Sex and aging – Men’s issues

Will sex change as you get older?

The issues surrounding sex in older people are still not openly discussed. Older people have been stereotyped as asexual and devoid of feelings or emotion, but this of course is wrong. The way people express themselves sexually varies widely. While sex in older couples is likely to be different to that in younger couples, it doesn’t have to be any less pleasurable.

Today men and women are living longer, healthier lives. As a result of this improvement in health, many older couples continue to enjoy intimacy and sex. A global study showed that sexual desire and sexual activity are common in middle-aged and elderly people of both sexes and these continue into old age. Over 80% of men and 65% of women aged 40-80 years had had intercourse in the last year. However, sexual problems were common in both sexes and few people sought help for these.

Older couples who have been in long-term relationships do not necessarily find it easier than anyone else when it comes to discussing sexual difficulties (see our factsheet ‘Explaining sexual problems to your GP’).

Will you still be able to have sex as you get older?

The ageing process causes many normal changes in the body, some of which affect sexual desire (‘sex drive’) and response. But sexuality extends beyond the genitals. Often couples can find new ways to stimulate each other, such as reading erotic literature or watching erotic videos. Being able to talk to your partner and discuss sexual desires, fantasies and experimentation is important.

Some men may notice that it takes them longer to get aroused (‘turned on’) and develop an erection, and their erections may not seem as hard. The sensation of ejaculation may be reduced, the orgasm may not feel as powerful as it once did, and smaller amounts of semen may be produced. The length of time between erections can increase and just thinking about sex may no longer be enough. Reduced sensitivity may mean more direct physical stimulation of the penis is required for a longer time. Ejaculation may take longer to achieve, but this can be a positive side of getting older as it may give more satisfaction to the partner. While some men may notice that their desire for sex reduces with age, others may remain sexually active throughout their life.

If you are finding it more difficult to get and keep an erection, you are not alone. Half of men between the ages of 40 and 70 years will experience this to some degree. However, help is available. Your GP may be able to prescribe one of the oral drugs (tablets) that can help erectile dysfunction (ED), known as phosphodiesterase (pronounced phos- pho- di- es- ter- ase) inhibitors (PDE5i). If these drugs do not work or are not suitable for you, there are other options available, such as penile injections, urethral pellets, topical creams, vacuum pump devices and surgical implants (see our factsheets ‘Oral treatment for erectile dysfunction’, ‘Injection, urethral and topical treatments for erectile dysfunction’, ‘Vacuum pump treatment for erectile dysfunction’. You may also want to consider sex therapy (see the following section on ‘Sex therapy’). Do not buy drugs online, as they may be fakes!

Does illness affect sex?

Yes, it can. As people grow older, they are more likely to experience disabling conditions and illnesses that can affect their sex lives. These may have physical effects (in the body) and psychological effects (in the mind).

Painful physical problems like arthritis may make it difficult to find a comfortable position for having sex. Neurological problems such as Parkinson’s disease may reduce sexual desire and cause erectile problems, as may some drugs. Diabetes may also cause erectile difficulties.

The psychological effects of illness can also affect sexual function, especially if a life-threatening or life-limiting illness has been diagnosed, or the illness affects a person’s appearance and/or self esteem. Cardiovascular problems such as high blood pressure, heart disease or a previous stroke may make you nervous about having sex.

Illness can also change a couple’s relationship in other ways, as previously independent people become dependent on their partner/carer. One partner may feel it is inappropriate to still have sexual desire if their partner is ill. While for many carers, the sheer stress and exhaustion of the role may reduce their desire. Lifestyle can also affect how you see yourself. Retirement and children leaving home is viewed by some as an end of a chapter in their lives, whereas for others it can mean the freeing up of time for each other.

Lifestyle factors can also play a part. Smoking, excessive alcohol consumption, recreational drug use, poor diet and a lack of exercise can all contribute to sexual problems.

If you find that illness is preventing you from enjoying sex with your partner, it is sensible to see your GP. They should be able to offer you help and advice or refer you for sex therapy (see the following section on ‘Sex therapy’).

If you are a widower: Is it wrong to look for love again?

We all need to be loved and wanted, and these needs do not lessen over time. However, you may find you are looking for a different kind of relationship than when you were younger. You may just require companionship and someone to share your favourite TV programmes with. If you are looking to rekindle your love life you may feel awkward and embarrassed, not knowing where or how to start. These are perfectly normal feelings, particularly if your partner had a long illness, or you have feelings of guilt and betrayal. It will help to talk to someone about those feelings. To help you to move forward in a new relationship, you may like to speak to your GP or contact a sex therapist (see the following section on ‘Sex therapy’). When sexuality is affected, it is often a matter of learning to adapt and adjust rather than accepting an end to all forms of sexual expression.

If you are embarrassed to seek help: What can you do?

The only person who will find this embarrassing is you. You have nothing to be afraid of and everything to gain by seeking help. Discussing sex later in life can sometimes be difficult, but there is no reason to think that because you are older, you cannot use all the services that are available to younger people. Sex is not abnormal after middle age and for many individuals it does not stop just because they are no longer able to conceive a child. Older age should not prevent you from seeking or receiving help from whatever source is most suitable for you. If you don’t want to discuss sexual problems with your GP, you can see a sex therapist (see the following section on ‘Sex therapy).

What is sex therapy?

Sex therapy is talking therapy where an individual or couple work with an experienced therapist to assess and treat their sexual and/or relationship problems. Together they will identify factors that trigger the problems and design a specific treatment programme to resolve or reduce their impact.
Sex therapy is considered highly effective in addressing the main causes and contributing factors of sexual difficulties. And it helps people to develop healthier attitudes towards sex, improve sexual intimacy, become more confident sexually, and improve communication within the relationship.

Sex therapy can also be used in combination with other forms of treatment.
Your GP or another health professional on the NHS may be able to refer you for sex therapy (depending on area), or you can contact a therapist directly and pay privately. It is important to make sure that they are qualified and are registered with an appropriate professional body. You can find more information on sex therapy in our factsheets ‘Sex therapy’ and ‘How to find, choose and benefit from counselling support’

What is the Take Home Message?

Sex is likely to change as you age but it does not necessarily need to stop – seek help if you need it

Where can you get more information?

The Sexual Advice Association is here to help. We cannot give individual medical advice, but we can answer your questions on any sexual problems and put you in touch with local specialist practitioners. We also have a number of factsheets and booklets on sexual problems and related issues for men and women that can be downloaded from our website or requested. Please feel free to email us or phone our Helpline (our contact details are at the bottom of this page).

You can also visit the NHS Choices website at www.nhs.uk for information and advice on many different health and lifestyle topics.

Further reading

For more information download or request our factsheets ‘Erectile dysfunction’ and ‘Sex and the psychology of growing older’ and/or our booklet ‘Sex and growing older – Men’

Donate

By donating to the Sexual Advice Association, you will know that you are helping improve the lives of people living with sexual problems. If you are interested in donating, please click here or contact us for more information (details at the bottom of this page).

Thinking About Sex Day: February 14th

Launched by the Sexual Advice Association, Thinking About Sex Day (TASD) is designed to encourage everyone to think about the physical and psychological issues surrounding sexual activity.

Lack of sexual desire and/or arousal

What are sexual desire and sexual arousal?

Sexual desire (also known as ‘sex drive’ or ‘libido’) is controlled by the brain. It is the biological, driving force that makes us think about sex and behave sexually.

Sexual arousal (being ‘turned on’) involves a number of changes in the body. These include increased blood flow to the vagina, increased vaginal lubrication, swelling of the external genitals or ‘vulva’ (including the opening of the vagina, the fleshy lips surrounding this and the clitoris), and expanding of the top of the vagina inside the body. The heart rate, breathing and blood pressure also increase.

How do these differ between men and women?

The sexual response cycle has been described as a 3-stage process in men and women: desire, arousal and orgasm. However, this may not be so straightforward in women for a number of reasons. Many women do not move through these stages in a step-wise manner (for example, some women may become sexually aroused and achieve orgasm as a result of a partner’s sexual interest, but did not feel sexual desire beforehand). And some women may not experience all the stages (for example, they may experience desire and arousal but not orgasm.)

While many women feel desire when starting a new sexual relationship or after a long separation from a partner, those in long-term relationships may not think about sex very often or feel spontaneous desire for sexual activity.
The goal of sexual activity in women may not necessarily be physical satisfaction (orgasm), but rather emotional satisfaction (a feeling of intimacy and connection with a partner). Having sex to maintain a relationship, to prevent the partner from being unfaithful, may be another motivation.

Psychological factors (in the mind) may play a major part in female sexual functioning. Examples include relationship issues, self-image, and previous negative sexual experiences.

What is a lack of sexual desire and/or arousal?

A lack of sexual desire (also known as a lack of ‘sex drive’ or ‘libido’), is a lack of interest in sexual thoughts and sexual activity. A lack of sexual arousal (not feeling ‘turned on’) is a lack of response to sexual stimulation, which is felt in the mind and/or the body. In the body this may include a lack of vaginal wetness and/or a lack of swelling, tingling or throbbing in the genital area. A lack of sexual desire and a lack of sexual arousal often occur together, and treatment of one often improves the other. For this reason, these conditions are now usually considered together.

Symptoms of a lack of sexual desire and/or arousal may include:

  • Reduced or no interest in sexual activity
  • Reduced or no sexual or erotic thoughts or fantasies
  • Not wanting to start sexual activity or respond to a partner’s attempts to start it
  • No triggering of sexual desire with sexual or erotic stimulus (read, heard or seen)
  • Reduced or no feelings of sexual excitement or pleasure during sexual activity
  • Reduced or no feeling in the genitals or other areas during sexual activity

Many women may experience a temporary reduction in sexual desire and/or arousal at some point in their lives. This is particularly common during or after pregnancy, or at times of stress, and does not usually cause too much of a problem. However, if these symptoms continue long-term, are present all or most of the time, and/or cause you distress, then you should see your doctor for advice.

What are the causes?

A lack of sexual desire and/or a lack of sexual arousal may be caused by physical problems (in the body), psychological problems (in the mind) or a mixture of both.

A lack of sexual desire and/or a lack of sexual arousal may be associated with a number of physical problems. These include diabetes, hormone deficiencies (low oestrogen or testosterone), urinary incontinence, arthritis, nerve problems (e.g. spinal cord injury, multiple sclerosis) and the effects of some prescription medicines (including some that affect mood and behavior, e.g. antidepressants, some used to treat conditions of the heart or blood vessels, e.g. antihypertensives, and some that affect the hormones, e.g. Tamoxifen and combined oral contraceptives).

A lack of sexual desire may also be associated with high blood pressure, Parkinson’s disease, dementia and schizophrenia. While a lack of sexual arousal may also be associated with disease of the arteries (atherosclerosis), thyroid problems, surgical procedures and radiotherapy to the genital area, pelvis or lower abdomen/tummy, as well as frequent urinary tract or vaginal infections and vaginal skin conditions.

Psychological issues that may cause or contribute to a lack of sexual desire and/or a lack of sexual arousal include depression, anxiety, relationship problems, sexual dysfunction in the partner, unrewarding sexual experiences, low self-esteem, negative body image and a history of sexual abuse, violence or humiliation.

How are they diagnosed?

Your doctor will probably ask you about your desire/arousal problem, your lifestyle and any other medical and/or psychological issues. They might need to examine you to see you have any obvious physical cause/s for the problem. This may include examination of your external genitals or ‘vulva’. They may also examine the inside of your vagina with gloved fingers and/or a speculum (a plastic instrument which is inserted into the vagina and gently widened to allow better visual examination).

Your doctor may want to do a ‘swab’ or urine test to check for infection. A ‘swab’ is where a kind of cotton bud on a long stick is rolled over the skin on the inside or the outside of the vagina to collect discharge or skin cells and then sent away to the laboratory to see what bacteria are present. They may also want do blood tests to check your hormones/general health.

If your doctor is not confident in diagnosing or treating you, or they think you require more tests, they may refer you to a gynaecologist or other specialist at your local hospital.

How are they treated?

If a lack of sexual desire and/or a lack of sexual arousal is caused by a medical problem, this should be treated appropriately.

You can find more information on diabetes in our factsheet ‘Sex and diabetes in women’

If reduced levels of the hormones oestrogen and/or testosterone are responsible, you may benefit from hormone replacement therapy (HRT). If vaginal dryness is a problem for you, this may be helped with a vaginal lubricant or moisturiser. You can find more information on HRT, vaginal dryness, and vaginal lubricants and moisturisers in our factsheet ‘Vaginal dryness and the menopause’.

If the effects of a prescription medication are causing the problem, your doctor may be able to reduce the dose or switch the medication.

You can find more information on urinary tract infections, vaginal infections and vaginal skin conditions in our factsheet ‘Pain during/after sex’.

Flibanserin (addyi™) is a new drug for treating low sexual desire. It has to be taken every day and should not be combined with alcohol. It was approved for use in the United States in 2015 but has not been approved for use in the UK yet. Women should always see their doctor before using this medication to ensure there are no health or medical concerns contributing to the symptoms

If psychological problems are causing or contributing to your problem, they may be best treated with sex therapy (see the following section on this). Depression, however, may need medical treatment. It is important that you see your doctor so they can investigate the cause of your problem and check if you have any health problems that require medical treatment.

How might you help yourself?

Once you have seen your doctor to find out what is causing your problem and have received treatment for this if required, you may be able to help yourself increase your sexual desire and/or arousal.

If you are willing to engage in sexual activity, it may allow you to become aroused, which in turn may make you feel desire. You are more likely to want to be sexually active again if your last experience was positive, physically and/or emotionally.

If you find sex unrewarding, this may be because you and/or your partner lacks skill or because your partner doesn’t know what you like. One of the best things you can do is tell your partner what you ’turns you on’, and where and how you like to be touched.

If you need help learning what ‘turns you on’, there are many sexual or erotic materials easily available online, including books, DVDs, vibrators, clitoral stimulators, erotic games and lingerie. If you lack sexual desire and/or arousal, you may have no interest in self-masturbation (pleasuring yourself). However, this may help you become more knowledgeable about your body, learning where and how you like to be touched.
If vaginal dryness is an issue for you, increasing the amount of foreplay and delaying penetration until you are really ‘turned on’ may help increase vaginal lubrication and make things more comfortable and enjoyable.

If your partner often ejaculates or ‘comes’ before you do, and sex usually stops at this point, you could ask them to continue to stimulate you with their hand or mouth. They will probably enjoy being able to please you.

Some women find it difficult to concentrate during sex. If this applies to you, fantasizing about something sexual may excite you and reduce any negative feelings. If you are close to orgasm, alternately tightening and relaxing your pelvic floor muscles may help you get there.

What is sex therapy?

Sex therapy is talking therapy where an individual or couple work with an experienced therapist to assess and treat their sexual and/or relationship problems. Together they will identify factors that trigger the problems and design a specific treatment programme to resolve or reduce their impact.

Sex therapy is considered highly effective in addressing the main causes and contributing factors of sexual difficulties. And it helps people to develop healthier attitudes towards sex, improve sexual intimacy, become more confident sexually, and improve communication within the relationship.

Sex therapy can also be used in combination with other forms of treatment. Your GP or another health professional on the NHS may be able to refer you for sex therapy (depending on area), or you can contact a therapist directly and pay privately. It is important to make sure that they are qualified and are registered with an appropriate professional body. You can find more information on sex therapy in our factsheets ‘Sex therapy’ and ‘How to find, choose and benefit from counselling support.’

What is the Take Home Message?

A lack of sexual desire and a lack of sexual arousal often occur together, and treatment of one often improves the other

Where can you get more information?

The Sexual Advice Association is here to help. We cannot give individual medical advice, but we can answer your questions on any sexual problems and put you in touch with local specialist practitioners. We also have a number of factsheets and booklets on sexual problems and related issues for men and women that can be downloaded from our website or requested. Please feel free to email us or phone our Helpline (our contact details are at the bottom of this page).

You can also visit the NHS Choices website at www.nhs.uk for information and advice on many different health and lifestyle topics.

Further reading

Download or request our factsheets ‘Problems with orgasm’ and/or ‘Explaining sexual problems to your GP’

Donate

By donating to the Sexual Advice Association, you will know that you are helping improve the lives of people living with sexual problems. If you are interested in donating, please click here or contact us for more information (details at the bottom of this page).

Thinking About Sex Day: February 14th

Launched by the Sexual Advice Association, Thinking About Sex Day (TASD) is designed to encourage everyone to think about the physical and psychological issues surrounding sexual activity.

Problems with orgasm

What are orgasms?

An orgasm (also called ‘coming’ or ‘climaxing’) has been described as an intense and pleasurable release of sexual tension that had built up in the earlier stages of sexual activity.

When a woman has an orgasm, her heart rate, breathing and blood pressure increase. The muscles in her feet may spasm, her genital/pelvic muscles may contract and a rash/flush may appear on her body. A small number of women ejaculate when they orgasm, where a clear fluid spurts from the glands close to the urethra (tube trough which you pass water). Orgasms are often followed by a feeling of relaxation.

However, it is important to remember that orgasms are very personal things, how they feel and how they happen varies greatly between women. They may not be an earth-moving experience for everyone and they may not happen every time a woman has sex.

In women, orgasms may occur through different sensory mechanisms, but the two most important are stimulation of the external genitals or ‘vulva’ (particularly the clitoris) and stimulation of the internal pelvic area and vaginal walls. So foreplay is important.

What are problems with orgasm?

Problems with orgasm include never having an orgasm, infrequent orgasms, delayed orgasms and a reduction in the strength of orgasmic sensations. Orgasms may also be painful. While some women don’t need to have an orgasm to enjoy sex, this may be a real issue for others and their partners.  Women who feel very aroused but do not orgasm may feel ‘nervous’ or edgy’ or experience an aching or discomfort in their pelvis.  A problem with orgasm may have always been there or it may have developed later in life.

How common are they?

Problems with orgasm are very common and may affect more than 20% of women.

How are they caused?

Orgasm problems have been associated with a number of physical and psychological factors. Physical factors relate to the body, while psychological factors relate to the mind.  Women who could orgasm in the past but now cannot, may have a medical and/or psychological problem. While those who have never had an orgasm may have a medical and/or psychological problem, or they may simply have never learnt what type and duration of stimulation they need to achieve one.

Physical factors include:

  • Diseases of the heart or blood vessels (cardiovascular disease (CVD))
  • Nerve problems (e.g. multiple sclerosis, Parkinson’s disease, spinal cord injury, those caused by diabetes)
  • Problems in the pelvis (e.g. fibroids, pelvic inflammatory disease, weak pelvic floor muscles)
  • Problems affecting the external genitals or ‘vulva’ (e.g. provoked vulvodynia)
  • Hormonal problems (e.g. low oestrogen, testosterone or thyroxine)
  • Side effect of prescription or recreational drugs (e.g. some types of antidepressant, antipsychotics, anticonvulsants, beta-blockers, cocaine, marijuana, amphetamines and heroin)
  • Drug or alcohol abuse

Psychological factors include:

  • Age
  • Education
  • Cultural background or religion
  • Negative attitude towards sex
  • Sexual abuse/violence
  • Fear of pain during sex
  • Relationship problems
  • Depression
  • Low self-esteem
  • Negative body image
  • Poor communication

Physical causes are more likely if an orgasm problem develops suddenly, while psychological causes are more common in long-term or life-long orgasm problems.

Painful orgasms may be caused by certain medical conditions or changes in body structure or function. These include painful uterine contractions occurring in the last 6 weeks of pregnancy or as a result of an ill-fitting intrauterine device (IUD), and increased tone of the pelvic floor muscles (seen in conditions which affect the nerves e.g. stroke, spinal cord injury and multiple sclerosis.)

Orgasm problems can affect women of any age. Older and younger women may have different advantages when it comes to achieving orgasm – while older women may have more sexual experience and knowledge of their own body, younger woman have more sexual desire (also known as ‘sex drive’ or ‘libido’).

Some studies suggest that women with a higher level of education are more likely to have orgasms. This may be because they are more knowledgeable about their bodies and how they work, and have greater access to information about sex and general health.

Depression may affect sexual desire and sexual arousal (feeling ‘turned on’), which may in turn affect orgasm (see our factsheet ‘Lack of sexual desire/arousal’). Anxiety may create a vicious circle where a woman does not focus on the act of sex because she’s distracted by concerns about reaching orgasm, which in turn makes her less likely to orgasm, and results in her becoming even more anxious and even less likely to orgasm.

Some women may be able to orgasm through self-masturbation (pleasuring themselves) but not with their partner. This may be due to a partner’s poor sexual technique, the partner ejaculating (‘coming’) too quickly, a lack of trust, or a lack of communication about where and how the woman likes to be touched.

How are they diagnosed?

Your doctor is likely to ask you about your orgasm problem, your lifestyle and any other medical and/or psychological issues. They will almost certainly need to examine you, to see you have any obvious physical cause/s for the problem. This is likely to include examination of your external genitals or ‘vulva’, which includes the opening of the vagina, the fleshy lips surrounding this and the clitoris. They may also need to examine the inside of your vagina with gloved fingers and/or a speculum (a plastic instrument which is inserted into the vagina and gently widened to allow better visual examination). Blood tests may be required to check for hormone or other problems.

If your doctor is not confident in diagnosing or treating you, or they think you require more tests, they may refer you to a gynaecologist or other specialist at your local hospital.

How are they treated?

At present in the UK, no medication is approved specifically for treating orgasm problems in women. If an orgasm problem is caused by a medical problem, this should be treated appropriately.

You can find more information on diabetes in our factsheet ‘Sex and diabetes in women’.

If you have weak pelvic floor muscles, increasing their strength may improve your ability to orgasm. You may be able to do this yourself with special exercises (see our factsheet ‘Kegel exercises’). If not, you may need the help of a physiotherapist. If your doctor thinks physiotherapy may help you, they can refer you for this on the NHS. Alternatively, you may be able to self-refer and arrange to see an NHS physiotherapist without going through your doctor (depending on area).You can also pay to see a physiotherapist privately (check that they have experience of treating your problem, they are fully qualified, and they are registered with both a recognised professional body, such as the Chartered Society of Physiotherapy (CSP), and the Health and Care Professions Council (HCPC).

Vulvodynia is covered in more detail in our factsheet ‘Pain during/after sex’.

If reductions in the hormones oestrogen and/or testosterone are responsible for your orgasm problem, you may benefit from hormone replacement therapy (HRT). You can find more information on HRT in our factsheet ‘Vaginal dryness and the menopause’. Thyroid problems resulting in low levels of thyroxine can be treated with medication.

Treating substance abuse should help improve the symptoms if this is causing the problem.

If an orgasm problem is caused by the side effects of a prescription medication, your doctor may be able to reduce the dose or switch the medication.

If psychological problems are causing or contributing to your orgasm problem, they may be best treated with sex therapy (see the following section on this).  Depression, however, may need medical treatment. It is important that you see your doctor so they can investigate the cause of your problem and check if you have any health problems that require medical treatment.

How might you help yourself?

Once you have seen your doctor to find out what is causing your problem and have received treatment for this if required, you may be able to improve your ability to have an orgasm yourself.

Women who find it difficult to orgasm may have no interest in self-masturbation. However, this may help them become more knowledgeable about their bodies, learning where and how they like to be touched. If you want to try helping yourself increase your sexual desire/arousal, or experiment to find out what helps you orgasm, you may find sexual or erotic materials helpful.  These are easily available online and include books, DVDs, vibrators, clitoral stimulators, erotic games and lingerie. Talking to your partner about what ‘turns you on’ and what kind of stimulation you need to orgasm may also help.

Training on masturbation has been shown to help orgasm problems, particularly in women who have had them a long time. But if you are able to achieve an orgasm on your own but not with a partner, measures to improve communication, increase trust and reduce anxiety may be more useful (see the following section on ‘Sex therapy’).

For some couples, sexual activity ends once the man has ejaculated. If you haven’t had an orgasm and still feel very aroused after your partner has come, you could ask them to continue to stimulate you with their hand or mouth. They will probably enjoy being able to please you.

Some women find it difficult to concentrate during sex. If this applies to you, fantasizing about something sexual may excite you and reduce any negative feelings. If you are close to orgasm, alternately tightening and relaxing your pelvic floor muscles may help you get there.

What is sex therapy?

Sex therapy is talking therapy where an individual or couple work with an experienced therapist to assess and treat their sexual and/or relationship problems. Together they will identify factors that trigger the problems and design a specific treatment programme to resolve or reduce their impact.

Sex therapy is considered highly effective in addressing the main causes and contributing factors of sexual difficulties. And it helps people to develop healthier attitudes towards sex, improve sexual intimacy, become more confident sexually, and improve communication within the relationship.

Sex therapy can also be used in combination with other forms of treatment. Your GP or another health professional on the NHS may be able to refer you for sex therapy (depending on area), or you can contact a therapist directly and pay privately. It is important to make sure that they are qualified and are registered with an appropriate professional body. You can find more information on sex therapy in our factsheets ‘Sex therapy’ and ‘How to find, choose and benefit from counselling support

What is the Take Home Message?

Problems with orgasm may be due to other health problems – see your doctor for advice

Where can you get more information?

The Sexual Advice Association is here to help. We cannot give individual medical advice, but we can answer your questions on any sexual problems and put you in touch with local specialist practitioners. We also have a number of factsheets and booklets on sexual problems and related issues for men and women that can be downloaded from our website or requested. Please feel free to email us or phone our Helpline (our contact details are at the bottom of this page).

You can also visit the NHS Choices website at www.nhs.uk/ for information and advice on many different health and lifestyle topics.

Further reading

Download or request our factsheet ‘Explaining sexual problems to your GP

Donate

By donating to the Sexual Advice Association, you will know that you are helping improve the lives of people living with sexual problems. If you are interested in donating, please click here or contact us for more information (details at the bottom of this page).

Thinking About Sex Day: February 14th

Launched by the Sexual Advice Association, Thinking About Sex Day (TASD) is designed to encourage everyone to think about the physical and psychological issues surrounding sexual activity.

Women’s Sexual Problems

What are they?

Sexual problems in women are common. They are estimated to affect around one-third of young and middle-aged women and about half of older women.

The main types include:

  • A lack of sexual desire
  • A lack of sexual arousal
  • Problems with orgasm
  • Pain during or after sex

Lack of desire and/or arousal
A lack of sexual desire (or ‘sex drive’) is often described as a loss of libido and many women can experience a variety of symptoms. A lack of sexual arousal (not feeling ‘turned on’) may result from a lack of vaginal lubrication, a relationship worry or ill health. A lack of sexual desire and a lack of sexual arousal often occur together. And treatment of one often improves the other. It is important you see your doctor to describe the symptoms you are having as there are a variety of treatments available (see our factsheet ‘Lack of sexual desire/arousal’).

Problems with orgasm
These include never having an orgasm, delayed or infrequent orgasms, and a reduction in the strength of orgasmic sensations. While some women do not need to have an orgasm to enjoy sex, this may be a real problem for others and their partners (see our factsheet ‘Problems with orgasm’).

Pain during or after sex
Some women can experience pain during sex. This may be due to reduced vaginal lubrication and insufficient foreplay before penetration. It can become a problem and stop a woman from having or enjoying sexual intimacy (see our factsheet ‘Pain during/after sex’).

How are they treated?

Treatments for sexual problems in women can be divided into those that are hormonal and those are non-hormonal. It is important to remember that relationship issues are also important and should be considered.

Non-hormonal treatments

Self-help
You may want to try helping yourself increase your desire and/or arousal, or experiment to find out what helps you orgasm or makes sex less painful. Sexual or erotic materials of all kinds are now easy to find online. These include books, DVDs, vibrators, clitoral stimulators, erotic games and lingerie.

Sex therapy
Sex therapy is talking therapy where an individual or couple work with an experienced therapist to assess and treat their sexual and/or relationship problems. Together they will identify factors that trigger the problems and design a specific treatment programme to resolve or reduce their impact.

Sex therapy is considered highly effective in addressing the main causes and contributing factors of sexual difficulties. And it helps people to develop healthier attitudes towards sex, improve sexual intimacy, become more confident sexually, and improve communication within the relationship.

Sex therapy can also be used in combination with other forms of treatment.

Your GP or another health professional on the NHS may be able to refer you for sex therapy (depending on area), or you can contact a therapist directly and pay privately. It is important to make sure that they are qualified and are registered with an appropriate professional body. You can find more information on sex therapy in our factsheets ‘Sex therapy’ and ‘How to find, choose and benefit from counselling support

Vaginal lubricants and moisturisers
If vaginal dryness is a problem this may be improved with lubricants and moisturisers.

Vaginal lubricants are used at the time of sexual intercourse. There are many different kinds available and they can be bought over-the-counter. Some are also available on prescription. They may be water-based (e.g. KY® Jelly), silicone-based (e.g. Replens™ Silky Smooth Personal Lubricant) or oil-based (e.g. peach kernel or sweet almond oils). The oil-based products may damage the latex in condoms, and it’s important to remember this if you want to prevent a pregnancy or sexually transmitted infection (STI). Some lubricants may feel better and last longer than others, so it is worth trying the different types to see which works best for you.

Vaginal moisturisers (e.g. Replens™ Longer Lasting Vaginal Moisturiser) help retain moisture in the vagina. These can be applied regularly and at least 2 hours before sex. They are available over-the-counter or on prescription.

Drug treatments
Flibanserin (addyi™) is a new drug for treating low sexual desire. It has to be taken every day and should not be combined with alcohol. It was approved for use in the United States in 2015 but has not been approved for use in the UK yet. Women should always see their doctor before using this medication to ensure there are no health or medical concerns contributing to the symptoms.

Treating other conditions such as diabetes or depression may also help improve sexual problems.

Hormonal treatments

Oestrogen
Oestrogen levels fall after the menopause and after trauma to the pituitary gland in the brain (usually the result of a head injury, subarachnoid haemorrhage or radiation to the head.) Oestrogen replacement can be given either systemically to increase levels throughout the whole body, or vaginally to increase levels in this area only.

Systemic oestrogen, which can be given by tablet, patch or skin gel, will also help other menopausal symptoms such as hot flushes. Vaginal oestrogens are inserted into the vagina and come as a tablet, ring or cream. Long-term treatment is needed, because symptoms will return if the treatment is stopped.

Testosterone
In women, testosterone is produced naturally in the ovaries and adrenal glands, and it is linked to female sexual function. A loss of sexual desire may be associated with a drop in testosterone levels. When a woman has her ovaries removed surgically (oo-phorectomy), her levels of testosterone suddenly fall.

Several studies have shown a benefit of testosterone therapy in women who have been through the menopause, but mainly in those using oestrogen. In the UK, the only licensed testosterone treatment for many years was an implant put under the skin using local anaesthetic. Testosterone gel and testosterone patches have also been used, but the patches have been withdrawn and the gel is not licensed for use in women.

Tibolone
Tibolone (Livial®) is often classed as a type of hormone replacement therapy (HRT). It is a man-made steroid with similar effects to the female hormones oestrogen and progesterone as well as testosterone. It can improve menopausal symptoms such as hot flushes and can improve lack of libido (‘sex drive’).

What next?

While women may find sexual problems difficult to talk about and very isolating, help is available. You can try to help yourself or see a sex therapist as discussed above. But if a sexual problem continues long term and is causing you distress, it is sensible to see your GP. They are trained to deal with these and can examine you for any physical problems and check your general health.

If possible, share your concerns with your partner and see if you are able to seek help together. You should be welcomed either on your own or as a couple when you ask for help from your GP, local hospital clinic or sex therapist (NHS or private).

Where can you get more information?

The Sexual Advice Association is here to help. We cannot give individual medical advice, but we can answer your questions on any sexual problems and put you in touch with local specialist practitioners. We also have a number of factsheets and booklets on sexual problems and related issues for men and women that can be downloaded from our website or requested. Please feel free to email us or phone our Helpline (our contact details are at the bottom of this page).

You can also visit the NHS Choices website at www.nhs.uk for information and advice on many different health and lifestyle topics.

What is the Take Home Message?

Sexual problems in women may be due to physical and/or psychological causes – both should be investigated.

Further reading

Download or request our booklet ‘Sex and growing older – Women’ and/or our factsheet ‘Sex and diabetes in women’.

Donate

By donating to the Sexual Advice Association, you will know that you are helping improve the lives of people living with sexual problems. If you are interested in donating, please click here or contact us for more information (details at the bottom of this page).

Thinking About Sex Day: February 14th

Launched by the Sexual Advice Association, Thinking About Sex Day (TASD) is designed to encourage everyone to think about the physical and psychological issues surrounding sexual activity.

Erectile Dysfunction

What is it?

Erectile dysfunction (ED) is when you are unable to get or keep an erection suitable for sexual intercourse or another chosen sexual activity.

How common is it?

It is very common; half of men between the ages of 40 and 70 years will have it to some degree. This means there are several million men in the UK suffering from ED and the numbers increase with age. Sadly, only a small percentage of sufferers actually receive treatment.

How is it caused?

Most men occasionally fail to get or keep an erection. This usually results from stress, tiredness, anxiety or excessive alcohol consumption and is nothing to worry about. However, worrying about it can increase the likelihood of it happening again due to ‘fear of failure’. Until about 20 years ago, ED was thought to be almost entirely due to psychological causes (in the mind). But we now know that physical causes (in the body) are more likely, and the most common of these is disease of the blood vessels which supply blood to the penis (atherosclerosis). However, most men with ED have a combination of psychological and physical causes, with one affecting the other.

Physical causes
Men whose ED is due to physical causes often experience a gradual onset of erectile problems, which usually occur with all sexual activities.

Physical causes of ED include:

  • Vasculogenic conditions (which affect blood flow to the penis) – including disease of the heart or blood vessels (cardiovascular disease (CVD)), high blood pressure, raised cholesterol and diabetes
  • Neurogenic conditions (which affect the nervous system) – including multiple sclerosis, Parkinson’s disease, stroke, diabetes and spinal injury or disorder
  • Hormonal conditions (which affect the hormones) – including an overactive thyroid gland, an underactive thyroid gland, hypogonadism (low testosterone level), Cushing’s syndrome (high cortisol level), a head or brain injury recently or in the past and subarachnoid haemorrhage or radiation to the head (these may cause hormonal changes, particularly a low testosterone)
  • Anatomical conditions (which affect the structure of the penis) – including Peyronie’s disease
  • Surgery and radiation therapy for bladder, prostate or rectal cancer
  • Injury to the penis
  • Side effect of prescribed drugs
  • Recreational drug use
  • Excessive alcohol consumption

ED is also more likely to occur in people who smoke, are overweight and/or are not active enough.

If atherosclerosis is the cause of your ED, this narrowing is likely to affect other blood vessels in the body as well, including the arteries that supply blood to the heart. This means ED can be an early warning sign of future heart problems, appearing some 3-5 years before a heart complaint. You may therefore be able to prevent a future heart problem from occurring if you see your doctor for treatment soon after your ED starts (see our factsheet ‘Erectile dysfunction and the heart’).

atherosclerosis
Atherosclerosis (narrowing) of an artery

Hormone problems may be a more common cause of ED than once thought. The most frequently seen of these is reduced testosterone (male sex hormone), which can occur in men of all ages, including the elderly. The current guidance on the use of testosterone replacement therapy in men recommends that that when they first see a doctor for ED and/or reduced libido (‘sex drive’), they should have their testosterone measured in the morning on at least two occasions (see our factsheet ‘Testosterone deficiency’).

If you have ED and ride a bike for more than three hours a week, your doctor may recommend you try a period without cycling to see if this helps improve things. It is important to make sure you are sitting in the correct position with a properly fitted, comfortable seat – some are specifically designed to relieve pressure on the blood vessels and nerves supplying the penis.

Psychological causes
A psychological cause of ED is more likely if:

  • Your erection is fine except with your partner
  • You are suffering stress and anxiety from work or home (money or family)
  • There are marital rows and dissatisfaction (which may also cause premature ejaculation)
  • You are depressed
  • Failing once is followed by fear of subsequent failure
  • Your partner has sexual problems
  • You are bored sexually
  • You are worried about your sexual orientation
  • You have suffered previous sexual abuse

When should you seek help?

If you have been suffering with ED for more than a few weeks, it is wise to see your doctor, because it may be a warning sign of other more serious health problems.

Many men find it very difficult to talk about such a personal problem as being unable to get an erection and may put off asking for help for 2 years or more. However, GPs are trained to deal with ED and in the end it’s usually not as embarrassing as was feared.

How is it diagnosed?

To diagnose the cause(s) of your ED, your doctor will ask you about your sexual history, diet and lifestyle. You will have an assessment, which includes measurement of your height, weight and waist. You will also need a medical, which includes:

  • Heart and lungs check
  • Blood pressure check
  • A quick check of your genitals to rule out any obvious physical abnormality
  • Cholesterol check
  • Diabetes test
  • A morning check of your testosterone (see our factsheet ‘Testosterone deficiency’)

If you have symptoms of an enlarged prostate gland, such as a weak stream and/or urgent and/or frequent urination, your doctor may also need to examine your prostate.

If you do not want to talk to your GP about ED, you can visit a genitourinary medicine (GUM) clinic. Their details can be found on the British Association for Sexual Health and
HIV (BASHH) website www.bashh.org You can also see a sex therapist (see the following section on ‘Sex therapy’)

How is it treated?

ED treatment involves tackling the cause of the problem, whether this is physical, psychological or a mixture of both. There have been major advances in the treatment of ED and most sufferers can now be treated effectively.

If atherosclerosis is causing your ED, your doctor may recommend some lifestyle changes, which will also improve your general health and help protect your heart. These include:

  • Stopping smoking
  • Limiting the amount of alcohol you drink to no more than 14 units a week
  • Losing weight if you are overweight (see out factsheet ‘Body Mass Index (BMI)’)
  • Eating a healthy Mediterranean-style diet (see out factsheet ‘The Mediterranean diet’)
  • Taking moderate daily exercise
  • Trying to reduce stress and anxiety

Your doctor may also prescribe medications to treat atherosclerosis (such as cholesterol-lowering statins and drugs to lower your blood pressure).

If lifestyle changes fail to improve things, tablets are usually the first line treatment. These are called phosphodiesterase (pronounced phos- pho- di- es- ter- ase) inhibitors (PDE5i) and include tadalafil (Cialis®), vardenafil (Levitra®), sildenafil (Viagra®) and avanafil (Spedra®). PDE5i work for many men but they will not cause an erection unless the man is mentally AND physically stimulated (see our factsheet ‘Oral treatment for erectile dysfunction’).

A drug called alprostadil (which is the same as a chemical that the penis produces naturally when it becomes erect) can be injected into the shaft of the penis. This allows more blood to flow into the penis and get trapped there, which helps you get and keep an erection. Injection therapy is very successful in those men who do not respond to tablets. There are two types of alprostadil injections available, Caverject® and Viridal®.

Invicorp is another type of injection therapy used to treat ED. It contains two active ingredients (aviptadil and phentolamine mesilate); one increases blood flow to the penis to help you get an erection while the other helps trap the blood there to keep the erection. Invicorp may work well for men who have found little success with other ED treatments and some may find it less painful to use than alprostadil injections.

Another option is to insert a pellet (MUSE®) that contains alprostadil into the urethra (the tube through which you pass water) after urinating. The pellet dissolves and gives you an erection.

Alprostadil can also be used topically as a cream (Vitaros®) which is applied to the penis. For more information on injection, urethral and topical treatments for ED, see our factsheet ‘Injection, urethral and topical treatments for erectile dysfunction’.

Vacuum devices draw blood into the penis to get an erection, and it is trapped there with a special ring at the base of the penis to keep the erection. These devices suit some people well (see our factsheet ‘Vacuum pump treatment for erectile dysfunction’)

Testosterone replacement therapy may be required if you are found to have low levels of this hormone (see our factsheet ‘Testosterone deficiency’).

Surgically implanted devices (penile prostheses), which strengthen the penis from inside, are available for the very few men who cannot get an erection in any other way.

Research has suggested that a small number of men with ED may benefit from exercises to strengthen the pelvic floor muscles. These lie underneath the bladder and back passage, and at the base of the penis. If your doctor thinks this approach may benefit you, they will refer you to a physiotherapist.

Sex therapy
Sex therapy is talking therapy where an individual or couple work with an experienced therapist to assess and treat their sexual and/or relationship problems. Together they will identify factors that trigger the problems and design a specific treatment programme to resolve or reduce their impact.

Sex therapy is considered highly effective in addressing the main causes and contributing factors of sexual difficulties. And it helps people to develop healthier attitudes towards sex, improve sexual intimacy, become more confident sexually, and improve communication within the relationship.

Sex therapy can also be used in combination with other forms of treatment.

Your GP or another health professional on the NHS may be able to refer you for sex therapy (depending on area), or you can contact a therapist directly and pay privately. It is important to make sure that they are qualified and are registered with an appropriate professional body. You can find more information on sex therapy in our factsheets ‘Sex therapy’ and ‘How to find, choose and benefit from counselling support’.

Will your age affect your treatment?

While you are more likely to suffer with ED as you get older, it is your attitude not your age that is the biggest barrier in treating the condition. While some older men and their partners accept loss of erectile function as a normal part of ageing and do not want treatment, others are unhappy about losing such an important part of their lives. It is perfectly normal for men and women to continue an active sex life way into old age and no one should be denied treatment for ED just because they are considered too old. Don’t be put off, you need to stay as fit and healthy as you can. If you have a partner, it is important to talk to them and also make sure that your doctor is aware of your treatment. Men in their 90’s are now seeking treatment for ED and usually respond to one of the available options.

Where can you get more information?

The Sexual Advice Association is here to help. We cannot give individual medical advice, but we can answer your questions on any sexual problems and put you in touch with local specialist practitioners. We also have a number of factsheets and booklets on sexual problems and related issues for men and women that can be downloaded from our website or requested. Please feel free to email us or phone our Helpline (our contact details are at the bottom of this page).

You can also visit the NHS Choices website at www.nhs.uk for information and advice on many different health and lifestyle topics.

What is the take home message?

ED may be a warning of a future heart problem – heed the warning because your life may depend on it – get checked out!

Further reading

Download or request our booklet ‘Sex and the heart’ and/or our factsheet ‘Explaining sexual problems to your GP’.

Donate

By donating to the Sexual Advice Association, you will know that you are helping improve the lives of people living with sexual problems. If you are interested in donating, please click here or contact us for more information (details at the bottom of this page).

Thinking About Sex Day: February 14th

Launched by the Sexual Advice Association, Thinking About Sex Day (TASD) is designed to encourage everyone to think about the physical and psychological issues surrounding sexual activity.

Ejaculation Problems

What are they?

There are 4 ejaculation problems that can affect men:

  • Premature ejaculation
  • Delayed ejaculation
  • Retrograde ejaculation
  • Anejaculation

Premature ejaculation

Premature ejaculation (PE) is when a man ejaculates or ‘comes’ sooner than he or his partner wishes on all or nearly all occasions. It usually happens before, or within about one minute of, vaginal penetration.  But just thinking about something sexually stimulating can trigger ejaculation and sometimes it happens before any direct stimulation of the penis occurs. The important thing to remember is that if ejaculation occurs sooner than the man and/or his partner wishes and this is causing distress, bother, frustration and/or the avoidance of sexual intimacy, then it can be considered ‘premature’.

How common is it?
PE is one of the most common, aggravating, sexual problems affecting men. It can occur at any age and under any situation, but it is most common in younger men, particularly those their teens and twenties. It is often due more to the novelty of the sexual experience (new partner or different situation) than to the man’s age, although most men will experience it at some time. Estimates of how many men are affected by PE vary widely, ranging from just 5% up to 31%.

How is it caused?
Most cases of PE are caused simply by being unable to control the ejaculatory response.  Erection problems may play a part, as some men ejaculate early if they think they might lose their erection. There are also some conditions in older men that may interfere with ejaculation, such as changes in the prostate gland, disease of the blood vessels (atherosclerosis), diabetes and neurological disorders.

Early sexual experiences may be important in shaping future ejaculatory habits. Initial nervousness and hurry, such as in having sex in the back of a car, one-night stands, fear of discovery or of being heard at home through the wall and other unsatisfactory early sexual experiences, may lead to a pattern of PE.

Another common cause of PE is relationship problems. Stress in a relationship may come from sexually demanding partners, unrealistic expectations, different needs and desires in a couple, dissatisfaction, lack of communication and trust, outside affairs, a partner who also has a sexual problem and an excessive desire to please a partner. Unkind remarks made at the time may make matters worse and can lead to a cycle of failure and anxiety.

How can you delay ejaculation?
Many men can help themselves to delay ejaculation, but some may need help. Discuss the problem with your partner first, to find out what she needs and how she feels. A simple self-help method that can be effective is called the ‘stop/start technique’. This can be done by the man alone or with his partner, whichever is preferred.

  • Step 1: Gradually start stimulation of the penis (a lubricant helps), stopping just before you think you are about to ejaculate (the point of no return!)
  • Step 2: Rest, with no stimulation for 30 to 60 seconds, until the need to ejaculate passes
  • Step 3: Begin rubbing the penis again, stopping or reducing the stimulation until the need to ejaculate passes. Rest, as above
  • Step 4: Repeat the above steps 4 or 5 times, until you begin to recognise when you are about to ejaculate. Allow ejaculation to occur. This needs to be done regularly for a couple of weeks

This ‘stop/start technique’ can be changed to include your partner and is then called the ‘squeeze technique’. Your partner masturbates you up to the point of no return, then firmly squeezes the penis where the glans (knob) joins the shaft using the thumb and forefinger. The sensation of being about to ejaculate will reduce. There may be some softening of your erection, until stimulation begins again. This technique is a bit more difficult to master. A couple will need to be really committed if either of these techniques are to work.

Do ‘delay sprays’ work?
Delay sprays contain local anaesthetics. These can reduce the sensitivity of the glans of the penis, but you may not feel yourself ejaculating either.  The most commonly used spray contains lidocaine and can be prescribed by your doctor.

Research has shown that an anaesthetic spray applied to the penis 5 minutes before intercourse helped men with lifelong PE last 6 times longer, with few side effects. It increased the time of intercourse from 0.6 minutes to 3.8 minutes, while the placebo treatment (that contained no active ingredient) only increased the time from 0.6 minutes to 1.1 minute.

When using anaesthetic sprays, it is important to remember that you may transfer the anaesthetic to your partner and reduce her pleasurable sensations, so it’s best to use a condom.

Use of antidepressants
Some antidepressants are known to slow down ejaculation, but most of these are not licensed for the treatment of PE in the UK. However, if your doctor thinks it may help your PE, they may prescribe one of these drugs, usually a selective serotonin-reuptake inhibitor (SSRI) or clomipramine. One tablet is taken at night for a month. If that helps the PE, the treatment can then be taken when required, an hour before intercourse. There are side effects such as a dry mouth, occasional blurring of vision and sleepiness. It should only be taken at night and great care should be taken with driving or with using machinery the next day.

Dapoxetine (Priligy®) is the first drug treatment for PE to be licensed for use in the UK. It is a type of SSRI, but because it works much faster than those described above, it can be taken ‘on demand’ around 1 to 3 hours before sexual activity. It has been shown to significantly lengthen the time of intercourse. Dapoxetine is not generally recommended in men who are taking phosphodiesterase (pronounced phos- pho- di- es- ter- ase) inhibitors (PDE5i) such as Viagra®, because this combination may cause the blood pressure to drop. For this reason, these medicines should only be prescribed by a doctor who will take your health and other medications into consideration (see our factsheet ‘Oral treatment for erectile dysfunction’). Dapoxetine should not be combined with recreational drugs or alcohol. In trials, very common side effects included dizziness, headache and nausea, and common side effects included anxiety, insomnia, strange dreams, tremor, blurred vision, tinnitus, erectile dysfunction and reduced libido.

Other drug treatments may be available for PE, particularly if you also have erection problems. Talk to your doctor about your options. When taking any drug, particularly those that are not ‘essential’, you need to be sure that the benefits outweigh the risks and these should be discussed with your doctor.

Drug treatments for PE may be also prescribed in combination with sex therapy (see the following section on ‘Sex therapy’).

Delayed ejaculation

Delayed ejaculation (DE) is not anyone’s fault and it is not uncommon. With this problem, ejaculation is affected and the man finds it very difficult to ejaculate or ‘come’ even though he wants to and is receiving sufficient stimulation for this to occur.

How is it caused?
DE may be caused by physical problems (in the body) psychological problems (in the mind) or a mixture of both. Physical causes include severe diabetes, drug therapy and neurological problems, such as those caused by spinal cord injury, pelvic surgery, multiple sclerosis or alcoholism.

Psychological causes are more likely if you don’t have any of the above conditions. Some men may have unknowingly taught themselves to respond in a certain way or manner and ejaculation can only occur in this situation. For example, ejaculation may only happen with masturbation rather than intercourse, as some men get used to a certain type of manual stimulation and find it difficult to adjust to the change in sensations when with a partner. There may also be an underlying relationship problem.

How is it treated?
At the moment, there are no drug treatments approved for DE. Treatment usually involves sex therapy (see the following section on ‘Sex therapy’).

Retrograde ejaculation

Retrograde ejaculation is where you may not see any fluid (semen) after orgasm. If this happens, you may also have noticed that when you first pass water after intercourse it is cloudy. This is because the semen is being expelled backwards into the bladder.

How is it caused?
The most common cause of retrograde ejaculation is surgery to the prostate or the bladder neck. Many men who have had a prostate operation will experience this.  Other causes include neurological problems caused by diabetes or multiple sclerosis, spinal cord injury, and some prescription medications (mainly for blood pressure control). The sensation of ejaculation may also be reduced.

How is it treated?
Treatment for this condition would only be considered if fertility was an issue.  If you find this condition distressing, you may benefit from sex therapy (see the following section on ‘Sex therapy’).

Anejaculation

Anejaculation is when you get the sensation of ejaculation but you don’t ejaculate at all. It is uncommon.

How is it caused?
The main cause is neurological damage resulting from spinal cord injury, major lymph node surgery, diabetes or multiple sclerosis. It may also be caused by a psychological problem.

How is it treated?
Anejaculation would only be treated if fertility was an issue. If you find this condition distressing, you may benefit from sex therapy (see the following section on ‘Sex therapy’).

Sex therapy

Sex therapy is talking therapy where an individual or couple work with an experienced therapist to assess and treat their sexual and/or relationship problems. Together they will identify factors that trigger the problems and design a specific treatment programme to resolve or reduce their impact.

Sex therapy is considered highly effective in addressing the main causes and contributing factors of sexual difficulties. And it helps people to develop healthier attitudes towards sex, improve sexual intimacy, become more confident sexually, and improve communication within the relationship.
Sex therapy can also be used in combination with other forms of treatment.

Your GP or another health professional on the NHS may be able to refer you for sex therapy (depending on area), or you can contact a therapist directly and pay privately. It is important to make sure that they are qualified and are registered with an appropriate professional body.

You can find more information on sex therapy in our factsheets ‘Sex therapy’ and ‘How to find, choose and benefit from counselling support

Where can you get more information?

The Sexual Advice Association is here to help. We cannot give individual medical advice, but we can answer your questions on any sexual problems and put you in touch with
local specialist practitioners. We also have a number of factsheets and booklets on sexual problems and related issues for men and women that can be downloaded from our website or requested. Please feel free to email us or phone our Helpline (our contact details are at the bottom of this page).

You can also visit the NHS Choices website at www.nhs.uk for information and advice on many different health and lifestyle topics.

What is the take home message?

Ejaculation problems may result from physical and/or psychological causes – these require very different treatments.

Further reading

Download or request our factsheet ‘Explaining sexual problems to your GP’ and/or our booklet ‘Sex and the prostate

Donate

By donating to the Sexual Advice Association, you will know that you are helping improve the lives of people living with sexual problems. If you are interested in donating, please click here or contact us for more information (details at the bottom of this page).

Thinking About Sex Day: February 14th

Launched by the Sexual Advice Association, Thinking About Sex Day (TASD) is designed to encourage everyone to think about the physical and psychological issues surrounding sexual activity.

Sex and Ageing

Sex and ageing in women

Today men and women are living longer, healthier lives. Sexual intimacy and activity is an important part of life. This fact sheet will help you with some queries that you may have.

Does sex change, as you get older?

There is a common myth that older women do not have sex. However, studies have found that over half of women aged over 50 are satisfied with their sex lives. Women’s sexual responsiveness increases with age with only slightly reduced interest and functioning in many women, except during or after illness and bereavement. Many postmenopausal women have an increased sexual responsiveness, which may be due to factors such as a reduced fear of pregnancy, no longer having to use contraceptives and the end of menstrual periods.

What changes can I expect as I get older?

Estrogen levels drop after the menopause and this may lead to painful sex as the vaginal walls become thinner and less lubricated. This can be helped by using lubricants, moisturisers or estrogen tablets, creams or pessaries which are put into the vagina (see fact sheet about vaginal dryness and the menopause). You may find that the vaginal area and breasts become less sensitive to touch, and that orgasm may take longer. You may require different stimulation than before.

Can I have good sex without intercourse?

Yes, most definitely. For men and women, sex in later years may change, but can be just as emotionally satisfying as before and perhaps more so. The importance is in learning to
communicate in a way that will lead to emotional and physical fulfilment for you.

Does illness affect sex?

Yes, it can. As people grow older they are more likely to experience disabling conditions and illnesses that may affect how they respond sexually. Arthritis, stroke, coronary disease, diabetes, Parkinson’s, surgery and the side effects of drugs can all affect how they respond. The psychological effects of illness can also have an impact on sexual function, especially if the diagnosis of a life-threatening or life-limiting illness has been made, or if the illness affects self-esteem or alters body image drastically. Illness can bring change in the structure of a couple’s relationships, as previously independent people become dependent on their partner/carer. Talk to your GP if you find that illness is preventing you from enjoying sex with your partner; they may be able to help and offer solutions or put you in touch with a therapist.

I am a widow: is it wrong to look for love again?

We all need to be loved and wanted. These needs do not diminish over time, but you may find you are seeking other forms of attachment than when you were younger. If you are looking to rekindle your love life, you may feel awkward and embarrassed. These are perfectly normal feelings, particularly if your partner had a long illness, and you may have profound feelings of guilt and betrayal.

Can I get a sexually transmitted infection after the menopause?

Unfortunately, yes you can. Sexually transmitted infections are increasing in all age groups. Therefore, it is important to consider using condoms when entering a new relationship. Also if you have worrying symptoms you should get help early rather than ‘wait and see’.

Where can you get more information?

The Sexual Advice Association is here to help. We cannot give individual medical advice, but we can answer your questions on any sexual problems and put you in touch with local specialist practitioners. We also have a number of factsheets and booklets on sexual problems and related issues for men and women that can be downloaded from our website or requested. Please feel free to email us or phone our Helpline (our contact details are at the bottom of this page).

You can also visit the NHS Choices website at www.nhs.uk for information and advice on many different health and lifestyle topics.

Further reading

Sexual Health and the Menopause. eds Tomlinson JM, Rees M, Mander T. 2005. Royal Society of Medicine Press and British Menopause Society Publications Ltd.

Donate

By donating to the Sexual Advice Association, you will know that you are helping improve the lives of people living with sexual problems. If you are interested in donating, please click here or contact us for more information (details at the bottom of this page).

Thinking About Sex Day: February 14th

Launched by the Sexual Advice Association, Thinking About Sex Day (TASD) is designed to encourage everyone to think about the physical and psychological issues surrounding sexual activity.

Explaining sexual problems to your GP

Discussing sexual problems with a doctor or health professional can be embarrassing. However, it is important not to suffer in silence. Sexual problems can badly affect your quality of life and erectile dysfunction (ED) with men, for example, is now thought to be an early marker of heart disease. Doctors will not be judging your sex life but need to have information to be able to come to a diagnosis and recommend treatment. All information you give will be strictly confidential and not given to anyone else, even a spouse or parent without your permission.

Here are a few tips to make it easier to talk about your problem and a guide to what your doctor or health professional needs to know.

Describing the problem

You need to explain exactly what the problem is rather than making your own diagnosis, as this can lead to the doctor coming to the wrong conclusion. You will also need to explain:

  • How long you have had the problem and how it affects you and your relationship
  • Your current partner’s age and sex
  • If you have several partners, whether the problem with a particular one
  • Whether you’ve had problems with previous partners
  • If your partners have a problem
  • The type of intercourse you have– vaginal, oral or anal
  • Whether you have ever been sexually abused or assaulted, as an adult or as a child

Contraception and sexually transmitted infections (STIs)

  • What type of contraception you and your partner use?
  • Whether you use condoms with a new partner, even though you do not need to for contraception
  • If you have concerns about STIs
  • Whether you have had an STI in the past and how you were treated
  • Whether you have attended a genitor-urinary clinic

What do you want to do?

  • Do you want to try drug therapy? If so, think about what preparation would suit you best
  • Do you want to have counselling? If so, think about where you would like to go and what type of therapist you would like to see

The discussion with your doctor or health professional may be over several appointments and should lead to you agreeing to a management plan that suits you.

Where can you get more information?

The Sexual Advice Association is here to help. We cannot give individual medical advice, but we can answer your questions on any sexual problems and put you in touch with local specialist practitioners. We also have a number of factsheets and booklets on sexual problems and related issues for men and women that can be downloaded from our website or requested. Please feel free to email us or phone our Helpline (our contact details are at the bottom of this page).

You can also visit the NHS Choices website at www.nhs.uk for information and advice on many different health and lifestyle topics.

Donate

By donating to the Sexual Advice Association, you will know that you are helping improve the lives of people living with sexual problems. If you are interested in donating, please click here or contact us for more information (details at the bottom of this page).

Thinking About Sex Day: February 14th

Launched by the Sexual Advice Association, Thinking About Sex Day (TASD) is designed to encourage everyone to think about the physical and psychological issues surrounding sexual activity.

Taking A Sexual History

Taking a sexual history frequently bothers health professionals because they may not have been taught how to do it. They may be embarrassed about asking intimate questions, or they feel the patient may be embarrassed as well. Sexual problems are not simply a life style issue as they can adversely affect quality of life and erectile dysfunction is now thought to be an early marker of heart disease.

Here are a few techniques to make it easier. The majority of patients prefer to see the health professional first on their own, especially if a discharge or possibly a sexually transmitted infection is involved. Starting with a social history and asking about work will give useful background information and helps to put the medical problems into perspective.

  • greet the patient warmly
  • the patient should be helped to be made as relaxed as possible
  • look for physical signs of nervousness and embarrassment such as a flushed neck or nervous hand movements
  • don’t ask any patient questions, especially personal ones, with them lying on a couch and you looming over them
  • do not be judgmental about a patient’s sex life

Techniques for finding out the problem

  • Patients often have difficulty in starting a conversation. Pick up clues and clarify them.
  • Try and find out precisely what the patient is talking about before you examine them. Don’t jump to the wrong conclusions: ‘I think I am impotent’ can often really mean ‘I have premature ejaculation’.
  • Asking open questions such as ‘How can I help you?’ or ‘tell me what problems you are having allows a person to tell the story in their own words.
  • Try not to use medical terms, as the patient may not sure what you mean.
  • Do not be judgmental, especially with adolescents and older or disabled people, and particularly of their sexual habits.
  • An embarrassed and anxious adolescent can appear very truculent and irritating, and an older or disabled person can be quite unnecessarily ashamed of having to ask for advice.
  • Respect patient’s silence as during that time they may be formulating their thoughts on how to answer your question.
  • Postural echo This technique will tell you when patients are fully at ease. If they are, they will sit in an exact mirror image of you. It can also be used to make someone feel easier, if you adopt their position in reverse.
  • Repetition of the last word or phrase is a valuable technique to get the patient to expand on what he or she is trying to say. When used deliberately, it can be a very powerful tool to get history one would not normally elicit.

When to stop

Know when to stop asking questions especially if the patient is finding your queries intrusive. Change the subject.

What you need to ask about in the medical history

The problem

  • the problem as the patient sees it
  • the severity of the symptoms and their duration
  • the relationship, its duration and the age and gender of the partner, with details of any possible cultural or religious differences
  • number and gender of current sexual partners
  • if multiple current partners, is the problem restricted to one partner?
  • previous sexual partners and any problems experienced with them
  • do the partners have a problem?
  • the type of intercourse – vaginal, oral or anal
  • history of sexual abuse and assault

Contraception and STIs

  • forms of contraception, and use of a condom with a new partner, despite having no need for contraception
  • concerns about sexually transmitted infections, previous sexually transmitted infections and treatments

Current and past medical and social history

  • any genital surgery
  • for women their obstetric, gynecological and menstrual history
  • concomitant medical conditions such as diabetes, cardiovascular disease, cancer, depression
  • drugs: prescribed and recreational
  • work and social stresses
  • presence of children still at home

Agreeing a management plan

Once the history has been taken, a plan of management should be explained to the patient. Once you have their approval of what is to come, you will find that agreement will be easier with the management plan whether this involves drug or psychological therapies or both combined.

Where can you get more information?

The Sexual Advice Association is here to help. We cannot give individual medical advice, but we can answer your questions on any sexual problems and put you in touch with
local specialist practitioners. We also have a number of factsheets and booklets on sexual problems and related issues for men and women that can be downloaded from our website or requested. Please feel free to email us or phone our Helpline (our contact details are at the bottom of this page).

You can also visit the NHS Choices website at www.nhs.uk for information and advice on many different health and lifestyle topics.

What is the Take Home Message?

A good history, carefully taken, will give the diagnosis in the majority of problems, and can save a lot of repetitious questioning and missed diagnoses, while enabling the patient to be more comfortable about discussing a potentially embarrassing issue.

Further reading

For fuller details see: Taking a sexual history – Tomlinson JM in ABC of Sexual Health 2nd Ed Oxford Blackwell-Wiley 2005.

Donate

By donating to the Sexual Advice Association, you will know that you are helping improve the lives of people living with sexual problems. If you are interested in donating, please click here or contact us for more information (details at the bottom of this page).

Thinking About Sex Day: February 14th

Launched by the Sexual Advice Association, Thinking About Sex Day (TASD) is designed to encourage everyone to think about the physical and psychological issues surrounding sexual activity.