Sexual Function in Older Men and the Role of Physical Therapy

Men over the age of 40 know that testosterone gradually declines as they age. Fear not—this is perfectly normal. Still, sexual dysfunction causes side effects that can be distressing for men as well as their sexual partners. If you’re an older man, you should be able to experience healthy sexual function for many years to come, although it may take some support at different stages.

What can men expect as they age?

The natural decline of testosterone in men causes decreased testicular function. In daily life, this often manifests as:

• Lower sexual interest in general.
• Feeling less arousal or requiring more stimulation to get aroused.
• Less success at achieving an erection and ejaculating.

More aging complications

Chronic diseases like diabetes, high cholesterol and high blood pressure add to performance difficulties. On top of that, in managing chronic diseases patients often discover that sexual dysfunction is a common a side effect of certain medications used to treat the diseases.

All these changes can lead to relational dissatisfaction for both partners, creating unnecessary distance and frustration in the relationship. You may find it increasingly difficult to sustain a satisfying, intimate relationship. In addition, you may feel ashamed to bring up sexual dysfunction to your doctors.

“I’ve had patients wait 25 years before bringing up sexual problems to their doctor!” says Dr. Patrick Donovan, owner of Heather Lane Physical Therapy in Denver. And many doctors will not introduce sexual function into the discussion, either. So if you want medical help, you may have to reach out. Your primary care physician (PCP) can assist with medications for more simple cases. A PCP will determine whether a specialist is indicated to create an individualized treatment plan to meet your needs.

Treatment options for sexual problems

Options to treat low testosterone or trouble with sexual function include:

• Testosterone supplements. While supplements improve sexual function for many men, they may carry negative side effects.
• Erectile dysfunction drugs. These can help short-term but do not solve the overall problem, and they are not recommended if you suffer from certain cardiovascular diseases. Dr. Donovan says, “If you struggle with sexual performance issues, your doctor will build a plan around medications, testosterone supplementation or a combination of both.”
• Physical therapy. A physical therapist can design a program to build your peripheral muscles, which will improve your body’s ability to manage blood flow. That can help sexual performance. It has not proven, however, to raise testosterone levels.
• Boosting General Health. Exercise and a good diet make a difference with everything going on in your body, including sexual function. Find a workout routine that is fun and not too strenuous, and eat well! “I encourage my older men to try a plant-based diet and pursue regular, moderate-intensity exercise,” Dr. Donovan says.
• Improving sleep. Poor sleep is associated with sexual dysfunction. You should aim for at least 7 hours of sleep each night.
• Working on your relationship. Sexuality isn’t the only dynamic of a relationship and, in fact, you are more likely to experience sexual dysfunction if your relationship is already struggling. You and your partner can try to spend more positive, quality time together or see a counselor to work through issues.

You aren’t powerless to deal with the loss of sexual appetite and physical function that comes with age. When you’re proactive, you should be able to find a way to stay sexually active as long as you desire to do so.

Citations
Andrews, C. N., & Pieterman, L. (2007). Sex and the Older Man: GP Perceptions and Management. Australian family physician, 36(10), 867-869.
https://www.racgp.org.au/afpbackissues/2007/200710/200710andrews.pdf

Cho, J. W., & Duffy, J. F. (2019). Sleep, Sleep Disorders, and Sexual Dysfunction. The world journal of men’s health, 37(3), 261–275. doi:10.5534/wjmh.180045

Decaroli, M. C., & Rochira, V. (2017). Aging and sex hormones in males. Virulence, 8(5), 545–570. doi:10.1080/21505594.2016.1259053

Ivanov, N., Vuong, J., & Gray, P. B. (2018). A Content Analysis of Testosterone Websites: Sex, Muscle, and Male Age-Related Thematic Differences. American journal of men’s health, 12(2), 388–397. doi:10.1177/1557988317734667

Walther, A., Mahler, F., Debelak, R., & Ehlert, U. (2017). Psychobiological Protective Factors Modifying the Association Between Age and Sexual Health in Men: Findings From the Men’s Health 40+ Study. American journal of men’s health, 11(3), 737–747. doi:10.1177/1557988316689238