patients that I care for (which may be skewed since I am a urologist who often treat men with sexual issues), I have perceived that in general—with exception—the aging male has a more robust sexual desire than his partner.  I have observed many men eager for the possibility of improving erectile function via chemical and other means (Viagra, Cialis, etc.), while his partner does not share his enthusiasm.

In most first marriages (commonly age late 20s to early 30s), men are typically a few years older than the women they marry. However, the older that men are when they marry, the greater the differential in age between them and their spouses, holding true in both first and second marriages. Perhaps age-related diverging sexual desires among males and females are among the factors that may help explain this phenomenon.

So, what to do?

Each partner in a relationship should make an effort to be more understanding of and sympathetic to their partner’s situation and needs and strive to compromise and find middle ground. Psychological counseling may be of great benefit to the couple suffering with the issue of libido imbalance.  Urologists and gynecologists can help male and female patients, respectively, with libido and other issues of sexual dysfunction.

Whereas male sexual dysfunction has received considerable attention and many management options are available, female sexual dysfunction by comparison has received short shrift.  Fortunately, the tides are changing and female sexual dysfunction—paralleling the male situation—has come out of the closet, is the subject of ongoing research and is now a subspecialty of gynecology with numerous management choices available.

Decreased sexual desire in males and females can often be successfully managed with hormone replacement therapy, estrogen and testosterone, respectively, when used in the proper circumstances under medical supervision.  Addyi (Flibanserin)—sometimes referred to as “female Viagra”—is a recently available pill that can effectively manage decreased female sexual desire.  Over the counter lubricants and moisturizers can help manage vaginal dryness and discomfort associated with sexual intercourse. Small amounts of topically applied estrogen or DHEA can be helpful as well. Oral ospemifene (a selective estrogen receptor modulator) may also be used successfully for vaginal dryness and painful intercourse related to menopause.  Fractional carbon dioxide laser treatments applied to the vagina may also prove beneficial when used under the right circumstances.  For the male with erectile dysfunction, there are numerous options to help restore erectile rigidity in the event that the oral pharmaceuticals are ineffective.

Despite the importance of sex, for many couples emotional intimacy can be equally important to, if not more so, than physical intimacy. Furthermore, all forms of sex can be enjoyable and there are numerous ways one can sexually satisfy one’s partner aside from penetrative penile-vaginal intercourse with both partners capable of achieving sexual gratification and climax without the involvement of an erect penis.

Bottom Line: A mismatch in sexual desire is a common issue among partners. Important factors are gradually declining testosterone levels in men and the more sudden decrease in estrogen levels in women.  The recently introduced concept of “couple-pause” is a couple-oriented approach that strives to address the sexual needs of the couple as a whole, rather than an isolated approach to one individual of the pair.  The good news is that disparity of intensity of sexual drive and interest among partners as well as other forms of sexual dysfunction are issues that can be addressed and improved, if not resolved.

Wishing you the best of health,

2014-04-23 20:16:29

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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.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health


PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor