Hope Springs eternal but not without concerns

By Ginger Manley | Posted: Tuesday November 6, 2012

Dear Ginger,

I liked what you said about “Hope Springs” (Oct. 2012, Mature Lifestyles). I thought it was one of the better movies I have ever seen on this topic.

I wrote you when you first started this column (March 2009, Mature Lifestyles) to say that my husband of 42 years seemed to have lost all interest in sex, never initiated any sex play, and seemed to never get an erection. He would clam up and say “nothing” was wrong – sounds like Arnold in the movie, huh?

You told me to get him to see his doctor and for us to get some counseling. We never got the counseling, but he started on testosterone (the patch), and then he started taking shots several months ago. Wow – his libido has become very healthy and robust, and this has done wonders for my sexual energy.

He does still have trouble sometimes getting or keeping an erection. He has been using Cialis™ once or twice a week, and he is having more satisfactory erections with good duration and also having enjoyable orgasms, although he occasionally does not have them (orgasms) but says he’s enjoyed himself anyway. On a recent vacation, we had sex nine or 10 times in a 12-day span.

I am worried, however, about the possibility of side effects of Cialis™, like hearing loss, and would prefer that he not have to use erection medicine if he can get the same results and pleasure another way. Do you have much experience or info about the vacuum pump for erection assistance? It seems like a rather mechanical way to initiate sex, but it might help him avoid the potential side effects of the drug.

There’s one more thing – I may have to have a hysterectomy, and I’m feeling a little nervous that any potential changes in my body would be sad and disconcerting. If it comes to a choice of a vibrant physical experience versus surviving, it’s sort of a no-brainer, but it would be very disappointing to have to give up the newfound intimacy that has been so surprising and fun for us.


Dear Marianne,

Thanks for writing again. The title of the movie, “Hope Springs,” is taken from the name of the fictional Maine village, Great Hope Springs, where Kay and Arnold go for their marital retreat. You and your husband have given a new meaning to the title – hope springs eternal. From what you have written, I think my readers may vote you a unanimous choice for Lifetime Achievement Oscar, and you may also be contenders for best comeback roles. Wow – what a story. (And to any of my readers who may be skeptical, this is not fiction. I have never made up any question I have ever published).

I only have a limited number of words for each column, so I am going to respond in parts, extending over several columns. First, I will address the issues you raise about erection, performance, orgasm and satisfaction. In next month’s column, I will address the issues of side-effects from erection-assisting medicines and any alternatives to these, including vacuum pump. Then in the third month, I will address your possible upcoming surgery and any sexual alterations that may result from it.

Your husband’s positive response to male hormone replacement therapy – testosterone – is a wonderful example of the importance of involving one’s health care provider in evaluations about sexual concerns. It sounds like with a little medical testing your hubby was found to have lower than ideal levels of testosterone. With this information, his doctor could then help him to find the correct method and dosage of replacement hormone.

Erections require both an adequate amount of testosterone to “push the start button” and a good enough blood supply to “prime the pump.” The latter is what erection-assisting medications (known in medical jargon as PDE5-inhibitors), such as Viagra™, Levitra™, and Cialis™ do. Each one of these medications works basically the same, but they differ around the span of time they remain in the man’s system. Viagra™ remains in the system up to 4-6 hours; Levitra™ stays in the system for 6-12 hours; Cialis™ stays in the system for about 36 hours. All of these are potentiators, meaning they dialate the blood vessels allowing more blood to flow into the penis as potential for an erection, but they usually do not cause a full erection without some stimulation – like from the spark of sexual turn on and especially from direct physical stimulation of the penis.

Orgasms are a little different. They require enough testosterone in the system to cause a spark, but testosterone alone is not responsible for orgasm and PDE5 drugs do little to enhance orgasms. Orgasm has two parts – the sense of urgency or, as many men describe it, the point of no return, and the pump-like expulsion of fluid through the penis, known as ejaculation or climax. As men age, typically both of these functions become a little muted. It is usual for a man who is in his sixties or older to have less sense of urgency and/or to report that occasionally he does not ejaculate. While this may be a disappointment, older men are often surprised that they can enjoy a sexual encounter from time to time without climaxing, as your husband has told you is true for him, Marianne.

From what you have said, your husband’s renewed sexual vigor has prompted changes in both of you – changes that you welcome, like increased interest and frequency of sexual encounters, as well as changes that concern you, like potential for dangerous side effects from medications. I am glad that you are curious and that you are remaining creative in your sexual expressions – that’s really important in order to promote Joyful Noise in the Bedroom (JNITB). Next month, I will discuss the possible downsides of sexual medicines, and also I will address your question about external assistive devices – the vacuum pump and others.


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