Sex Therapy > Shame: How It Effects Sexual Desire

Coping With Male Obsolgnium

(Waning sexual desire secondary to aging)
By Dan Pollets 

I. Introduction:

1. Aging – “Impermanence” and associated sexual changes are unavoidable.
Sexuality is associated with worth, adequacy, power, manliness, security, and
Self-esteem.
Loss of performance and desire can therefore lead to shame and vulnerability
A. Problematic coping: contempt, anger, scorn projected; disengagement, withdrawal; depression-avoidance loss
B. Effective coping: knowledge regarding appropriate sexual changes and Mindfulness.
2. Vulnerability is seen as weakness in men and is forbidden under “boy code.”
3. Unacknowledged shame sets men up for sexual and relationship issues as we age and experience physical loss.
4. Plan: discuss shame and vulnerability, research regarding aging and sexual functioning and how Mindfulness is secret “elixir” to cope with aging.

II. “Boy Code”:  Exacerbating “Shame Proneness”
And then armoring against vulnerability

1.Men are conditioned in society through family to be strong, assertive, invulnerable “warriors” who must tolerate physical and emotional deprivation.  This is the “Lock and load” culture of manliness.
2. In “macho” society man is under great inner and external pressure to conform to standards of strength and invulnerability.  To do otherwise is to risk disapproval, rejection, humiliation and of course shame.
3. Shame: “A painfully diminished state that makes us feel foolish, awkward, and paralyzed.  A wordless emotion that makes our eyes turns inward so that we feel exposed, inferior” (G. Kaufman).

III. Shame Triggers:
1. Crying.  “Don’t be a crybaby (pussy, wussy, girlie, etc.).  Deep emotional expressions of vulnerability are shameful.  Men feel ashamed of feeling sad and think they have to apologize for showing emotion.
2. Fear: boys are scolded for showing fear.  We’re not supposed to be afraid.  Men think something is wrong with them for feeling fear and deficient for showing signs of fear.
3. Touching/Holding: holding and touching (non-sexual affection) is not comfortable.
4. Failure: failure is weakness is shameful. To succeed is to be worthy. Self esteem equals performance.

When men feel shame, they are taught to externalize their shame and avoid dealing directly and honestly with their pain.  Underneath, they experience this emotionally as hidden, secret depression (Terry Real).  This shame-avoidance-fear of vulnerability sets men up for a variety of problems secondary to depression.  In this state of “hidden depression pain is externalized (extruded) and symptoms result such as: physical illness, etoh and drug abuse (addictions), domestic violence, failures in intimacy, self-sabotage careers, and sexual avoidance.

This results in markedly reduced capacity for intimacy especially when the inevitable changes in desire and function begin to appear.

IV. Biologic Changes in Sexual Desire and Arousal

Biological factors have indisputable effects on sexual activity among the aging but they do not directly determine who remains sexual.   Numerous studies demonstrate that as men age, they undergo adaptations in physiology, hormonal levels, sensory capacity, and blood flow that reduce on average human sexual desire and activity.

Chronic disorders such as CVD, hypertension, diabetes, arthritis, and prostate disease can have a negative effect on sexual functioning and response.

Not whole story: psychological factors that predict sexual activity in aging:
Shame-vulnerability (allegiance to boy code), body image, self-esteem, eroticism (capacity for emotional expression and imagination, relationality, Mindfulness (or lack thereof): being able to be present and accepting of what the moment brings.
There are clear “assaults” on sexual desire/function from biological effects of age but if we are trying to predict sexual activity in old age, not the complete story.  

1. Research:
Large sample studies show that sexual desire decreases with age abut not nearly as fast as popularly believed:
Low Desire age 65 to 69:27%
70 – 77: 50%
63% of men >80 continue to be sexually active
Marsiglio: 24% of sample over age 75 was having sex more that 2Xs/month
Lauman: men 50-59; 3X more likely to experience low desire and erection problems than 18 to 29.  Still only 18% of sample. (PE is 30% across all age groups).

2. Sexual function changes with age with men; Reductions:
Spontaneous and am erections
Rigidity of erection: faster detumescance
Pre-ejaculatory sensation
Force/volume of ejaculation
Need to ejaculate
These changes can lead to distress and trigger shame response.
Kuzmarov concluded that older men who continue to be active are less orgasmically driven and more intimacy driven.
VII. Factors Relevant to Sexual Desire in Mid-life

1. Testosterone: age-related decrease in libido most frequently (see commercials) attributed to decline in T levels and changes in receptor site sensitivity to Androgen.  Around age 50, T gradually declines.  By age 80, may only be a sixth of that of younger man.
2. Need to check Androgen levels: no evidence that T replacement augments sexual drive in men with normal baseline T levels.  Administering massive doses of androgen to an 80 year old will not restore libido.  May give prostate cancer, however.
3. Erections: prevalence at age 50 is 18%.  This rises with age
4. Medical conditions will potentiate ED (as loss of desire): diseases that affect cardiovascular health (CVD) and neurological status will effect functioning: e.g. Hypertension, arthritis, prostate Ca diabetes, neurological disorders, obesity, depression/anxiety will markedly impact health of erection.  Great argument for practicing good nutrition and developing fitness program.
5. Drugs that impact: antidepressants, hypertensive drugs in particular.  Check with Doc.
6. ED and PDE-5 (Viagra, Cialis, etc): Very effective in alleviating physical effects of reduced erectile function. Relaxes smooth muscle and promotes blood flow to penis upon stimulation.  Not a desire drug though nothing succeeds like success.  Does treat performance anxiety; help getting over “hump.”  
Interesting side effect: some partners have interpreted use of these agents as a sign of diminished interest in sex in general or with them in particular

 VIII. Predictors of Loss of Desire:

1. Arousal and desire co-exist and reinforce each other.
2. Desire is a product of an interaction between biological (endocrine, vascular), Cognitive – wish to believe sex will be pleasurable with positive outcome, and Motivational-Emotional – willingness to participate, and Relational – having a secure and supportive bond with partner.
3. Research has shown that biological factors alone do not predict who continues to be active when old.  Relevant factors include: diminished income, divorce, unresolved danger, separation from loved one, medical illness, depression and medications.  Depression and anxiety also plays big role.

IX. Mindfulness as Antidote to Obsolgnium:

1. It is your response to these age-related normative biological changes to desire-arousal that is critical.
2. If you experience the losses or changes as indicative of inadequacy and failure, weakness or unworthiness, leading to shame and then the armoring against the shame; e.g. withdrawal, anger, or detachment, disengagement from your partner can occur and sexual life deteriorates.
3. A mindset that interprets these changes as a failure to meet a performance standard, avoiding intimacy can protect the self from being threatened and shamed but the proverbial baby gets thrown out with the bath water.  Men suffer and the relationship suffers.
4. Mindfulness is an attitude towards life experience and its inevitable change (“impermanence”) that can reduce suffering and keep you in the ball game.  Mindfulness is awareness of what IS, in the present moment, without identifying with it.  Things as they are, so to speak.  This mindset expedites coping with change as it keeps you present and engaged.

X. Attitudes that Characterize the Mindful:

1. Present in the moment.  Aware but not identified with the thought.
2. Non-reactive and non-judgmental
3. Self-compassionate
4. Relational
5. Change and loss is seen as inevitable and accepted with equanimity.
6. You can step back from negative judgment (reactivity) and accept what is happening in the moment.
7. Contrast with trying to “hold on;” needing to be “perfect,” performing up to standard, denying the inevitable.  In this “mindless” mode, more resistance is generated which ultimately results in more pain and suffering.
8. Mindfulness is a trait that is cultivated by daily practice of the state of meditation.

XI. Applying Mindfulness to Aging and Sexuality Changes:

Physical changes associated with aging:

1. T levels drop, desire diminishes
2. Spontaneous erections cease
3. Direct stimulation becomes necessary to maintain erection. More help needed from partner.
4. Continual stimulation needed.
5. Erections take longer to achieve and not as firm
6. Erections become unstable.
7. Firmness might wax and wane.
8. A longer period of stimulation is needed to ejaculate.
9. A closing window of opportunity (to ejaculate).
10. Ejaculations can become elusive.
11. Volume and velocity of ejaculate decreases.
12. Diminished experience or orgasm.

If you are aware of these changes that accompany our aging bodies and don’t judge or become shame triggered, you can be more accepting and self compassionate.  
Practice “letting go” of what cannot be avoided or changed.
In your love-making, focus on pleasure, sensation, intimacy, love, heightening your partner’s sensation.    Innovate and experiment.  Be in the present experience and don’t be the witness or observer of it.  Play, Have Fun, Be Here and Now.
Do the best you can with what you have and resist comparing with your prior self or some cultural standard. Let Go and Let God.