Man, 82: "I don't know how to approach a lady friend for sex"

I'm 82, I can get an orgasm but can't get a firm erection. I don't know how to approach a lady friend of 65 for sex. I'm afraid to reveal my problem. What can I do?

-- Russ

Russ, by all means, talk to your lady friend about your situation. Frankly, I'm sure she's assuming that you do have erectile difficulties at age 82, and she's not bringing it up, leaving it up to you to decide when or how much to disclose.

Fortunately, you are capable or orgasms without erections. Many women don't know this is possible, so you'll be giving her good news. When you get to this point, please take matters into your own hands to show her exactly the kind of touch that you need. It may be difficult at first to do this, but understand that a woman can't know how to please you unless you show her.

It used to be easy for us--as well as for you!--when an erection showed us that we were doing what you liked, and you pretty much liked anything we did! But now, both genders have changed in what works for us, and we all need to be more straightforward in communicating this with our partners.

As for her pleasure, are you aware that few women experience orgasms through intercourse alone? Our pleasure centers are our brains, our skin, and our clitoris -- all of which are accessible without erections. I'll be posting some techniques for giving women pleasure without an erection shortly, and I'll have many more in my upcoming book, Naked at Our Age: Talking Out Loud about Senior Sex.

Since you're not sexual yet with your lady friend, but you'd like to be, I hope you're spending quality time with her, getting to know each other as friends, learning how to talk easily together. Let your inner "flirt" out at times, and see how she responds. Compliment her, take her hand, make eye contact, ask her questions about herself.

When you make casual, physical contact--taking her hand, touching her arm, leaning in closer to talk--be super sensitive to her reactions, especially her body language. When you lean in, does she match you, or pull away? When you touch her arm, does she slide it closer, or retract it? You can learn a lot about whether she feels sexual about you by how she reacts to these simple gestures.

I wish you well with your new relationship. I hope you'll let us know how it develops!

- Joan

Viagra "not a sack of cement installer"

I'm writing the chapter about cancer and sexuality for my new book, Naked at Our Age: Talking Out Loud about Senior Sex. The stories people sent me about reclaiming their sexuality after cancer treatment fill me with admiration. I looked back at some older posts on this blog that deal with sex & cancer, and decided to bring back this one from 2006. With the prevalence of Viagra use, I think BillyBob's experience and his thoughts about it are important. - Joan

BillyBob, age 62, has told some of his story previously as a comment here. He recently sent me an email detailing an experience that he wants to share -- and he makes an important point:

I started dating a lady I have known for a year, mostly through phone conversations. I knew that she likes sex. Last weekend we went for dinner. After dinner she wanted to go back to my place for a while.

Well, as it turned out, it was the most embarrassing time I have ever had, all because of a misconception some woman have about impotency.

I took a Viagra after we got back to the motel hoping it worked fast! It did its normal thing and got me sexually aroused but not 100%. She knew I had to take it because of the prostate cancer killing my prostate.

Here is where the misconception comes in. It seems that women who do not know about Viagra seem to think if you take it you just get ramrodding hard, and they do not need to do any stimulation. Well that’s just plain wrong. Men still need stimulation along with the Viagra. The drug is not a sack of cement installer.

And I was not about to masturbate myself in order to get it hard. Not in the presence of a woman.

So as it turned out she turned me off instead of on. What a bummer. It was so disappointing. I had looked forward to our meeting for some time. And the possibility of finally enjoying good sex with some one that likes sex.

All a woman needs to know about the drug is that you do things as normally, using stimulation together. So please tell your readers what my experience was.

BillyBob, thank you for sharing this experience. Viagra helps when there's a physical cause for lack of erection, as you know, but it doesn't increase libido, or substitute for all those other crucial components of good sex that you (and I, and probably everyone reading this) crave -- touching, kissing, bonding, stimulating each other physically and emotionally, enjoying each other's pleasure as well as our own.

It sounds like most of this experience was missing for you. What a bummer, I agree. I'm sorry you didn't feel you could communicate your needs and desires to your partner -- I don't know, maybe she would have been happy to help you get aroused if she had understood. It's hard to understand why she didn't seem interested in stimulating you just as part of the sex play (with or without Viagra), since that's a good part of the fun of sex.

I know you were too embarrassed to masturbate in front of her when she didn't help arouse you, but as a woman, I find it very pleasurable and exciting to watch a man stimulate himself. I don't know if your partner would have reacted this way, but I'll bet she would have.

If you see a future or at least a repeat date with this woman, I hope you'll communicate candidly with her before you get to "the act." And please continue to write.

Thank you again, BillyBob.

-- Joan

Erectile Dysfunction: Michael Castleman Talks to Women

Update note: I first posted this interview in June 2007. I have so many new readers now that I wanted to bring it to the forefront, because it's such an important issue for both men and women. Often men feel they can't talk about ED with their partners. Women tell me their men seem to emotionally disappear and avoid sexual activity and discussion. Michael Castleman helps all of us understand what's going on. -- Joan

In a previous post, I interviewed Michael Castleman, a sex educator, counselor and journalist specializing in men's sexuality to answer some questions for men about erectile dysfunction. In this part of the interview, Castleman talks directly to women:

Q: What don't women understand about erectile dysfunction (ED)?

MC: Like men, few women understand the difference between true ED and erection dissatisfaction. [See Erectile Dysfunction: Michael Castleman Talks to Men for explanation of the difference.] Women also don't really appreciate how men FEEL when EDis or ED develop. It's sort of like how women feel when they lose a breast to cancer. You're still alive, but you feel diminished. A part of your body you took for granted isn't there anymore, or in the case of men, doesn't work like it used to. And this isn't just any part of the body. It's a body part that in a profound way DEFINES you as a man or woman. For women, loss of a breast raises issues like: Am I still attractive? Am I still sexual? Can I still please a man sexually? Men with ED and EDis wrestle with similar issues.

Beyond this, men have lived their whole lives pretty much taking their penises for granted: See a sexy woman, get hard. See porn, get hard. Think a sexual thought, get hard. Then all of a sudden--and in many men this happens pretty suddenly--they're in a situation where they expect to have to rearrange their underwear to accommodate some swelling down there, and then....nothing. Nothing happens.

Many don't understand what's happening to them or why. But even those who do, me for example, feel surprised, upset, disappointed, depressed. Change is stressful. But when the changes concern the penis, well, men get seriously freaked out.

Now women often (and rightly) believe that men are too focused on the penis. That's often true. It takes most young men years (sometimes decades) to leave penis-centric sex behind and understand the erotic value and pleasure of whole-body sensuality, a lovestyle more based on whole-body massage than on just sticking it in somewhere. Men who never get there, men who continue to view sex as penis-centered, when their penis stops behaving as they expect, they often think it's the end of sex, that they're over the sexual hill, that it's all over. In my experience as a sex counselor and writer, few women appreciate how diminished men feel as they get used to EDis... if they ever adjust.

Q: Why can't men express these concerns?

MC: Many reasons. In general, men tend to be less emotionally articulate than women. Men are socialized to be the "strong silent type," to keep a "stiff upper lip," to "grin and bear it." In other words, to deny what they're feeling and just go on. As a result, men get less practice than women discussing their emotions, and when they do, they're less skilled than women. Now some women believe that men don't HAVE emotions because they don't discuss them. Wrong. Men feel things just as deeply as women. They just are less likely to discuss them, and if they do, they're less likely to be able to really articulate how they feel.

The two genders have different natural histories of sex problems. With the exception of vaginal dryness, which is easily mitigated with lubricants, most women have most of their sex problems/issues when they're young. Young women wrestle with the mixed messages that they should be sexy but not trampy, that they should want love/sex, but not want sex "too" much, not be "too" easy. But how easy is too easy? Young women also have issues with orgasm. Many don't have them and have to learn how to release orgasms.

Meanwhile, few young men have sex problems--other than coaxing women in to bed. The young penis works just fine, thank you very much. Maybe the guy comes too soon (this is the #1 sex problem of young men), but only rarely do young men have problems with erection. Then they hit 45 or 50 and suddenly, the erections they took for granted their entire lives start to fail them. They freak. It's almost unthinkable. Many Americans found themselves speechless after Sept. 11. It was so horrible, unimaginable. Men don't discuss their ED or EDis in part because it's unimaginable--then it happens and they're speechless.

To many men, having reliable erections is a significant part of what defines them as men. If they have problems in the erection department, some fear that the women in their lives will view them as less than real men. So why talk about it? Why invite her to rub his nose in the fact that he's less of a man?

Q: When should a couple seek counseling?

There's no hard-and-fast rule on this. But when a problem festers, when you find yourselves having the same conflict over and over again, when there seems to be no way out, no resolution, basically, when you feel stuck, that's when to consider counseling.

Now every sex problem is also a relationship problem and visa versa. If the main issue is power/control/decision making or conflict resolution, then a couples counselor is probably the place to start. But if they main problem is sexual--a desire difference, orgasm issues for the woman, erection issues for the man--then I'd start with a sex therapist.

Personally, I'm a fan of sex therapy. This is not self-serving because I am not a sex therapist. But studies show that two-thirds of couples who consult sex therapists report significant benefit within 6 months. That's pretty good. Men with ED or EDis need to reframe their thinking about sex. They need to get away from porn-inspired sex and explore whole-body sensuality. This is often unfamiliar to men. They often fight it. So going back to a therapist week after week can help keep them on the path to self-discovery.

To find a sex therapist, visit the American Association of Sex Educators, Counselors, and Therapists (AASECT). Click the map of the U.S. and Canada, and get a list of all the AASECT-certified sex therapists in your state or province.

Q: What if the man won't go?

The woman should go by herself. This is not as good as the couple going. But going solo gives the woman a place to vent. It may equip her with new coping skills that can help deal with the couple's issues. And she may be referred to some written material, e.g. my book and others like it, that she can litter around the house and hope he picks up and checks out.

Michael Castleman, M.A., is the author of twelve books, including Great Sex: The Man's Guide to the Secrets of Whole-Body Sensuality and Sexual Solutions: For Men and the Women Who Love Them. From 1991-95, he answered the sex questions submitted to the Playboy Advisor. Visit his website about sex after midlife, http://www.greatsexafter40.com/.

Men: ED? See MD -- it can save your life

Erectile dysfunction can be a cardiovascular health alarm going off, finds a German study reported in Circulation: Journal of the American Heart Association.  ED should take you to the doctor's office and a cardiovascular workup, never ignored. It can be the first sign of atherosclerosis, which can show up in the penis several years before the onset of cardiovascular disease, because arteries in the penis are smaller.

According to an article by Thomas H. Maugh II in the LA Times,

Dr. Michael Bohm, a cardiologist at Germany's Saarland University, and his colleagues studied 1,519 men from 13 countries who were involved in a study of two drugs to treat cardiovascular disease. The men were also queried about their ED at the beginning of the study, two years into it and at the end at five years. A full 55% of the men had ED at the beginning of the trial, nearly double the normal incidence of about 30% in the population at large.


The team reported that, in the five years of follow-up, men with ED were 1.9 times as likely to die from heart disease, twice as likely to have a heart attack, 1.2 times as likely to be hospitalized for heart failure and 1.1 times more likely to have a stroke. The risks increased with the severity of the ED.

This study is one more of many that point to the need not only to consult a doctor about ED but also to make sure a cardiovascular workup follows.
 
In writing Naked at Our Age, I hear from many men with ED who are justifiably concerned and exploring medical diagnoses and solutions. But I also hear--often from women whose spouses have developed ED--about men who will not go to a doctor, will not discuss it with their wives, and often withdraw from sex and intimacy altogether. Others may ask their doctor for Viagra or Cialis without ever investigating the cause of the ED.

About.com sex educator Corey Silverberg brings up another part of the problem -- doctors aren't trained to talk about sex,and it's hard to get a useful conversation going about it. True, Corey, but our lives may depend how hard we try.

Don't ignore ED and don't just treat the symptoms with drugs-- find out what's going on. Please.

I invite your comments.

“Endless foreplay and multiple orgasms”- she's 58, he's 68, ED no barrier

 While Better Than I Ever Expected: Straight Talk About Sex After Sixty celebrated the joys of senior sexuality, my new book, Naked at Our Age (coming Spring 2011 from Seal Press) concentrates on the other part -- the physical setbacks and emotional challenges of sex and intimate relationships in later life. I have more than a hundred personal stories and a bevy of amazing experts answering questions and addressing concerns.

As I work on this book, the stories keep coming. This one, from Evonne, age 58, struck me as so inspiring and joyful amid all the problems I'm addressing that I had to share it with you right away. It shows that erectile dysfunction doesn't have to be a barrier to a passionate and immensely satisfying sex life. Evonne's joy makes me happy, and I hope it does that for you, too.

My fiance (age sixty-eight) and I are in an incredible, sensual, passionate relationship. We met about a year ago. Sparks flew immediately, and we jumped full force into each other emotionally. I must say, I was quite surprised, as I didn't know I could be that passionate again, and neither did he.

He was widowed, and I was divorced after a long-term marriage where I was rather bored with sex with my ex. My new lover aroused me in ways I never felt before. Neither one of us had had many sexual experiences and were not "world wise," but what came naturally - whew! What a ride.

My lover has had prostate cancer, and so we didn't expect much sexually. He is not able to sustain an erection. But--what the man can do with his hands! Wow. He is able to give me "inside" orgasms as well as out. All I can say is endless foreplay and multiple orgasms. I just roll with it and we play for at least an hour.

I pleasure him daily also. At first it was a little weird to kiss and caress him while he was not erect. But I got over it, and he gets so much pleasure out of it and I enjoy doing it for him.

We both are enjoying being truly desired and wanted. I am slightly overweight and always felt uncomfortable about my body with my ex-husband. But, my new lover tells me often how much he loves every inch of me. What a gift to my self-esteem he has been!

We both enjoy cuddling and this is a great source of comfort and intimacy for us. We are both in shock over the pleasure this sexual relationship gives us. Of course, we are in love and I truly believe that we could only reach this level of connection and intimacy in a spiritual committed relationship. We are getting married in June.

We sleep in the nude, which I love also. We believe this greatly enhances our activity as we are always open and available to each other’s touch and arousal usually follows. We plan to cuddle and snuggle--we call it “huggle”--for many years to come!

Doug, 80: "8 penises on his hands"

Doug, a reader from the Philippines, wrote a comment that was so interesting and helpful that I'm excerpting it here so you won't miss what he said. Doug wrote,

I am 80 years young and have had ED (erectile dysfunction) all of my life. It has taken me a whole lifetime to come to the point of seeing sex but the tip of the relational iceberg.

Yes, I also know that we men are our penises and our penises are the man. This is a mental hang-up that we need to change.

Doug addresses a reader in an earlier post who wrote that her husband can no longer have erections and has given up on sex and communication. Doug says to this reader,

Until your husband can change the way that he sees his masculinity, he'll never really feel good about himself. He has eight penises on his hands and the best penis in his mouth. And that up close and personal penis can and does give my wife wonderful, body-shaking orgasms, one right after the other, that most penile intercourse cannot come close.

And best of all, my ego isn't lying on the ground of mental failure. It works for me and it can work for your hubby.

Doug, you've been most helpful to our readers here, and I thank you for sharing your perspective. Would you please contact me personally so I can invite you to be in my next book?

No Erection, No Intimacy, No Discussion

Molly, age 63, wrote a comment that was featured in a blog post titled "He thinks he can't please her without an erection, so why bother?" She recently emailed me an update, and I asked her permission to share it with you:

I wanted to thank you for trying to help with my situation. I was the person who asked what to do when he doesn't want to have intimacy anymore because he couldn't get an erection. He just said "why bother?"

Unfortunately, our relationship ended. Not by me, by him. He does not communicate in any way with me. I've tried everything to get him to talk to me, but it's as if I've fallen off the face of the earth. This is after over two year relationship.

I took your advice and have contacted a therapist. She has been a great help to me. But somehow I think he would benefit so much from seeing someone, too.

It's just so unfortunate that my guy thinks so little of our relationship that he only based it on one thing. I wish I could try to turn back time and make him understand that an erection is not everything in a loving sex life. But that's not possible, he has completely cut me out of his life. Won't talk, or accept any communication from me.

I still love the man and I think I always will. It's so sad. Life is so very short not to enjoy it all.

Thanks again for your wonderful blog, I can't tell you enough how it has helped me cope.

I feel the heartbreak in Molly's words. She obviously loves this man, but he has shut her out completely.

I don’t think, though, that Molly's partner’s inability to communicate or accept her loving means that their relationship doesn’t mean enough. I think he's devastated and depressed by what he perceives to be the end of sexual possibility. It isn't, we know that, but that's how he sees it. He may be too stuck and too afraid to seek help.

I hear from men who say they have to unlearn the “I am my penis” lessons they learned as boys and teens. This notion becomes deeply ingrained and is a difficult lesson to unlearn, but the old story no longer serves them, or us.

I know it was difficult for Molly to share her story here, and I hope, readers, that you'll show her how valuable it was by sharing what you learn here that helps in your own relationship. I'm sure she'll welcome your warm comments.

He thinks he can't please her without an erection, so why bother?

An important question was posted as a comment to my blog interview with Michael Castleman who answered my questions about erectile dysfunction. Here's what a reader asked:

I've been in a loving relationship for over two years, its been great. Until now, its taken a complete turnaround. His thinking is because he can't get an erection he's a failure in pleasing me. No matter what I say, his comment is "why bother". I have been completely satisfied with our love making up until now, I am completely confused. Our love and intimacy made our relationship what it was, now what? What do I do?

This question moved me and I asked Michael Castleman if he would answer this reader He promptly replied:

I feel for you. When men develop erection difficulties and withdraw from lovemaking, they often seem completely shut down and unreachable, and no amount of reassurance seems to help.

Of course, such reactions are not unique to men. Imagine that you suddenly gained 100 pounds and no matter how hard you dieted and exercised, you could not lose an ounce. Now imagine that your lover said: "It's all right. It doesn't matter. I still love you, and want to make love with you." Would you believe him? Would you want to have sex?

To most men, sex means erection, and the notion of sex without erection makes a much sense as baseball without bats. But men CAN enjoy sex--and have great sex--without erections. Erection is NOT NECESSARY for male orgasm. Vigorous fondling of the penis by hand, mouth, or sex toy can produce orgasms every bit as intense and satisfying as the ones he used to have with erections. And erection is not necessary for female pleasure or orgasm either. In fact, only 25% of women are reliably orgasmic during vaginal intercourse because the old in-out doesn't provide much clitoral stimulation. Many women prefer a man with a talented tongue and fingers to a guy who just sticks it in.

Of course, it's a major adjustment for men to decouple sex from erection. Given how adamantly your man has been saying "why bother?" I think your best bet would be to try to coax him into joining you in consulting a sex therapist. To find one near you, visit the American Association of Sex Educators, Counselors, and Therapists or the Society for Sex Therapy and Research.

If he refuses to go, then I urge you to go by yourself. The therapist can help you cope, and make suggestions you might try at home with him. And the fact that you're going may show him how important the sensual side of your relationship is to you, and eventually he may relent and join you. Good luck!

Michael Castleman, M.A., is "one of the nation's top health writers" (Library Journal). He has specialized in health, medicine, and sexuality for 36 years. He is the author of Great Sex: A Man's Guide to the Secrets of Whole-Body Sensuality. From 1991-95, he answered the sex questions submitted to the Playboy Advisor. Visit his Web site about sex after midlife, GreatSexAfter40.com.

"A Powerdrill in Your Pants" -- Who wants that?

I get many spam emails advertising a bevy of erectile enhancement drugs and devices. I delete them without reading them. Today one came through with a header promising "a powerdrill in your pants." Others tell me (thinking I'm a man, or not caring who I am) that my woman will love being pounded, plundered, and otherwise assaulted with a huge tool.

Who actually believes -- and buys! -- this stuff? Is there a man alive who really thinks we women erupt in orgasms over a "powerdrill" of a penis? Ewwww. Even the thought is painful. Has anyone today -- male or female -- missed the message that a woman's pleasure center is her brain, number one, and her clitoris, number two. A powerdrill in the vagina doesn't set off either one of these. I wouldn't even insert an electric toothbrush. (Now a made-for-the-task vibrator, that's another story. But more on that another time.)

And while I'm questioning the sexual messages that bombard us, have you noticed that every time a couple on television get excited enough to start shedding clothing, they rip clothes off each other and often start having intercourse on the floor, or on a narrow couch, or against the wall, anywhere other than the comfort of a bed. And forget foreplay. Just get to it.

Even when I was young and quick to arouse, I chose comfort, slow arousal, and leisurely sex. Am I the only woman who never had sex against a wall, and who never wanted to? Or is this just one more example of how media sex is disconnected from real sex?

Are we teaching our young people that this is the way we like and expect to be treated? Shudder.

I welcome your comments!

Senior Sex: More than Erections

Here's something you don't know from the inner workings of this blog: Advertisers and promoters of erectile drugs and alternatives are always trying to promote their products via comments (usually totally off-topic) on my posts. I reject them so you never have to wonder if they're the answer to your prayers -- they're not. They want your business, pure and simple, and if they really wanted to help a man with ED, they'd talk him into going to his doctor and dianosing the cause of his erectile problems, rather than trying to sell him a product over the Internet.

I love your comments -- they're immensely valuable for my readers -- and I encourage you to post them (if you're not sure how that works, click here for easy, step-by-step directions. Just don't advertise THE solution for ED -- that's between you (or your partner) and your doctor.

Here's an excerpt from the chapter "When You or Your Partner Can't" from Better Than I Ever Expected: Straight Talk about Sex After Sixty on this subject:

According to the spam I receive in my e-mailbox daily, ED is the major concern of men, and an advertiser's dream. I am reminded of this guy joke that a male friend used to tell me:

Q: "What's the difference between fear and panic?"
A: "Fear is the first time you can't get it up twice. Panic is the second time you can't get it up once."

According to a 1994 study, sixty-seven percent of the men surveyed at age seventy experienced mild-to-severe ED. A partner's ED is an important challenge for some of women I interviewed, and I am grateful for their candor about sharing this intimate part of their lives. Many have found that sex can be satisfying when both partners communicate and seek creative and loving solutions, whatever the penis is or is not able to do...

Erectile dysfunction, not to minimize its importance, is only part of the picture. The sexual challenges of aging bodies go beyond penis problems.

The fact is that both partners may have health problems to deal with that affect sex. Arthritis, osteoporosis, heart disease, cancer--all of these impact our sex lives as well as our daily living. These and many other health problems require relationship adjustments including an extra dose of understanding from our partners. While health problems are certainly not the exclusive domain of genarians in the upper ranges, they occur with more frequency in older adults.

It's ironic, isn't it? We're at the prime time of life to enjoy sex. We know ourselves and our partners, the kids are long gone, we have more leisure time, we're less driven, our partners have learned how to satisfy us. What a cruel twist of fate that this is the time our bodies start acting up -- or down....

In the new book I'm working on -- I'm still welcoming your stories -- I'll have specific tips from medical experts and sex therapists about enjoying a satisfying sex life while living with ED (and other health challenges).*

*As you know if you've been following this blog, I put this book (and everything else) on hold while dealing with Robert's illness and death. I'll return to it soon -- it's my work and it was important to Robert as well.

Sex and Intimacy after Cancer

If you or your partner has been diagnosed with cancer, what part does sexuality play in your quality of life? How will cancer treatment impact your sexuality -- physically and emotionally? How do you cope with changes in function, libido, body image, and pain? How can you maintain intimacy in the face of these challenges?

“Sexuality is all about who you are as a man or a woman,” says Sage Bolte, MSW, LCSW, OSW-C, a renowned authority on sex and intimacy after cancer and an oncology counselor at Life with Cancer®, an Inova Health System service in northern Virginia. “It’s a critical part of your quality of life.” Sex and intimacy are key ways to affirm, “I’m alive, I’m human,” and of getting back what was important to you before cancer.

On March 11, 2008, the Leukemia and Lymphoma Society presented a teleconference with Bolte for 1,400 listeners. It was superb. Fortunately, the teleconference will be available as a transcript and MP3 recording sometime in April 2008 at www.lls.org/survivorship.

Forty to 100 percent of people with cancer will experience some form of change in sexual function, says Bolte, which can impact willingness to engage in sexual activity. However, she assures us, “Patience and techniques can help you regain a sense of sexual self and confidence.”

Although Bolte’s message was targeted at the special challenges of cancer, all of her suggestions also apply to living with any chronic or life-threatening illness, as well as the sexual challenges of aging itself. Here are some of her techniques for coping with specific problems:

Vaginal dryness and discomfort: Apply 100% vitamin E oil to the vaginal tissues and clitoris on a regular basis after showering, and use a water-based lubricant as needed during sex. Talk to your doctor about whether an estrogen ring or testosterone patch would be appropriate to regain moisture and restore elasticity of the vagina.

Erectile dysfunction: Tell your physician about this problem and have him/her look at all your medications. Have your testosterone levels checked. If you’re having a harder time maintaining an erection, try finding the positions that is most stimulating for you. Help your partner reach orgasm before intercourse. Devices for men that may help include penile pump; penile injections, suppositories, penile implant, penile rings. But if you’re on blood thinner or have low platelets, you need to consult with your physician before using any of these devices, because they might put you at risk. Viagra and similar medications are not recommended for men who have heart concerns or are taking blood pressure medications.

Pain and fatigue: After cancer treatment, the time of day that’s right for sex might change. If you’re too exhausted in evening, switch to morning or have a special lunch break. Take pain medication 30 to 60 minutes before activity. Get exercise, which can minimize fatigue and assist in decreasing some joint pain. “Remember that we can rest during sex,” says Bolte. “It’s not a marathon.”

Fear of rejection: Consider seeing a couples counselor or sex therapist. Often the problems of miscommunication, misinterpretation, and anxiety get in the way of your sexuality and intimacy. Work on your communication skills. (Note: I’ll be writing more on this topic in another post.)

Difficulties reconnecting with your partner: Communicate your own desires, ask for what you need, and ask your partner to communicate honestly, too. Be affectionate. Take it “slow and easy.” Take time to be together and to connect. Find other ways for both of you to have pleasure.

Redefine your expectations,” suggests Bolte. “Sometimes you can’t get back to the function you had prior to cancer, but that doesn’t mean it can’t be good or pleasurable.” Focus on touch, sensation, pleasurable feelings. Use sex toys. Engage in mutual masturbation. Read fantasy to each other. Touch yourself. Massage each other and cuddle.

“Take more time to get stimulated, talk yourself into sex,” Bolte recommends. Realize that instead of the physiological response coming first and driving the emotional response, it may need to be the other way around, a “mind thing first.” Schedule your sex time – plan it, think about it, fantasize, and work yourself up to the mental excitement that will stimulate the physical excitement.

Don’t let sex feel like pressure to perform. Sometimes practice just touching without the expectation of intercourse. Re-explore alone what feels good to your body now. “Start with self-pleasuring experiences,” says Bolte. “Your body has changed since treatment. You need to be comfortable touching yourself and knowing what feels good now.”

I applaud the Leukemia and Lymphoma Society for recognizing the importance of sexuality to people diagnosed with cancer and Sage Bolte for generously providing her expertise.

Tom, 55, “My wife had her first orgasm in six years”

Tom, age 55, wrote me a beautiful account of how he and his wife rediscovered their intimacy and sexual pleasure after a combination of health issues and medications left his wife unable to have orgasms. She was taking blood pressure medicine and antidepressants, and had stopped hormone replacement therapy. Tom had his own health issues, including low metabolism and testosterone levels. Combined with his wife's lack of lubrication, decreased sensation, and anxiety, "our sex life seemed to be drying up."

We slowly reached the point where we decided we needed to fix the situation. We started taking more time in our lovemaking and trying different lubricants, and that did work much better for us. I also bought your book Better Than I ever Expected, and it has been very helpful.

However, I found that when we had romantic weekends, I would occasionally have problems maintaining my erection. That had never happened before and was really stressful, so I now use Levitra to have confidence that I can be erect. The effects of Levitra seem to linger, so I don't feel like I need to take it right before lovemaking. I can take it anywhere from one to 12 hours ahead of time and it still works for me.

Unfortunately, no amount of foreplay, oral or manual stimulation was able to bring about an orgasm in my wife. This was really frustrating to me, since I felt that our lovemaking was too one-sided. I think it maybe bothered me more than my wife. In the past, I was very good at knowing her body and her response and I could bring about very nice orgasms by a combination of oral and manual massaging. So, after reading your book, and doing some additional reading and research, I spent $225 on an Eroscillator. We had never experimented with sex toys, so I wanted to get something that looked like it would be effective, and this seemed to have the recommendations and documentation to back it up.

What a difference! The first time we tried it, we spent some time together getting warmed up, and I used the soft fingertip attachment on her, and my wife had her first orgasm in six years within just a few minutes, and she cried in my arms afterwards. This has made a huge difference in our lovemaking, and my wife now has very strong orgasms.

We are still trying to figure out the best way to work it into our lovemaking, we had never used any vibrators or sex toys before. I love it because I now can be sure that I can please her, and I want her to be able to come first. I like it because it is nearly silent, and very effective.

Thank you, Tom, for your candor and for the details that will help other people in the same situation. As you know, I've been a fan of the Eroscillator (the soft fingertip attachment is my favorite, too!), and I found my own eyes starting to water when I read about your wife crying in your arms after her first orgasm in six years. As for how to work it into your lovemaking, the woman can hold it and use it for clitoral stimulation while her partner is caressing and arousing her manually, and she can also use it during intercourse, depending on the position.

"What would you tell others in your situation?" I asked Tom.

I would just tell others that there are ways to make things better. Talking with doctors and counselors can help, but I think that the familiarity of their doctors with sexual issues may be lacking, so specialists may be needed. I do know from personal experience how difficult it is to go to a doctor and ask for help on sexual matters. Requesting a prescription for Levitra was a very tough thing to do, so I can imagine that talking about more difficult issues can be very hard.

Fortunately, with some effort, the Internet can be a good source for information. That (Amazon.com) is where I learned about your book and blog, and I also picked up Dr. Ruth's book. I also used it to search for different lubricants to try and learn about the Eroscillator. Especially for people who are not in a major city the Internet is a great tool.

Please click on the picture below to learn more about the Eroscillator:

Cory Silverberg: Sex blogs to vibrators

Every time I revisit Cory Silverberg's sexuality guide at About.com, I'm impressed by the amount of dynamic, useful information. Cory's section about senior sexuality includes links to articles he has written about aging and sexual satisfaction, HIV and the older adult, erectile dysfunction, vaginal dryness, Kegel exercises (with instructions for both men and women), and more.

Silverberg is a certified sex educator, co-founder of Come As You Are, and co-author of The Ultimate Guide to Sex and Disability. He helps Sue Johanson select the sex toys that she reviews on her TV program, Talk Sex with Sue. I can't resist telling you that Johanson gave a splendid mini-review of my book on April 15, 2007:

Sexual activity changes as we age, but that does signal the death of pleasure. BETTER THAN I EVER EXPECTED by Joan Price is a fabulous book about sex after 60 that is aimed primarily at females. If you have been brain-washed into thinking sex is only for the young, this is the book for you. Get a copy for yourself or for your parents. They will thank you.

In other sections of Silverberg's comprehensive sexuality site, he discusses everything from sex blogs to vibrators. Take a look!

73-yr-old man pleases wife with "ten fingers and a tongue"

A reader who wants to call himself "Buttonbob" sent me this email:

I am a 73 year old male. For the past few years I have been using Viagra. I must confess that most of the time it didn't do the trick. But an old friend of mine reminded me that I had ten fingers and a tongue.

I found to my surprise that my lady didn't need intercourse and was more than happy to settle for hugging and oral touching and caressing. Once over the shock I discovered I began to enjoy the touching and caressing even more, My advice to others is get over the idea that intercourse is the end all. Enjoy your close relationship with your spouse that touching and hugging can give.

This is a subject that comes up over and over. Many men think that intercourse is the goal of sex, and that if they have erectile difficulties, they might as well give it up. Not true! Sex is two minds, two bodies, and two hearts making love -- not just two sets of genitals! There are many ways to please a partner without intercourse, and this reader is right on track with "ten fingers and a tongue"!

I welcome your comments.

Intimacy after prostate surgery

Several readers have posted and emailed me about sex and intimacy after prostate surgery. I asked Anne Katz , RN PhD, author of Breaking the Silence on Cancer and Sexuality: A Handbook for Health Care Providers and sexuality counselor at CancerCare Manitoba in Winnipeg, Manitoba, to respond to a common question:

Ever since my husband had his prostate removed because of prostate cancer, he has been reluctant to touch me. This is so upsetting. I love him very much and don’t know what to do.

It is common for men to be unable to have an erection after this surgery. Depending on the type of surgery (nerve sparing or not), his ability to have erections may or may not return. Many men are deeply distressed by this and may avoid all physical contact with their partner so as not to “lead them on” or disappoint them. This leads to a very unhappy partner who wants to express his/her love and support but feels cut off and cut out.

What is important is for the couple to TALK. It is often really difficult to talk about a sensitive topic when emotions are running high. But talking goes a long way to healing and connecting. Start with an “I” statement: “I miss touching you and being touched by you. How can we reconnect again?” Or perhaps: “I love you so much and want our relationship to be the way it was before the surgery. What can WE do to help this happen?”

While there are medications and treatments that may help, further treatment should be a couple’s decision and the man should always include his partner in medical appointments so that both people can express themselves and have their questions answered. Because communication is so important, the couple may need professional help to start the communication flowing. But seeking help is the first step.

For more posts about cancer and sexuality, please click "cancer" in the "labels" list in the right-hand column.

Is this helpful? Let me know what questions you'd like me to explore as we age and encounter physical and emotional challenges to our sexuality.

--Joan

Gerald Haslam talks about prostate cancer and sex

Gerald Haslam, author of Grace Period, is living with prostate cancer. He wrote a stunning summary of his views of the importance of sexuality while living with cancer for my upcoming book. I know I have many readers who are looking for information on sexuality and cancer, so I'm giving you an advanced look at some of the insights he shared:

A seventyish man who was recovering from a prostatectomy asked fellow members of a prostate-cancer support group how they could have sex if they were leaking urine. He ended with a timeless observation--"My wife is willing to be pissed off but not pissed on."

Despite the laughter that followed, his was a serious problem, but the first response solved it: "Put a band on your penis --a cock ring. A lot of older guys who aren't incontinent use them to maintain erections, but if you're leaking they're a good answer, especially if you use a pump."

The first man was honest enough to admit, "I hadn't thought of that. We've never used any...devices. Of course, I've never had prostate cancer before, either." In fact, the prostate cancer world introduces many guys to devices and positions and concepts previously unimagined.

A physician pal said to me shortly after I was rendered impotent by prostate surgery and radiation, "You'd better start pumping up your penis every day, whether you're going to use it right away or not, or it'll shrivel into a Vienna sausage. As soon as you lose spontaneous erections you lose penile tone. No tone, and there'll be nothing to pump when you do want to use it."

In fact, sex seems to be the second most common topic--after cancer therapies--in discussions at most prostate cancer support groups, and I learned that many men, rendered impotent and perhaps stripped of libido by hormonal ablation, simply but not happily accepted the verdict that their sex lives were over, a defining activity lost. A dread frequently mentioned to me by my fellow prostate-cancer survivors has been not only the sudden absence of sex but of sexuality itself. This is especially grave since sex and sexuality can represent the life force's most powerful affirmation in the face of death.

Unfortunately, many of us men grow up believing that our sexuality dwells almost exclusively in our genitals, so a damaged penis may lead to a damaged personality. As one wife admitted at a session for couples, "There's not much fun in our lives anymore, and I don't just mean sex. He's just so sad." A penile fixation may also lead one to forget how much sexual satisfaction can be achieved by giving pleasure to a partner you love.

Please read my review of Gerald Haslam's Grace Period. Click here to view or order Grace Period on Amazon.

Erectile Dysfunction: Michael Castleman Talks to Men

So many readers--both male and female--have been asking for information about erectile dysfunction that I asked Michael Castleman, a sex educator, counselor and journalist specializing in men's sexuality to answer some questions. His interview starts here and continues here.

Q: Explain erectile dysfunction (ED) and why it happens.

MC: Only a small fraction of men from age 45-60 have true ED. A larger but still modest fraction of men over 60 have true ED. True ED is the inability to raise an erection despite vigorous extended hand massage of the penis. True ED is usually the result of a medical problem, either a problem with the nerves that control erection, or more likely, narrowing of the arteries that carry blood into the penis. Like the arteries of the heart, the arteries into the penis can become narrowed by atherosclerotic plaques. Causes of plaque formation: heart disease, diabetes, smoking, high blood pressure, high cholesterol, high-fat diet, sedentary lifestyle. In other words, all risk factors for heart disease are also risk factors for ED. In addition, ED can be caused or aggravated by stress and anxiety, which constrict the arteries and limit blood flow into the penis.

Q: What about men who are capable of erections, but they're less reliable than they used to be and require more stimulation?

MC: While only a fraction of men over 45 experience true ED, just about every man experiences what sex therapists call "erection dissatisfaction" (EDis). After 45 or 50 or so, men with EDis can still raises erections, but they don't rise as quickly as they used to. They no longer rise from fantasy alone--seeing an attractive woman or some erotic scene. Men begin to need direct penis stimulation by hand or mouth. When erections rise, they may not look/feel as firm as they were in the man's 20s. They may also droop from minor distractions, anything from donning a condom to hearing a motorcycle roar up the street.

The good news is that EDis is a normal and natural part of aging. If older erections wilt a bit, hand massage and/or oral stimulation bring them back up again--IF the man remains relaxed and patient with himself. If the man gets stressed and anxious, this reduces the likelihood of a return to fullish erection.

Many (most?) older men are unclear on the distinction between true ED and EDis. Many mistakenly think they have ED when they experience the normal age-related erection changes of EDis. Now EDis can be disconcerting. I've been a sex educator for 30 years. I knew all about what happens to erections after 50. But when those changes started happening to ME, I found them unnerving. P.S. Erection medication (Viagra etc) helps treat EDis. In fact, most men who take erection drugs don't have true ED. They have EDis.

Q: Many men fear that they can't please a woman without an erection, or they give up on sex altogether. Is an erection necessary for sex?

MC: Of course not. As you know, women's pleasure organ is the clitoris. Many women prefer cunnilingus to intercourse. Surveys show that only 25% of women are reliably orgasmic from intercourse, no matter how vigorous or how long it lasts. So women know that an erection and vaginal insertion are not necessary or sufficient for sexual pleasure and orgasm. But many men DON'T know this.

Q: How did men's sexual education skip that important concept that women's orgasms are based on clitoral stimulation, and that most women don't need penis-in-vagina penetration for their pleasure?

Most men get most of their sex ed from pornography. Porn is totally penis-centered. Porn actors have monster cocks, which makes normally endowed men feel they're "too small." Mainstream porn includes a bit of massage and cunnilingus, but it's mostly about sucking and fucking, so that's what men come to believe sex is all about.

I've spent my life as a sex educator and counselor trying to persuade men that they'll have better sex and get better reviews from women if they ditch their preoccupation with their penis and focus instead on leisurely, playful, whole-body, massage-based sensuality. But compared with porn, which is viewed overwhelmingly by men and is by far men's #1 source of sex ed, the combined voices of every sex expert on earth amount to a little whisper in the hurricane of porn porn porn.

Here's where I plug my book, Great Sex. Its message to men: If you want great sex, if you want women to sing your praises as a lover, stop trying to imitate porn. In fact, do the opposite of what you see in porn. Not only will she be happier, you will be, too. You'll enjoy sex more and have fewer sex problems--more cooperative erection and better ejaculatory control.

Michael Castleman, M.A., is the author of twelve books, including Great Sex: The Man's Guide to the Secrets of Whole-Body Sensuality and Sexual Solutions: For Men and the Women Who Love Them. From 1991-95, he answered the sex questions submitted to the Playboy Advisor. Visit his website about sex after midlife, http://www.greatsexafter40.com//.

Bill B: 59-yr-old Guy's Viewpoint

I just received an email from Bill B., age 59, who brings up so many provocative topics and expressed so skillfully that I'm giving Bill his own post here:

Hi, Joan, I just became aware of your book about sex over 60 featuring the feminine perspective and look forward to reading it. In response to some of your questions, as a guy, I think we generally like things presented in a "Problem: Solution" format. For example; a chapter titled 'Rise & Shine' might present the various forms of ED, and then some of the available answers for each 'challenge'.

While I'm currently most interested in keeping my long term relationship viable and fun, I would like to know how I might have to deal with forming new relationships after becoming a 'sudden single'. I hope there'd be room and topic enough for both sides of relationship issues.

I would like to read men's perspectives on the issues, both from a what didn't work, to what did and, when possible, why. Possibly a survey of some sort, answered by both men and women might provide some supportive insight to the specific cases or examples you would cite. Maybe it would present something like:

"John's gruff attempts at intimacy made him feel like something else had been lost to aging; he couldn't remember the way to a woman's heart, so he quit trying because he would just fail again. Marcy is married to a man like John, and feels ... about it. Our Survey shows xx% of men say that they share these feelings and have found that ... helps fix the problem. yy% of women responding to Marcy's situation say ... Clinical remedies suggest that ... is usually effective in cases like this because ..."

I would also like a woman's perspective on the things I feel and experience. Sometimes a spouse can be too supportive, when a firm dose of reality might be better in the long run (maybe that's another 'guy' thing).

I like all the topics you suggest. Most guys in my age group were pretty heavilly 'John Wayne-ized' as kids, i.e.: emotions are for women and non-men. I think a chapter or section titled something like "I wonder if other guys ... ?" that dealt with subjects guys don't usually discuss could be worthwhile. I grew up in a single mother household and didn't get to see the daily life of a man. I'm far from alone in that. We've had to make it up, or copy it, from whereever we could.

Another thought occurs to me; If you want to lose a little title symmetry with your other book, you might call it "Sex after 60 for men: A user's guide" -- Muy Macho! I suspect that might cost you quite a few readers, because I think more women are still going to buy this book than men. After all; we're men, and don't need to stop for directions for anything (a feeling too true for too many guys).

Most of the sex manuals I've bought in the past were intended for my wife; I might browse some, pause at the art, and then put it somewhere she'd have to almost stumble over in hopes she'd read it and become my dreamt of 'whore in the bedroom' without my having to actually deal with anything. Of course it didn't work, so my fix was to stop buying those silly manuals -- they clearly weren't worth much! I wonder if any of the publishing companies have buyer stats on their various sex manuals, and if they'd share them?

You have my permission to post any or all of this email with my signed name. I'm clearly no author; these are just some ramblings that occurred to me as/after I read your request for thoughts. I'm 59, Male, Married, Cauc, Some College, retired from USAF, retired from a computer consultancy, and have way too much time to annoy others.

Best of luck with your project,
Bill B.

What good timing, Bill, because I'm drafting my new book proposal this month. You've reinforced my ideas and given me some new ones. Readers like you, who get genuinely involved in speaking out about senior sexuality, let me know that I'm not on this mission alone!

Readers: Please comment. Men, do you agree that you'd be interested in the book Bill describes? Any additional ideas? Women, do you agree that you buy the books about sex, even (especially?) those for and about men?

Thanks, everyone!

-- Joan

Dean asks, "Does Granny like oral sex?"

I just got an email from Dean, who describes himself as "a very active 70 year old" from Kansas. He asks this:

Joan: I have had sex with ladies 40 to 74 in the last ten years. However I am diabetic and take pills for high blood pressure, so due to those two items I am as you guessed, impotent to the Nth degree. I have had and given oral sex to several partners but I feel like they feel that this isn't normal. My question, I guess, is, does granny really like this or is it that she feels, well, that's all he can do? Can you come up with a ball park figure in percentages of the lassies that do and don't get excited about oral sex? I have known ladies that were extremely sexual but would have nothing to do with oral. Is this very much the way granny thinks? Joan, I love the ladies and they like me, but what's a relationship without a little pandering?

Dean, I imagine our readers will have plenty to say, but let me start out by saying that calling a woman with whom you want to have sex "Granny" or "Lassie" just isn't sexy! I don't know how you interact with these women, or what you call them during pillow talk, but your wording here makes me wonder!

As far as whether older women like oral sex, there's no percentage I can give you. I can tell you that the better the man is at giving oral sex -- the more he tunes in to the sounds and movements that show him what she likes -- the better she'll enjoy it. That means not developing a one-technique-fits-all approach, but gathering many skills and the most important skill: being attentive to her cues and responding to them.

I'd like to recommend a book to you, Dean, and to every man who wants to understand better what a women enjoys during oral sex: She Comes First: The Thinking Man's Guide to Pleasuring a Woman by Ian Kerner. This book is clever, practical, and full of tips and techniques guaranteed to help any man become a better lover!

Changes after Prostate Surgery: Tina Tessina

Many of you have been reading and asking about prostate cancer, how it affects sexuality, how spouses/lovers can communicate and keep their love strong while living with it. Some of the most widely read posts on this blog have been those dealing with prostate cancer, such as "A man asks about sex after prostate cancer" and "Grace Period: a novel about living with prostate cancer."

In response to your interest, I've asked Tina Tessina, Ph.D. to comment on this subject. Besides being a psychotherapist and author, Tina writes from experience: her husband is living with prostate cancer. Here are her comments:

The changes that come after prostate surgery are, like all changes, not easy. We don't like to have to deal with changes, especially those that confront us with our mortality. But, I can happily report, with some encouragement and enthusiasm from me, my wonderful husband is quite functional sexually. His surgery was in 2002, he just got another 'undetectable' PSA test, so we are blessed.

For us, the blessing is in how heightened our love and appreciation (which was pretty good before) has been by the threat of terminal illness. Richard is lucky -- they got it early, it has not spread, the surgery went well. His second surgery to have an artificial sphincter put on his urethra, also went well.

Others, I know, have a more difficult time. But, as Gerald Haslam wrote in Grace Period, "Live for the moment, since that may be all you have." Richard and I decided to do that in 2002, and we've been making the most of our moments ever since. Every day is a gift, another cup of sweetness, and we drain it to the last drop. One of our joke lines is "I'd like another one of them there drinks," from Scrooge, referring to the Cup of Human Kindness given to him by the Ghost of Christmas Present.

For some couples, the tension of serious illness creates crabbiness and bickering. Richard and I have never wanted to waste time arguing, and we haven't for a long time. I don't believe it helps anything that's going on. In my newest book, Money, Sex and Kids: Stop Squabbling About the Three Things That Can Destroy Your Marriage out from Adams Media spring 2007, I help couples who are fighting learn new methods of getting along so they can enjoy their time together.

For more, see Tina Tessina's Dr. Romance Blog. Dr. Tessina is a psychotherapist, author of several books including It Ends With You: Grow Up and Out of Dysfunction, How To Be a Couple and Still Be Free, and The Unofficial Guide to Dating Again. She writes the "Dating Dr." column on www.CouplesCompany.com and "Dr. Romance" on Yahoo! Personals.