I would like to encourage you to do more on the sexual benefits of living well. In my practice, I am astonished and saddened to hear about the lack of sex people over 50 are having with their partners. It goes well beyond just ED. It has to do with fatigue, low libido, poor body image and difficulties with positioning due to BMI. I hate to be so frank about it, but it is true and I feel it is very important. I hope that you/we can spend more time addressing this highly personal, highly important topic.
Physical health, we wholeheartedly agree, is downright crucial for sexual well-being, for numerous reasons. And we think it’s a message that’s gotten lost in the ad mix these days. Yes, at this point the images of claw footed bathtubs on hilltops and log cabin jam sessions have etched (or mercilessly seared) themselves into the collective consciousness of our society. (Ladies: the pharmaceutical industry has had a harder time coming up with ideas for you. In 2004, Viagra’s makers literally threw up their hands  and gave up, citing women’s confounding lack of causal connection between arousal response and sexual interest.)
Annoyingly omnipresent as these ads are, we’ll give them this: they have encouraged the more seasoned of our society to envision the possibility that they can enjoy healthy sexual functioning in their later decades. Our beef with the ads: society’s growing association between healthy sexual functioning with a pill instead of overall health itself.
Behind the Dysfunctional Scene
The truth is, healthy men and women should be able to enjoy fulfilling sexual experience decades past middle age without the use of the latest pharmaceutical concoction. But healthy is the operative word here. There are, of course, many physiological and psychological factors behind sexual dysfunction.
For men, in particular, conditions that negatively impact vascular health, such as diabetes, atherosclerosis, high blood pressure as well as obesity, back pain, and lack of physical fitness all serve to raise the risk of sexual dysfunction and/or diminished performance/libido.
For women (as the Viagra anecdote illustrates), factors are more complex, including the above physiological conditions as well as other conditions. Just as ED is the common buzzword for men’s sexual dysfunction, HSDD  (hypoactive sexual desire disorder) has been applied to women’s common experiences in this arena. Experts estimate that 14-55% of women experience HSDD, with older women accounting for the upper percentages.
Add to the mix, we find all-too-common hormonal imbalance – and not just in terms of the “sex hormones.” Experts agree that hypothyroidism  is a major factor in women’s sexual health. For some women, sexual dysfunction  can be traced to unaddressed anatomical problems like prolapsed uterus, incontinent bladder and a weakened pelvic floor, conditions often related to childbirth.
Beyond the realm of physical conditions and impairments lies the more subjective side of one’s psychological experience of and interest in sex. Little wonder, is it, that stress figures into the picture for so many men and women. Given the physical toll stress can take on the body and its overwhelming ability to distract our thoughts and attention, stress naturally (but unfortunately) leaves us emptied of the motivation, creativity and emotional energy crucial to both the desire and the effort required for sexual fulfillment.
The Benefits of Health
So, besides popping a pill, what can the more mature among us do to retain and enhance our sexual functioning and fulfillment? While the initial proposals seem obvious, we don’t seem to hear them often enough. Since so much of sexual function relates to vascular health, it’s crucial to keep blood pressure in check and to prevent or actively treat diabetes and atherosclerosis. For both sexes, diet (i.e. low carb and good fatty acid balance) and exercise (i.e. moderate cardio and regular strength conditioning) that promotes hormonal balance is key.
It’s important, of course, to keep body mass index (not the best indicator of health, we know ) as close as possible to recommended levels. Well-rounded physical fitness offers the benefits of sexual endurance as well as the muscular strength and litheness advantageous to positioning and comfort. Numerous studies  have supported the impact of exercise and physical fitness on body image, sexual function, confidence, responsiveness, performance, and fulfillment. Keep in mind, however, that compulsive or exhaustive exercise can inhibit sexual functioning in both genders because of its impact on hormonal balance.
In addition to standard physical conditioning, women can especially benefit from exercise such as pilates and some yoga positions, that focuses on strengthening pelvic floor muscles. Look for a physical therapist with experience in this area or individual consultations with a well trained pilates instructor. A strong pelvic floor can support bladder control as well as significantly enhance arousal experience and orgasm.
Nutritional and herbal supplements can augment a healthy lifestyle to further boost sexual function. Gingko biloba, for example, is commonly advised for vascular health, while B-complex and other anti-oxidant supplements are recommended for lessening the physical toll of stress. Testosterone is a commonly discussed treatment for both men and women. We recommend lifestyle changes that will naturally sustain or enhance testosterone production. For men, strength training is key. For women, whose testosterone levels naturally don’t increase as much with exercise, we recommend diet and exercise that maintains overall hormonal balance and individual consultation with physicians regarding the impact of particular hormonal replacement therapies and birth control pills (which can blunt natural rises in testosterone during mid-cycle).
Thanks, as always, for the great questions, and keep ’em coming! And please do offer feedback on this and all of our reader response posts.