Middle-Age Erection Dissatisfaction: What Happens From Around Age 45 to 55
Middle-age erection changes are normal and inevitable. Appreciate the difference between middle-age erection dissatisfaction and later ED.
Guess who is most likely to take erection medication. Not the elderly men the drugs were developed for, but middle-age men who can (usually) still get it up but want “erection insurance.” Middle age is a time of erection changes, and change is unsettling. Here’s what middle-aged men and their partners need to know.
ED means no erections from masturbation.
According to the American Urological Association, erectile dysfunction (ED) is “the inability to achieve or maintain an erection sufficient for satisfactory sexual performance.” Huh? That’s absurdly vague. If you define “an erection” as what you see in porn, and “satisfactory sexual performance” as porn sex—instant, rock-hard erections that last forever with climaxes always on cue—then just about every guy has ED. What is it, really? For practical purposes, ED means that men who are sober (no alcohol or other erection-impairing drugs) have persistent difficulty raising erections during extended masturbation or can’t raise them at all.
Most middle-aged men suffer not ED but erection dissatisfaction.
Starting around age 45 to 50 (possibly earlier for smokers and/or diabetics), erections change, in some men gradually, in others more quickly. Men lose the ability to raise erections solely from sexual fantasies. Direct fondling becomes necessary. When erections appear, they may rise more slowly and not become as firm as they used to during men’s twenties and thirties. And minor distractions—an ambulance siren on the street—may cause wilting. These changes alarm many men, who jump to the conclusion that they must have ED. But if you can still raise erections during masturbation, you don’t have ED. You have erection dissatisfaction.
Middle-age erection changes are normal and usually inevitable. But some lifestyle factors can postpone or even temporarily reverse them: falling madly in love, getting in shape (see below), and making love earlier in the day when you have more energy.
Unfortunately, other factors exacerbate erection dissatisfaction: anxiety, alcohol, many other drugs, relationship problems, and making love when fatigued, i.e., late at night after a long day and a big dinner with wine or other alcohol.
Anxiety about erection changes is particularly pernicious. It triggers the fight-or-flight reflex that sends blood away from the central body, including the penis, and out to the limbs for self-defense or escape. Less blood in the central body means less blood available for erection. Erection dissatisfaction is upsetting, but try to accept it. It’s normal. And if you become anxious, erections become less likely. Good ways to minimize anxiety: a hot shower before sex, and during lovemaking, deep meditative breathing, a slow pace, and lots of sensual touch all over.
Erection dissatisfaction can actually enhance lovemaking.
The gathering clouds of middle-age erection changes have a silver lining. Young couples often experience conflict because young men become aroused faster than young women. Young men are often all finished before young women have even become aroused. Middle-age erection changes slow men’s arousal so their erotic pace more closely matches women’s. A slower pace allows plenty time for kissing, cuddling, and whole-body massage, all essential to most women’s enjoyment of sex. Seen in this light, for many middle-age couples, erection dissatisfaction can be a gift.
Healthy lifestyle may postpone ED.
Erection depends on blood flow through the penis. Anything that impairs it increases ED risk: smoking, diabetes, high cholesterol, high blood pressure, heart disease, being overweight, little regular exercise, more than two alcoholic drinks a day, and fewer than five daily servings of fruits and vegetables. In most men, avoiding these risk factors does not prevent middle-age erection changes, but it preserves erection function and helps postpone later ED.
The drugs are worth trying for erection insurance, but don’t expect miracles.
Everyone has heard of Viagra, but Cialis is actually more popular because it’s effective longer—24 to 36 hours instead of three to five. Erection drugs improve erections in around two-thirds of men. They don’t work for about one-third. They do not produce porn-star erections. Over time, many men need larger doses. But as dosage increases, side effects become more likely, notably, headache and nasal congestion. Finally, the drugs have no effect on arousal, so men may raise erections but do not feel particularly interested in sex. Many men feel disappointed with the drugs. Fewer than half refill their prescriptions.
Erection changes can mark the end of sex or a new erotic beginning.
When erection dissatisfaction develops, some men decide that’s it, sex is over. Others accommodate and continue to enjoy lovemaking as long as they live. The choice is yours.
After around 60, ED becomes prevalent. The studies on ED prevalence in older men are all over the map, from only a small proportion of men affected to most. The studies showing a low prevalence have relied on face-to-face interviews. When directly facing an interviewer, men tend to underestimate their level of ED. The studies showing higher prevalence have used phone and Internet surveys, more socially distant, so less embarrassment in front of interviewers, and a greater likelihood of coming closer to the truth. The best study comes from Australia’s ongoing Florey Adelaide Male Aging Study (FAMAS), which has included both in-person and socially distant surveys repeatedly over many years. It shows that 91 percent of men over age 65 report noticeable ED, which varies from mild to severe. Nine percent claim no problems, but the large majority admit impairment. Something to think about and prepare for in the future.
The drugs work best in combination with sex therapy.
Several studies have shown this. There’s more to satisfying sex than an erection. Relationship issues are crucial, especially if sex has been a sore point or if the couple hasn’t had much for a while. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists.
If you’re no longer having intercourse, you don’t need erections.
Most men assume that erections are necessary for sex. No. Couples can have great sex without them. Intercourse becomes problematic for older couples. Men develop ED and post-menopausal women suffer vaginal dryness and atrophy that can make intercourse uncomfortable impossible even with lubricants. Many older couples jettison intercourse in favor of “outercourse”: kissing, hugging whole-body mutual massage, oral sex, sex toys, and perhaps some kink—and enjoy hot sex.
Men can have orgasms without erections.
That’s right, you don’t need an erection to have an orgasm. In an erotic context filled with kissing, cuddling, fondling, massage, oral, and sex toys, a man with a semi-erect or even flaccid penis can enjoy orgasms as intense as any he ever experienced during intercourse.
Bottom line: Appreciate the difference between middle-age erection dissatisfaction and probably later ED. Live a lifestyle that supports erections. And understand that over the next decade or so, you’re likely to develop some ED—but you can still enjoy sizzling sex and fabulous orgasms.
[scroll down for related Questions & Answers]
References
Blanker, M.H. et al. “Erectile and Ejaculatory Dysfunction in a Community-Based Sample of Men 50 to 78 Years Old: Prevalence, Concern, and Relation to Sexual Activity,” Urology (2001) 57:763.
Corona, G. et al. “Age-Related Changes in General and Sexual Health in Middle-Aged and Older Men: Results from the European Male Aging Study (EMAS),” Journal of Sexual Medicine (2010) 7:1362.
Johannes, C.B. et al. “Incidence of Erectile Dysfunction in Men 40 to 69 Years Old: Longitudinal Results from the Massachusetts Male Aging Study,” Journal of Urology (2000) 163:460.
Laumann, E.O. et al. “Sexual Dysfunction in the United States: Prevalence and Predictors,” Journal of the American Medical Association (1999) 281:537.
Laumann, E.O. et al. “Sexual Dysfunction Among Older Adults: Prevalence and Risk Factors from a Nationally Representative U.S. Probability Sample of Men and Women 57-85 Years of Age,” Journal of Sexual Medicine (2008) 5:2300.
Martin, S. et al. “Clinical and Biopsychosocial Determinants of Sexual Dysfunction in Middle-Aged and Older Australian Men,” Journal of Sexual Medicine (2012) 9:2093.
Martin, S.A. et al. “The Florey Adelaide Male Ageing Study (FAMAS): Design, Procedures and Participants,” BMC Public Health (2007) 7:126.
Pinnock, C.B. et al. “Erectile Dysfunction in the Community: A Prevalence Study,” Medical Journal of Australia (1999) 171:342.
Questions & Answers
I’ve answered more than 12,000 sex questions from people around the world, of all ages, for free. Here are a few that relate to the topic of this post.
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I am in my 40s and get erections effortlessly but lately find them hard to sustain. Recently my urologist suggested I take Viagra and it worked. Actually its effect remained for more than 24 hours. My concern: will it be harmful in the long run? Or can you suggest something different? Read my response…
I’m very upset and so is my wife. I’m 46 and healthy. I can get an erection just fine when I masturbate. Sometimes I also wake up with morning erections. But during sex with my wife, I’m having real erectile dysfunction. Sometimes I don’t get hard at all. Other times, I get it up, and then lose it. I love my wife. I find her very sexually attractive. And I’m not having an affair. But she wonders if I love her, if I’m attracted to her, and if I’m cheating. Help! Read my response…
I am 43 years old. I have suffered erection malfunction although I am healthy and fit. My penis does not become 100% erected, just 75 %. I need to overcome this. Are there herbs or healthy foods I can use? I don’t want drugs. What do you advise me? Read my response…
I’m 43 and have been stressing over erectile issues this past year. I was worried that I had erectile dysfunction due to cardiovascular disease. My doctor in November assured me that my circulation is fine. I got my borderline-high blood pressure and cholesterol (201 now 130) back in normal ranges. I guess I have erectile dissatisfaction at this point. I haven’t been prescribed ED meds yet. Would taking supplements like L-Arginine or L-Citrulline help improve the blood flow down there? Read my response…