Health care for elderly men: Analyzing psychogenic sexual dysfunction

Psychological Sexual Dysfunction in the Elderly

The sexual psychological disorders experienced by the elderly are also a socio-psychological factor. This powerful and long-term social opinion exists latently in everyone's consciousness. However, this is ultimately acquired and artificially instilled in people's consciousness, and it is exactly the opposite of human physiological instincts. When people's consciousness and social opinion deny the existence of sexuality in the elderly, it inevitably contradicts their actual sexual self-awareness and desires, thus producing a psychological change called a "defense response," manifesting in various psychological forms such as repression, projection, transference, sublimation, and embellishment, that is, released in the form of disease or variation. Generally speaking, about 75% of sexual dysfunction in the elderly is caused by psychological factors, mainly manifested as:

1. Psychological decrease or disappearance of libido. Traditional social concepts and the elderly themselves generally believe that after the age of 60, one has no sexual desire or should not have sexual needs; only by "purifying the mind and reducing desires" and "abstaining from women" can one preserve vitality and prolong life; otherwise, one will die young. The Bible, Greek mythology, and ancient Indian traditions all warn men, "Do not sleep with a woman, for she will drain your bodily fluids and kill you." Different eras, regions, ethnicities, and customs share a similar understanding on this issue, resulting in a distorted mentality of "sexual phobia." This psychological state severely suppresses the normal sexual desires of the elderly, leading to a "monk-nun mentality"—a vehement denial of their innate sexual desire. Prolonged suppression results in "disuse sexual function," leading to decreased or absent libido. Elderly women experience the same psychological state.

2. Psychological frigidity. Some elderly people, while possessing sexual desire and ability, show little interest in sex. Besides the aforementioned psychological factors, there is also a sense of shame, a feeling that they should no longer engage in "that kind of thing." Being over fifty, surrounded by children and grandchildren, they feel embarrassed to have sex in public if their children and grandchildren find out. Although sexual activity can still bring him, especially older women, to normal orgasms, they can only try their best to suppress their libido, gradually entering a state of sexual indifference.

Furthermore, after remarrying, older people often retain deep feelings for their ex-spouse, unable to forget the affection of their first spouse. Although rationally they feel they should maintain the new family in all aspects, giving their partner joy and sweetness, psychologically they lack the adaptability to the new partner and the new family. Regarding sex, they hold the belief that "this life belongs only to the old partner," and cannot accept conforming to another person's feelings, both emotionally and personally. The saying "young couples become companions in old age" reflects this psychological transformation of sexual concepts, leading to their extreme indifference towards sex. Even when they reluctantly engage in sexual activity with a new partner, it is done out of guilt and a sense of obligation. They deeply feel they have wronged their first spouse, especially women.

3. Psychological impotence. Psychological impotence accounts for 85%–90% of all cases of impotence. A common psychological factor contributing to erectile dysfunction in older men is sexual ignorance, leading to feelings of guilt. Generally, the duration and firmness of penile erections gradually decrease with age, and occasional erectile dysfunction is normal; wives should understand and cooperate. However, if the wife lacks sexual knowledge and fails to understand occasional erectile dysfunction, or even complains, blames, ridicules, or belittles her husband, it will cause him to experience intense self-blame and guilt. He may even mistakenly believe that he is "useless in his old age." This psychological state transforms into anxiety, tension, and even fear, making him hesitant to engage in sexual activity or causing him to worry before each sexual encounter. As a result, the erectile dysfunction worsens, eventually leading to incomplete or even complete erectile dysfunction.

Another common psychological factor contributing to erectile dysfunction in older men is "disuse atrophy" or "widower syndrome," which is more common in healthy men around 60 years old. In many cases, the husband abstains from sexual activity for extended periods due to the wife's chronic illness and the husband's fear of negatively impacting her health. He then devotes himself to caring for his wife, leading to a psychological abstinence and self-suppression. Once this psychological suppression becomes ingrained, even if the wife recovers and regains normal libido, or if the husband remarries after widowhood, he may still be unable to achieve an erection, resulting in erectile dysfunction.

4. Painful intercourse. This is more common in women over 60. Reduced or absent vaginal secretions prevent penile penetration, causing friction and pain in the vagina or lower abdomen during intercourse. In some cases, even with secretions, vaginal wall spasms lead to difficulty and pain during intercourse. The psychological factors contributing to this are similar to those in male erectile dysfunction.