The New Naked: The Ultimate Sex Education for Grown-Ups (13 page)

Bottom line: Just as you know you need to incorporate exercise into your daily life, so do men. If they’re sedentary, they should start slowly and not go crazy on the weight machines or free weights because they
will
get hurt. And if your man starts lifting
weights obsessively, he might find it hard to lose weight, because adding all that muscle quickly makes a man insatiably hungry. The best thing to do is find a resistance-training program that gradually increases muscle mass. This will keep his appetite in check and help get the weight off.

You might also suggest that you work out together. If you can both join a gym and coordinate your schedules, that is a fantastic incentive. You don’t have to do the same workout, but you’ll be less likely to cancel if you’re committed to meeting at a certain time. Or, see if he can join a team. He might not get quite as much exercise on a team as if he went for long runs, but the camaraderie is a ton of fun, and whenever exercise is fun, it’s a lot less likely to fall off the calendar.

Bear in mind, too, that when a sedentary, overweight man starts exercising, he might gain a small amount of weight at first from the muscle mass he’s adding to his body. This should be followed by a significant weight loss once the new muscles increase his metabolic rate.

To lose weight smartly, men (and anyone for that matter) should walk a minimum of 10,000 steps each day. That will improve his heart health and gradually increase his stamina. If there’s a question of how many steps your guy is walking, get him a pedometer, which tracks the number of steps. If he doesn’t get close to that number, try to have him walk around the neighborhood for a while (if at all possible) or do a DVD or streaming workout until he does.

Whatever workout he chooses, it should be something he likes so he’ll stick to it. I see men in the gym every day, running on the treadmills and bored out of their minds. They’re not working out
at maximum capacity because they don’t really enjoy it. I can exercise as much as I do because tennis is one of my great passions and stress relievers. That keeps me on the courts even when I’ve had an exhausting day. It keeps me fit and strong, and it keeps my libido juicy.

A common question my older patients ask me is: When do you become a sexual senior?

My answer: When you feel like one!

I’ve lost count of how many sixty-something male patients have sat in my office worrying about their age and their cholesterol and minor aches and pains.

“Do you have morning erections?” I ask them.

They nod yes.

“Do you have regular sex, at least two to four times a week?”

They nod yes.

“Then you’re healthy.”

They look at me in shock.

“The penis is the dipstick of a man’s health,” I explain. “A well-functioning penis and a regular sex life mean your body is working as it should. Of course you should still have regular medical checkups, but this is one of the best indicators a man can have that he’s in good shape.”

They nod again, smiling happily.

“If, on the other hand, your sexual drive starts to decline,” I hasten to add, “and if you only feel like having sex once or twice a month, or once or twice a year, that tells me something’s wrong, and it needs to be investigated. But in the meantime, enjoy yourself!”

When it comes to aging, women have it rough. Not only do you go through hormonal hell every month while you are fertile, but you can go through an even worse hormonal hell during perimenopause, when the female hormones estrogen and progesterone start to decline, and during menopause, when these hormones decline even more rapidly.

Men don’t age in quite the same way. While women can find their hormonal drops to be rather precipitous, testosterone levels gradually slide down the slope by only about 1 percent each year, usually starting around the age of thirty. As a result, a man’s chronological age is not the best kind of indicator of where his biological clock stands.

I know men in their seventies and, rarely, in their eighties who have the sexual stamina of a man fifty years their junior. Now that’s saying something. Conversely, a man in his thirties with low testosterone will have the sexual stamina of his grandfather. For him, that’s saying something, too—only not in the way he wants!

The best way to gauge the male biological clock is by measuring three physical factors:

• Testosterone (how high the level)
  

• Erections (the quality and reliability)
  

• Weight gain (within a normal range, especially waist size)
  

A man who’s not having any difficulties with these three factors is considered biologically young even if he is chronologically
old, although the quality of the genetic material in sperm does degenerate with age.

Still, as both men and women grow older, both take longer to become aroused. Women have less vaginal lubrication, and men’s erections aren’t as high or as robust (what I already called the angle of the dangle). And lots of other factors come into play, because overall health also determines sexual health and sexual aging. These factors include how well a man takes care of himself by: eating nutritious food and exercising regularly, getting enough sleep, not smoking, avoiding excessive alcohol or drug consumption, not having other illnesses or accidents, and avoiding exposure to environmental hazards, as well as by the luck of the draw with his genetic history. Obviously, women need to deal with these same factors, as well as the physical changes that come with large drops in hormonal activity over the perimenopause years.

Eventually, of course, men need to confront their mortality the way you women often already do. I know how my wife felt when she realized her fertile years were behind her. Although we already had three teenage children by then, for her as for so many other women, it was still is a shock to realize that she was getting older and there’s no turning back that clock. A man coming to grips with his aging penis will be struggling with the same feelings.

Older couples who come to see me frequently ask what the secrets are to keeping up a gratifying sex life as they start to slow down. I’ll address this more in
Part II
, but overall, the key for both men and women is to keep your relationship strong through a few basics that you may have already heard. Foster great communication with your partner; help each other feel secure and loved; keep desire alive with a willingness to experiment and try new things;
and adapt playfully to the bodily changes that accompany aging. You have to do your best to laugh about getting older, because, as the old cliché goes, the alternative could be worse.

And, of course, there’s the miracle of modern medicine for men—in the form of the little pills that have revolutionized the treatment of sexual dysfunction, and can ease the stresses and strains and worries about aging because they keep those erections coming. (Sorry, bad pun!)

Lots of my patients jokingly refer to their little blue Viagra pills as their own special “Vitamin V.”

Viagra made a huge splash when former presidential candidate Bob Dole did commercials for it on TV after its initial launch in 1998. Pundits were incredulous—here was a politician, a statesman, a public figure, no less, speaking candidly and without shame about a man’s need for a sexual aid because the natural effects of age had slowed him down. Talk about courage!

The point of Bob Dole’s story is that no man with sexual dysfunction, no matter what his age, should be embarrassed about needing medical help to improve the quality, duration, and frequency of his erections. As I’ve said already, it is perfectly normal for men to have some kind of sexual dysfunction at some point in life—usually from a temporary situation like stress or fatigue or the emotional anxiety of having a new sexual partner. A decrease in sexual prowess is also to be expected as years go by. Blame it on biology and the fact that we age and slow down.

That said, if a man is having any problem with a loving partner
in bed, he should make an appointment with his doctor or a urologist to discuss it and options for treatment (both medical and non-medical). Once medical reasons such as low testosterone or other factors are ruled out, and when warranted and truly needed, erection-enhancing drugs (EEDs) like Viagra, Levitra, and Cialis can be just the kind of oomph a guy needs. Sometimes just knowing that there are meds to help with erections is all a man needs to get over whatever is keeping him down.

And it’s not only about his needs. Your needs are just as important. A man who knows that he can easily get a little oomph to help him perform is a man who will regain his sexual confidence. That should make you both happy, in bed and out.

Although testosterone declines very slowly over the years, a man of fifty will still have about 20 percent less testosterone than he did when he was thirty. With those numbers, and factoring in other conditions such as weight, diet, cardiovascular health, and different medical conditions, it’s been estimated that 50 percent of men between the ages of fifty and sixty have some level of erectile dysfunction. Sixty percent of men at age seventy do, as do 70 percent of those at age eighty or above. For them, EEDs can be fantastic.

EEDs work by blocking an enzyme that controls the way arteries in the penis constrict after the release of nitric oxide, making it easier for a man to get an erection and to maintain it. It’s important to note that EEDs do not
cause
erections. Nitric oxide needs to already be present in the penis—and as you read on
page 78
, nitric oxide is only produced by your body in response to physical or mental sexual stimulation. This is a good thing, because otherwise every man taking an EED would walk around with an
erection for hours, if not days, and that can be a
huge
impediment to normal functioning.

In a man who doesn’t need that extra boost, an EED will enhance his erection by adding a maximal amount of blood into the penis. Because he’ll have a shorter latency period, he might be able to have another erection in less time. He can ejaculate again, too. This can be a good thing for you if he was too quick for you to be able to have an orgasm the first time. A second erection can slow him down and give you the time you need for your own pleasure.

But if the desire for sex isn’t there, an EED is not going to work. EEDs also don’t work well in men with low testosterone and the ensuing low libido. But if hormone replacement therapy works, the EEDs should, too. Viagra and Levitra need to be taken about thirty to sixty minutes before sexual activity is expected. The effects typically last for four to six hours. Cialis got its nickname as “the weekender” because its effects stick around for about thirty-six hours, which gives a man a larger window for the time when he wants to have sex.

If the EEDs don’t work and testosterone levels are normal, further medical intervention may be required. There might be some other medical issue, or perhaps damage to either the blood vessels or nerves involved with erections. There are erection-creating options such as self-injection into the penis, intra-urethral suppositories (yes, just what it sounds like!), vacuum devices, and penile implants, but all have their drawbacks and are treatments of last resort.

As a urologist who has seen the emotional pain, worries, and suffering that men robbed of their ability to have satisfying and
regular sex suffer from, you might think I’d be brimming with joy that EEDs are so widely prescribed, used, and accepted. After all, before these pills were created, many men were unable to have a healthy and happy sex life due to erectile dysfunction. Now that these pills can alleviate some of this dysfunction, it should be a win-win for these men and their partners, right?

Not so fast. Yes, EEDs can be near-miracle workers for men who really need them. But because EEDs are all too often dispensed the way antibiotics are—for illnesses that don’t really require them—and scarfed down by men who don’t have a clue about the real cause of their erectile dysfunction, EEDs fall into the category of overprescribed and overused.

Since erectile dysfunction can be an early sign of a serious medical problem, a prescription for an EED should
never
be dispensed unless a man’s overall health is properly assessed first. Conditions like diabetes, heart disease, or cancer that may be causing the erectile problems need to be ruled out.

Lots of men don’t want to know this, so they doctor-shop until they get the prescription they want. (Please do not get me started on medical practitioners who prescribe improperly!) For these men, having erections when they want them is more important than taking optimal care of their health. Lots of younger guys take EEDs to reduce performance anxiety, too.

Remember, any man willing to potentially risk his well-being simply to have more sex is taking chances with his health. Make it clear to him that pill-popping is never a substitute for common sense and self-worth.