Sexual difficulties in middle age are just as natural to the aging process as a change in hearing, vision, or physical strength. While it’s important to understand why most men over 40 experience some form of sexual difficulty, it’s more important to understand that sexual difficulties in middle age (and beyond) can be managed.

Types of Sexual Difficulties

Ejaculation disorders
This includes premature ejaculation (the inability to delay ejaculation until it is mutually desirable by both partners), inhibited or delayed ejaculation (ejaculation that is slow to occur, or doesn’t happen at all) and retrograde ejaculation (ejaculate is forced back into the bladder rather than through the urethra and out the end of the penis at orgasm).

Premature ejaculation is the most common of these problems, especially among younger men. There are techniques men can use to help delay ejaculation—and using condoms may help too (and, as a bonus, they help protect against STIs and unintended pregnancy). While medications can play a role in ejaculation problems, both premature and inhibited ejaculation may have a psychological cause, like anxiety about sex or sexual performance, or sexual trauma. A qualified therapist or counselor may be helpful in resolving the issue, if this is case.

Retrograde ejaculation can be the result of side effects from medication, nerve damage, or surgery, such as prostate or bladder surgery. Depending on the cause, the treatment usually consists of changing an existing medication or prescribing a new medication. If surgery is the underlying cause, the condition may not be correctable. However treatment isn’t medically necessary—unless pregnancy is goal. In that case, treatment would be needed to allow a man to ejaculate semen through the penis.

Loss of Libidio
A loss of libido, also called inhibited desire, is a decrease in desire for, or interest in, sexual activity. This can affect both men and women, and for some of the same reasons—stress, depression, side effects of medication, or relationship problems. But loss of desire for sex in men can also be the result of a decrease in testosterone levels, which is natural as men age.

Erectile dysfunction
Erectile dysfunction, or ED, is the inability to achieve or sustain an erection suitable for sexual intercourse. While more common as men get older, ED is a medical condition that can affect men of any age. ED happens when there is not enough blood flows to the penis, preventing an erection. Causes are largely physical, but there can be psychological and lifestyle causes as well.

The majority of cases of ED have physical causes, often related to vascular diseases (related to blood flow) such as heart disease, high blood pressure and diabetes. It can also be caused by other types of physical conditions, like neurological problems (e.g. stroke or Parkinson’s disease), trauma to the pelvic area (including trauma from surgery, such as surgery related to prostate cancer), hormonal problems (e.g. thyroid disease) or chronic illnesses.

Sometimes there are psychological reasons behind ED. These might include depression, relationship problems, or a fear of intimacy. Lifestyle factors can also play a role, including drug abuse, alcoholism, smoking, obesity, and a sedentary lifestyle. Sometimes prescription drugs taken to treat a variety of conditions are the source of the problem (there are many prescription drugs that can cause ED.)

It is however, not uncommon to see ED in an otherwise completely healthy person, both physically and psychologically. Read more about ED here and check out our video on myths and facts about ED below.