For this reason some think the best heterosexual combination is a woman in her 30s or 40s and a young man in his late teens or early 20s. (See our article "Older Women, Younger Men, Nothing New!")

But for many reasons, we seek to partner with people whose age is similar to our own. This means as we age, we must be aware of bodily and emotional changes that affect our sexual health. For women, the most significant change is loss of natural lubrication from decrease in hormone production. Men also experience a reduction in testosterone levels which can lead to a decreased libido. But perhaps the change that causes the most concern for men has to do with performance: the frequency and duration of erections.

As men age, they will take longer to achieve an erection. This is not necessarily a reflection of decreased sexual desire, nor a symptom of impotence. Rather, it is the result of physiological changes: the body secretes less testosterone (the hormone that regulates sexual performance and desire), and it conducts nerve impulses more slowly. Also, the blood vessels in the penis are less able to maintain the pressure necessary for a full erection. The result is that men may feel less sexual urgency, have erections that are less firm than when they were younger, and may need to wait longer between ejaculations. These changes may seem distressing at first, but they can be advantageous by allowing men and their partners to extend foreplay, sustain intercourse longer, and delay orgasm to the point where both partners may achieve greater satisfaction.

Testing has shown that women of any age require, on average, 13 minutes of arousal and stimulation before climaxing, but for young men this may occur in as little as 3 minutes or less. Aging lengthens the amount of time between a man's sexual arousal and climax, bringing it closer to his female partner's norm. Actual physical impotence (the inability to achieve or sustain erections, also known as erectile dysfunction or ED) among men in their late forties and early fifties is actually not very common, and is associated more often with excessive alcohol consumption than with any other single factor. Maintaining an active and regular sex life helps decrease the possibility of ED. In one study of men over 60, those who engaged in more frequent sex had significantly greater levels of testosterone in their blood. If you do not have a partner, regular masturbation can help maintain your sexual health just as well as sex with a partner. Sometimes divorced or single men of middle age turn to paid companionship such as escorts for sexual release. There is certainly nothing wrong with this but it is crucial to practice safe sex for any activity.

Sometimes illnesses that affect us as we age can affect our sex lives. Following any major illness, you should check with your doctor to find out when you can resume sexual activity. If you develop a chronic medical condition, such as diabetes or high blood pressure, ask if there are any restrictions on the types of activity. Half of all male diabetics over fifty are impotent to some degree because the disease affects both blood vessels and nerves. Yet how the diabetic perceives his sexuality is also important. Keeping a positive attitude and taking control of your own health by maintaining a healthy diet and exercise routine are crucial to managing diabetes. For those with arthritis, sex can actually be a pain reliever. Sexual orgasm may stimulate the production of hormones such as cortisone and adrenaline, which may help reduce arthritic discomfort for up to six hours. This may also be true for certain neurological conditions such as sciatica, or for back pain. Check with your doctor. Early in your recovery after major surgery, you probably shouldn't have sex, and probably will not feel like it. Usually when your desire for sex returns, you are ready to resume activity, but check with your doctor or surgeon to see if you should abstain from sex for a specified period of time or if you need to take any special precautions. Hernia surgery is relatively straightforward but being active too soon afterwards can cause problems or rupture. Following prostate surgery, some men may have a "dry" climax, an orgasm in which semen ejaculates backward into the bladder, where it is later passed in the urine. This does not mean you have any sexual dysfunction, and need not interfere with the enjoyment of sex for either you or your partner.

The basic changes that will occur as men age are summarized in a book by Robert W. Birch, "Sex and the Aging Male: Understanding and Coping with Change". Birch mentions the following as the most significant sexual changes in men after they reach their mid-40s:

1. Sexual drive and urgency decrease
This is due to decreased hormone production and is usually gradual, but some men may find a more sudden decrease in sexual feelings. If this concerns you see your doctor as there is always a possibility of some additional cause beyond normal aging.

2. Spontaneous erections cease to occur
Men will remember (perhaps fondly) the days of their adolescence when they would get hard just looking at an erotic image or by the presence of a woman. The body is simply no longer capable of such rapid-fire sexual response as it ages, and men should not see this as a decrease in vitality. On the contrary, it signifies a greater amount of control!

3. Direct stimulation becomes necessary
Young men can merely think about sex and become aroused. The sight of a naked partner or even a kiss will intensify an erection. But as a man ages, sexual thoughts and physical sensations become less intense, and an erection may not occur without direct stimulation. It is important for a man's regular partner to become comfortable with this change, and to be adept at providing this stimulation manually or orally. Some married couples find their sex lives diminish not due to the lack of physical ability but because of an unwillingness on the part of either partner to approach sex differently. Women need more foreplay, and so do men! So enjoy this opportunity to explore and gain expertise to enhance your sex life. A man's need for more stimulation should not be seen as a decrease in a woman's desirability, merely a call for her to utilize her sexual prowess for the desired outcome.

4. Continual stimulation is often necessary
Not only does continual stimulation help a man maintain his erection, but it can help him focus on pleasure (his and his partner's) and not on the anxiety associated with the potential loss of an erection. If a man perceives his partner is enjoying this stimulation and the mutual pursuit of pleasure, he will be better equipped psychologically to overcome feelings of inadequacy, which some men feel as they get older and their sexuality goes through the changes being discussed.

5. Erections change!
The amount of pre-ejaculate diminishes; erections may be less firm, or become more difficult to sustain at a desired level of firmness; even the angle of the erection may change. Don't let these changes deter you or your partner. Remember the days when you could be having sex, receive a phone call, go to the kitchen for a drink, and return to the bedroom with no diminishment of your hard-on? This "superhuman" power will diminish as you get older. The "instability" of an erection's firmness as you age is also related to mental distraction, so taking the phone off the hook and shutting off the TV and eliminating the possibility of interruptions may be helpful.

6. It takes longer to achieve climax/ejaculation
For some men who had been rapid ejaculators, this might be one of the few physical advantages to growing older. On the other hand, for other men, the amount of time necessary to reach orgasm can become frustrating for them and, possibly, their partners as well. This can become even more of a concern if one or both have lost physical agility, have become more easily fatigued, or experience muscle or joint pain. Staying focused and not letting yourselves get upset is the best course of action. Some men may feel they now have a more limited "window" of time within which to achieve climax, as opposed to the ability to build up arousal and postpone ejaculation that some younger men enjoy. But as you get older delayed ejaculation may cause a numbing sensation, so if a "quickie" seems called for, go for it! You can always please your partner manually or orally afterwards. It's possible you may not always be able to achieve ejaculation when you set out to. But this need not cause physical discomfort or mental worry, as it sometimes does in younger men.

7. Different sensations during climax
In older men, ejaculation may undergo some changes.The amount of semen decreases, as does the force with which it is expelled. The aging male can no longer spurt large amounts of ejaculate over great distances (not that you ever wanted to do this, did you?) . At some point the aging male will discover that he is oozing smaller quantities of semen, although his sperm is still fertile if he has not had a vasectomy. It is also likely you will have to wait longer to attain another erection or have another climax than you did when younger. You may not be able to "go" more than once a day. Men may also experience a lower level of intensity in their orgasm. The decrease in the strength of the internal contractions not only accounts for the loss of velocity, but also may lead to a diminished sense of emotional or mental sense of pleasure. But it is important to remember that this is purely psychological and to try and adjust your attitude accordingly.

Our sexuality evolves as we do: physically, emotionally, mentally. Sex is life, and just as we adapt to changes in our careers, relationships and living situations, we must adjust to our changing sexual needs and abilities. But there is no reason to stop having sex or to stop being sexual beings, ever!