Sex is the perfect anti-ager. But what can you do when it goes wrong?

WHEN we age, ‘sex doesn’t disappear, it just changes forms’, said the novelist Erica Jong. And, contrary to popular belief, it may change for the better.

Research published by King’s College London looking at women’s libido found some women’s sexual function actually

improved after the menopause. Lead researcher Tim Spector, a professor of epidemiology, calls the results of the four-year study, published in the Journal of Sexual Medicine in 2015, ‘a little surprising’. ‘By modifying your life and attitudes towards desire, you can change things sometimes surprisingly for the better, although you are older,’ he says.

There is also no doubt that, for others, sex becomes less important.

The good news is that if sex matters to you, research shows it can actually help to ward off the diseases that can blight old age, such as heart disease, and improve brain function.

When it comes to the heart, it seems the benefits are both physical and psychological.

A study involving 40-to-70-year-old men, published in the American Journal of Cardiology in 2010, found men who had sex at least twice a week were less likely to develop heart disease, compared with men who had sex once a month or less.

The research said this might be because sex has both a direct physical benefit (as a form of exercise), but also an emotional effect.

The thinking is that regular sex means a man is in a supportive intimate relationship and the support and stress reduction this provides can boost health.

More frequent sexual activity has also been linked to improved brain function in older adults, according to a study published by the universities of Coventry and Oxford last year.

Researchers found that people who engaged in more regular sexual activity scored higher on tests that measured their vocabulary and their ability to perceive objects and the spaces between them.

Meanwhile, research published this year found that sexually active couples perform better in memory tests in middle-age.

So, there it is: sex is anti-ageing. The problem is that, while the spirit may be willing, the ageing flesh can be weak.

Here, experts set out the problems that could be sabotaging your sex life — and what you can

do about them . . .

WOMEN

FOR women, many physical problems stem from hormonal changes related to the menopause. Contrary to popular belief, though, menopause doesn’t have to end your sex life, says gynaecologist Dr Heather Currie. ‘The main problem is that many women are too embarrassed to talk about their menopausal symptoms to get them sorted,’ she explains.

LOST LIBIDO

IT COULD be your hormones. It’s not just oestrogen levels that fall with the menopause — so, too, does the hormone progesterone, which stimulates production of another sex hormone, testosterone. (Testosterone is usually associated with men, but women produce small amounts, too, and it is key to their sex drive.)

The reduced levels of oestrogen also play a role, affecting your sensation and the ability to orgasm.

Oestrogen helps the body produce collagen, a protein that keeps tissues healthy, and is needed for lubrication. A lack of it means that the tissues can thin, weaken and shrink, which can make sex uncomfortable.

WHAT YOU CAN DO: It may seem difficult to believe, but the more you have sex, the more you want it, says Dr Catherine Hood, a psychosexual medicine expert. But, as you get older, it’s important to make time for intimacy and foreplay as spontaneous desire is more likely to have faded, she adds.

Hormone replacement therapy (HRT), which helps to restore a woman’s levels of oestrogen and progesterone, can also bring back a woman’s sex drive.

Some doctors also believe taking testosterone in the form of a gel, patch or implant can improve a woman’s libido.

This is available only via an ‘offlabel’ prescription at your GP’s discretion and you may have to pay for private treatment to get it.

DISCOMFORT

THIS can be due to vaginal dryness that tends to occur after oestrogen levels fall during the menopause. The tissues become thinner and prone to irritation.

Painful sex can also be a sign of other gynaecological conditions, including pelvic inflammatory disease, endometriosis, fibroids, ovarian cysts or cancer, so see your GP if you are worried.

WHAT YOU CAN DO: Dr Currie recommends internal moisturisers — pessaries that slowly release a variety of soothing ingredients such as aloe vera over a few days. For a more immediate solution, there are lubricants that can be bought over-the-counter, though some can be prescribed. HRT may also restore vaginal health.

However, if the main menopausal symptom is vaginal dryness, the use of vaginal oestrogen, rather than an HRT pill, can be more effective. Indeed, it may be needed even if HRT is being taken.

Vaginal oestrogen is available as a pessary, a cream or an internal ring and can be prescribed by your GP.

Some studies have shown that plant-based therapies taken as supplements can provide modest reductions in dryness.

An analysis of more than 60 studies in 2016 by Erasmus University Medical Center in Rotterdam, in the Netherlands, found soya and soya extracts, as well as herbal remedies including red clover, can reduce dryness.

Fennel, in supplement form, is also a safe, effective treatment, said a study last year by the North American Menopause Society.

BLADDER PROBLEMS

DISCOMFORT during sex can also be linked to chronic cystitis, to which women are more prone around the menopause.

The urethra can narrow, thus encouraging bacteria up into the bladder, explains Richard Viney, a consultant urological surgeon.

‘We also see changes at a cellular level, with the immune system becoming less effective,’ he says.

WHAT YOU CAN DO: ‘There is no need to suffer in silence,’ says Mr Viney. ‘If the behaviour of your bladder is changing, seek an opinion from your doctor to rule out other causes.’

Treatments are aimed at reversing these changes. ‘Use of lubricants for intercourse and a greater emphasis on hygiene can help,’ he says.

However, often, he adds, other options are needed, including HRT — either as a pill or in the form of a pessary.

But forget cranberry juice for cystitis.

‘Over-the-counter, there is better evidence to support D-mannose, a sugar (taken as tablets or powder) that interferes with bacterial adherence to the bladder wall, and sodium or potassium citrate (found in standard over-the-counter cystitis relief powders), which alter the urinary pH to the disadvantage of bacteria,’ he says.

‘For some patients, we offer bladder cocktails — solutions we wash into the bladder to reinvigorate and protect the lining from bacteria.

‘Ultimately, for some, we offer long-term, low-dose antibiotics to prevent recurring infections.’

INCONTINENCE

INCONTINENCE is often associated with childbirth, but you don’t need to have had children to experience it. In fact, many women don’t have problems until after the menopause.

It’s usually caused by weakness in the sphincter muscle, most commonly as a result of damage to the nerves, but also because the surrounding muscles and tissues weaken as a result of the drop in oestrogen around the menopause.

WHAT YOU CAN DO: Physiotherapy and pelvic floor exercises — sometimes called Kegels — can really help (see next page).

Sex is a great form of pelvic floor exercise and it ensures a regular supply of blood to the area, keeping tissues healthy and functioning effectively.

In fact, avoiding sex can make things worse, says Dr Jane Woyka, a GP with a specialist interest in the menopause.

In more severe cases, women may need surgery to repair the pelvic floor.

MEN

AS MEN get older, they experience two main sexual health problems: flagging libido and erectile dysfunction. By the age of 40, around 40 per cent of men are affected by erectile dysfunction at some point; by 70, it’s 70per cent, according to a major US study. This can be due to a number of factors, such as high cholesterol, high blood pressure and heart disease, which is why it should be investigated. ‘Erectile dysfunction can be the first sign of heart disease because tiny blood vessels in the penis can become furred up first,’ says Suks

Minhas, a consultant andrologist (male health expert).

Another possible underlying cause is diabetes — high blood sugar levels can damage the blood vessels and nerves, including those that supply the sexual organs.

As well as affecting sensation, it may cause erection problems.

Some treatments for prostate cancer can also damage these nerves and blood vessels. Usually, the effect is temporary, although in some men, it can be permanent.

Hormone treatments for prostate cancer can also affect a man’s sex drive, as they lower the amount of the male sex hormone testosterone in the body; prostate cancer cells usually need testosterone to grow.

WHAT YOU CAN DO: Losing weight is the first step. ‘This can help get high cholesterol and high blood pressure under control and help with testosterone levels,’ says Mr Minhas.

Abdominal fat produces toxins that effectively ‘switch off ’ the production of testosterone, which affects their libido.

THESE also convert testosterone to the female hormone oestrogen, which is why men get ‘man boobs’. Improved testosterone levels should also improve erectile function.

First among medical options for impotence are drugs called PDE5 inhibitors, such as Viagra, Cialis and Levitra. They all work in the same way, dilating blood vessels supplying blood to the penis.

Viagra and Levitra are shortacting and can work within one hour, wearing off after four to six; Cialis takes two hours to work, but can be effective for 24 hours.

Men can now also buy Viagra over-the-counter, providing they meet certain criteria (it won’t be sold to men with severe heart disease or those on medications with which it could interfere).

When tablets don’t work, other options include injections of the drug alprostadil into the penis. These injections relax the muscles and blood vessels, while helping to keep blood in this area.

They can be prescribed by a GP and the patient injects himself.

There’s another type of injection — usually prescribed by a urologist, rather than a GP — called Invicorp, which can be less painful.

Vacuum pumps and penile implants are the final options.

IS THERE MALE HRT?

THERE has been much talk in recent years about the ‘male menopause’. The theory is that men’s testosterone levels plummet from their 40s and 50s, leading to symptoms such as low libido, low mood and a lack of energy.

Proponents claim giving middleaged men testosterone replacement can transform their libido.

But it is a controversial area, with some experts warning the jabs are being used as a ‘lifestyle drug’ and could increase the risk of heart attack or stroke.

In 2014, the US Food and Drug Administration (FDA) even issued a warning about the possible connection between testosterone therapy and increased risk of heart attack or stroke. The warning was based on research published in the journal PLOS One.

However, other studies suggest that it may have a beneficial effect. Research published in 2016 in the American Journal of Cardiology reported testosterone therapy helped to reduce the risk of heart attack and stroke in older men with low testosterone levels who were suffering from severe coronary artery disease.

And Mr Minhas says: ‘Research also shows that men with diabetes can benefit from testosterone replacement therapy if they have a low reading.’