In men, hormone levels usually go down very gradually from a peak in late teens onwards. In some men, a quicker drop in their late fifties leads to symptoms like the menopause in women. These can be hot flushes, aches and pains in joints, loss of energy, including libido, and a sense of slowing up mentally.

The Sexual Response in Men is affected. Erections come less easily and less often. They are less hard, and once they have gone down are more difficult to get back. Orgasms are less intense and rhythmic spasms of the muscles are over quicker. The amount of semen is less and the refractory period after orgasm is longer. While the need to ejaculate is less intense, sexual satisfaction amongst older men is often said to be good. The ability to continue being sexual certainly remains an important part of the older man’s self-image..

The frequency of sexual activity goes down with age but is very varied. Men who start having sex early in life are more likely to go on till late in life. The amount of sexual activity depends on having or getting a partner. The longer a couple have been together the less sex they have.

Joe was a professional photographer, working for a magazine, when at the age of 44, he became aware of weakness in his arms and legs, and pain in his eyes on occasion. He was devastated, after several investigations, to be told that he had Multiple Sclerosis.

Joe and his wife, Jean, had had an active and good sex life until then. A few weeks after the diagnosis, Joe began to experience either partial erections, or could not perform at all. This was a very embarassing and difficult situation for both. After some months of struggling with the problem, they decided on seeing a sex therapist. Once the therapist had ascertained that Joe still had morning erections, and was aware of feelings of arousal, when wanting to make love to Jean, it was felt that the impotence was probably due more to his anxiety and panic at his diagnosis, and what the future held, than caused by the MS itself.

The therapist placed a ban on penetration for some weeks, and suggested various ways of spending time together, caressing, exploring each other's bodies, and generally relaxing with each other. This brought about the desired effect, removing the pressure to perform for Joe, and he discovered that he had erections while doing the 'exercises' with Jean. Over the ensuing weeks, using a graduated programme, they built up towards full intercourse, and after about 8 weeks, the ban was removed, and Joe discovered that he could perform just as well as before.

The psychological causes of erection difficulties are most often related to fear of failure, performance pressure and anxiety. There may be relationship stresses which make the problem worse. You really need to see a therapist for psychological treatment.

The first stage is to understand all the things which are causing the problem. There is often more than one cause. As far as possible, it is better to be seen with your partner if you have one, as it is much easier to overcome the psychological causes with the help of a partner. This is especially so where the problem only happens in the relationship.

Once the causes are understood, the next steps will be agreed with the therapist. Sometimes there are Sexual Abuse issues to be managed. Relationship stresses may need to be resolved. Any unrealistic expectations will have to be changed.

In the end, the most effective treatment will probably be sex therapy, but at first you may not be ready for it. Your therapist will guide you through it, and deal with any obstacles along the way.
A userful book is The New Male Sexuality, by Bernie Zilebergeld

Counselling by e-mail and chat or web conferencing is now well established as a useful way of getting help. The results are as good as, and in some cases better than, face to face, and many people prefer the anonymity of it. Also, it is usually cheaper than face to face counselling. You will not meet your counsellor or therapist unless you decide together to do so.

Your first step is to mail the counsellor of your choice and ask if they are available and willing to take you as a client. Sometimes they may refuse if they have a heavy caseload, or feel the issue you want to deal with is beyond their expertise.

The counsellor will then tell you their terms and conditions, what they will charge and what they will do for your money! and how and when you should pay. Any counsellor will be happy to answer questions about qualifications and training, codes of ethics and practice, what professional bodies they belong to and anything else about their professional status. They are most unlikely to answer any personal questions! Your counsellor will often ask for your real name, address, date of birth, and your doctor's name and address, in case of emergency.

To begin counselling, you will have to explain your problem and answer questions from the counsellor, some of which may seem unrelated, but there will be a good reason behind any question. If you really have to think about your answers, that is good. In counselling, it is generally the client who has to do the thinking. Your counsellor will not have the answers for you! You may be given tasks to fulfil, and books or articles may be useful for you to read. There may be web sites the counsellor can reccommend you to visit. Sometimes just telling somebody helps you to see your own way forward.

Overcoming Premature Ejaculation takes time and effort, but should be almost entirely successful, as there is usually nothing wrong with the penis. It is caused by anxiety and lack of attention to what the penis needs. Often there are other worries too, about pleasing the partner, being discovered and feeling embarrassed, or ashamed. You may like to see a therapist to help with these aspects.

1. Set aside three 20 minute slots each week, when you can be private and uninterrupted.
2. First masturbate very slowly, noticing carefully what sensations you get in your penis at the increasing levels of arousal before you are ready to come.
3. At the point just before you would come, stop touching and wait for the intense arousal to go down. You may lose the erection, but you will get it back. If you were too late stopping, and came, try again later, and stop a little earlier in the arousal.
4. Repeat three times, then allow yourself to come.
5. Do this three times a week, and after three weeks you should notice some improvement. Carry on, and you will overcome your problem.

Squeeze Technique
To make this technique work, you need to be prepared to set aside private and uninterrupted time three times a week. Don't be tempted to give up if after a few tries nothing seems to be changing. It can take a while to get the hang of it. Often it can take 30 attempts to learn the moment to squeeze, so giving up after 29 would be a mistake!

1. The place to squeeze is just below the glans, the rounded part at the top of the penis. If you have a foreskin, pull it back so the glans is uncovered.
2. Stroke and caress your whole genital area. This consists of the glans, the shaft of the penis, the testicles or balls, the area behind the balls which is called the perineum, and the anal rim. 5 parts altogether.
3. Practice touching and pleasuring all these parts so you are very aware of how each part feels in the stages of arousal before you are going to come.
4. Now increase your pleasure to a high state of arousal, and when you reach the point when you think you will come, squeeze the penis hard and hold ot for 20 to 30 seconds. The erection may go down, but you can get it back. If you were too late with your squeeze, try again later and squeeze a little earlier in your arousal.

Cialis, Levitra, Viagra and other Pills

There are now a number drugs which are effective in enhancing erection. The main scientifically established ones for taking as pills are Cialis, Levitra and Viagra, and Yohimbine. Whilst Viagra is the best known of the modern pills, Cialis and Levitra work equally as well and can be taken three times a week as opposed to an hour before sexual activity.

Yohimbine, made from the bark of a West Indian tree, has been used in the UK for at least 80 years. A number studies have shown significant improvement in ‘sustained erections’ for men taking between 20 and 40 mg daily. The drug acts in the brain to increase arousal and motivation. It has also been taken on an ‘as required’ basis one hour before intercourse in a 5 mg dose. Some people suggested the drug needs to be taken for several weeks to really work. It generally causes no side effects, but with high doses may inter-act with other drugs.

Alprostadil pellets, or MUSE

Alprostadil is quitesimilar to the natural substance in the body called Prostaglandin E1. It acts by widening blood vessels so that blood can flow into the penis more easily. Marketed in the form of a pellet the size of a pin-head the drug is placed in the opening at the tip of the urethra using an applicator. The technique for doing this is easy and painless. To assist the drug’s action physical activity which mobilises blood flow to the pelvis, such as walking, is recommended.

Viagra, or Sildenafil, has been available since 1998 and is the simplest to use of the new drugs for erection difficulties. It can be taken without anybody knowing, there are hardly any side-effects, and, when it works, you can depend on it. Erection only occurs when the man is sexually excited.

A starting dose of 25-50mg, later increasing to a maximum of 100mg in a 24 hour period, may cause mild side-effects. These can be facial flushing in about 20 minutes, slight indigestion, coloured haloes around objects and a mild headache. These effects are dose-related and pass off quickly.

If Viagra is taken before an evening meal a better erection response occurs with sexual excitement for up to 18 hours; the greatest effect lasts about 4 hours starting about an hour after taking the tablet.

There are some medical conditions which mean you must not use Viagra.If you are taking other medications such as erythromycin or cimetidine, you should only take half the dose of viagra. This is why it is so important to have it from a doctor.

Women's bodies produce two sex hormones, estrogen and progesterone, and men's bodies produce testosterone, which is also found in small amounts in women. As women and men get older, the level of sex hormones in the body drops. For women this leads to the menopause, usually in the mid to late 50s. The ending of monthly periods is a well known sign of the menopause. For men the decline in hormone level starts in the mid 20s and continues throughout life. It is not marked by any special event.

In women there can be unpleasant symptoms like night sweats, hot flushes, headaches, tiredness, loss of confidence, and others. It is easy to have the hormones raised, by taking them in tablet form, patches or implants. This has to be prescribed by a doctor, and there are side effects and risks, as well as great benefits. There are natural hormone replacements as well, and a herbalist or naturopath would advise you.

In men the picture is different. Lower levels of hormone can cause tiredness, reduced sex drive, reduction of erections, and other problems. Men sometimes mistakenly believe that by replacing testosterone, they will be restored. This is not correct, and taking testosterone in the wrong conditions is positively dangerous. Hormones for men are only given after checking the levels, and in particular cases.

There are four main ways to help sexual and relationship problems to get better. These are:

Medical Help,

This includes, from doctors.
You should start by seeing your GP or MD, who will work out if you need to see a specialist such as a genito-urinary consultant, a gynacologist, or psychiatrist. Examples of medical treatments for sexual problems are:

Therapeutic Help

You should only see a therapist who is accreditied with a recognised professional organisation.

Self Help

Mechanical (Sex) Aids