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Sexuality in Later Life

What Causes Sexual Problems? continued...

Diabetes. Many men with diabetes do not have sexual problems, but this is one of the few illnesses that can cause impotence. In most cases medical treatment can help.

Heart disease. Narrowing and hardening of the arteries known as atherosclerosis can change blood vessels so that blood does not flow freely. This can lead to trouble with erections in men, as can high blood pressure (hypertension). Some people who have had a heart attack are afraid that having sex will cause another attack. The chance of this is very low. Most people can start having sex again 3 to 6 weeks after their condition becomes stable following an attack, if their doctor agrees. Always follow your doctor's advice.

Incontinence. Loss of bladder control or leaking of urine is more common as we grow older, especially in women. Stress incontinence happens during exercise, coughing, sneezing, or lifting, for example. Because of the extra pressure on your abdomen during sex, incontinence might cause some people to avoid sex. The good news is that this can usually be treated.

Stroke. The ability to have sex is rarely damaged by a stroke, but problems with erections are possible. It is unlikely that having sex will cause another stroke. Someone with weakness or paralysis caused by a stroke might try using different positions or medical devices to help them continue having sex.

What About Surgery and Drugs?

Surgery. Many of us worry about having any kind of surgery-it is especially troubling when the genital area is involved. Happily, most people do return to the kind of sex life they enjoyed before having surgery.

Hysterectomy is surgery to remove the uterus. It does not interfere with sexual functioning. If a hysterectomy seems to take away from a woman's ability to enjoy sex, a counselor may be helpful. Men who feel their partners are "less feminine" after a hysterectomy may also be helped by counseling.

Mastectomy is surgery to remove all or part of a woman's breast. Your body is as capable of sexual response as ever, but you may lose your sexual desire or sense of being desired. Sometimes it is useful to talk with other women who have had this surgery. Programs like the American Cancer Society's (ACS) "Reach to Recovery" can be helpful for both women and men. Rebuilding of the breast (reconstruction) is also a possibility to discuss with your surgeon.

About 1500 American men develop breast cancer each year. In them the disease can make their bodies make extra "female" hormones. These can greatly lower their sex drive.

Prostatectomy is surgery that removes all or part of a man's prostate. Sometimes this procedure is done because of an enlarged prostate. It may cause urinary incontinence or impotence. If removal of the prostate gland (radical prostatectomy) is needed, doctors can often save the nerves going to the penis. An erection may still be possible. Talk to your doctor before surgery to make sure you will be able to lead a fully satisfying sex life.

Medications. Some drugs can cause sexual problems. These include some blood pressure medicines, antihistamines, antidepressants, tranquilizers, appetite suppressants, diabetes drugs, and some ulcer drugs like ranitidine. Some can lead to impotence or make it hard for men to ejaculate. Some drugs can reduce a woman's sexual desire. Check with your doctor. She or he can often prescribe a different drug without this side effect.

Alcohol. Too much alcohol can cause erection problems in men and delay orgasm in women.

WebMD Public Information from the U.S. National Institutes of Health

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