Suzi Godson: Nine questions about sex men always ask me 

Our sex columnist gives her answers to the common issues raised by men in midlife
Suzi Godson: Nine questions about sex men always ask me 

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Can we really relearn lust after 20 years of marriage? We're just not as attracted to one another as we were.

Sexual desire may decline with age, but what is more important is the length of time you have been in your relationship. Habituation is the enemy of arousal. Sometimes sexual desire rekindles by itself, often in response to big life changes such as pregnancy or bereavement, key events such as changing jobs or moving to a new town, or more commonly the threat of losing the person with whom you have spent 20 years building a life. It is not unusual for divorcing couples who haven't had sex for years to suddenly experience overwhelming feelings of sexual desire for each other.

In the absence of an emotional jolt, the best way to start to feel sexual desire is to see your wife through new eyes. Who is she? What do you admire about her? Why are you with her? How would your life change without her? If the relationship is fundamentally sound, consciously appreciating your other half is enough to spark intimacy - and then you'll find that having sex creates a positive feedback loop.

I've lost my libido. Can I get it back?

Low sexual desire does not respond to drugs like Viagra, so the only way to get your libido back is to work out why you lost it in the first place. Some culprits are obvious: booze, cigarettes, obesity, illness or prescription medications. Lifestyle changes can help, but don't go too mad in the gym (when it reopens). Although exercise boosts libido, men who regularly do high-intensity workouts can have lower libidos.

Less frequently, low libido may relate to low levels of testosterone or an excess of the hormone prolactin. After the age of 40 testosterone levels fall by about 1% a year. That doesn't sound like much, but by the age of 70 or so it can add up to about a 30% decline. Testosterone can boost libido, but there is some concern that enhanced levels through replacement therapy can increase the risk of heart attack and perhaps even prostate cancer.

Low libido can also be caused by depression and that is a particularly vicious circle because antidepressants can have the same effect. Selective serotonin and serotonin-norepinephrine reuptake inhibitors (SSRIs and SNRIs) negatively affect libido, orgasm and erectile function. 

Changing to a different type of antidepressant can make a big difference. Dr David Goldmeier, a globally renowned consultant in sexual medicine, recommends bupropion or trazodone because they have a minimal impact on sexual desire and response. He also suggests that taking a one or two-day medication "holiday" each month can help to improve libido without allowing the depression to return, but you should only do this when your depression has stabilised and discuss it with your GP first.

Relationship problems are a key factor in low libido and unfortunately you can't pop a pill to fix that particular problem. It may be helpful to make an appointment to see a relationship counsellor - many are offering video-conferencing sessions during the pandemic. 

I'm not as 'virile' as I used to be. What can I do?

I know it's an unappealing prospect to talk to your GP about such matters as a lack of firmness, but get yourself to the doctor soon.

It's estimated that about half of all middle-aged men will have some difficulty getting or maintaining an erection, but it is not an inevitable consequence of getting older and should not be regarded as such.

While there are myriad possible causes - ranging from anxiety to a side effect of medication, or low testosterone levels - it is often associated with underlying cardiovascular problems. Indeed, difficulties in the bedroom may be the first warning sign of an early heart attack or stroke a decade down the line.

Please talk to your GP who, as well as being able to help restore a normal sex life, will screen for underlying problems ranging from hormone issues to high blood pressure or cholesterol levels, and diabetes.

My partner and I have stopped having sex altogether. How can we restart?

You're definitely not alone. In a sexual frequency survey that I conducted, 20% of 3,500 participants were not having sex at all and 23% were only having sex once a month. 

With hectic, stressful lives it is easy to let sex slide but the longer you leave it, the harder it is to get back on track. If you can talk to each other about the issue and are both prepared to make an effort, you could try using "sensate focus" once a week as a way of easing yourselves back in.  You start with short sessions taking turns to touch each other with your clothes on. This touch should be affectionate and exploratory, and should avoid any genital or sexual contact. If body image is a barrier to intimacy, do this by candlelight. 

When you feel comfortable touching and being touched, remove your clothes and repeat the process. If you begin to feel aroused, you may be ready to progress, but my advice is not to rush it. When you find yourself desperately looking forward to next week's session you are just about ready to go all the way.

I'm in my 50s and so is my wife, but I want more sex than she does. What can we do?

In couples with mismatched desire it is the person with the lower sex drive who maintains control in the sexual relationship.  When one person's sexual needs are not being met in a relationship the chances of them seeking solace elsewhere increases. If your relationship is otherwise good and you want to work this out, trying to visualise your differing levels of sexual desire can take the emotional heat out of it and help you to agree on scheduled sex as a way forward. 

Pick a number on a scale of one to five that reflects how important sex is to you and get your wife to do the same. Making your levels of "desire" more abstract makes it less personal. When you know that she is a two her lack of interest stops feeling like rejection and when she recognises that you are a five your enthusiasm stops feeling like pressure.

My sexual appetite has declined, but my wife's hasn't. What do you advise?

When people think about declining sexual desire they automatically think that it is a female phenomenon, but it is not. What's more lots of men ask me about this.

Research has showed that 32% of women may experience a few months of low libido in any given year, but so will 15% of men. Although male libido is tied to testosterone levels, all sexual desire fluctuates depending on how happy and how healthy you are. 

Stress, anxiety, illness, medication, depression and the quality of your relationship can all affect your desire for sex, and because it is such a complex mix of anatomical, physiological, psychological, developmental, relational and even cultural factors you have to figure out what has gone wrong before you can work out how to make it right.

The solution might be testosterone or it might be relationship therapy. Either way, you will need to talk to your wife and tell her how you are feeling. Sometimes just getting it off your chest is enough to change the dynamic. Being honest takes the pressure off and instead of getting anxious about performing you can relax and enjoy cuddling and skin-to-skin contact as a way of maintaining intimacy. Because arousal is often responsive for men too you may find that naked cuddling naturally leads to sex.

I have a heart condition. I'm worried about having energetic sex. Do I need to be careful in bed?  

Please don't worry. Recent research by Professor Yariv Gerber of Tel Aviv University has shown that returning to your usual level of sexual activity within a few months of having a heart attack is associated with a 35% lower risk of death compared with abstaining from or reducing sexual activity.

Can I take Viagra if I have high blood pressure?

Men who have well-controlled high blood pressure can take Viagra, Cialis or Levitra, as long as they are not also taking nitrates or alpha-blockers, but you must discuss it with your GP first. Men who have uncontrolled high blood pressure should not take erectile dysfunction medication. Nor should men who have had a recent heart attack or stroke, or who have kidney or liver disease, or the eye disease retinitis pigmentosa.

Is there a natural alternative to Viagra?

I would advise you just to take it, if you're able to. Licensed pharmaceuticals like Viagra are rigorously tested; "natural" alternatives are not. Although the internet is awash with recommendations for the magical sex powers of avena sativa, damiana, ginseng, ginkgo biloba, maca, muira puama and zinc, I have seen no credible research to show that any of them improve sexual function and some of them can do harm if taken in excessive amounts.

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