Medical Matters

Courtesy of My Generation.

It’s not unusual for both men and women to experience sexual problems in their latter years, but many of these issues can be easily fixed,

Dr Janet Say, Sexual Health Physician with the Auckland Sexual Health Service, blames hormonal changes in menopause for creating havoc in many women’s sex lives. She suggests all women over 50 should be using a good quality lubricant.   

“As oestrogen levels drop, the thickness of the mucus membrane of the vagina is reduced from about 25 cells down to as low as six and there’s a lack of natural lubrication. This discomfort can cause lots of stress when women do not understand the cause as many cannot tolerate sexual activity.  In some cases it leads to reflex vaginismus when the pelvic floor muscles tighten like a closed door.”

She points out that local oestrogen,  such as.Ovestin cream (which must be prescribed by a doctor), can have excellent results with major improvements in the lining. “The oestrogen in the vagina leads to only minute amounts, nanograms, absorbed into the bloodstream so it is not an HRT treatment as such. Women who have had breast and ovarian cancer often use it but should check with their doctor first. It really can change relationships and lives.”

Dr Say also stresses the importance of “careful partner selection” in new mid-life relationships. ”STDs can still be a problem and condoms should be used. Many new couples insist on a check at a sexual health clinic – a sort of WOF for a new partnership.”

The erectile dysfunction drugs have helped many men, but Dr Say warns it’s important for couples to decide about use. “Suddenly some women have to get used to a rampant male again after thinking their sex life was over – it has to be a mutual decision.”

Fit older men can expect to continue to be sexually active, but should heed the safe sex message because many of the common sexually transmitted diseases – such as herpes and warts – are not easily diagnosed, GP Dr Warrick White cautions.

He has extensive experience in managing male sexual dysfunction with a clinic specifically for this purpose. He also sees men in his general practice and believes this is where most of these problems should be managed.

Dr White has treated men up to 88 years old and points out sexual difficulties embrace a much broader spectrum of problems than poor erections or premature ejaculation. These also cover a raft of issues ranging from sexual drive to bends or lumps in the penis.

He says men with sexual dysfunction should initially exclude the possibility of significant disease. “ Your GP can do this and perhaps start with some sensible advice or direct you to a more appropriate practitioner, counsellor or therapist.”

The main medical problems that can disrupt sex lives are alcohol, cigarettes, diabetes, hypertension and trauma (especially surgery)  relationship issues, work or family stress.   He also strongly advises men to talk to their GPs about any drug requirements and refrain from Internet ordering.

Dr White’s main area of interest is re-establishing sexual function after invasive abdominal surgery – especially for prostate cancer. “These men can nearly always return to function and the treatment should be commenced soon after the operation within two to three months.”

Following a period of celibacy (often following a divorce of the death of a partner), men can have some difficulties. “But, in the absence of other disease, some counselling and/or a short course of medication may get the new relationship back on track.

“It’s often just because you are out of practice. No one would go back and play tennis in the A grade after five years on the side line.”