Prime Time (36 page)

• And then there are candles, the true friends of older lovers. Place them—lots of them—in strategic places around the room so that you and your partner are shown at your best.

• If you are beginning a new sexual relationship, you must protect yourself! Individuals fifty and older account for 11 percent of the cases of AIDS in the United States … and this has increased by 22 percent in the past decade. Older women are especially vulnerable because our thinning vaginal walls can tear so easily. We must use condoms unless we know the health status of our partner. If you have a new partner in a monogamous relationship, get tested now, and again in six months. Only then should you stop using condoms.

This chapter has been about the ways in which sex changes with age. The following chapter talks about some of the ways we can mitigate those changes.

Some Suggested Readings, Videos, and Sex Shops

The Good Vibrations Guide to Sex
by Cathy Winks and Anne Semans (Cleis Press, 1994)—how to have safe, fun sex … tips and techniques from the folks who run one of America’s favorite sex-toy stores

Good Vibrations—
books and sexual products for women and couples
1210 Valencia Street
San Francisco, CA 94110
(415) 974-8990

Eve’s Garden
119 West 57th Street
Suite 1406
New York, NY 10019
(212) 757-8651

Sex therapy video series
(
Sexual Pleasure,
available in three editions:
Heterosexual Couples, Lesbian Couples,
and
Gay Couples
). For information visit
www.HSAB.org
.

KEGEL EXERCISES

The goal is to squeeze and release your PC muscle 200 times a day, using both slow movements and rapid ones. (See
this page
for diagram of muscle location.) You can start slow—three slow sets a day five days a week—and work your way up. This gets easier as you do more of them.

The Slow Squeeze

Squeeze for 10 seconds as though you’re trying to stop the flow of urine, then relax for 10 seconds. Do this 10 times. (You may want to start with 3 seconds and work up to 10, but the squeeze and the release should always be of the same duration.)

The Quick Squeeze

Squeeze and release the PC muscle as rapidly as you can for 2 minutes; don’t forget to breathe normally throughout.

Try to do the exercises in various positions—standing, lying down, sitting—including on the toilet while urinating. Think of trying to stop the flow of urine.

Your ob-gyn can provide you with a prescription for small weights of graduating heaviness that are inserted into the vagina while you perform the Kegels. This focuses your awareness and gives you something to resist … a vagina workout, if you will.

CHAPTER 14

The Lowdown on Getting It Up in the Third Act

Those searching for the fountain of youth may be surprised to learn that perhaps the easiest and most natural way to achieve healthy aging isn’t found in the doctor’s office, drug laboratory or rain forest, but in the bedroom.

—ROGER LIBBY

In our relationships, how much can we allow them to become new, and how much do we cling to what they used to be yesterday?

—RAM DASS

I
N THE OLD DAYS—BACK IN 1998, WHEN VIAGRA WAS FIRST APPROVED for commercial sale—the thinking was that as long as a man could get an erection, a good sex life was ensured. According to a 2007 report from the
New England Journal of Medicine,
one out of seven men use the sexual pharmaceuticals Viagra, Levitra, or Cialis. There’s no question that these phosphodiestease inhibitors, or PDE5s as they’re called, have done a lot to enhance sexual capacity. For some men they can turn back the clock, say, ten years. But a panacea they aren’t. If a man and his partner expect these drugs to be the Fountain of Youth, they will be disappointed. On their own, the drugs don’t produce an erection. What they do is make the blood flow into the penis possible. But without desire on the man’s part and a great deal of direct stimulation of the penis (way more than when we were young), the erection won’t happen.

Drugs and Other Methods to

Address Erectile Dysfunction

Let’s look at each of the drugs currently on the market. But first of all, remember that, erection-wise, the results of each drug will vary from man to man. And these drugs are not without possible side effects, some of which may be serious for certain people, so you really must consult your own doctor about all of this.

Generally, Viagra is effective for from one to four hours. However, because the pill works fastest if it is taken on an empty stomach, a guy who is planning to have sex in the evening needs to time things rather carefully. Gone are the days of having a long romantic dinner with good wine, going straight home while there’s still a buzz, and getting right to it. Now he will probably want to wait for an hour or so after dinner and then ingest the pill, then wait thirty to sixty minutes for it to take effect. Alternatively, the pill can be taken prior to dinner, but some men may experience indigestion as a result. The effects of Levitra can be very similar, but Levitra may be taken with or without food. The effects of Cialis are supposed to last thirty-six hours, but you can’t always count on that, either. Some men have told me that they take Cialis and then, after a while, as the time for sex approaches, they add a Viagra for a little bump. Combining erectile dysfunction medications can be quite dangerous, however, so never mix and match unless you are instructed to do so by a medical doctor who is experienced in prescribing these drugs (and then follow instructions carefully).

It can be important, at this stage of life, for both partners to know if sex is on the agenda on a given day or evening. The pills are not cheap. It can be a source of irritation if the man has taken a pill, expecting to have sex, only to discover that his partner isn’t interested. Talk about crossed signals: One night I took a sleeping pill just as my partner came in telling me he’d taken a Levitra. We proceeded (lazily) down his chosen path and it was not uninteresting (hated to waste all that money), but we won’t make that mistake again. Let’s face it: Sexual spontaneity may be harder to come by or a thing of the past for many Third Acters. Then again, advance planning—anticipation and fantasy—can be sexy in itself.

Dr. Michael Perelman, a clinical associate professor of psychiatry, reproductive medicine, and urology at Weill Cornell Medical College, explained to me that “it’s particularly important for some men to realize that just taking the pills will not give them an erection. Yes, sexual pharmaceuticals can restore function, but you still need the same kind of friction you always needed, only more of it for a longer time, and you need romantic or hot, sexy thoughts for the pill to result in the best experiences sexually.” They should put this advice on the label:
Take pill. Add friction and fantasy.

Besides the pills, there is a tool called a penis ring, a thick, flexible rubber ring that comes in varying widths and tightnesses. You slide it down the shaft to the base of the penis and it keeps the penis engorged with blood in the same way a tourniquet works. This is important because many older men experience venous leakage. There is one valve that allows blood to enter the penis and another one that keeps the blood in the penis and then lets it out. When that valve develops a leak, the man can get a hard-on but loses it right away. Pleasurable results can also be had by encircling the testicles within the ring as well as the shaft. Such a ring should be thicker and softer as well as larger. Then a second cock ring could be added, just around the penis, to give added strength to the erection. In fact, in general, softer and thicker is better than harder and thinner. Such skinnier rings can be painful. It may take a while before you or your partner finds a ring that is the right size and fit, but it is worth the investment! Some top-of-the-line rings come with vibrators on top for stimulating the clitoris as well as the penis during intercourse. Properly positioned, these rings can give tremendous pleasure to both partners. Along with lubricants, penis rings should be a permanent part of any senior’s sexual tool kit. Rings should not be worn for more than thirty minutes without taking them off for a short break to avoid any potential damage to the delicate penile tissue. Never fall asleep with one on!

Penile injections
before sex can be effective. They are done with a very fine needle, and if applied at the part of the shaft where there are no nerves, they are painless. Eighty percent of the men who try these respond very well. It gives a man a predictable, reliable erection about five minutes after the injection. But as Dr. J. Francois Eid said in an Internet videoconference about erectile dysfunction, “I have a lot of compassion for men who try injections. It takes courage and also it doesn’t feel natural. Each time you want to make love, you have to excuse yourself and take an injection.” Dr. Eid also noted, “I have to tell you that approximately 80 percent of patients will drop out of injection therapy the first year. Over 50 percent of the patients that start injections stop in the first two months of therapy. So yes, it is effective. It is a good treatment. But it takes a lot of motivation to do it.”

Dr. Perelman said, “One thing to point out is by working with the man and his partner, we can actually improve that 80 percent dropout rate by helping the couple introduce their intimacy again in a way that takes into consideration the female partner’s needs as well as just providing an erection.”

Perhaps the partner could learn to give the injection and the couple could learn to see this joint effort (pardon the pun) as part of foreplay. I know it sounds so dramatic, sticking a needle into a penis, but with few nerve endings in the area where the needle is inserted, you really can’t feel anything.

The
vacuum pump
is a plastic tube that is placed over the penis. A hand-powered or battery-powered pump will activate the vacuum, drawing blood into the penis in the same way a breast pump works. Like injections, the vacuum pump works for 70 to 80 percent of men. Personally, I always found that breast pumps were too painful, and many men have found these pumps to be the same. The hair at the base of the penis may need to be trimmed or shaved and then, after an erection has been obtained, a rubber penis ring is rolled off the end of the pump to encircle the base of the penis so as to keep the blood trapped inside. The pump is a simple, one-time purchase that requires a prescription. If the erection from use of one of the ED pills begins to wane, the pump can be used to get it up again. Doctors at the Mayo Clinic say that the pump can also be used apart from intercourse as a way to exercise the penis by bringing blood into it, irrespective of intercourse.

Self-administered intraurethral therapy (Muse).
This treatment involves using a disposable applicator to insert a tiny suppository, about half the size of a grain of rice, into the tip of the penis. (A flashlight will help you see exactly what you are doing! Try holding a small one in your mouth during the insertion to light your way.) The suppository, placed about two inches into the urethra, is absorbed by erectile tissue in the penis, increasing the blood flow and causing an erection within approximately three minutes. Absorption is helped by rolling the penis between the palms of the hands for a minute or longer. The erection should last from forty-five minutes to an hour. Side effects may include pain, burning, minor bleeding in the urethra, dizziness, and formation of fibrous tissue in the urethra. In fact, 10 to 20 percent of men experience pain or burning with Muse or injections. If your urologist prescribes Muse, be sure that both you and your partner go on the website to get all the instructions. Doctors don’t always explain everything, but you can ask. For instance, it was only on the website that I learned that you should hold the penis upright before and during insertion of the pill and then, after rolling the penis between your palms, as previously described, walk around for a few minutes, holding the penis upright, to increase the blood flow.

If the sexual pharmaceuticals, injections, vacuum pumps, and suppositories have not worked for a man, the next thing to consider is the penile pump.

The penile pump consists of two or three devices. The pump is inserted through a small incision in the scrotum and placed invisibly within a fatty deposit between the testicles. A reservoir cylinder is placed next to the bladder, in the lower abdomen, and another soft cylinder goes into the penile shaft. None of the penile nerves are cut or damaged. When the pump is squeezed, a saline solution is pumped from the reservoir into the cylinder in the penis to create an erection for as long as is desired. When sex is over, the solution is pumped back into the reservoir.