Chapters:
Index Page
Being a Digger and a Bloke
Choose Health - Be Active!
Talking to Your Doctor
Vascular Health and Diabetes
Mental Health
Your Lungs
Pills, Potions, Drugs & Alcohol
Cancer
Living with Chronic llness and Pain
Making Sense of Sensory Loss
Men as Carers
Dental Health
Healthy Driving

Other Resources :
Magazine
Feedback on the Men's Health Peer Education program. An e-mail address has been established to take feedback and comments on your experiences with the MHPE program. Click here to provide your feedback to us.

Being a digger and a bloke

Sexuality and intimacy

What is sexuality?

The term sexuality includes all those qualities that allow one human being to feel comfortable with their own bodies and with their ability to form a sexual relationship with someone else.

Sexuality is part of ourselves from before we are born until we die. It involves all those aspects of our lives that make us the people that we are.

In the past there were clear ideas about what was right for men and what was right for women, eg. 'men don't cry', 'women don't wear trousers'.

These days society is a lot more open about how we express ourselves, and the ways in which people express their sexuality. For example it is OK to consider sexual relationships between:

Old people
People with intellectual or physical disabilities
Same sex relationships.

Some people are happy about these changes. Others, especially if they are unsure about their own sexuality, feel threatened by this change.

The things we learned as we grew up influence our sexuality and how we feel about it.

If questions about our body were answered openly and honestly we will probably feel pretty good about ourselves.

However, if each time we asked a question relating to sexuality we were laughed at, or told an untruthful answer, or sidetracked, or told off for talking about such things, we may well still feel unable to talk about these issues, and indeed, even feel there is something 'dirty' about sexuality.

This is not our parent's fault; they did not have the information to give us. They grew up in the post-Victorian era when even chair legs had to be 'dressed' in case they incited excitement in men!

Sexuality and ageing

As we age all aspects of our body's functioning change, including aspects of our sexuality.

Most of us are aware of the changes in women's bodies brought about by the hormonal changes of menopause. Apart from an end to menstruation, changes can include a dry vagina meaning that a lubricant is necessary before intercourse, and a longer time to become sexually aroused so more time is needed for foreplay.

However, many of us are unaware that changes are also occurring in men's bodies. Menopause in women happens over a few years. The 'male menopause' may be more gradual, as the level of the male sex hormone testosterone, which also causes changes in their sexual functioning, declines more gradually.

The ability to obtain and maintain an erection gradually changes, so that between the ages of fifty and seventy, 50% of men will have problems in this area. Many men are not aware of this, and the next time they attempt to have sexual intercourse they remember their previous failure. This raises their anxiety levels and leads to a vicious cycle where they fail each time. The decrease in the number of times one ejaculates also leads to a decrease in the amount of testosterone in the body. The old adage, 'use it or lose it' is true!

As men enter their seventies and eighties the period of time between one ejaculation and the next ejaculation also increases.

If you are aware beforehand that these events are normal and can occur you can find ways to deal with them.

Male sexuality has, for a long time, been associated with the ability to perform penetrative sexual intercourse. Therefore when any of these problems arise, many men feel very threatened, and may blame their partner, become aggressive, or give up attempting to have sexual intercourse.

Remember, penetration and ejaculation are not the only forms of sexual pleasure. If you believe this, you are limiting your sex life, and missing out on the pleasures of exploration.

Older men need a longer foreplay time. Make use of this time to find out more about what feels good. How long since someone ran a feather down your body? Have you tried chocolate body paint?

Apart from the changes mentioned above, difficulty in getting erections may also occur as a result of the medical conditions and treatments, which become common as we age. These include medications which are prescribed for heart conditions, and conditions such as diabetes and multiple sclerosis.

What can we do about these 'problems'?

As we enter middle age we can use this time to reassess our sexual activity. Our children are probably older and many will have left home.

'The best way to deal with any of the changes that are occurring in our lives is by maintaining good communication with our partners. This is especially important in the area of sexuality.'

Our lives may have become routine, and the intimacy, or romance, with which we used to approach our sexual lives, may have become routine also.

How long is it since you brought your partner flowers? Told them you loved them? Planned a weekend away? Asked them what pleased them sexually?

Sexuality and intimacy do not have to involve penetrative sexual intercourse. There are many other ways of satisfying our sexual needs. These can include massage, a warm bath or shower together, a cuddle on the couch. Masturbation, alone or as a couple is also acceptable, though the prohibitions (taboo) on this activity we were taught as children make this a difficult option for some people!

It is also acceptable to not have any sexual activity. There are periods in our lives when many people choose this option. Difficulties may occur in a relationship if one partner wishes to disengage from sexual activity for a time, and the other wishes to continue. In this instance, the options mentioned above may be useful.

Impotence

Impotence is a term used to describe a man's inability to achieve or maintain an erection.

Lifestyle choices can cause impotence.
Physical or psychological stress, overuse of alcohol and use of non-prescription drugs can all cause impotence.

Medications, medical conditions, and impotence

It is well known that some medications can cause impotence, especially those given for heart conditions and some antidepressants. With some medications this will be temporary, but with some will last for the time you are on your medication. If you have a problem, persevere with your medication for at least six weeks to see if the problem improves. There are many different drugs available, and your doctor may be able to change you to another drug without this side effect.

Do NOT stop your medication without consulting your doctor.

There are some medical conditions which may cause impotence (eg. diabetes) or make it painful or uncomfortable to be intimate with a partner (eg. multiple sclerosis, arthritis). There are ways around most of these problems.

As before, the first treatment is open and honest communication with your partner. Can you find ways around the problem yourself? Good control of your diabetes will delay the onset of circulation problems. A warm bath and good positioning with pillows may help people with arthritis.

Most support groups have an information booklet or leaflet addressing the sexuality issues specific to that condition. Family Planning clinics can help you access trained counsellors for specialist support.

Medical treatments

Viagra

Viagra is a tablet which increases the blood flow to the penis, thereby helping men who have erectile difficulties achieve and maintain an erection.

DVA will authorise prescriptions for Viagra, from your medical practitioner, if you have specific war-caused or service-related disabilities with erectile dysfunction. DVA will fund one pack of four tablets per month.

Although this drug may help you achieve an erection, it may not cure any other sexual problems which are occurring in your relationship. The best treatment for sexual problems is open and honest communication with your partner.

Viagra can be dangerous in some situations. It is important that you do NOT take Viagra if you are on medication for chest pain, specifically medications like Anginine or Nitrolingual spray. There are other medications which interact with Viagra so it is important that you tell your doctor about ALL other medication you are on when you visit him/her. (This is a good general rule for all of your visits to your doctor!)

Penile pump

A pump draws blood into the penis, and a rubber ring is then slipped onto the penis to keep the blood in place until after intercourse. It is important of course to remove the rubber ring on completion! Some men with minor erectile problems can obtain the same effect by using a condom.

Implants

There are two types of implants available for men having trouble with erections. One is a flexible plastic tube, which is implanted into the penis, and the other is an expandable cylinder, which is pumped up when a man wishes to have intercourse.

Injections

Injections like 'Caverject' can be self-injected after appropriate training into the penis before intercourse.

Most sexual problems are due to performance anxiety or difficulties in a relationship. Look to addressing these issues first.
This information must be used with advice and ongoing medical supervision.

Issues for presenters

Sexuality is a difficult issue to deal with. If you do not feel comfortable talking about these issues, it is better not to do so, but have a list of contacts where you can refer people if questions do arise.

If you are having this session as part of a series of education sessions, hold it towards the end of the course when people within the group have had a chance to get to know each other.

Here are a few ideas to help make your session successful if you are talking to a group:

At the start of the session ask the group to set some 'ground rules', as it is important that participants have a sense of 'group safety'. These could include:
- Confidentiality (very important)
- Respect for others opinions
- One person talking at a time.
Once they have been decided on, write them out on a sheet of butcher's paper and attach them to the wall. You can then refer to these if necessary.
Tell people in your introduction that you do not need to know about personal experiences, that you will be discussing sexuality in general.
Be aware of your own limitations, and have available a list of contact numbers in your own area to which you could refer people.

Have fun!

Where can I go for help?

Your medical practitioner who knows your medical history is the best person to talk to in the first instance. If she/he feels unable to help there are other options available.
Your local Family Planning Clinic will have practitioners who specialise in male health issues.
Sexual Health Clinics have male staff who may be able to deal with your issue. They do not just treat sexually transmitted diseases.

There may be a medical centre in your area which deals specifically with men's health issues. There are also many women's health centres.

On the web

Mens Health: Andrology Australia - is an informative site with information on the male body, prostate disease, testicular cancer, male infertility, androgen deficiency, impotence and much more:
www.andrologyaustralia.org

1Up Health - is a medical and health information resource containing a database of health articles and reference materials. Consumers and health professionals alike can depend on it for information that is authoritative and up-to-date.
The Penis - an Owners Manual is available electronically from this site:
http://health.allrefer.com/links/mens-health.html

Sexual Health Info Centre - is an excellent site providing information on better sex, safer sex, STD's, sexuality and ageing, lesbianism and homosexuality, and sexual problems:
http://www.sexhealth.org/man.shtml

Sexual Healthline Queensland Health site - offering information from a doctor or nurse for the community and health professionals on STD's and HIV, fertility and sexuality:
http://www.health.qld.gov.au/pah/sh/healthline.htm

In this Chapter...