Are You "Man" Enough?

These are some of the top conditions Dr Ng Kok Kit, Consultant Urologist, Andropause and Men’s Health Clinic at Changi General Hospital has been seeing in recent years. Although these problems may be due to reasons such as financial or relationship stresses, andropause – a condition brought about by declining levels of the male hormone, testorone – can also result in sexual problems with the advent of middle age.

It is not necessarily a mid-life crisis, but rather an actual physical decline of the body,” said Dr Ng.  “For older couples, it is important to understand how ageing affects both partners and that they should accommodate each other’s limitations.”

Sexual woes

Doctors interviewed agree that sex-related problems such as erectile dysfunction, impotence and reduced libido rank among the top concerns that middle-aged men seek treatment for. How one copes with ageing depends on one’s personality.  “As a man ages, one of the first things he notices is that he has poorer erections.  But the sexual act is not the end in itself.  One can still take time to enjoy romance and foreplay,” said Dr Ng.

A matter of perspective

Solving age-related sexual problems requires a change in perspective, said Dr Ng Beng Yeong, Senior Consultant Psychiatrist and Head of the Department of Psychiatry at Singapore General Hospital, who has been managing patients with sexual concerns for more than six years. He believes that there is a wide range of sexual performance levels for men and they can feel satisfied with their sexual experiences even in old age. 
“Sex is not a question of function or dysfunction, or whether you can do it or not.  No single definition for ‘normal’ or ‘abnormal’ sexual function applies universally,” he said. Not to mention the number of misconceptions that exist, especially when it comes to erectile dysfunction drugs.
He added: “Many people have the mistaken belief that after taking a drug like Viagra, they will spontaneously have an erection.  For the drug to be effective, a couple needs to engage in foreplay and very often, direct stimulation to the penis is required.”

Medical solutions

At present, the most common treatments for erectile dysfunction include taking drugs such as Viagra, Levitra or Cialis under medical supervision.  The most drastic treatment is a surgical procedure which involves inserting a penile implant.
Reduced libido caused by a lack of testosterone can be confirmed with a blood test and treated with testosterone supplements. The treatment can be given in an oral form or via a series of injections, with regular follow-ups to ensure that the patient’s testosterone is replaced adequately and safely.

Prevention is better than cure

The effects of ageing are evident, even in fit, young men, as revealed in autopsies of casualties from the Vietnam War. Thus, it is important to have a well-balanced lifestyle – physically, emotionally and financially – as it is the first step towards graceful ageing and a healthy sex life. If you have any chronic medical problems such as diabetes, hypertension, hyperlipideamia and depression, they need to be managed well so as to prevent long-term complications.
Experts warn against drug and alcohol abuse, as these have a toxic effect on the nervous system, damaging nerves that are critical to sexual desire.  Smoking causes early atherosclerosis (which leads to premature erectile dysfunction and is also associated with heart attacks, strokes and many cancers) and should be avoided.
Exercise regularly to improve your self image (which increases desire and boosts sex hormones) and promote healthy blood vessels (which means delaying the onset of erectile dysfunction). On the emotional front, focus on relationships with important people in your life and let go of past grievances. Also, be mentally and financially prepared for retirement.  If one enters the golden years possessing financial stability, companionship and meaningful hobbies, one will be well equipped to lead a more fulfilling life in the later years.

Misconceptions about sexDr Ng Kok Kit, Consultant Urologist, Andropause and Men’s Health Clinic at Changi General Hospital (CGH) and author of Managing Male Ageing (S$18.50, CGH’s retail pharmacy), shares five common myths about male ageing and sex:
1.  “I’m impotent, but my friends don’t seem to have any complaints about their erections.”Every man’s erection becomes weaker with age.  However, men with medical conditions like diabetes, hypertension and high cholesterol may experience erectile dysfunction earlier in their lives.	2. “My penis is too short for good sex.”Many men have this misconception that good sex requires a long penis.  Procedures to lengthen the penis are merely cosmetic and do not enhance erection.  In fact, they may even impair erections in some cases!	3. “I can’t have multiple erections.”Most men do not have multiple erections.  After ejaculation, the penis will have a refractory period whereby it cannot become erect.
4. “I use erection drugs to improve my sex life.”Erection drugs do not increase sex drive.  They increase blood flow in the penis, allowing erections to be stronger and more rigid.	5. “I can die from taking erection drugs.”Deaths from erection drugs are very rare and they happen when men take the drugs without medical supervision.  Victims may also have underlying medical conditions like heart problems.  When taken properly under medical supervision, erection drugs are actually very safe.