Posts Tagged ‘limp penis’

What To Expect of Your Erections As You Age…20’s, 30’s, 40’s and Beyond

December 26, 2015

Andrew Siegel,  MD  12/26/15

I have written more than 250 blogs, this being the overwhelming most popular one with 50,000 plus views in 2015.  I am therefore reposting this as an encore final entry of 2015. 

shutterstock_side view manjpeg

It is shocking how ill prepared we are for aging. Nobody informs us exactly what to expect with the process, so we just sit back and observe the changes as they unfold, dealing with them as best we can. Although educational books are available on many topics regarding other expected experiences, such as “What To Expect When You’re Expecting,” I have yet to see “The Manual of Man,” explaining the changes we might expect to experience as time goes on. Some day I wish to author a book like that, but for the time being I will blog on what to anticipate with male sexual function as time relentlessly marches on.

“But the wheel of time turns, inexorably. True rigidity becomes a distant memory; the refractory period of sexual indifference after climax increases; the days of coming are going. Sexually speaking, men drop out by the wayside. By 65, half of all men are, to use a sporting metaphor, out of the game; as are virtually all ten years later, without resort to chemical kick-starting.”

Tom Hickman, God’s Doodle: The Life and Times of the Penis

Aging can be unkind and Father Time does not spare your sexual function. Although erectile dysfunction (ED) is not inevitable, with each passing decade, there is an increasing prevalence of it. Present in some form in 40% of men by age 40 years, for each decade thereafter an additional 10% join the ED club. All aspects of sexuality decline, although libido (sexual interest and drive) suffers the least depreciation, leading to a swarm of men with eager “big heads” and apathetic “little heads,” a most frustrating combination indeed.

With aging often comes less sexual activity, and with less sexual activity often comes disuse atrophy, in which the penis actually becomes smaller. Additionally, with aging there is often weight gain, and with weight gain comes a generous fat distribution in the pubic area, which will make the penis appear shorter. With aging also comes scrotal laxity and testicles that hang down loosely, like the pendulous breasts of an older woman. Many of my older patients relate that when they sit on the toilet, their scrotum touches the toilet water. So, the penis shrinks and the testicles hang low like those of an old hound dog…Time and gravity can be cruel conspirators!

So, what can you expect of your sexual function as you age? I have broken this down by decade with the understanding that these are general trends and that you as an individual may well vary quite a bit from others in your age group, depending upon your genetics, lifestyle, luck and other factors. There are 30-year-old men who have sexual issues and 80-year-old men who are veritable “studs,” so age per se is not the ultimate factor.

You may wonder about the means by which I was able to craft this guide. I was able to do so through more than 25 years spent deep in the urology trenches, working the front line with thousands of patient interactions. My patients have been among my most important teachers and have given me a wealth of information that is not to be found in medical textbooks or journals, nor taught in medical school or during urology residency. Furthermore, I am a 50-something year-old man, keenly observant of the subtle changes that I have personally witnessed, but must report that I am still holding my own!

Age 18-30: Your sexual appetite is prodigious 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 just 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, merely the 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 and you are capable of ejaculating an impressive volume of semen forcefully with an arc-like trajectory, a virtual comet shooting across the horizon. When you arise in the morning from sleep, it is not just you that has arisen, but also your penis that has become erect in reflex response to your full bladder, which can make emptying your bladder quite the challenge, with the penis pointing up when you want to direct its aim down towards the toilet bowl.

It doesn’t get better than this…you are an invincible king… a professional athlete at the peak of his career! All right, maybe not invincible…you do have an Achilles heel…you may sometimes ejaculate prematurely because you are so hyper-excitable and sometimes in a new sexual situation you have performance anxiety, a mechanical failure brought on by the formidable mind-body correction, your all-powerful mind dooming the capabilities of your perfectly normal genital plumbing.

Age 30-40: Things start to change ever so slowly, perhaps even so gradually that you barely even notice them. Your sex drive remains vigorous, but it is not quite 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 in the past. 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 ejaculating increases. You are that athlete in the twilight of his career, seasoned and experienced, and the premature ejaculation of yonder years is much less frequent an occurrence.

Age 40-50: After age 40, changes become more obvious. You are still interested in sex, but not nearly with the passion you had two decades earlier. You can usually get a pretty good quality erection, but it now often requires tactile stimulation and the rock-star rigidity of years gone by gives way to a nicely firm penis, still suitable for penetration. The gravity-defying erections don’t have quite the 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 a bit feebler than previous. Getting a second erection after climax is not only difficult, but also may be something that you no longer have any interest in pursuing. 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 can still be respectable and functional, but is not the majestic sight to behold that it once was, and touch is necessary for full arousal. Nighttime and morning erections become few and far between. The frequency of intercourse declines while the frequency of prematurely losing the erection before the sexual act is complete increases. Your orgasms are definitely different with less intensity of your climax, and at times, it feels like nothing much happened—more “firecracker” than “fireworks.” Ejaculation has become noticeably different—the volume of semen is diminished and you question why you are “drying up.” At ejaculation, the semen seems to dribble with less force and trajectory; your “high-caliber rifle” is now a “blunt-nosed handgun.” Getting a second erection after climax is difficult, and you have much more interest 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 bit of a misleading word…this is 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 diminished desire. Erections are still obtainable with some coaxing and coercion, but they are not five star erections, more like three stars, suitable for penetration, but not the flagpole of yonder years. They are less reliable, and at times your penis suffers with attention deficit disorder, unable to focus and losing its mojo prematurely, unable to complete the task at hand. Spontaneous erections, nighttime and early morning erections become rare occurrences. Climax is, well, not so climactic and explosive ejaculations are a matter of history. At times, you think you climaxed, but are unsure because the sensation was so un-sensational. Ejaculation may consist of a few drops of semen dribbling out of the end of the penis. Your “rifle” has now become a child’s plastic “water pistol.” Seconds?…thank you no …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 remaining sexual desire left in you, but it’s a far cry from the fire in your groin you had when you were a younger man. With physical coaxing, 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 your erections has noticeably dropped, with penile fullness without that 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 every which way. Spontaneous erections have gone the way of the 8-track player. Thank goodness for your discovery that even a limp penis can be stimulated to orgasm, so it is still possible for you to experience sexual intimacy and climax, although the cli-“max” is more like a cli-“min.” That child’s “water pistol”…it’s barely got any water left in the chamber.

Age 80-90: You are now a 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. (But even this plus is often compromised by the aging prostate gland, wrapped around the urinary channel like a boa constrictor, making urination a challenging chore.) Compounding the problem is that your spouse is no longer a spring chicken. Because she been post-menopausal for many years, she has a significantly reduced sex drive and vaginal dryness, making 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! Penis magic has gone the way of defeated phallus syndrome. So, when and if you get an erection, you never want to waste it!

Wishing you a healthy, peaceful, happy (and sexy) 2016,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: Coming soon is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: or Amazon.


Limping Along

November 14, 2015

Andrew Siegel MD   11/14/15


(Above image courtesy of: staff. “Blausen gallery 2014“. Wikiversity Journal of MedicineDOI:10.15347/wjm/2014.010ISSN 20018762.)

This  entry is intended to be unisex, since both genders are equally susceptibility to clogged arteries and impaired blood flow to muscles and other vital organs (a.k.a., ischemia).  Although sexual dysfunction resulting from compromised pelvic blood flow is outwardly more obvious in the male with the inability to achieve an erection or difficulty in obtaining or maintaining an erection, females as well can suffer with sexual consequences to a similar degree with impaired arousal, lubrication and climax.

Male sexual response is so evident, conspicuous and literally palpable, a binary system with a digital “one” or “zero” response, whereas female sexuality is to all appearances so much less obvious and so much more subtle and nuanced. However, this framing of human sexual response is off target as the female sexual response results in genital anatomical changes as profound as those that occur in males, just less apparent. Under normal circumstances, the vagina is no more “primed” for sex than is a flaccid penis, the un-stimulated vagina being merely a potential space with the vaginal roof and floor in direct contact. However, when stimulated, the vaginal walls lubricate and the vagina expands, lengthens and widens in order to accommodate an erect penis, changes that are as dramatic as the transition of a flaccid penis to an erect penis.  

Because the primary driver of the human sexual response is BLOOD FLOW, females can be as susceptible as males to compromised circulation and can “limp” in the bedroom just as much as males can. It’s just not as ovvious and apparent. Furthermore, both genders are susceptible to limping in the street. 

In terms of ambulation, many people limp instead of walk because of peripheral arterial disease (PAD), a medical condition in which the arteries in the legs clog due to a buildup of fatty plaque. This impairs blood flow and the delivery of oxygen and nutrients to muscles and other tissues, giving rise to pain when exercise increases the muscle’s demand for oxygen.

PAD commonly occurs on the basis of poor lifestyle–obesity, diabetes, an unhealthy diet, a sedentary existence and often the use of tobacco. When muscles are denied the increased blood flow required with the demands of movements such as walking or exercisizing, pain and limping result, known as claudication, from the Latin “claudeo,” meaning “to limp.”

Claudication often does not demonstrate itself until there is significant blockage–usually about a 70% restriction– to arterial flow. It occurs because of insufficient oxygen to the leg muscles causing the buildup of lactic acid, which causes discomfort and pain. Claudication typically responds to stopping movement, which resolves the pain.

Claudication is by no means limited to the leg muscles, but can happen to any muscle in the body. “Claudication” of the heart muscle—which occurs when the coronary arteries are compromised—is known as angina. “Claudication” of the brain—which occurs when the carotid arteries are compromised—can give rise to mini-strokes or transient ischemic attacks (TIA). “Claudication” of the penis—which occurs when the penile arteries are clogged with years of accumulation of fatty plaque—is known as erectile dysfunction (ED), a.k.a., when the penis limps along.

Sexual dysfunction in either gender can be a warning sign that an underlying medical problem exists, the quality of sexual response serving as a barometer of cardiovascular health. When it comes to men, the presence of rigid and durable erections is an indicator of overall cardiovascular health, and conversely, the presence of ED can be a clue to poor cardiovascular health. For this reason, men with ED should consider undergoing a basic medical evaluation seeking arterial disease elsewhere in the body (heart, brain, aorta, and peripheral blood vessels). Since the penile arteries are generally rather small—1 to 2 millimeters in diameter—and the coronary (heart) arteries are about 4 millimeters in diameter, it stands to reason that if vascular disease is affecting the tiny penile arteries, it may well be soon affecting the larger coronary arteries as well. The presence or absence of erections may thus be considered a genital “stress test.”  The same applies to females who are limping in the bedroom.

The presence of ED is as much of a predictor of cardiovascular disease as is a strong family history of cardiac problems, tobacco smoking, or elevated cholesterol. The British cardiologist Graham Jackson expanded the meaning of the initials ED to: Endothelial Dysfunction (endothelial cells being the type of cells that line the insides of arteries); Early Detection (of cardiovascular disease); and Early Death (if missed).

Bottom Line: Heart-healthy and blood vessel-healthy is sexual-healthy (and vice versa). If you do not care to limp when you walk or be limp in the bedroom, commit to a healthy lifestyle. Minimizing the buildup of fatty arterial plaque will prevent claudication everywhere in the body. To do so requires weight management, healthy eating, regular exercise, avoiding tobacco, etc. And if you are already limping (whether it is on the sidewalk or the bedroom), a lifestyle “angioplasty”—cleaning up your unhealthy lifestyle habits—can help reverse the problem.  This applies equally to both men and women. 

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: or Amazon.

10 Things You Can Do To Prevent a Limp Penis

August 19, 2014

Andrew Siegel MD Blog # 168

It’s great to have a penis…so handy, convenient and multifunctional! As many an older man will attest to, even when erections become mere memories, the penis will still allow you to stand up to urinate—an absolute joy—and a distinct competitive advantage over the female gender. To borrow from a cartoon by an artist named Collins, “Men have elevated peeing to an art form best expressed perhaps on a snowy landscape, a wall or a steam grate. Superior pressure control and the multidirectional penis make the men the masters of urination. Women on the other hand with their small bladders and clumsy apparatus find it very difficult to pee without creating a frightful mess…no precision accuracy here.” As fabulous as it is having a “spigot” for controlled urination, it is even better when you can maintain “penis magic” to old age and observe the transformative process by which the limp penis alters its shape, size and constitution in nanoseconds, rising in defiance of gravity to majestic rigidity.

Our ability to perform physically—in any domain—declines as we get age, explaining why most professional athletes are in their twenties or thirties. In terms of sexual function, when you were young you could achieve a rock-hard erection simply by seeing an attractive woman or thinking a sexual thought. As the years go by, erotic thoughts or sights are no longer enough, as you need direct touch and stimulation. Your sexual interest can skid and your erections may become softer and less durable with less intense orgasms and meager, dribbling-quality ejaculation. When you were young, you could get a second erection with a short recovery time (refractory period) but as you get older, refractory period may be days in length.

What to do? Should you be reactive and wait for your sex life to go south or should you take measures to ensure your continuing sexual health? Why not take a proactive approach? “An ounce of prevention is worth a pound of cure” rings very true for nearly all health issues, and so it does when it comes to sexual function.

  1. Maintain a Healthy Weight If you are overweight, you are more likely to have fatty plaque deposits, which clog up your blood vessels, including the artery to the penis. Abdominal fat converts your male hormone testosterone to the female hormone estrogen, literally emasculating you and causing development of man boobs.  Obesity steals away your manhood, male athletic form and body composition, mojo, strength, and one of your most precious resources—the ability to obtain and maintain a good-quality erection.
  1. Eat Healthy Fueling with nutritionally wholesome and natural foods will help you prevent the build-up of harmful plaque deposits within your blood vessels that compromises blood flow to the penis. Poor dietary choices with meals that are calorie-laden, nutritionally-empty selections (e.g., fast, processed, or refined foods) puts you on the fast tract to clogged arteries that can make your sexual function as small as your belly is big.
  1. Minimize Stress Stress causes the release of the hormones adrenaline and cortisol. Adrenaline narrows blood vessels, which has a negative effect on erections. If you ever have experienced performance anxiety it was because of adrenaline release in response to nervousness. Excessive cortisol secretion, which helps drives your appetite, causes the accumulation of the bad belly fat (as opposed to fat under the skin).


  1. Eliminate Tobacco Tobacco narrows your blood vessels, impairs blood flow, decreases the supply of oxygen, and also promotes inflammation, compromising every organ in your body.
  1. Alcohol in Moderation In small amounts, alcohol can alleviate anxiety and act as a vasodilator (increasing blood flow) and can actually improve erectile function, but in large amounts it can be a major risk factor for erectile dysfunction. Everything in moderation!


  1. Sleep Well Sleeping has a vitally important restorative function as your brain and body requires this important down time. During sleep, there is an increased rate of tissue growth and synthesis, and a decreased rate of tissue breakdown. Sleep deprivation causes a disruption in endocrine, metabolic, and immune function, resulting in decreased levels of leptin (your appetite suppressant), increased ghrelin levels (your appetite stimulant), increased cortisol, and increased glucose levels (higher amounts of sugar in the bloodstream). If you are exhausted, your penis is going to be weary as well.


  1. Exercise Exercise can have an amazingly positive effect on your sexual function through stress busting, mood improvement, fatigue reduction, increase of energy and better quality sleep. Long term it will reduce your risk for diabetes, heart disease, stroke, high blood pressure, some cancers, osteoporosis, chronic medical problems, and physical disability. Let’s not forget improvement in muscular strength and tone, reduction of body fat and help with weight control. Exercise makes your heart a better and stronger pump, your blood vessels more elastic, and your muscles better able at using oxygen. Exercises that work out the muscles involved in sex—the core muscles, the external rotators of the hip, and the all-important pelvic floor muscles—will improve your performance.B e careful with saddle sports like cycling and horseback riding, which may contribute to sexual dysfunction, particularly for those who spend prolonged time the saddle. This can cause compression damage to that very valuable human real estate located between your scrotum and anus that contains the nerves, blood vessels, and muscles that are vital to your sexual health. 


  1. Pelvic Floor Muscle Exercises The pelvic floor muscles play a vital role with respect to both erections and ejaculation. When you are sexually stimulated, the pelvic floor muscles activate and engage to help maintain penile rigidity and a skyward angling erection. These muscles are not only responsible for getting the stimulated penis from a tumescent state (plump with blood) to a state of bone-like rigidity, but also for maintaining that rigid state and for being the “motor” of ejaculation. Numerous scientific studies have documented the benefits of pelvic exercises (Kegels) in the management of erectile dysfunction. The Private Gym is a comprehensive, interactive, follow-along exercise program that helps men strengthen the pelvic floor muscles that support sexual health.It is the first line of defense against the onset of erectile dysfunction and can assist in reversing its occurrence. It is a safe, easy-to-use, natural, medically sanctioned and FDA registered means of targeting and strengthening the all-important pelvic floor muscles.


  1. Use It (or Lose It) Keep your penis fit by using it regularly for the purpose it was designed for—in other words, stay sexually active! Scientific studies have clearly demonstrated that men who are more sexually active tend to have fewer problems with erectile dysfunction as they age.
  2. Maintain a Healthy Relationship It takes two to tango, so relationship harmony factors strongly into good sexual functioning just as discord and interpersonal issues can profoundly contribute to ED. The mind-body connection is of immense importance to sexual function and the “big head” is equally important to the “little head.”

Bottom Line: The “Golden Rule of the Penis”: Treat your penis kindly (in terms of a healthy lifestyle) and it will return the favor; treat your penis poorly and it will rebel. The proactive approach will keep you functioning smoothly for many years, and hopefully will keep you out of my office for erection issues, although please don’t forget to get your prostate and PSA (Prostate Specific Antigen) checked!


Wishing you the best of health,

2014-04-23 20:16:29

Andrew Siegel, M.D.

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:

Author of: Male Pelvic Fitness: Optimizing Sexual and Urinary Health; available in e-book (Kindle, iBooks, Nook, Kobo) and paperback:

Private Gym website for pelvic floor instructional DVD and resistance training equipment: