Are You "Man" Enough?

Don’t let the flame go out of your sex life just because age is catching up.

Erectile dysfunction. Decreased sex drive. Urinary problems.

These are some of the top conditions seen in recent years by urologists practising at SGH Urology Centre and other clinics in Singapore. Although these problems may be due to reasons such as financial or relationship stresses, andropause – a condition brought about by declining levels of the male hormone, testosterone – can also result in sexual problems with the advent of middle age.

“It is not necessarily a mid-life crisis, but rather an actual physical decline of the body,” said Dr Ng Kok Kit, Consultant Urologist at Changi General Hospital. “For older couples, it is important to understand how ageing affects both partners and that they should accommodate each other’s limitations.”

Sexual woes

Doctors interviewed agree that sex-related problems such as erectile dysfunction, impotence and reduced libido rank among the top concerns that middle-aged men seek treatment for. How one copes with ageing depends on one’s personality.  “As a man ages, one of the first things he notices is that he has poorer erections.  But the sexual act is not the end in itself.  One can still take time to enjoy romance and foreplay,” said Dr Ng.

A matter of perspective

Solving age-related sexual problems requires a change in perspective, said Dr Ng Beng Yeong, Senior Consultant Psychiatrist and Head of the Department of Psychiatry at Singapore General Hospital, who has been managing patients with sexual concerns for more than six years. He believes that there is a wide range of sexual performance levels for men and they can feel satisfied with their sexual experiences even in old age. 

“Sex is not a question of function or dysfunction, or whether you can do it or not.  No single definition for ‘normal’ or ‘abnormal’ sexual function applies universally,” he said. Not to mention the number of misconceptions that exist, especially when it comes to erectile dysfunction drugs.

He added: “Many people have the mistaken belief that after taking a drug like Viagra, they will spontaneously have an erection.  For the drug to be effective, a couple needs to engage in foreplay and very often, direct stimulation to the penis is required.”

Medical solutions

At present, the most common treatments for erectile dysfunction include taking drugs such as Viagra, Levitra or Cialis under medical supervision.  The most drastic treatment is a surgical procedure which involves inserting a penile implant.

Reduced libido caused by a lack of testosterone can be confirmed with a blood test and treated with testosterone supplements. The treatment can be given in an oral form or via a series of injections, with regular follow-ups to ensure that the patient’s testosterone is replaced adequately and safely.

Prevention is better than cure

The effects of ageing are evident, even in fit, young men, as revealed in autopsies of casualties from the Vietnam War. Thus, it is important to have a well-balanced lifestyle – physically, emotionally and financially – as it is the first step towards graceful ageing and a healthy sex life. If you have any chronic medical problems such as diabetes, hypertension, hyperlipideamia and depression, they need to be managed well so as to prevent long-term complications.

Experts warn against drug and alcohol abuse, as these have a toxic effect on the nervous system, damaging nerves that are critical to sexual desire.  Smoking causes early atherosclerosis (which leads to premature erectile dysfunction and is also associated with heart attacks, strokes and many cancers) and should be avoided.

Exercise regularly to improve your self image (which increases desire and boosts sex hormones) and promote healthy blood vessels (which means delaying the onset of erectile dysfunction). On the emotional front, focus on relationships with important people in your life and let go of past grievances. Also, be mentally and financially prepared for retirement.  If one enters the golden years possessing financial stability, companionship and meaningful hobbies, one will be well equipped to lead a more fulfilling life in the later years.