Men: Troubleshoot Your Sex Life

Follow these 5 steps to improve your sexual vitality and performance as you get older.

Medically Reviewed by Michael W. Smith, MD
6 min read

The Marlboro man just doesn't keep it up like he used to.


On the outside, they may still look like the epitome of the rugged American male -- a man's man. But inside, it's another story: years of cigarettes, liquor, and steak and eggs can do a number both on a man's heartand sexual vitality.


Well, it didn't have to happen. Sure, men experience a drop in levels of the sex hormone testosterone as they age. Many a man finds that they're no longer the young buck, bed-wise, that they were in their randy youth.


But if you're worried that your sexual life is headed off into the sunset as you approach midlife, rest easy. You can maintain -- even boost -- your sexual vitality by making a few smart decisions now.


"Healthy men can have erections at any age," says Michael Castleman, a sex educator and health writer based in San Francisco. "Once you hit about 50, erections change. They are slower to rise, they don't rise from fantasy alone -- you need manipulation and direct sexual stimulation. What happens to a lot of men is that they notice these changes and they flip out and think, 'Omigod, I've reached the end of my sexual road.' Well, things aren't over, they've just changed."


The problem is that most men don't know that many of these changes are preventable. They don't do anything about maintaining sexual vitality until a problem occurs, and by then it's closing the barn door after the horse has bolted, says a leading expert in erectile dysfunction (ED).


"The emphasis in this field has been on the treatment, not on the prevention," says Irwin Goldstein, MD, professor of urology and gynecology at Boston University School of Medicine in Boston, in an interview with WebMD.


As a result, doctors know that several medical conditions are associated with erectile dysfunction. About 40% of men with diabetes have some erectile dysfunction. Problems with erections are also common in men with cardiovascular disease, especially those with angina or after a heart attack. And they can be caused by medications used to treat such conditions as high blood pressure. Many doctors think that reversing these problems would also boost a man's sexual vitality. But they don't know for sure.


Your best bet? Prevent the problems before they affect your sex life.


There is at least one health habit -- exercise -- that has a clear link to sexual vitality, Goldstein says. Among men enrolled in the Massachusetts Male Aging Study, a long-term, community-based study of health and aging, researchers found that men who burned an average of at least 200 calories per day through exercise were far less likely to become impotent over time than men who didn't exercise.

But not all forms of exercise are equal, Goldstein cautions: Men who rode bicycles -- on the road or in the gym -- were nearly twice as likely to be impotent as men in the general population. Researchers chalk it up to continued compression of the nerve and blood supplies to the penis.

The ability to have an erection relies on a complex network of factors, some physical, some psychological. One of the most important factors is healthy arteries. The penis contains an intricate network of tissues that fill with blood during an erection, and if these arteries are blocked by atherosclerosis, there may be trouble in paradise.

"It's incontrovertible that atherosclerosis, the narrowing of arteries because of plaque deposits, begins in youth," Castleman tells WebMD. "The thing is that it usually doesn't cause significant clinical symptoms until guys are in their 40s or 50s. But if you're a man and you're in your 40s or 50s, you can pretty much rest assured that you have some narrowing. Maybe it's not affecting your heart function, but it's there, and the narrowing of arteries doesn't happen just in the coronary arteries of the heart, it happens all over the body, including the pudendal arteries that carry blood into the penis."

Three of the best ways to prevent atherosclerosis and boost sexual vitality down the road are:

  • Cut unhealthy fats from the diet
  • Lose weight if you're overweight
  • Quit -- or better yet, never start -- smoking

"I wish I could buy billboards all around the United States that said 'With every puff (of tobacco), your penis suffers,'" Castleman says.

Erectile dysfunction can also be an unwelcome side effect of many commonly prescribed drugs, as well as some over-the-counter agents and illegal substances, according to researchers.

Talk to your doctor about this possible side effect if you're taking drugs to treat:

Your doctor may advise you to switch to another drug. Or your doctor may suggest taking the drug at a particular time of night when it's less likely to interfere with your sexual vitality.

Substances such as alcohol, anabolic steroids, heroin, and marijuana can also cause impotence, experts say.

There are several treatments for erectile dysfunction. Most of you know about the drug treatments: Cialis, Levitra, and Viagra. But those drugs aren't for everyone.

Other treatments include therapy, penile injections of medications and surgery. Each type of treatment has its own advantages and disadvantages. Talk to your doctor to determine the best treatment for you.

It may be no surprise to women who are reading this, but men who are used to being ruled by their loins rather than their heads need to understand that "sex doesn't just happen in your penis: Lovemaking is a whole-body experience," Castleman says.

"When Michael Jordan takes a jump shot, does he use just his wrist? No. He's using his whole body; everything's got to work together. The way the human body is constructed neurologically is that sexual excitement, sexual arousal is a whole-body experience, and if you focus too much on one part of your body it doesn't work right."

He says that men should have a realistic understanding that after about age 50, erections are slower to rise, and they come and go during love-making.

"After the mid-40s, many men have erections that kind of wax and wane during lovemaking," Castleman says. "It's perfectly normal, and what men need to do is have a little chat with the women in their life and say, 'Look, this is what's happening to me now, and I need more stimulation from you.'"

Originally published May 20, 2003.

Medically updated Oct. 18, 2004.

SOURCES: Irwin Goldstein, MD, professor of urology and gynecology, Boston University School of Medicine. Michael Castleman, sex educator and author, San Francisco. American Family Physician, Sept. 15, 1999. The Primary Care Management of Erectile Dysfunction. Department of Veterans Affairs Veterans Health Administration Publication No. 99-0014, June 1999.