As husband and wife urologists, we talk a lot about sex (mainly at work). There are several issues that commonly arise in our patients that can lead to a less than satisfactory sex life. The great news is many treatment options exist.
There are many factors affecting men and women as they age that can interfere with sexual relations. In women, vaginal dryness, prolapse and incontinence are most common. A decrease in circulating estrogen in peri and post-menopausal women leads to atrophy, or dryness, of the vagina that can result in pain. Symptomatic pelvic organ prolapse can create physical barriers to intercourse. Embarrassing urinary incontinence is another reason some shy away from intimacy.
Nearly all women who are experiencing painful vaginal dryness or dyspareunia (pain with intercourse) can be safely treated with a vaginal estrogen cream. Unlike hormone replacement therapy (HRT), vaginal estrogen poses few risks and can safely be administered without fear of cancer, stroke or clotting problems. The cream is placed in the vagina several times weekly at night, helping to improve tissue quality and relieve symptoms of pain and dryness.
For women who struggle with a vaginal bulge, many options exist to maintain sexual function. A pessary can be fitted in some women who are able to remove it themselves. More often, outpatient surgery is used to restore normal anatomy and maintain sexual function if desired.
Incontinence, the involuntary leakage of urine, has many causes and several treatment options exist depending on the type.
Diagnosing and treating male urologic factors are also key to maintaining intimacy. Erectile dysfunction (ED) is common in aging men for a variety of reasons including but not limited to vascular, hormonal and psychologic issues. Certain treatments for an enlarged prostate or prostate cancer can also lead to ED. The backbone of therapy for erectile dysfunction includes pills like Viagra or Cialis. For some men who do not respond well to these medications or have side effects that are intolerable, penile injections provide a simple and effective solution. As a last resort, surgical options are also available.
Peyronies disease is another issue we frequently see in men that affects sexual quality of life. This is caused by deposits of scar tissue in the penis. This scar tissue can frequently cause curvature with erection, which makes sex difficult or painful. Excellent non-operative and operative treatments exist which can restore a couple’s sexual quality of life.
Whether sexual intercourse remains a priority in your relationship as you age is a very personal decision and is ultimately up to you. If you are suffering from conditions interfering with your ability to be sexually active, many treatment options exist and we encourage you to speak with your doctor about these issues.
Richard P. Holm, MD passed away in March 2020 after a battle with pancreatic cancer. He is founder of The Prairie Doc®. For free and easy access to the entire Prairie Doc® ® library, visit www.prairiedoc.organd follow Prairie Doc® on Facebook. D. Joseph Thum and Lauren Wood Thum are both board certified Urologists at Urology Specialists in Sioux Falls, SD.
