In the Czech Republic, at the Faculty of Medicine of Charles University in Prague, this renowned sexologist, MUDr. Luděk Daneš, CSc., has been working for a long time and has a track record of successfully treated cases. It is important to know here that the intimate life of each of us in later age is natural, normal, and of course is also associated with problems related to aging. Sex should be a pleasantly spent time that both partners must make time for these intimate matters. Best of all, regularly, precisely to establish those sexual stereotypes. We sat down with him to discuss this and other matters.

I assume that you see patients with the most common health problem related to erectile dysfunction? And from what age do your patients start having these fundamental problems?

It is one of the most common problems, but here at the sexological institute we also address problems of a reproductive nature, when couples cannot have children, various disorders related to sexual life, but also expert court opinions from our medical field. Otherwise, you are right; the most common problem is erectile dysfunction. Here, the organic changes within these diseases appear around the age of fifty, and then of course, the older a person is, the greater their claim to their health problems. I should not forget one of the main diseases, which is arteriosclerosis, which is closely related to the problem of erectile dysfunction, and it would also be good to mention andropause in older people, which is actually the same for men as menopause is for women. This andropause is actually a decline in testosterone, and it in men begins roughly between forty and fifty. It comes very insidiously, and the first problems may manifest after ten years from the beginning of andropause. Usually, testosterone begins to decline at forty, but the first disorders of erectile dysfunction, loss of libido, manifest only between fifty and sixty.

What are the other symptoms of andropause in men?

What interests us mainly is the loss of sexual appetite, loss of libido, and with that is associated erectile dysfunction. But there are even changes in personality traits and expressions, and also psychological changes in mood. Older men are so irritable and even depressed, complaining about everything, as we can often observe. They lament variously that when they were young, it was perfect, and now everything is bad. There is also a loss of that life spark, the desire for some physical activity, or even worse, patients sleep. All of this may be related to testosterone. There, it can be seen that if a patient has been irritable since youth, then it is more likely a personality trait than just a decline in hormone. Muscle mass also decreases, since it acts anabolically. Here it needs to be emphasized that it is insidious, not like in women. In women, it is usually abrupt, where the decline in hormones drops actually within a year. But back to men, I usually discuss with the patient that eight years ago he had sexual intercourse three times a week and now he has it once a month. Usually, the wife or partner helps, who herself has a greater interest and also motivates the partner through her interest. Just for illustration. The average sexual need for people around fifty is sexual intercourse, about twice a week.

And how is it with women regarding this hormonal decline during their menopause?

For women, the situation is similar, but there are fundamental differences. As I have already mentioned, women experience menopause, which involves a very sharp decline in the production of estrogen and progesterone hormones, typically occurring over the course of about one year. Secondly, women do not consult a sexologist for this issue but rather address it with their gynecologist. Sexologists do not "fit into" this scenario. Otherwise, the same principle applies here: hormonal medications can be prescribed, but only after a medical examination, which must also rule out any suspicion of cancer. Back to hormone supplementation. For example, in the USA, the general trend is that women often supplement this hormonal decline because, in addition to its impact on sexual life, it is also beneficial for the skin and complexion, as well as for mental well-being. It can even affect self-confidence. However, this is also individual, simply case by case, for both men and women.

So, do not hesitate and, if any problem arises, come to us for preventive care as soon as possible?

Definitely. Here, supplementation of hormonal substances is also an option, for example, testosterone for men. However, just as with women, men also need to ensure that their prostate is in order. If a patient has prostate cancer or another type of cancer, they cannot simply take hormonal medications, such as "Undestor." Above all, it is advisable to consult with a doctor. For instance, people often think that if they have a cardiac pacemaker or a bypass, they cannot take medications like "Viagra" or "Cialis," which are erectile dysfunction medications, as we know. However, this is not true. If the patient is not taking "Nitrates" and the doctor verifies other medications, these drugs can also be prescribed.

However, I once again seriously emphasize that this should only be done after a medical examination. The best possible option is, of course, when everything still works without medication. A person should primarily have a strong desire for intimate life. There are often complaints that patients lose interest after five minutes, and when men experience erectile dysfunction, what should they do? In such cases, it is important to slow down for a moment, switch to non-coital activities, and then resume after a short while. It should definitely not be a race. It should be a pleasant time that both partners should allocate to these intimate matters, preferably regularly. This is precisely to break down sexual stereotypes.

So, what is another frequent problem that patients bring to you?

In general, the most common problem for patients is that they come with a significant delay. When a problem arises, patients simply and usually quietly postpone their sexual life, telling themselves they will return to it once things are better. This is the fundamental mistake that turns into the problem itself. Here, nothing should be postponed, and certainly not quietly. These matters must be openly addressed. It is also beneficial for the relationship as a whole. Once postponed, first, there is the assumption that they will no longer want to engage in it, as both partners will fear returning to it, with the man fearing his own impotence even more. Second, both partners will fall out of their established intimate stereotype. This exacerbates the problem, which doctors are very well aware of. It often happens that someone becomes widowed and is without a partner for eight years, or as I said, when they fall out of that stereotype and subsequently find a new partner, especially men fear that when it comes to intimate matters, it will not work, and their partner will leave them. It is clear that choosing partners at this age, around seventy, is difficult. The stress of being left by a partner is naturally greater than in one's thirties, when there is no problem finding another partner. Therefore, every patient in this age category must expect that resuming sexual life after several years of pause will be somewhat more complicated. It is advisable to consult a sexologist before resuming intimate life in a new relationship, so to speak, to "insure" the intimate beginning, perhaps with just advice, but also with the medications that today significantly help. Very often, older individuals who anticipate psychological problems come to the doctor with the courage to do so, and we gladly give them advice, or agree on a solution procedure where we prescribe medications three to four times, and when the fear subsides, they mentally recover. This applies equally to both the younger and older generations.

At what age should men stop worrying that it is a normal biological process, because first, they suffer unnecessary trauma, and second, it is naturally hidden?

It is important that the partner has a partner who is primarily interested. Of course, if the partner refuses sexual life, there is no point in forcing them in any way. And if the partners have mutual interest, then intimate life is important, as it strengthens their mutual marital or partnership relationship. Do not ignore the notion that it is abnormal for older people to have sex. Unfortunately, this takes away people's motivation, leading them to say, "We won't do it in our sixties, and we'll stop with retirement," wondering what their children will think. Here it is important to know that intimate life for each of us at an older age is natural, normal, and of course, it is also associated with problems related to aging. The main point is that something can be done about it. It is certainly necessary to say that friends in pubs or knitting club friends will not help anyone, but one must visit a specialist. For in the pub, everyone is a world champion or knows everything. We recommend a healthy lifestyle: do not smoke, do not drink large amounts of alcohol, sleep regularly, and at least maintain physical condition within the possible limits. Therefore, it is necessary to follow such psychological guidelines. Among these is mental health. This means having hobbies and following what is happening in the world. Similarly. So do not sit at home and watch apathetically in front of the television.

So, does this mean that no one should give up their sexual life at any age and should strive to maintain their quality of life?

Yes. And it should be adapted to one's health condition, without expecting a seventy-year-old diabetic to perform heroic feats. The partner should be reasonable and help find a way together, perhaps through non-coital activities, so that mutual satisfaction is achieved, albeit in a different form. Of course, there are many such alternative activities. It is important to say that a problem in this area for one person is actually a problem for both. Sometimes partners tend to say, "Well, just give up on it now, and when you're healthy again, come back." The man is naturally on edge, and with fear, he tries again in a month, which naturally ends up poorly again. Well, if his wife says, "Let's just give up on it," we'll stop. Naturally, to avoid future unpleasant moments, as I have already mentioned, they quietly put their problem aside, and their sexual life often practically ends. And that is why we, as sexologists, try to help those who have the courage to address these issues, so they can continue to enjoy a qualitative life and not just live from memories.

Jan Vojtěch, Editor-in-Chief - General News