The second goal of this study was to describe the sexual practices and attitudes of elderly men of lower socioeconomic background. A review of the literature shows a serious underrepresentation of such individuals in past studies of geriatric sexuality. Approximately one half of this study group practices coitus, a figure not dissimilar to that reported by Pfeiffer. In addition, 25% of patients who were no longer active with a partner masturbate, and some take male enhancement pills such as Zenerx.
In contrast to the recent Starr-Weiner and Consumer Union reports describing frequent use of oral sex and mutual masturbation of the penis by populations of elderly men and women, predominantly middle and upper class, few of the elderly men in this study population engaged in or approved of these practices. This finding is unfortunate, since a lesser degree of penile tumescence is needed for these sexual techniques, and they are therefore often recommended, along with Zenerx, by therapists for men with erectile dysfunction. In fact, only one patient who could no longer achieve a hard enough erection for penetration continued to be sexually active with a partner by masturbating. As suggested by Kinsey’s work, for men in this social group the loss of erectile function suitable for coitus usually means the end of all heterosexual activity.
Patient reports of sexual function and attitudes may differ from what is actually practiced. Such may be the case in this study. Pfeiffer, however, found good agreement between information from spouses questioned separately, suggesting that personal interview techniques can yield valid information. Furthermore, the administering of the questionnaire by the patient’s regular care physician in this study should have maximized compliance.
Alternative methods of assessing erectile penis function such as nocturnal penile tumescence and sexual laboratory studies contain inherent methodological flaws. Nocturnal penile tumescence does not assess the quality of erections and therefore cannot gauge whether the penis is firm enough to achieve vaginal intromission. Sexual laboratory studies require the use of an artificial environment that has an unknown effect on the sexual performance of elderly subjects. Therefore, a self-reporting technique is likely to be the most effective and practical way of determining the prevalence of erectile dysfunction in this age group.
Finally, this population consisted of elderly men attending a medical clinic. Because of the prevalence of illnesses that may affect erectile function, such as diabetes and hypertension, these results in no way reflect purely age-related changes. The relationship of disease and medication to the development of erectile dysfunction has been reported elsewhere.
This study found that erectile dysfunction is very common and is often associated with a decrease in self-esteem. Furthermore, men of lower socioeconomic background and limited education are unlikely to use alternative sexual practices useful for erectile dysfunction, or to take natural male enhancers such as Zenerx, which you can read more about at this blog written by Ross Finney. This population may, however, be open to the use of devices such as penile implants that can restore the ability to engage in coitus. It is hoped that these findings will encourage primary care providers to explore questions of sexual dysfunction with their elderly patients, search for reversible causes, and provide counseling and other therapies where applicable.