Are My Macho Days Over?
Many middle-aged men come to see me, troubled that their macho days are over. Few are cognizant of, or prepared for, the normal changes in the male sexuality that accompany ageing. A large fraction of these men also erroneously believes that age is just a 'state of mind', that chronology has nothing to do with it, and that a man's sexuality remains unchanged even in he seventies and eighties. They thus attribute their present depleted sexual state to stress, or a stale relationship, or a passing phase, without even trying to understand the medical facts. Braggadocio claims made by some impotent oldies who boast that they can have the sex addict every day, only obscure the picture further for others. Several men, even the educated ones, have fallen prey to useless medication in the quack or aphrodisiac market for these reasons. After many years, when nothing has worked, they come to me. Otherwise, the usual joke at parties is, 'Doc, you are one specialist I hope I never have to come to.' The irony is that, despite such resolve, many eventually do. They land up at my office when they have finally come to terms with reality, have realized that this phase just doesn't passage to manhood, and are convinced that aphrodisiacs are not working for them! By this time usually, a lot of water has already flown under the bridge.
So, what are the sexual problems of middle and old age? What can be considered a normal, age-related change, and what is abnormal
Let's talk about normal changes first.
'Tell me,' I finally had a chances to jump in, 'When you do get aroused finally, how are the erection, the performance, and the satisfaction quotient of both partners?'
'Disastrous doc, I just told you. Weak initial rigidity, no sustenance, no ejaculation, no partner orgasm. Everything is a disaster.'
I reassured him and proceeded to explain that sexuality changes with age, and that what he was going through was not unusual, and that millions of men the world over go through the same things. 'After a particular age, men finally learn to think with the right heads,' I tried to light-heartedly reassure him. I was not telling him the whole truth, of course. It is certainly not normal for all elderly men to be totally impotent, but I didn't want to break the bad news to him yet.
I went on to tell Mr Sluggish about the other changes accompanying ageing. One of these, I told him, is the ejaculatory experience. With age, both the intensity and the volume of ejaculation can reduce. This again, is a source of major perturbation for many men. Thus, a man who could proudly squirt his semen a few feet ahead in his heydays, gets a rude shock when the squirt gets reduced to a mere ooze, a drop, or sometimes nothing at all. Besides, he whole ejaculatory experience itself becomes much less intense, and is no longer 'mind-blowing' or 'earth-shattering' like it used to be. In fact, quite often, the middle-aged man is content not ejaculating at all, and actually abandons coitus without doing so even though his erection is good. The overpowering urge to release pent up sexual tension and semen is simply no longer there. This actually perplexes both him, and his partner, but is again just a variation of the normal. Some years ago, such a sexual response would have been unthinkable to the same man. The vascular congestion of the sexual the better diet organs consequent upon sexual arousal in both the sexes is so severe in younger ages, that not attaining climax can actually cause congestive pains in the genital regions and other symptoms elsewhere. Many young men who lack sexual opportunity and who believe that masturbation is harmful and cause weakness, chronically suffer from such pains. Sexual release is the only cure for this.
However, all this changes considerably as the man ages.
With age, the angle of the erection also changes. In young boys and young men, erections are nearly vertical and almost touch their lower abdominal walls. With age, the 'angle of the dangle' reduces, and you can be said to be doing well if the erection is at or just above the horizontal. Of course, it goes without saying that you are in deep trouble and need urgent help if your aroused apparatus points to the ground. If it's limp as well, then that would constitute a really major dual fiasco.
There are other hormone-related changes in the ageing male too. These affect various organ systems in the body and are clubbed together under the term 'andropause' or 'male menopause'. This is discussed in another chapter.
It is important that more men understand these bodily changes and come to terms with a sexuality that is age appropriate. Too many men are either needlessly languishing in misery or trying to compensate for their waning manhood by posing as macho studs in their middle age. Remember, even top level athletes and sportsmen in many fields retire when they are only in their twenties and thirties. Physical fitness always fades after a particular age. It is inevitable.
You must be wondering what happened to Mr Sexually sluggish. Well, I conducted some tests on him. these revealed that he did not have any major medical condition like diabetes, high blood pressure, high cholesterol or very low testosterone, but he did have considerably reduced blood flow to his penis. I tried the new wonder drugs on him but they worked only partially. I finally suggested a surgery, which gives excellent results, but, like many Indian men, he is petrified of the scalped and is taking his own time to make up his mind. Meantime, he is using a vacuum device (an external device used to induce erection), with the help of which he seems to be doing at least something.
I hope that many of you are feeling much better now, after reading all this. You may now put away your protractors!
Take Home Message:
Male sexuality goes through different phases as a man ages. Unfortunately, on account of various prevailing myths and misinformation, these phases are very poorly understood. A correct understanding of what constitutes age-appropriate sexuality, and what constitutes an andrological diseases state is important so that one may take timely action if necessary. Since both venereal disease states and physiological changes can co-exist in middle age and beyond, it is important to recognize the vas deferens between men and women . Physiological changes are to be lived with, whereas pathological states will require treatment.