Part 1: Changes in Sexual Function in Middle-Aged and Elderly Men and Correct Understanding
Based on the current physiological and psychological conditions of men in my country, it is generally believed that they enter old age after 60, while 35 to 60 years old is considered middle age. However, after 45 years old, the decline in physiological functions gradually becomes obvious, and age-related diseases begin to occur. Therefore, 45 to 60 years old is called the "early old age" or "pre-old age," which is closely related to old age both physiologically and pathologically. Therefore, the middle-aged and elderly men referred to in this book are men over 45 years old, including both the pre-old age and old age stages.
The pursuit of a normal sex life is a natural biological phenomenon and a physiological need for health, and this is no exception for middle-aged and elderly people. Renowned physician Watt Alvarez points out that even at 80 years old, people can still experience sexual desire and derive pleasure from it. As long as there are no specific medical conditions or other restrictions, regular sexual activity can be maintained into old age and is beneficial to both partners.
However, like any physiological function, male sexual function also undergoes changes with age. Starting in middle age, sperm production gradually decreases with age; after age 60, serum testosterone levels gradually decline. Therefore, the sexual function of middle-aged and elderly men inevitably weakens or undergoes various changes. At the same time, many age-related diseases and psychological and social factors can also affect the sexual function of middle-aged and elderly men.
As stated in Wu Jieping's translation of "Sexual Medicine": "An elderly couple with a strong sexual interest can indeed maintain their sexual interest and ability until they are seventy, eighty, or even ninety years old. However, the sexual ability of a considerable number of elderly people will change, mainly manifested as: general sexual apathy, sexual aversion, sexual physiological damage, cultural inhibition, and disuse atrophy of sexual function."
With the increasing number of middle-aged and elderly people in my country, the sexual function problems of middle-aged and elderly men have attracted more and more attention in order to enable them to have a satisfactory sex life and thus promote their overall physical and mental health.
I. Changes in the sexual physiology of middle-aged and elderly men
As middle-aged and elderly men age, their genitals and sexual function undergo a series of changes, a phenomenon known as the aging phenomenon of sexual function.
1. Changes in the testes and male hormones
The seminiferous tubules within the testes are where sperm are produced. In my country, men can produce mature sperm as early as 14-15 years of age; spermatogenesis is most vigorous between 24-25 years of age; spermatogenesis begins to decline after age 30, and the decline becomes more pronounced after age 40; between 50-60 years of age, the walls of the seminiferous tubules thicken significantly, the lumen expands, and the sperm count decreases significantly. However, research by Chinese scholar Lü Debin on the histology of the testes of elderly men shows that the testes of men over 70 years of age still retain spermatogenic function.
The interstitial cells outside the seminiferous tubules are the tissues that secrete the male hormone testosterone, which is an important substance affecting human sexual function. With age, these interstitial cells can undergo aging and degenerative changes, leading to a decrease in testosterone secretion, which inevitably causes a decline in sexual function.
2. Changes in libido
In middle-aged and elderly men, libido gradually declines due to decreased testosterone secretion. However, the decline in libido with age does not have an absolute parallel relationship with the decrease in testosterone levels. The authors of "Practical Concise Andrology," edited by Lü Debin, conducted a survey on the decline in libido in elderly men and summarized the findings in Table 1.
The relationship between age and changes in libido
Age: 60---Number of cases, High libido: 18 (8.61%), Normal: 99 (47.37%), Decreased: 66 (31.58%), Absent: 26 (12.44%), Total: 209 (100.00%)
65 --- Number of cases: Vigorous 8 (6.50%), Normal 61 (49.59%), Weakened 32 (26.02%), Disappeared 22 (17.89%), Total 123 (100.00%)
70 --- Number of cases: Vigorous 3 (3.37%), Normal 31 (34.83%), Weakened 28 (31.46%), Disappeared 27 (30.34%), Total 89 (100.00%)
Of the 75 cases, 1 was vigorous (2.56%), 15 were average (38.46%), 11 were weakened (28.12%), and 12 were absent (30.77%), for a total of 39 (100.00%).
80 --- Number of cases: General 2 (16.17%), Reduced 2 (16.17%), Disappeared 8 (67.66%), Total 12 (100.00%)
85 --- Number of cases, reduced by 2 (50.00%), disappeared by 2 (50.00%), total 4 (100.00%)
Total cases: Vigorous 30 (6.30%), Normal 208 (43.70%), Weakened 141 (29.60%), Disappeared 97 (20.40%), Total 476 (100.00%)
3. Changes in the sexual response cycle
The human sexual response cycle begins with sexual arousal, progresses through orgasm, and then returns to a state of calm. This systemic, cyclical change, primarily involving the sexual organs, can be divided into four phases: excitement, plateau, orgasm, and resolution.
Changes in the excitement phase: Compared to their younger years, middle-aged and older men experience slower penile erection induced by sensory stimulation, require longer durations, and necessitate more direct contact. Many middle-aged and older men cannot respond to effective stimulation within a few minutes, and even when they do achieve an erection, it is not as firm as it was in their youth.
Plateau phase changes: When middle-aged and older men reach the plateau phase of sexual response, erection is usually quite good, but testicular elevation, mild scrotal congestion, and testicular vasodilation may be barely noticeable. With age, preejaculation urethral discharge disappears or significantly decreases.
Middle-aged and older men typically experience a longer plateau phase in their sexual response compared to younger men. From the initial heightened sexual tension to complete satisfaction, they can usually maintain a high level of sexual arousal for a considerable period without becoming weak due to the urge to ejaculate. Middle-aged and older men generally have better control over ejaculation than younger men, thus achieving more pleasurable sexual satisfaction.
Changes in the orgasmic phase: The most obvious physiological changes in the sexual response cycle of middle-aged and older men occur during the orgasmic phase. The orgasmic phase is usually shorter, often lacking the urgency and inevitability before ejaculation, and even if it does, it only lasts for 1 to 2 seconds, while in younger men it lasts for 3 to 4 seconds.
While the rhythmic contractions of the penis and urethra during ejaculation also occur at intervals of 0.8 seconds in middle-aged and elderly men, there are only 1 to 2 contractions, whereas in younger men, there are generally 3 to 4 contractions, or even more. This is because the characteristic penile contractions, i.e., the propulsive force of the semen bolus, are reduced in middle-aged and elderly men, resulting in a shorter distance for semen to be ejected from the urethra.
The amount of semen in middle-aged and elderly men gradually decreases with age. Even after abstaining from ejaculation for 24 to 36 hours before ejaculation, the amount of semen in middle-aged and elderly men is only 2 to 3 milliliters, while that in younger men can reach 3 to 5 milliliters. However, these physiological changes do not seem to impair the sexual desire and orgasm of middle-aged and elderly men; they can still achieve extreme excitement and experience complete euphoria during orgasm.
Changes in the resolution period: The refractory period of sexual response in middle-aged and older men, that is, the time when they are physiologically unresponsive to sexual stimulation after ejaculation, is prolonged. It usually takes several hours for the penis to become fully erect again. In contrast, the refractory period of younger men usually only lasts a few minutes, and they can become fully erect again under effective stimulation.