“Rocking but Rusty”

This is an encore blog entry and is perhaps my most popular blog ever written. It is worthy of another look as Valentine’s Day approaches this week. This was a fun one to write, imbued with plenty of humor, with a factual basis behind the humor. I credit one of my patients for the “Rocking but Rusty” title, as this is how he colorfully described his sexual function.

GUIDE TO SEXUAL FUNCTION BY DECADE

I have arbitrarily broken sexual expectations down by decade, with the understanding that these are general trends and that an individual may vary greatly from others in his age cohort, depending upon genetics, lifestyle, luck, and other factors. There are 30-year-old men who have major sexual issues and 80-year-old men who are veritable “studs,” so age per se is not the ultimate factor.

I crafted what follows after almost 35 years in the urology trenches, working the front line with thousands of patient interactions. Furthermore, I am a 60-something year-old, keenly observant of the subtle changes that I have personally witnessed (although I must report that I am still holding my own!). Educational books are available on so many topics regarding expectations, such as “What to Expect When You’re Expecting,” but I have yet to see “The Manual of Man,” explaining the changes we might expect to experience as time goes on. (I would love to tackle writing that book someday, but it would be a formidable task considering all that may go awry).

SEXUAL FUNCTION BY DECADE

Age 18-30: Your sexual appetite is mighty, and sex often occupies the front burners of your mind. It requires very little stimulation to achieve an erection—even the wind blowing the right way might be enough to stimulate a rigid, gravity-defying erection, pointing proudly at the heavens. The sight of an attractive woman, the smell of her perfume, the mere thought of her can arouse you fully. You get erections even when you don’t want them… if there was only a way to bank these for later in life! You wake up in the middle of the night sporting a rigid erection. When you climax, the orgasm is intense, forceful, and powerful. When you arise from sleep, it is not just you that has arisen, but also your penis.

It doesn’t get better than this… you are an invincible king… a professional athlete at the pinnacle of your career! All right, maybe not invincible… you do have an Achilles heel—you may at times ejaculate rapidly because you are hyper-excitable and sometimes in a new sexual situation you may have performance anxiety, a form of stage fright brought on by your all-powerful mind dooming the capabilities of your perfectly normal plumbing.

Age 30-40: Changes occur ever so slowly, perhaps so gradually that they are barely noticeable. Your sex drive remains vigorous, but not as obsessive and all-consuming as it once was. You can still get quality erections, but they may not occur as spontaneously, as frequently and with such little provocation as they did previously. You may require some touch stimulation to develop full rigidity. You still wake up in the middle of the night with an erection and experience “morning wood.” Ejaculations and orgasms are hardy, but you may notice some subtle differences, with your “rifle” being a little less powerful and of smaller caliber. The time it takes to achieve another erection after ejaculation increases. You are that athlete in the twilight of his career, seasoned and experienced, with the premature ejaculation of yonder years occurring much less frequently.

Age 40-50: After age 40, changes become more obvious. You are still interested in sex, but not nearly with the passion of two decades earlier. You can usually get a decent-quality erection, but it now often requires more tactile stimulation and the rock-star rigidity of years gone by has given way to a “firm” penis, still quite suitable for penetration. The gravity-defying erections don’t have quite the upward angle they used to. At times, you may lose the erection before the sexual act is completed. You notice that orgasms have lost some of their kick and ejaculation has become feebler than previously. Getting a second erection after climax is not only more difficult, but also may be something that you no longer have much interest in. All in all though, you still have some game left.

Age 50-60: Sex is still important to you and your desire is still there but is typically diminished. Your erection is still respectable and functional, but not the majestic sight it once was, and touch is often a necessity for full arousal. Nighttime and morning erections become fewer and further between. The frequency of intercourse declines while the occurrence of losing the erection before the sexual act is complete increases. A more dribbling-quality ejaculation occurs with diminished volume and force, begging the question of why you are “drying up.” Orgasms are less intense and at times it feels like nothing much happened—more “firecracker” than “fireworks.” Getting a second erection is difficult, and you find much more delight in going to sleep rather than pursuing a sexual encore. Sex is no longer a sport, but a recreational activity… sometimes just reserved for the weekends.

Age 60-70: “Sexagenarian” is quite the misleading word… more apt a term for the 18-30-year-old group, because your sex life doesn’t compare to theirs—they are the athletes and you the spectators. Your testosterone level has plummeted over the decades, probably accounting for your somewhat diminished desire. Erections are still obtainable with some coaxing, but they are not five-star erections, more like three stars, suitable for penetration, but not the rigid flagpoles of yonder years. They are less reliable, and at times your penis suffers with “attention deficit disorder,” unable to focus and loses its mojo prematurely, unable to complete the task at hand. Spontaneous erections, nighttime, and early morning erections become rare occurrences. Climax is not so climactic and explosive ejaculations are a matter of history. At times, you think you climaxed, but are unsure because the sensation was frankly un-sensational. Ejaculation is down to a mere dribble. Seconds?… no thank you… that is reserved for helpings on the dinner table! Sex is no longer a recreational activity, but an occasional amusement.

Age 70-80: When asked about his sexual function, my 70-something-year-old patient replied: “Retired… and I’m really upset that I’m not even upset.” You may still have some lingering sexual desire left in you, but it’s a far cry from the fire in your groin that you had when you were young. With physical coaxing and coercion, your penis can at times be prodded to rise to the occasion, like a cobra responding to the beck and call of the flute of the snake charmer. The quality of erections has noticeably dropped, with penile fullness without the rigidity that used to make penetration such a breeze. At times, the best that you can do is to obtain a partially inflated erection that cannot penetrate, despite pushing, shoving, and manipulating. Spontaneous erections have gone the way of the 8-track player. Thank goodness for discovering that even a limp penis can be stimulated to climax, so it is still possible for you to experience sexual intimacy, although the cli-“max” is more like a cli-“min.”

Age 80-90: You are now a full-fledged member of a group that has an ever-increasing constituency—the ED club. Although you as an octogenarian may still be able to have sex, most of your brethren cannot; however, they remain appreciative that at least they still have their penises to use as spigots, allowing them to stand to urinate, a distinct competitive advantage over the womenfolk. Compounding the problem is that your spouse is no longer a spring chicken and because she has likely been post-menopausal for many years, she has a significantly reduced sex drive, vaginal dryness, and perhaps medical problems that make sex downright difficult, if not impossible. If you are able to have sex on your birthday and anniversary, you are doing much better than most. To quote one of my octogenarian patients in reference to his penis: “It’s like walking around with a dead fish.”

Age 90-100: To quote the comedian George Burns: “Sex at age 90 is like trying to shoot pool with a rope.” You are grateful to be alive and in the grand scheme of things, sex is low on the list of priorities. You can live vicariously through pleasant memories of your days of glory that are lodged deep in the recesses of your mind, as long as your memory holds out! When and if you do get an erection, you never want to waste it!