Monday 18 December 2017

Sexual health and dealing with decades of differing challenges

Whether they are 17 or 70 there is always pressure on men to perform

Illustration: Tom Halliday
Illustration: Tom Halliday

Mary O'Conor

It starts in school, both academically and around sport, and continues when they begin their working career. Men are expected to perform. It is also true in the sexual arena - men are expected to be 'good in bed' to 'give her an orgasm' to 'give her a baby' among other things. No wonder the term 'performance anxiety' is used so frequently in relation to men and sex.

THE TEENS AND TWENTIES

The late teens are often times of great uncertainty for young men. They are having all sorts of sexual awakenings, they are sometimes uncertain around girls when it comes to getting together and some are questioning their own sexuality. It is also the time when they probably have their first fully sexual encounter - with varying results!

But before they ever get to having sex, parents should ensure that their young boys pay attention to their hygiene, hopefully laying down the basis for a lifelong habit. Most young Irish men are not circumcised unless for religious reasons.

As a result young boys should be taught from a young age to clean under their foreskins while in the shower. This will prevent smegma build-up which can produce an unpleasant odour and can sometimes lead to infection.

The first problem a young man may encounter when he attempts to be fully sexual is that this foreskin will not easily retract, causing him pain. Sometimes this tightness will ease by simply practising rolling it back with a little Vaseline, but in some cases he will require a circumcision. The GP will be the best judge as to whether surgery is required. It is a fairly straightforward operation but the healing process can take some time, and frequent baths with Epsom Salts still appears to be the best method of easing the pain.

Assuming everything is in working order then the most common sexual problem in the late teens and early twenties is premature ejaculation (P.E.). The length that a couple would like intercourse to last varies from couple to couple but if he ejaculates sooner than either of them want then that is considered premature. P.E. is often due to a combination of lack of confidence, inexperience and the fact that the whole sexual arena is so exciting. Guys with P.E. feel a huge sense of shame and are often terrified that the girl they were with will tell other people.

As a result they tend to have only one night stands or indeed stay away from female contact altogether. P.E. responds really well to therapy in a lot of cases but if you cannot attend a therapist then the Barry McCarthy/Michael Metz book Coping with Premature Ejaculation is particularly good. In some extreme cases the GP may prescribe medication.

It is important here to mention checking for testicular cancer. Just as girls are encouraged to check their breasts every month, young men should check their testes every month and be on the lookout for any changes that occur. The highest incidence of testicular cancer is in those between the ages of 15-35 and even though treatment has a very high success rate early detection is vital.

THE THIRTIES

In his thirties a man can encounter problems in his sex life, and a lot of these are related to stress. This is a time when a lot of men are settling down to married life, having children, trying to advance their career, paying the mortgage and if their partner is also working they can both experience tiredness and in some cases a loss of libido. It is a common assumption that any man is ready, willing and able at all times to have sex, but this is not the case. Sometimes his partner may have a higher sex drive than him, so checking how things are with her is vital.

THE FORTIES

In his forties erectile dysfunction (ED) may become an issue. In fact at any age this can be a problem. Particularly if he has become fairly lax in exercising, his diet may be not all that it should be leading to weight gain, and so his cholesterol levels may be too high. High cholesterol levels can lead to a build-up of plaque in the arteries which in turn can block the blood flow to the penis. Many men's high cholesterol is treated with medication generically called statins, but these statins can also cause ED which means that the 'cure' is going to add to the existing problem of ED. It is important therefore that he has annual check-ups where his doctor can keep an eye on things before they get too serious. There are splendid medications such as Cialis and Viagra available that specifically treat ED, and psychosexual therapy is also highly effective. It is also very important to look at the state of the relationship - if all is not well between the couple then he cannot expect an erection on demand.

THE FIFTIES AND SIXTIES

The fifties and sixties bring prostate problems, heart problems and very often problems with arthritis. Any form of heart attack or stroke is a very big wake-up call, and sex will be the last thing on a man's mind. But as time passes and they recover, men often speak of their fear of being sexual in case sexual activity places too much of a strain on the heart. This is a perfectly normal response and very often the partner is even more worried than the patient. If this is the case both partners should talk with a doctor about their concerns. If arthritic pain is a problem they should try different positions and use pain killers and/or heat to help the joint pain before making love. A hot bath can also be a great help.

THE SEVENTIES

Men are now into the Senior Sex category. One of the great benefits of this age group is that with it comes retirement, more leisure time, and the possibility of being sexual at different times of the day, not just at night. Of course there are problems as well - a need for more stimulation to achieve and maintain an erection and orgasm, shorter orgasms and less forceful ejaculations are some of the things that men mention. So they need to adapt to their changing body, and that of their partner, and perhaps even adjust the lovemaking to allow for extra stimulation. They should try to stay positive and focus on ways of being sexual and intimate that work for both partners.

It's not all about intercourse - the primary object of intercourse is procreation and people in their seventies are probably not wishing to procreate - but it is about giving and receiving pleasure in whatever way works. They should be open to new ways to enjoy sexual contact and intimacy.

Some men have absolutely no problems in discussing their sex lives with their doctor, but for others - especially when the doctor has become a friend - the prospect of baring all can be daunting. But your first port of call should be a GP, and remember it doesn't have to be your regular doctor. If necessary the doctor will refer the patient on to a urologist - which is the male equivalent to a gynaecologist - for more specialised treatment. Many medications such as those used to treat depression can affect one sexually so it is important to check with the doctor if prescribed medication has side effects.

A few final points:

* Men take care of their cars and get them serviced regularly - they should do the same with their bodies.

* Maintain good dental habits and visit the hygienist regularly. Remember, it all starts with a kiss!

* No matter what the age safe sex should be practised - sexually transmitted diseases are still a risk, even if pregnancy is not.

* If you are going to a sex therapist, go to a fully-qualified practitioner. Irish accredited psychosexual therapists are now listed on a website: www.sextherapists.ie

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