Q: I am 63 and underwent angioplasty for two coronary blocks about four months back. I avoided sex for these four months. I’m keen to know if I can start sexual activity now. If not now, then when? Do I need to take permission from my cardiologist before resuming my sex life?
A: Your cardiologist would be the best person to answer this question. In uncomplicated cases of coronary artery disease, cardiologists invariably allow and even encourage the patient to resume all normal activities immediately after the angioplasty. If your cardiologist has allowed you to walk a mile or if you are able to climb a flight of stairs without distress, then you can safely have sex.
Many cardiologists avoid talking about sex with their patients and couples are reluctant to bring up the subject in front of them or even with each other sometimes.
I once met a cardiologist who expressed his fear to me about imagining one of his young cardiac patients dying of a heart attack during sex. He felt responsible for his patients. He spoke to me at great length about the guilt and it occurred to me that there is still a lot of awkwardness and a great taboo associated with talking freely about sex between many doctors and patients.
Sometimes couples are afraid to talk to each other about their feelings, fears, needs and concerns as well. This is a problem.
Four months have passed since your angioplasty. Angioplasty has opened up your coronary arteries and has made your heart function normally. If you are on regular exercise regime and back to all your usual physical activities – at home and at the work place and if you are feeling comfortable and healthy, there is no reason for you to hold yourself back in sex.
Q: I am 60 and my desire for sex has diminished over time. My wife, who is 55, also doesn’t feel like being sexually active any more. We both have no complaints about this state of affairs. After all, we have enjoyed sex for 34 years of our married life. However, when I read questions asked by people elder to us about sex, I start wondering if we are ‘abnormal’ in some way? Or is their desire for sex at their senior age ‘abnormal’? I’m confused.
A: Every sexual being is unique and incomparable. The period during which one’s sexual drive increases, peaks and decreases, varies from person to person. Only you know your body and understand all its needs. It’s alright if you don’t wish to engage in the sexual act. Nothing wrong with that. Not engaging sexually does not negatively impact upon your sexual capability, health or your longevity.
Several people assume that their sex life is all over at 50 and resign themselves to a sexless destiny.
This gets further fuelled by ageist jokes, folklore and sometimes even cultural norms. Ever heard of the phenomenon whereby an older lady gets ridiculed for being dressed glamorously or provocatively?
Also, a lot of consumer marketing and communication is geared towards the youth as they are a lucrative upwardly mobile marketing segment that makes to target – for services and products to be able to hawk their ware. The media and society focuses on them as the future! These are facts. However, despite progressive ageing, you’re well within your right to fully understand and are fully responsible for the fulfilment of your needs.
Most people are sexually active throughout their lives. The active period varies from person to person and at some point for everyone, their sex drive begins to diminish.
If you and your wife are truly satisfied with your current level of physical intimacy, there is no need to compare yourself with others. That’s not being fair to yourself. Everyone is differently constituted. Let nature take its course and shed the presuppositions. Life always finds a way forward.
Q: I am 69. I had my prostate removed 7 months back. Since then, I have found that I do not get an erection at all when I am sexually excited. I really want to have sex with my wife. I was also detected with two partial coronary artery blocks. I feel like my health is getting compromised. Will Viagra or Levitra help me?
A: A prostate removal surgery such as a “radical prostatectomy” can cause injury to the pelvic nerves resulting into neurogenic erectile dysfunction. The incidence of erectile dysfunction after radical prostatectomy depends on whether a “nerve-sparing” surgical procedure was performed or not. Reported rates of erectile dysfunction after bilateral nerve-sparing radical prostatectomy range from 18 to 82%. Other factors related to disease or surgery can also affect erectile function.
You said that you are over 69 and have partial blockage of coronary arteries. In that case, you may be either already on ‘nitrate’ preparations which are usually given in cases of anginal pain. This is common with partial coronary blocks. This makes it very risky for you to take either Sildenafil (Viagra) or Tadalafil for erectile dysfunction. The combination of Sildenafil and Nitrates can make your blood pressure suddenly drop to unsafe (even fatal) levels causing dizziness, fainting – thus resulting in a heart attack or stroke. I do not wish to scare you but the above factors need to be kept in mind. In addition, the safety of Sildenafil or Tadalafil has not been studied adequately for men above sixty five years of age. You’re welcome to go and discuss the matter with your family doctor or with a qualified sexologist for further clarity.
Q: You have mentioned that ‘Sildenafil’ and ‘Tadalafil’ can be taken to ‘sustain’ an erection. This is interesting. I am 71-year-old but I keep rather physically fit due to a well-regulated life. I’m into yoga, brisk walking, eating well and I lead a very comfortable retired life. I am a widower but I have some female friends whom I am attracted to. Due to my age, I am unable to hold an erection for a longer duration. I wish to enjoy sex for another ten years at least. Can I take these medications and enjoy casual sex with women? I have no ailment like heart problems, blood pressure or diabetes. What do you think?
A: Technically speaking, one can enjoy sex till one desires and till one is capable of performing physically in bed. This has to happen with mutual consent for it to be equally pleasurable for the individuals involved. It’s not unknown that the ageing process affects all aspects of life. That is why many countries and trades adhere to a certain ‘retirement age’ when even the most capable individuals have to quit certain jobs or positions when they reach a certain age.
The gradual ageing process is likely to eventually restrict all physical functions while affecting all corporal attributes. The ability to perform sexual intercourse is no exception.
If you seek medication, you are best advised to meet with a licensed medical practitioner so that the necessary bodily investigations are made before you ingest any medicines. Self-medication is not advised under any circumstances. This is regardless of how healthy you feel or how healthy you truly are.
While it is beyond the scope of a question-answer book to prescribe any medication to you, you should be aware that the safety of Sildenafil and Tadalafil has not been adequately studied and established for men above the age of 65 (the age group you fall under). These preparations are not ordinarily prescribed for men above the age of 65. Also remember, there are a host of sexually transmitted diseases and infections that you may invite (HIV included) when you engage in casual sexual encounters with multiple partners.
Q: I am a 70-year-old man and find my erections are not good enough for sex. I have come to know that there are devices known as Dildos which can better the sexual satisfaction to women. Please let me know where in India are these dildos available and the approx. price if possible.
A: Dildos are ‘sex toys’ used by women for self-pleasuring and masturbation. Dildos are shaped like penises. They come in different sizes. They are usually meant to be inserted in the vagina. Some are made out of hard plastic, but the newer ones are made of soft rubber, or a gel-like substance that feels more like a real penis. Some are flexible and can be bent into different shapes. Some also include suction cups on the base so that they can be freestanding. Dildos are neither manufactured nor sold in India officially. Most people get it from their personal visits to foreign countries.
At 70, for you to experience erectile dysfunction is not unnatural. If you wish you may consult a sexologist for help.
Q: My husband and I have been married for 34 years. We are both spiritually inclined. We read a lot of spiritual books and we also practise meditation together. Lately, I’ve been feeling extremely guilty every time we have sex with each other. The passion during lovemaking makes me feel like a beast. My husband also feels wild in the same way. We both try and control these aggressive moments and actions during sex, but it becomes very difficult at times. I feel extremely low about myself at the end of every sexual encounter with him. I can’t shake off the feeling that something is seriously going wrong. Can you help us understand what is happening to us?
A: It would seem that you’ve learned that spirituality and sexuality are in opposition. Many so-called spiritual and even mainstream religious streams view ‘sex’ as an obstacle or distraction on the path of spirituality. This is a myth.
Sex is one of our natural instincts. The ability to procreate was gifted to us unasked, by existence. It is as normal and healthy as other bodily functions. Spirituality also guides the seeker to accept all aspects of life. Life is an invaluable gift that should be accepted in totality. Pain. Suffering. Joy. Upliftment. These are continuous pursuits of every generation that seeks a way to move forward in life. To reject or condemn any aspect of ‘the gift of life’ is a way trying to improvise over existential wisdom.
Passion during lovemaking is as existential and innate as the desire to seek answers, pray and meditate. These are like two sides of the same coin. It is the same energy that manifests in both the expressions. From the dawn of civilisation and even in old practices of faith such as animism – which is one of the oldest beliefs that manifested in the history of man when he was still a hunter gatherer, supernatural powers that organize and animate the material universe were referred to. What powers are these? I believe they were talking about nature’s instincts for self-preservation and survival. Whatever your faith or beliefs, know that the even back then, it wasn’t really considered worthwhile fighting against nature and that sex is the sustaining and passionate energy that gives continuity to our species.
Feel free to express yourself in a way that feels natural to you – during lovemaking with your husband. Don’t stand in judgement of yourself. You may not be perfect but you’re human and the human experience is an iterative one.
Sex is a culmination of the love that exists between you and your husband and thus some may even refer to it as a divine act. Sharing of intimacy does not make you less spiritual. The self-condemnation and the guilt that you are experiencing is more harmful to your spiritual growth than the natural passion you feel and express.
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Read the Cover Story of our May 15, 2024 issue titled ‘Sex and the 60+’ by Dr Rajan Bhonsle
