Andrew Siegel MD 6/20/15
(Thank you Pixabay for above image)
“Welcome to the club.” These four words have become my favorite response to a variety of the presenting complaints of my middle-age patients. As a fifty-something year-old male, I am a member of this club, the one in which things are not necessarily bad or problematic, but certainly different from the way they used to be.
I find that this sentence—gently stated in a heartening manner with a smile on my face—is calming and reassuring to my patients who are uncertain if they have a genuine medical issue that they might need to be concerned about. By being told that they are “members of the club,” they immediately understand that their complaint is not only common and shared by many of their peers, but also is to be expected and is not a major concern.
“Things fall apart, the center cannot hold.” –Chinua Achebe
Things change. We get older and we look and function differently…again, not necessarily badly, but differently. Unfortunately, humans do not come with a “user manual” that explains what to expect as we age, which could help us make the distinction between the normal expectations of aging as opposed to problems that demand medical attention. On my bucket list is to write such a “Manual of Man,” at least from a urology perspective, discussing the urinary, genital and sexual changes to be expected with the aging process. The challenge is to recognize the difference between “normal aging” and “pathological aging.”
On Becoming A Slack In The Sack
After age 40, you are still interested in sex, but not nearly with the all-consuming passion you had decades before. Testosterone levels fall ever so gradually, resulting in this decrease in sexual appetite. That stated, libido seems to be the element of male sexuality that survives the longest, intact to some extent long after the penis functions only to allow you to stand to urinate. However, what was once a raging “fire” may now be mere “embers.” It can be a source of great frustration to have functioning software but poorly functioning hardware!
You still may be able to get a respectable erection, but now it probably requires a bit more effort—often demanding touch for full arousal, whereas at one time it took only a smidgeon of erotic stimulation. Although the penis may be capable of getting hard enough for penetration, it has probably lost some of the rock-star majestic rigidity of yesteryear. Although the erection still can defy gravity, it might not have quite the angle it used to. On occasion the erection may soften before the sex act is completed. Nighttime and morning erections are fewer and farther between. Getting a second erection after climax is difficult, and you probably have more interest in going to sleep rather than pursuing a sexual encore.
Ejaculation and Orgasm
Ejaculation becomes noticeably different. The volume of semen is diminished and you question why you are “drying up.” Climax happens with less force and arc, sometimes just a mere dribble; your once “high-caliber rifle” is now a “blunt-nosed handgun.” Orgasms are unquestionably different with loss of some kick and intensity. At times, it may feel like nothing much happened—more “firecracker” than “fireworks.” Sperm quality also tends to go by the wayside with aging, but who really cares since procreation is for the next generation!
The penis often becomes less sensitive, not only making it more difficult to achieve and maintain an erection, but also at times giving rise to difficulty achieving climax, with delayed ejaculation. Perhaps this is an improvement over the premature ejaculation that may have been an issue when you were younger.
Changes In Genital Anatomy
Not a day goes by in my urology practice when I don’t hear the words: “Doc, my penis is shrinking.” The truth of the matter is that the penis can shrink from a variety of circumstances, but most of the time it is a mere illusion—a sleight of penis. Weight gain causes a generous pubic fat pad—the male equivalent of the female mons pubis—making the penis appear shorter. However, penile length is usually intact, with the penis merely hiding behind the fat pad, what I call the “turtle effect.”
There are genuine reasons for penile shrinkage such as treatments for prostate cancer including radical prostatectomy and testosterone deprivation as well as “disuse atrophy,” penile “wasting” resulting from not using the penis as nature intended. Additionally, with aging there is often a fatty plaque buildup within the penile arteries, loss of erection chamber smooth muscle and elastic tissue (replaced with scar tissue) and weakening of the pelvic floor muscles. This results in less elastic and expansive erection chambers that do not fill up and trap blood properly. It also causes a loss in penile length, girth and the ability to maintain the high penile blood pressures that cause bone-hard rigidity. If scar tissue forms on the sheath of the erectile chambers, it can cause penile curvature and pain with erections, a.k.a. Peyronie’s disease.
On Becoming Slack In The Sac
While the penis may shrink, the scrotal sac expands, time and gravity being cruel conspirators. This smaller penis and larger and looser scrotum–appearing like the genitals of an old hound dog snoozing on the veranda–is not a particularly appealing sight! While the sac expands, the testicles often shrink in size. One of the complaints voiced not infrequently by middle-aged and older men is that their testicles hang down loosely, similar to pendulous breasts in older women. At times, men complain that when they sit on the toilet, their scrotum touches the toilet water. Ouch! The scrotum may hang so low that when you pass wind, your testicles may become airborne like a kite flying erratically in a sudden gust.
The only male organs that get bigger with age are our noses, ears, scrotums and prostate glands. Unfortunately, the prostate is wrapped precariously around the urethral channel and as the prostate enlarges it can constrict the flow of urine. You may observe a weaker stream that hesitates to start, takes more time to get going and longer to empty, starts and stops and the sensation that you have not emptied completely. You might notice that you urinate more often, get up one or more times at night to empty your bladder and when you have to go, it comes on with much greater urgency than it used to. Almost universal with aging is post-void dribbling, that annoying dribble that occurs after emptying your bladder.
Bottom Line: If you are a middle-aged male and are experiencing some of these symptoms, “Welcome to the club.” If these symptoms become annoying and interfere with your quality of life, it is time to check in with your friendly urologist!
Wishing you the best of health,
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Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Kindle, iBooks, Nook, Kobo) and paperback: http://www.MalePelvicFitness.com
Co-founder of Private Gym: http://www.PrivateGym.com
available on Amazon and Private Gym website
The Private Gym is a comprehensive, interactive, follow-along exercise program that provides the resources to properly strengthen the pelvic floor muscles that are vital to sexual and urinary health. The program builds upon the foundational work of Dr. Arnold Kegel, who popularized exercises for women to increase pelvic strength and tone. This FDA registered program is effective, safe and easy-to-use: The “Basic Training” program strengthens the pelvic floor muscles with a series of progressive “Kegel” exercises and the “Complete Program” provides maximum opportunity for gains through its patented resistance equipment.
Tags: Andrew Siegel MD, decreased libido, ejaculation, erectile dysfunction, lower urinary tract symptoms, male pelvic fitness, penile shrinkage, Private Gym, prostate gland, scrotal expansion, welcome to the club