Sex RX
Diabetes, obesity, high cholesterol and cardiovascular disease all become more common in older men and women. And all can impede blood flow, affecting your sexual response. "Diabetes has two dramatic impacts with sexual activity because it affects both the nerves and the blood vessels," says Barkin. If you're obese, "Physically, the act of sex can be more difficult because you just can't get close enough to your partner."

Naturally, we' re going to suggest weight loss, better diet and exercise. "More aerobic activity will increase blood flow and oxygenation," says Barkin. Cut back on alcohol, which makes you less alert and slows your response time. Paulsen suggests: "Get a physical. See if there are things that you can be doing to feel healthier."

  • Certain medications like antidepressants and blood pressure drugs can interfere with sexual function or desire. Ask your doctor about side effects. It may be possible to modify the drug or dose to lessen the impact.
  • If you develop a physical disability like arthritis or stroke, experiment with different aids and positions. "Is being in the bathtub together a more pleasurable environment? Or propping pillows differently? It's about being creative and trying something that works," notes Paulsen.

Under the knife for your sex life?
For people who yearn to trade in their private parts for newer models, is surgery an option? When it comes to surgically treating age-related changes in a bid to improve your sex life, perhaps not. Some cosmetic surgeons offer vaginoplasties, also known as "vagina tightening" for women who feel their slackened vaginas are interfering with their sexual function. That said, medical societies are cautious and concerned and cite a lack of long-term research on safety and efficacy. Like all surgeries, there can be serious risks to these surgeries and, without clear evidence of benefits, the medical experts don't recommend them. In fact, the Society of Obstetricians and Gynaecologists of Canada cautions that there's little evidence to show that having an operation on your vagina will actually enhance your pleasure—or your self-esteem.

Similarly, older men who notice a bit of shrinkage because of increased abdominal fat or lack of blood flow should steer clear of so-called enhancement procedures. These surgeries very often do more harm than good, says urologist Jack Barkin, and the Sexual Medicine Society of North America considers them "experimental." Some Canadian clinics even offer fat injections to increase size, but this carries serious risks as well, including infection and scarring. "There is no way to make a penis longer than what it is," Barkin adds. In other words, gents, it's not the size—it's how you use it that counts.

A version of this article appeared in the September 2017 issue with the headline, "Sexual Healing," p. 78-80.

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