Weak Erections Or Erectile Dysfunction (ED)?

Most men have no idea that at some point after 40, and usually by 50, their erections start to change. The same men who, from their teen years into their forties, could raise firm erections quickly just by thinking sexual thoughts suddenly find that after 40, fantasies just don’t work anymore, that they need to have their penises stroked or sucked—often vigorously for an extended period—to become erect. And once their erections rise, minor distractions can cause them to wilt—even right in the middle of lovemaking. In other words, when men reach middle age, firm erections can no longer be taken for granted.

Erection Dissatisfaction Vs. Erectile Dysfunction

Most men find this transition very disconcerting. Because so few men see it coming, many jump to the conclusion that they have developed erectile dysfunction (ED), the 21st-century term for what used to be called impotence. For the vast majority of men over 40, this is not the case. ED involves persistent inability to raise erections at all, despite erotic excitement and vigorous penis stimulation. What most men over 40 have is erection dissatisfaction, erections  that are just not as full, firm, and reliable as they used to be. But with enough stimulation—through masturbation or partner sex—erections still rise, though they may or may not be firm enough to accomplish intercourse.

Erection changes after 40 are all the more unnerving because, for most men, they seem to come out of the blue. Most men can recall having to rearrange their underwear to deal with erections that appeared spontaneously for no reason in their youth. But by around 50, those erections are gone, and even when men feel turned on, their erections may be slow to cooperate. It’s as though some wires between their brains and their penises got cut and the connections that were once so predictable—see a naked woman, get hard—just don’t work anymore.

Quick Self-Tests for ED

Are your balky erections normal, age-related erection dissatisfaction? Or true ED?

First, do you wake with morning erections? This does not have to happen every day, nor do morning erections have to be as firm as they were when you were 20. But if you experience morning erections, chances are you have normal, balky over-45 erections, and not ED.

Can you raise an erection by masturbation? Here again, it may take longer to do this than it used to. It may take more effort, more stroking, and more concentration on erotic fantasies. And your erections may not be as firm or persistent as they were 20 years ago. But if you can you raise an erection by masturbation, chances are you have normal, age-related erection dissatisfaction, and not ED.

At Your Doctor’s Office

If you still have questions, it’s prudent to have a complete medical check-up. The years after 40 are the time of life when genetics, bad luck, or decades of less-than-healthy living begin to produce chronic medical conditions: high cholesterol, high blood pressure, heart disease, diabetes, and obesity—all of which can contribute to ED.

Adopt a Healthy Lifestyle

  • If you have high blood pressure, chances are you’re taking blood pressure medication. Some blood pressure drugs increase risk of ED. Talk to your doctor about this. You may be able to switch to medication with a lower risk of sexual side effects.
  • In addition, lifestyle changes can reduce blood pressure considerably and may allow you to reduce your drug dose or stop taking drugs. Two lifestyle changes in particular have been shown to help reduce blood pressure: a near-vegetarian diet based on lots of fruits, vegetables, beans, and whole grains, and daily, moderate exercise, for example, brisk walks for 60 minutes a day.
  • If you have high cholesterol, the same lifestyle changes can help. Or you may need medication. But unlike many blood pressure drugs, cholesterol medication is not associated with ED.
  • If you smoke, ask your doctor for help quitting. Smoking narrows the arteries that carry blood into the penis and contributes to ED. But a few years after quitting, arterial damage heals. (However lung cancer risk remains elevated.)
  • If you’re overweight, ask your doctor for help losing weight. Many men who lose about 10 percent of their weight notice more sexual energy and more cooperative erections. Eating less meat and cheese and daily exercise aids in weight control.
  • If you drink alcohol, consider not drinking for a few hours before sex. Alcohol is a central nervous system depressant that impairs erection. A couple of drinks may not have affected your erections when you were in your twenties. But by 50, even one drink may hit you below the belt. If you drink to excess–more than two drinks a day, or any alcohol binges of four or more drinks at one sitting, ask your doctor for help with controlling your alcohol use.
  • Get regular moderate exercise. Exercise maintains normal arterial function, including the arteries that carry blood into the penis.
  • Avoid diabetes. Adopting all of the above usually does this.

Living Happily with Erections After 40

What young men want to do all night…takes older men all night to do. That’s the basic truth of older erections. They rise slowly, so plan accordingly.

Forget the quickies of your youth. After 40, erections don’t like quickies. Instead, understand that lovemaking after 40 takes more planning and time. This is not a bad thing. In fact, once you get used to the idea, it can be quite enjoyable. Make dates for sex so you know when you’ll be making love. Make an evening of sex, or even a whole day.

To Help Your Erections, Things To Do

  • Spend some quality, nonsexual time with your lover before sex. Have a nice meal. Take a walk. See a movie or video. Pleasant social time together helps men over 40 unwind from the erection-impairing stresses of daily living.
  • Bathe or shower together beforehand. This is also relaxing, and erection-enhancing.
  • Feather your love nest. Young men can have sex almost anywhere—in cars, on hikes, you name it. Men over 40 often need comfortable surroundings. Consider clean sheets, a warm bedroom, candle light, and music.
  • Be patient with yourself. You may not have an erection when you get into bed. That’s okay. Breathe deeply. Enjoy some whole-body, sensual touch. Dream up vivid erotic fantasies. Ask for the kinds of penis stroking you enjoy. And remain patient with your penis. After 40, erections take time—and often a good deal of stimulation—to become firm.

Things To Avoid

  • Don’t drink alcohol for several hours before sex.
  • Don’t rush lovemaking. Give your body all the time it needs. Most women prefer slow, extended sex.
  • Don’t get upset if your erection subsides in the middle of things. For men, this is perfectly normal. Accept it. Getting upset with yourself simply releases stress hormones into the bloodstream that impair erection even more. Relax. Breathe deeply. Get into whole-body sensuality and erotic fantasies. And ask for more stimulation. Your erection should return.

Erection Medication: A Low Dose Might Suffice

Erection medications—Viagra, Cialis, Levitra—were developed to treat ED. But since these drugs have been approved, millions of men who have erection dissatisfaction, not ED, have used them to deal with post-40 balky erections. In fact, these days, more men take erection medication for erection dissatisfaction than for true ED. As long as you have no medical reason to avoid these drugs (use of nitrate medications, notably nitroglycerine for angina), there’s nothing wrong with using them as erection insurance.

If you’re using erection medication for insurance purposes, you may not need the standard dose. At first, try cutting the pills in half. Frequently, half a pill is all that’s necessary to make an erection rise more easily and stay firm. (Pill cutters are sold at pharmacies.) Of course, you may also need the full dose. Over time, many men find they need to increase their dose of erection medication.

However, erections medications have been over-hyped. They may not do much. Even with erection medication, men over 40 may still experience balky erections that subside during sex. Simply use the suggestions already mentioned: Breathe deeply. Enjoy whole-body massage, and exciting erotic fantasies. Ask for stimulation you enjoy. And be patient with your penis. Trust it. Sure, it’s older and a little iffy. But it still works, and you can still enjoy great sex.

If you would like more information about erection issues after 40, consult a sex therapist. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

References:

Aschka, C et al. “Sexual Problems of Male Patients in Family Practice,” Journal of Family Practice (2001) 50:773.

Derby, CA et al. “Modifiable Risk Factors and Erectile Dysfunciton: Can Lifestyle Changes Modify Risk?” Urology (2000) 56:302.

Heiman, JR. “Sexual Dysfunction: Overview of Prevalence, Etiological Factors, and Treatments,” Journal of Sex Research (2002) 39:73.

Kim, SC. “Hyperlipidemia and Erectile Dysfunction,” Asian Journal of Andrology (2000) 2:161.

Laumann, EO. “Sexual Dysfunction in the United States,” Journal of the American Medical Association (1999) 281:537.

Simons, JS and MP Carey. “Prevalence of Sexual Dysfunctions: Results from a Decade of Resarch,” Archives of Sexual Behavior (2001) 30:177.

Wei, M et al. “Total Cholesterol and HDL Cholesterol as Important Predictors of Erectile Dysfunction,” American Journal of Epidemiology (1994) 140:930.

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