Freguently Asked Questions

Questions on Impotence and Testosterone

Q: Is Testosterone Replacement Treatment completely safe?

A: No medication can be said to be 100% safe and effective. However, provided certain precautions are taken, like checking that your Prostate Specific Antigen (PSA) is normal then Testosterone Replacement Therapy is very safe and well tolerated.

Q: I have heard that Testosterone treatment can cause cancer of the prostate. Is this true?

A: No, testosterone treatments do NOT cause cancer of the prostate or of anything else for that matter. Prostate cancer occurs in older men with very low testosterone levels and is rare in younger men with high levels. But where prostate cancer already exists, giving testosterone in this situation might serve to accelerate its growth. This is why keeping a close eye on PSA is essential for any many on TRT.

Q: Are there any ‘fringe benefits’ to taking TRT apart from the sexual ones?

A: Yes. Apart from improving you sexually there are a number of potential benefits that are now beginning to emerge for men who have been taking TRT long-term. Among these are:

Improvements to your cardiovascular system

Improvements to your cognitive function and memory

Increased mineral bone density to help against fractures

Increased muscle mass and decreased body fat.

All that said it is a mistake to expect miracles. The benefits from TRT are often subtle and mild and not life transforming but rather life enhancing.

Question on Sex and Ageing: Men’s Issues

Today men and Women are living longer, healthier lives. As a result of this improvement in health many older couples now still continue to enjoy intimacy and sexually fulfilling lives. This fact-sheet will help you with some queries that you may have.

Q: Does sex change as you get older?

A: The issues surrounding mature sexuality are still not openly discussed. Cultural biases have tended to stereotype older people as asexual, devoid of feelings or emotion. Couples who haste been in long- term relationships do not necessarily find it any easier than others when it comes to discussing sexual difficulties. Like many activities in Life sexual expression is highly variable. Sexual function may well be different from that of a younger couple but that doesn't mean that it has to be any less pleasurable.

Q: Will I still be able of have sex as l get older?

A: The ageing process involves many normal physical changes, some of which naturally affect sexual response, but sexuality is much more than a focus on the genital nature of sex. Often couples can find new ways to stimulate each other, such erotic reading or videos. Partner communication and frank discussion of sexual desires, fantasies and experimentation are important. Some men may notice that they take longer to become aroused and achieve erection, and that their erections do not seem as hard. Just thinking about sex may no longer be enough. More direct physical stimulation of the penis may be required for a longer time. This may be due to reduced sensitivity. Some men may also find that the length of time between erections becomes longer as they age. The sensation of ejaculation may diminish and the man may find that orgasm doesn't feel as powerful as it did and that the amount of semen is reduced. Ejaculation may also take longer to achieve, and this can be a positive side of getting older as it may give more satisfaction to the partner. Some men may notice that their desire for sex may be reduced, but others may remain sexually active throughout life. 

If you have found that you are experiencing difficulty obtaining and maintaining your erection, you are not alone. One in ten men in the UK have difficult with their erections. A lot of help is now available. The clinic may be able to prescribe one of the oral drugs that now help erectile disjunction. If, for whatever reason this is not suitable for you, then there are alternatives such as small urethral pellets, penile injections, vacuum aid devices, sex therapy, counseling and surgical implants.

Q: Does illness affect sex?

A: Yes, it can. As people grow older, they are more likely to experience disabling conditions and illnesses that may affect how they respond sexually. Arthritis, stroke, coronary disease, diabetes, Parkinson’s, surgery and the side effects of drugs can all affect how they respond. The psychological effects of illness can also have an impact on sexual function, especially if the diagnosis of a life-threatening or life-limiting illness has been made, or if the illness affects self-esteem or alters body image drastically. Illness can bring change in the structure of a couple’s relationship, as previously independent people become dependent on their partner/ career. One partner may feel it is inappropriate to still have sexual desire if their partner is ill. For many careers the sheer stress and exhaustion of the role may adversely affect desire. Lifestyle can also have an impact on how you may see yourself. Retirement and children leaving home are viewed by some as an end of a chapter in their lives, whereas for others it can mean the freeing up of time for each other. Lifestyle factors also have to be taken into consideration. Smoking, excessive alcohol, use of recreational drugs, poor diet and lack of exercise can contribute to sexual dysfunction.

Q: I am a widower: is in wrong to look for love again? 

A: We all need to be loved and wanted. These needs do not diminish over time, but you may find you are seeking other forms of attachment than when you were younger. You may just require companionship and someone to share your favorite TV programs with. If you are looking to rekindle your love life you may feel awkward and embarrassed, not knowing where or how to set off. These are perfectly normal feelings, particularly if your partner had a long illness, and you may have profound feelings of guilt and betrayal. It will help to talk to someone about those feelings. To help you to move forward in a new relationship, you may like to speak to our doctor or therapist. When sexuality is affected, it is often a matter of learning to adapt and adjust rather than accepting an end to all forms of sexual expression.

Q: I am embarrassed to seek help: what can l do?

A: The only person who will find this embarrassing is yourself; you have nothing to be afraid of and everything to gain by seeking help. Discussing sexuality in mid-life can sometimes be difficult, but there is no reason to think that because you are older, you cannot use all the services that are available to younger people. Sex is not abnormal after middle age, and for many individuals it does not just cease because procreation is no longer possible. Older age should not prevention from seeking or receiving help from whatever source is most suitable for you.

Questions on Delayed Ejaculation

This fact sheet will look at the less common ejaculatory disturbances of delayed ejaculation, retrograde ejaculation and an ejaculation. There is a separate fact sheet for premature ejaculation.

Q: It seems to take me a long time to ejaculate even though I am aroused, what’s the matter with me, whose fault is it? 

A: The problem that you describe of delayed ejaculation isn't anyone's fault. There could be a number of explanations for this although it is quite uncommon.

Ejaculation is impaired and the man finds great difficulty reaching orgasm even though he wants to, and is getting sufficient stimulation for this to occur. The causes may be physical or psychological.

Physical causes could include, diabetes mellitus, prostatic disease and drug therapy, especially some antidepressants and beta-blockers. Psychological causes are the most likely cause if you are not affected by any of the above conditions.

Sometimes men have subconsciously conditioned themselves to respond in a certain way or manner and ejaculation can only be achieved under repetition of these circumstances.

Sometimes ejaculation can only occur with masturbation and yet not during sexual intercourse. This is called situational delayed ejaculation and is exactly that, i.e. ejaculation is delayed only in some circumstances and not in others. An example of this could be anxiety with a new partner. During masturbation you are responding to self-stimulation and this is often less anxious for the man, therefore ejaculation seems easier to achieve. The severity of the problem is variable; some men are unable to experience ejaculation intra vaginally under any circumstances and often some men find it difficult to show emotion at all.

Treatment for these men will often involve psychosexual therapy from our therapist. The aim of treatment is to relearn how to overcome the inhibitory behavior that has been learned.

Retrograde Ejaculation

Q: I have the sensation of ejaculation, but there doesn't seem to be any fluid, why is this?

A: Retrograde ejaculation is the medical term for the condition described above.

There are many reasons why you may fail to see any fluid (semen) after orgasm.

If this happens, you may also have noticed when you first urinate after intercourse the urine appears cloudy. This is because the semen is being expelled from the testicles, but instead of it being propelled by rhythmic contractions out of the urethra it is traveling backwards and into the bladder through the bladder neck. The most common reason for this is surgery to the prostate, or bladder neck. Many men who have undergone prostatectomy may have experienced this. There are other reasons for this to happen and they include disruption of the nerve supply if there has been a spinal cord injury, diabetes mellitus, multiple sclerosis and some prescription medications particularly tablets for blood pressure control. The sensation of orgasm and ejaculation may also be reduced. Treatment for this condition would only be considered if fertility was an issue.

Anejaculation

Q: I don't seem to ejaculate at all, why is this?

A: The condition you describe is called anejaculation; although it is relatively uncommon new cases are reported annually. Anejaculation can result from spinal cord injury, major lymph node surgery, diabetes mellitus or multiple sclerosis. It can also be a result of a psychological problem. The classic cause of anejaculation is disruption of the nerve supply that may be caused by traumatic injuries.

Treatment of anejaculation is only indicated to restore fertility. If medical therapy fails the only mechanism for inducing ejaculation may be with electro-ejaculation.

Using a rectal probe and pulsed electrical current ejaculation can occur in up to 75% of patients using this method. Vibratory stimulation has also been used successfully to induce ejaculation in patients with spinal cord injury.

Sexual Dysfunction Association (formerly The Impotence Association)

Tel: 020 7486 7262.

Email:info@sexualadviceassociation.co.uk.