Sex and old age is a subject seldom approached in the medical literature but perhaps in greater measures by the mass-media, but which concerns all of us. This is a discussion about what is physiologically normal, of the causes leading to impotence, frigidity, I consider this may be welcome, especially for older people.
The aim of MACROBIOTICS is that to reach advanced ages in full harmony with nature, without diseases, and with an optimal functional capacity. Death should not frighten us, it is something natural in the life cycle. We should be careful and prevent chronic diseases, (severe and incurable), which lead to functional incapacity and make us dependent upon others. The functions of organs and systems are scheduled for the whole biological cycle, so that only external causes alien to the organism bring disharmony and their premature ceasing.
Atherosclerosis, prostate diseases, the adverse effects of drugs, toximanias and many others, which do not belong to our life, are the causes of sexual dynamic disturbances, whose implications are the most important once upon the human psychic.
Although human life is ephemeral in the universe context, it has numerous frustrations among which we benefit by a limited reproductive and sexual period.
"Edwin Flatto", M.D. in his magnificent book "Super Potency" said that "Even the creator thought otherwise as "Adam" lived 930 years and had all this time sons and daughters. He endowed the man with the possibility to have a sexual activity as long as he lives".
Premature impotence, is more depressing as our modern life emphasizes more activity, initiative, vigor and youth. It is a mistake to consider the sexual activity only an attribute of young age. It is true, with age that sexual dynamics present certain peculiarities, but the sexual function "per se" remains normal until the most advanced age.
Sexual function supposes a circulating, nervous and hormonal system unimpaired. The erection is a reflex function, physically stimulated, or tactile at the level of erotic areas. By vasodilatation the blood is directed to the penis level, which increases gradually. A normal sexual intercourse supposes an erection for 10-20 minutes until the maximum exciting phase, after which follows the ejaculation. Testosterone plays an important role in sexual dynamics, but the mechanism of faction is not known.
The libido (the wish to have "sex") remains throughout life.
In the elderly more time is required, and a direct stimulation in order to have an erection. The number of spontaneous erections is less. Secretion of sperm is present even in the 8th decade as are potent men at this age. There are psychological changes, and to have sex once a month at the age of 80 is absolutely normal. From the psychical point of view this is very important for the man. It creates in him a feeling of comfort, of high spirits and independence.
It is the impossibility of the male organ to become erected and make sexual contact. The absence of ejaculation or premature ejaculation are components of impotence.
Sterility means impossibility to have descendants and it should not be confused with impotence.
Impotence may be total, temporary, incomplete, or partial.
In fact, any man may experience in his life moments when he has problems of erection. A feverish state, stress, fear, fright, tiredness, excess of alcohol, cigarettes, sedative and antihistaminic drugs are very often the cause of temporary, or total impotence. It is important for the sexual partner to understand these problems. In a contrary situation, the man is self-conscious and impotence may be repeated. I had many patients who experienced such discomfort.
I especially remember Engineer P.E., 34 years old. In a more tensioned period of his life, his sexual partner did not realize neither did she want to understand the temporary situation of her "friend". The solution I recommended to him was to end their relationship. The engineer did not accept my recommendation; on the contrary, he regarded it with great suspicion. After a few months he consulted me again presenting a severe state of depression, and of course total impotence. After a few discussions with his "friend", I tried to help her understand the psychical state of her partner, and I advised her to show a tactful attitude, but it was in vain. After a while I had the pleasure to see him again. He was in high spirits, with a psychic entirely recovered. He had finally gathered strength to end the relationship and came to thank me, and asking me that "in similar cases for me to make the same recommendation", it was the only one capable of curing this type of impotence and depression.
My patient reveals in fact the important role the partner has from a psychical point of view, specially when they are a true friend.
It is estimated that about 15-20% of men present different degrees of impotence, and at the age of 60, the rate increases 30-35%. At the age of 80, 40-50% of men still present a great interest for a sexual life.
According to Sigmund Freud, in 90% of the cases impotence is a psychical feature.
In the past decades it has been considered that numerous physical causes are the origin of impotence.
There are diseases which accompany impotence. The patients with diabetes mellitus, obesity or gonorrhea in their history, complain of impotence in a proportion of 40-60%. Arteriosclerosis affecting the central nervous system and the pelvic vessels is also associated with impotence. The same state is noticed in variable proportions in those with arterial hypertension, prostate diseases, Parkinson's diseases, tabagism, alcoholism, drug addiction, Roentgen-therapy, other penis diseases, anti-depressants and hypertension treatments.
For many men, impotence is more difficult to bear than any other chronic disease.
By the modifications of pelvis arteries sizes and the prevention of blood to reach the penis, arteriosclerosis is one of the main causes of impotence. The anginous pains, dizziness and loss of balance, tinnitus, leg cramps in gait and at night, as well as impotence, are signs of arteriosclerosis, which you should bear in mind and for which you should see a physician.
The diseases of prostate are often the reason of sexual dynamics disturbances. Between 70-90% of men during their life time change and complain of prostate. After the age of 40 it is advisable for men to have a "check-up" yearly. Among the preventive and curative treatments for prostate complaints and maintaining a normal potency, I recommend:
Edwin Flatto, M.D. gives us a model for prostate gymnastics at anybody's age and anytime: "contract for 30 times the buttock muscles, after which 30 relax; repeat 25 times in the morning and 25 times the evening".
Almost anytime when I make these recommendations I remember one of patients, Mr. S.I.(74 years old), who presented pains at perineum level, urinating disturbances, and impotence almost complete. After 4-6 months he was doing this kind of exercises he did not feel urinating disturbances and his potency was much improved.
More and more patients particularly the elderly use drugs for situations in which a corrective diet would be indicated, giving up to salt, coffee, tobacco, etc. In addition, the explosive number of drugs during the last decade brings another question: Do we really know everything about these drugs? Positively, we exceeded long ago the period of Voltaire, who declared: "The doctors are those who prescribe drugs about which they know little, treat diseases about which they know even less, and the human organism about which they know nothing".
Even today, more rarely, or more often, we ask ourselves: Really why this drug, or these drugs? After an interval of using these drugs, frequently, and often unconfessed, one of the side effects is impotence. The drugs act on different phases of sexual intercourse and can be divided thus:
A special mention should be made on the use of alcohol and tobacco. Of course, it is an essential difference between being an alcoholic and to drink occasionally/socially a glass, or two of wine. Alcohol in small quantities (7-10g.), which represents 100g of wine stimulates appetite, creates an euphoric state, and can be considered a food. In small quantities it also stimulates the libido. In big quantities, although seems to stimulates the sexual interest and wish, in fact it reduces the performance.
Master and Johnson, in 1970, in a reference work, "Human Sexual Inadequacy", considered alcohol as one of the frequent causes of impotence. Because of the effect of suppressing the inhibition exerted by alcohol, even small quantities may induce temporary impotence, it ruins the satisfactory erection and induces a premature ejaculation". We have to take into consideration the individual reactions, also. In alcoholism, the testosterone blood level is low, and most of the chronic drinkers present impotence. In women too, the habit of alcohol is not lacking of consequences; the women's effectively and response are changed, it appear the difficulty of orgasm and laxity of vaginal wall. Association of tranquilizers, of sedatives, and of tabagism potentialities the negative effects of alcohol on the sexual life and health state.
The static data confirm the negative effect of smoking on potency; in smokers, the impotence and frigidity are noticed in a great proportion.
Constipation, usual and common, of the persons who change an armchair with another one, is associated in many cases with impotence. The change of life style, of the habits, it is the only reasonable conduct. And to make a play on words, impotence is alone and complete in those with the constipation of the colon, and "mental constipation", too.
Life should be regarded positively, optimistically.
Americans say: "Life is great", even when they have few reasons to be happy. To look forward, to have humor even in the sad moments of your life, "to smile in the face of adversity", to not insult, to find the good part of bad things, to be generous, to have a good laugh, means to be mentally free. This category of men may give the measure of a first-rate sexual intercourse. Life should be regarded and lived with much imagination.
As the author of these lines and in medical practice for more than 30 years, I have never told a patient: the medical examination cost so and I only gained from this attitude. I have always seen again my patients with a smile and friendship in their eyes.
Writing these lines, I am treating myself, I am learning again what I should change in my way of life, emotionally charged enough.
Bruce and Eileen MacKenzie in the book "It's Not All in Your Head" present the revealing signs of impotence of psychical origin: "Temporary impotence in case of a psychical shock (death, accident of a close person), a prolonged state of depression; you may have sex with your partner but not with anyone else".
The data of the last few years attest that the physical impotence we meet in 50-60% of the men; in 40-50% of cases the cause is represented by a disease like diabetes, hypertension, constipation, etc.
What is the conduct one should follow in case of impotence?
Impotence of a psychical nature is frequently benefited by: psychotherapy, acupuncture, hypnosis, biofeedback (relaxation-induction). The psychologist recommendations include: adoption of a positive attitude, changing of some habits, more effectively and a wish to communicate, avoiding conflicts and independence indecision making. An important percent of physical impotence is treated by the company of an intelligent woman with imagination.
Men should be solved first the cause which determined this aspect. If necessary seek the examination of a sexologist, or/and a physician with training in sexology. Besides the treatment of the diseases it is better for those who present impotence to have also some other knowledge.
It has been discussed much about the so-called aphrodisiac drugs, plants and vegetables (garlic, plums, vitamins). From scientific point of view they have no effect, besides that to stimulate the imagination. The medical world remains skeptic on the efficiency of vitamin E and of ginseng products.
During the treatment with L-Dopa, apomorphine and testosterone, it was noticed an improvement of erection.
Yohimbine and papaverine may induce a satisfactory erection which allow penetration of penis in vagina.
There are physicians who administer with good results injections of papaverine, nitroglycerine and prostaglandine (E) in the penis cavernous body. It is well to have always in mind that any drug administered for impotence has side effects with unknown, non/predictable, and anyhow much less efficiency than the natural recommendations which are not harmful.
Viagra ® is a kind of treatment but in many adult and old people we have to take care.
Since the end of 50's, and the beginning of 60's penis implant operations began to be performed. With good results, the semi-rigid implants of Dr. "Scott", and afterwards those with silicon. The silicon implants, generally, were severally criticized in the later period, and the Food and Drug Administration of the USA imposed a restriction of them.
Human sexual intercourse is more than a simple moment of life of the continuation of the species. It is an expression of strengthening the relation and communication between partners. This supposes a prelude and a period of development. Therefore, a premature ejaculation is more than a harmful experience of the emotional and physical background. The premature ejaculation (a notion difficult to define), means the sperm emission before, or immediately after penis penetration. Premature ejaculation, by its psychologic implications, is one of the frequent causes of total impotency.
This complex intercourse, by education, self-control and the power of will, may be directed and controlled.
Dr. "Jaimes Seamans" adopted a method and he declares that the good results were as a matter of fact 100%. Starting from the fact that in a high percentage ejaculation occurs in about 2 minute in those with precocious expression, the performance can be improved. This method suppose a partner who should induce manually the erection until the point of reaching the ejaculation. To repeat it twice a week, for a month means to correct the speed of reflex. Meanwhile the method was ameliorated.
Orgasms in women is also a complex process, in which the physical component has even a higher prevalence than in man. It supposes a complete psychical self abandonment of women, which the man should understand and appreciate. Frigidity (non-participation of women in sexual intercourse, or to simulate) is physically and psychically determined by environmental factors and by education.
The sexual intercourse implies a lot of details and as I mentioned it is important to maintain the married life.
Sexual education with the approach of different aspects (specially in the conditions of AIDS explosion) is welcome and should be made at all levels: school, university, family.