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Reproductive and sexual health changes occur as a man gets older. These changes involve fertility, hormone levels, prostate health and erectile function.

Fertility

Sperm counts decline with age and the ability of an older man to father a child declines.

Hormones

Testosterone levels begin to slowly fall from the age of 40 years onwards.

The fall is not as dramatic as the drop in oestrogen that occurs in women at the menopause. Whilst low testosterone may result in a decreased libido, ageing men are at risk of osteoporosis and decreased muscle mass.

Tiredness and irritability may also be a feature of low testosterone.

Ongoing research is aimed at establishing at what level men should be treated with testosterone and at what dose. There is still no general consensus on this issue at this moment in time.

Prostate

The commonest change with the prostate gland in the ageing man is benign enlargement. This may affect urine flow. A less common change is prostate cancer which may present with the same symptoms as benign prostate disease or no symptoms at all. Regular prostate checks over the age of 50 years is recommended.

Erectile Dysfunction

Erectile dysfunction increases with age. This may be exacerbated by the presence of medical conditions such as high blood pressure, high cholesterol and diabetes. Many new treatments have been developed for erectile dysfunction.

Roughly half the world’s population is female so it is worthwhile to understand the factors that will determine good female sexuality and what some of the difficulties are due to.

In general because females only have a small amount of the libido hormone testosterone, sexual interest and behaviour is more influenced by personal wellbeing, relationship dynamics, context of the sexual activity, appropriateness of the sexual behaviour, sexual beliefs and sexual education. Women may be more affected by negative factors such as lack of time, fatigue, anger and resentment and lack of intimacy.

Among younger women lack of sex education and experience, shyness and insecurity about their bodies and lack of assertiveness may be major contributors to difficulties. Later, tiredness, poor relationships and anger become more relevant and then with menopause hormonal factors, health issues, longevity of the relationship and partner health and sexual function issues become significant.

The main female sexual difficulties are:

• Inhibited sexual desire and desire discrepancy
• Orgasmic difficulties
• Sexual pain disorders
  • Vaginismus
  • Dyspareunia

Management of each of these difficulties requires specific strategies based on understanding the individual’s sexual, psychological and relationship history. Inhibited sexual desire has to be evaluated by understanding the broad range of normal female sexual desire which at one end may be that the female is responsive to a male on a few occasions early in the relationship adequate for impregnation. Nature is not particularly interested in recreational sexual activity. In a desire discrepancy situation both partners may be sexually, medically and psychologically normal.

Orgasmic difficulties mainly require behavioural sexual techniques and encouragement to overcome inhibitory behaviours. Dyspareunia needs to be properly medically evaluated and relevant causes treated, before corrective behavioural and psychological therapies are instituted. This is the same for pain disorders. Vaginismus needs a very empathic history and then supportive behavioural sex therapy.

With menopause and age related changes there needs to be a proper medical evaluation of the hormonal and anatomical situation before corrective advice is given. It is unusual for medical difficulties to be present in isolation from psychological and relationship issues.

If you are unhappy or worried about any aspect of your sexuality or relationship seek help early so that you can get the best possible out of your life.

The intention of this handout is for educational purpose only and not to be used as a guide for self-management. Consult with your specialist or GP.

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