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Question: I, Me, XXXX
Age 66
175 cms, 83 kg
Fit and active
Value lifestyle over longetivity
Generally happy asnd enjoying life, BUT
Much frustrated by collapse of my sex life
History
Sex activity and life declining slowly with age from (say) age 45
By 2010 (age 60) coupling successfully 2-3 times pw
Limited use of PDE5 inhibitors - typically 1 x 10 mg Cialis pw
Few failed attempts (<30%)
2010 (Dec) Open heart surgury
Replacement of bicuspid aortic valve, aortic root & ascending aorta
"Full" recovery
By mid 2011, more fit and able than pre surgery, BUT
2011-2013 (age 61-63) coupling successfully 1-2 x pw
Heavy use of PDE5 inhibitors - typically 6 x 10 mg Cialis or 6 x 25 mg Viagra or combination pw
Many failed attempts (>50%)
2013 (Dec) hospitalized with endocarditis for 6 weeks
Agent was Golden Staff
Suffered strokes and kidney damage from "vegitation"
No damage to heart valves etc - the repairs of 2010 survived
"Good" recovery, except eGFR recovered to 52 only
Not as fit and able as before, but not too bad for dark side of 65, BUT
2014-2016 (age 64-66) coupling successfully 1-2 x pw
enormouse use of PDE5 inhibitors - typically 12 x 10 mg cialis or
12 x 25 mg viagra or combination pw
many, many failed attempts (>80%)
By 2016 (Mar) (Age 66) coupling successfully 0-1 x pw
Large use of PDE5 inhibitors despite they being effectively useless
(typically 8-10 x pw) (less than 2014-16 because I had given up))
Successful couplings almost all with CAVERJECT (5mcg)
NB that both collapses in sex life in 2011 and 2014 were step functions in the 2nd quarter of their respective years, corresponding to my resuming sex after hospitalization. These were not gradual decays over the time periods nominated.
Parallelling this, a measure of physical ability is my swimming. In 2011-13 I regularly swam 1 km 2 x pw. In 2014-15 I could swim a half km. Presently I can swim only 100-200 metres, but I atribute this to the distance that I now live from the nearest pool.
In January 2016 I was diagnosed with AF by my cardiologist. This had not been identified (?reported to me) before. A 24 hour monitor confirmed frequent episodes of AF in the period, which was one of considerable physical activity in very hot conditions (daytime temperatures of 35+deg C). A maximum heart rate of 200 bpm was observed. At no stage was I aware of this, nor was I discomforted by it so far as I recall.
I suspect that the tendency to AF was caused or exacerbated by the events of 2010 and 2013, and my cardiologist has (obliquely) supported this.
Medical Consultations
I have seen two urologists to discuss the above. Both impressed me in the negative with their disinterest in me and in my observations, and by their avarice. Neither would listen to me, both accorded me the shortest possible time and hustled me out of the door. One's response to my questions was "What do you expect"? They did advise that my prostrate was "normal" though the Technical Officer who did the ultrasound for one opined that it was enlarged.
Situation Now
I can engage in moderate-hard physical activity for 6+ hours/day without distress
I have occasional morning erections without any PDE5 (or other) drugs
I have full erections (8/8) every morning with 10 mg Cialis/day, and
I can have full erections after taking 20 mg Cialis, 100 mg Viagra or 40 mg Levitra, BUT
the erections collapse quickly if I mount the wife and start thrusting (although they will sustain if she mounts me and I lie quietly, and will sustain if I think "happy thoughts" and lie quietly (no sex)).
In the first case I rarely ejaculate and in the second never.
I have substantial erections (7/8) after injecting with 5mcg Caverject, the erections will sustain for 15-30 minutes and usually I will ejaculate. Caverject injections are not an appealing foreplay.
In any events, ejaculations are weak and usually disappointing.
Other
I have become increasingly inorgasmic since (say) 2005, probably a natural progression but one that has exacerbated my frustration, and one that has fed on my erectile failures. I believe that there is a psychological element in my problem, but such require time to overcome. At age 66 I do not have time, and anyway am unsympathetic to and am not interested in pursuing "councilling" or similar "therapies".
Current Drug Regime
Cephalexin 500 mg x 2 twice per day
Xaralto (rivaroxaban) 15 mg daily
Cordilox (verapamil hydrochloride) 180 mg daily
CRESTOR 2.5 mg daily
Valdoxan 25 mg daily
Progout (allpurinol) 100 mg x 2 daily
Raprazole sodium 20 mg daily
Fish oil 1000 mg x 2 twice per day
CENTRUM Multivitamin (tablet) daily
Vitamin C 500 mg daily
Vitamin E 500IU daily
Zinc (tablet) daily
Testosterone cream 1 ml M-F
Cialis, Viagra, Caverject various, as and when
Questions.
1. Is the above history typical of an active mid 60s male?
2. or am I being silly trying to hold onto past fun?
3. Is the above history typical of an active mid 60s male who has had multiple heart "events" in the past 5 years?
4. What is the prognosis for the future?
5. or when does sex end?
6. for me?
7. Realistically can anything be done to restore sustainable erections?
8. Erections collapse when I start thrusting - I appear to go into AFwhen working hard - are these related?
9. If so is there anything that can be done?
10. Any other advice? Should I close the book on this part of my life?
Thanks
XXXX
Age 66
175 cms, 83 kg
Fit and active
Value lifestyle over longetivity
Generally happy asnd enjoying life, BUT
Much frustrated by collapse of my sex life
History
Sex activity and life declining slowly with age from (say) age 45
By 2010 (age 60) coupling successfully 2-3 times pw
Limited use of PDE5 inhibitors - typically 1 x 10 mg Cialis pw
Few failed attempts (<30%)
2010 (Dec) Open heart surgury
Replacement of bicuspid aortic valve, aortic root & ascending aorta
"Full" recovery
By mid 2011, more fit and able than pre surgery, BUT
2011-2013 (age 61-63) coupling successfully 1-2 x pw
Heavy use of PDE5 inhibitors - typically 6 x 10 mg Cialis or 6 x 25 mg Viagra or combination pw
Many failed attempts (>50%)
2013 (Dec) hospitalized with endocarditis for 6 weeks
Agent was Golden Staff
Suffered strokes and kidney damage from "vegitation"
No damage to heart valves etc - the repairs of 2010 survived
"Good" recovery, except eGFR recovered to 52 only
Not as fit and able as before, but not too bad for dark side of 65, BUT
2014-2016 (age 64-66) coupling successfully 1-2 x pw
enormouse use of PDE5 inhibitors - typically 12 x 10 mg cialis or
12 x 25 mg viagra or combination pw
many, many failed attempts (>80%)
By 2016 (Mar) (Age 66) coupling successfully 0-1 x pw
Large use of PDE5 inhibitors despite they being effectively useless
(typically 8-10 x pw) (less than 2014-16 because I had given up))
Successful couplings almost all with CAVERJECT (5mcg)
NB that both collapses in sex life in 2011 and 2014 were step functions in the 2nd quarter of their respective years, corresponding to my resuming sex after hospitalization. These were not gradual decays over the time periods nominated.
Parallelling this, a measure of physical ability is my swimming. In 2011-13 I regularly swam 1 km 2 x pw. In 2014-15 I could swim a half km. Presently I can swim only 100-200 metres, but I atribute this to the distance that I now live from the nearest pool.
In January 2016 I was diagnosed with AF by my cardiologist. This had not been identified (?reported to me) before. A 24 hour monitor confirmed frequent episodes of AF in the period, which was one of considerable physical activity in very hot conditions (daytime temperatures of 35+deg C). A maximum heart rate of 200 bpm was observed. At no stage was I aware of this, nor was I discomforted by it so far as I recall.
I suspect that the tendency to AF was caused or exacerbated by the events of 2010 and 2013, and my cardiologist has (obliquely) supported this.
Medical Consultations
I have seen two urologists to discuss the above. Both impressed me in the negative with their disinterest in me and in my observations, and by their avarice. Neither would listen to me, both accorded me the shortest possible time and hustled me out of the door. One's response to my questions was "What do you expect"? They did advise that my prostrate was "normal" though the Technical Officer who did the ultrasound for one opined that it was enlarged.
Situation Now
I can engage in moderate-hard physical activity for 6+ hours/day without distress
I have occasional morning erections without any PDE5 (or other) drugs
I have full erections (8/8) every morning with 10 mg Cialis/day, and
I can have full erections after taking 20 mg Cialis, 100 mg Viagra or 40 mg Levitra, BUT
the erections collapse quickly if I mount the wife and start thrusting (although they will sustain if she mounts me and I lie quietly, and will sustain if I think "happy thoughts" and lie quietly (no sex)).
In the first case I rarely ejaculate and in the second never.
I have substantial erections (7/8) after injecting with 5mcg Caverject, the erections will sustain for 15-30 minutes and usually I will ejaculate. Caverject injections are not an appealing foreplay.
In any events, ejaculations are weak and usually disappointing.
Other
I have become increasingly inorgasmic since (say) 2005, probably a natural progression but one that has exacerbated my frustration, and one that has fed on my erectile failures. I believe that there is a psychological element in my problem, but such require time to overcome. At age 66 I do not have time, and anyway am unsympathetic to and am not interested in pursuing "councilling" or similar "therapies".
Current Drug Regime
Cephalexin 500 mg x 2 twice per day
Xaralto (rivaroxaban) 15 mg daily
Cordilox (verapamil hydrochloride) 180 mg daily
CRESTOR 2.5 mg daily
Valdoxan 25 mg daily
Progout (allpurinol) 100 mg x 2 daily
Raprazole sodium 20 mg daily
Fish oil 1000 mg x 2 twice per day
CENTRUM Multivitamin (tablet) daily
Vitamin C 500 mg daily
Vitamin E 500IU daily
Zinc (tablet) daily
Testosterone cream 1 ml M-F
Cialis, Viagra, Caverject various, as and when
Questions.
1. Is the above history typical of an active mid 60s male?
2. or am I being silly trying to hold onto past fun?
3. Is the above history typical of an active mid 60s male who has had multiple heart "events" in the past 5 years?
4. What is the prognosis for the future?
5. or when does sex end?
6. for me?
7. Realistically can anything be done to restore sustainable erections?
8. Erections collapse when I start thrusting - I appear to go into AFwhen working hard - are these related?
9. If so is there anything that can be done?
10. Any other advice? Should I close the book on this part of my life?
Thanks
XXXX
Brief Answer:
You should be discussing with your cardiologist...
Detailed Answer:
Hi,
I went through the details you posted with diligence. I am sorry that you are dealing with a set of complex medical condition. In the background of such complex medical condition, it is not easy to provide an opinion without a clinical examination. Perhaps this was a reason why no specialist on this forum attended your query.
I shall try and answer your question as a physician here.
1. Is the above history typical of an active mid 60s male or am I being silly trying to hold onto past fun?
It is quite common to see declining sexual functions in male beyond 60 years. However it is not a dictum that all men beyond 60 will have poor sexual erections. There are instants where men are able to have good sexual life at 80.
But in your case, the medical conditions you suffer from and your medications are expected to interfere with sexual activity significantly. Therefore though it is not silly to hold onto past fun, you should understand the limitations and not get frustrated.
2. Is the above history typical of an active mid 60s male who has had multiple heart "events" in the past 5 years?
I think I have fairly answered this question in my previous reply.
3. What is the prognosis for the future? or when does sex end? for me?
In general, there is no set age limit when I can say "it the end of sexual activities". However in this case you have significant cardiovascular risks and your sexual functions have already declined to a significant extent despite the medications. I don't see much improvement from here.
4. Realistically can anything be done to restore sustainable erections? If so is there anything that can be done?
There is an options to treat erectile dysfunction. But all the options are contraindicated when there is significant cardiovascular risks (AF) and while on antcoagulation (rivaroxaban).
If at all any of treatment should be tried, it should be done after seeking permission from your cardiologist. Talk to your cardiologist. He/she is the specialist who might provide suggestions to your urosurgeons with regards to this treatment.
5. Erections collapse when I start thrusting - I appear to go into AFwhen working hard - are these related?
Physical exertion of any form induces physiological changes which increases heart rate. Increase heart rate will cause misfiring leading to AF. Thus AF when working hard / thursting are related.
6. Any other advice? Should I close the book on this part of my life?
At this point, you should always seek cardiologist opinion before trying sexual intercourse. I would first look to treat AF especially when you have frequent / recurring AF.
Regards
You should be discussing with your cardiologist...
Detailed Answer:
Hi,
I went through the details you posted with diligence. I am sorry that you are dealing with a set of complex medical condition. In the background of such complex medical condition, it is not easy to provide an opinion without a clinical examination. Perhaps this was a reason why no specialist on this forum attended your query.
I shall try and answer your question as a physician here.
1. Is the above history typical of an active mid 60s male or am I being silly trying to hold onto past fun?
It is quite common to see declining sexual functions in male beyond 60 years. However it is not a dictum that all men beyond 60 will have poor sexual erections. There are instants where men are able to have good sexual life at 80.
But in your case, the medical conditions you suffer from and your medications are expected to interfere with sexual activity significantly. Therefore though it is not silly to hold onto past fun, you should understand the limitations and not get frustrated.
2. Is the above history typical of an active mid 60s male who has had multiple heart "events" in the past 5 years?
I think I have fairly answered this question in my previous reply.
3. What is the prognosis for the future? or when does sex end? for me?
In general, there is no set age limit when I can say "it the end of sexual activities". However in this case you have significant cardiovascular risks and your sexual functions have already declined to a significant extent despite the medications. I don't see much improvement from here.
4. Realistically can anything be done to restore sustainable erections? If so is there anything that can be done?
There is an options to treat erectile dysfunction. But all the options are contraindicated when there is significant cardiovascular risks (AF) and while on antcoagulation (rivaroxaban).
If at all any of treatment should be tried, it should be done after seeking permission from your cardiologist. Talk to your cardiologist. He/she is the specialist who might provide suggestions to your urosurgeons with regards to this treatment.
5. Erections collapse when I start thrusting - I appear to go into AFwhen working hard - are these related?
Physical exertion of any form induces physiological changes which increases heart rate. Increase heart rate will cause misfiring leading to AF. Thus AF when working hard / thursting are related.
6. Any other advice? Should I close the book on this part of my life?
At this point, you should always seek cardiologist opinion before trying sexual intercourse. I would first look to treat AF especially when you have frequent / recurring AF.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr XXXXXXX
Firstly, thank you for your honest appraisal of my condition and prognosis.
Your answer supports my suspicions that the 2 cardio incidents have damaged my heart in ways not acknowledged by my cardiologist or doctor. Further, I learned only 2 days ago that my father developed AF by age 78 (I knew that he had a "triple A bipass" then. but not of the AF). I conclude that a genetic disposition to AF and the 2 cardio incidents are responsible for my present condition. I wish that some of the medical people that I had consulted had so advised me earlier.
I acknowledge your concerns, but nonetheless should like to resume my sex life.
I saw my cardiologist last month, and I raised the matter of sexual and physical activity with her. She neither encouraged nor discouraged sexual activity but suggested that I "slow down" on physical work.
She has suggested to my doctor (but did not herself prescribe) 0.5mg digoxin daily. He has been reluctant to so do for reasons that I have been unable to elicit from him. I understand that digoxin is routinely (?) prescribed for AF. Have you any thoughts on this as applied to my aspirations?
Thanks again
XXXX
Firstly, thank you for your honest appraisal of my condition and prognosis.
Your answer supports my suspicions that the 2 cardio incidents have damaged my heart in ways not acknowledged by my cardiologist or doctor. Further, I learned only 2 days ago that my father developed AF by age 78 (I knew that he had a "triple A bipass" then. but not of the AF). I conclude that a genetic disposition to AF and the 2 cardio incidents are responsible for my present condition. I wish that some of the medical people that I had consulted had so advised me earlier.
I acknowledge your concerns, but nonetheless should like to resume my sex life.
I saw my cardiologist last month, and I raised the matter of sexual and physical activity with her. She neither encouraged nor discouraged sexual activity but suggested that I "slow down" on physical work.
She has suggested to my doctor (but did not herself prescribe) 0.5mg digoxin daily. He has been reluctant to so do for reasons that I have been unable to elicit from him. I understand that digoxin is routinely (?) prescribed for AF. Have you any thoughts on this as applied to my aspirations?
Thanks again
XXXX
Brief Answer:
Your doctors are the best judge here....
Detailed Answer:
As I indicated in my previous reply, your health problems are complex and I cannot provide a fair opinion without examination and without evaluating your reports. But yes, coronary artery disease which led to triple artery bypass and AF may be causes of impotency.
Digoxin besides controlling and preventing AF, it is also able to improve contractility of heart muscles thereby improving circulation. If your latest echo shows low EF (less than 50), then starting digoxin is worth.
Finally, I believe the call on 'should you or should you not indulge in sexual activity' rests with your cardiologist. If the doctor suggested that you slow down, it should be taken seriously. You should also discuss if there are contraindications to use of caverject injections.
In a nutshell, in my opinion you should indulge more in non prenetrative intercourse. Use caverject injections under moderation after permission from cardiologist and urologist instead of large dose of PDE 5 inhibitors.
I hope I have answered your questions. Let me know if I have missed any of your concerns.
Regards
Your doctors are the best judge here....
Detailed Answer:
As I indicated in my previous reply, your health problems are complex and I cannot provide a fair opinion without examination and without evaluating your reports. But yes, coronary artery disease which led to triple artery bypass and AF may be causes of impotency.
Digoxin besides controlling and preventing AF, it is also able to improve contractility of heart muscles thereby improving circulation. If your latest echo shows low EF (less than 50), then starting digoxin is worth.
Finally, I believe the call on 'should you or should you not indulge in sexual activity' rests with your cardiologist. If the doctor suggested that you slow down, it should be taken seriously. You should also discuss if there are contraindications to use of caverject injections.
In a nutshell, in my opinion you should indulge more in non prenetrative intercourse. Use caverject injections under moderation after permission from cardiologist and urologist instead of large dose of PDE 5 inhibitors.
I hope I have answered your questions. Let me know if I have missed any of your concerns.
Regards
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Prasad
Answered by
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