When failure to launch threatens a marriage

I have no opinion on whether it is right or wrong for a 25-year-old woman to get married to a 55-year-old man.

Both are adults and are capable of making their choices. And, if anything, age is just a number.These are the thoughts that went through my mind as Grace sat in front of me in the Sexology Clinic.

She was lamenting that she had not had sex for four months with her husband of two years. Reason? He had lost his erections.

LEAVE HIM

“Do you think I made a mistake of my life? Was the age difference too huge for this marriage to survive?” She blurted out her questions in a row. She was in obvious emotional distress.

“Let us concentrate on the primary issue here please,” I interrupted, “Am I right to say that what you want is your husband’s erections to get back to normal?”

She nodded vigorously as a ball of tear rolled down her right cheek. She fetched out her handkerchief, wiped the tears and blew her nose. “If he cannot get the erections back, I will leave him, I am too young for such frustrations!” she quipped.

And so the next day, Grace came back to the clinic accompanied by Richard, a big-bodied man with a huge potbelly. He was obese and had big breasts. “I no longer have an urge for sex, and when I force myself to try it, I fail to get an erection,” he said. Richard did not have sex fantasies or erections at night or in the morning as happens to many normal men.

I examined him and other than the obesity, all his body systems were fine. I ordered for a number of tests to confirm the examination findings. Out of all the tests, the main finding was low testosterone. Hence, Richard was obese, and with low testosterone. Testosterone is the hormone that makes a man feel sexual.

PEAK AT 30

It causes a man to fantasise over sex, have libido, get aroused at sexual situations and go through the sex cycle successfully without losing erections. Further, testosterone makes a man feel energetic. It causes vitality and elevates the mood. Testosterone levels rise from the teenage years and reach the peak at the age of 30.

Thereafter, the levels start falling at an approximate rate of 1 per cent per year. For most men, this does not affect their wellbeing and a number of them remain sexually active for years on end.

About a third of men, however, develop symptoms of low testosterone at a certain point as they grow older from the age of 30 years. Other than low libido and failing erections, such men feel generally tired and lack energy to carry out daily duties. They also become moody.

“You are very right, I think I sleep a lot and enjoy being alone these days, maybe that is why my weight is also increasing too fast,” Richard interrupted.

Weight gain can be caused by low testosterone but on the other hand, obesity itself causes low testosterone. It is therefore a chicken and egg situation, and it is difficult to know which one came before the other.

REVIVE ERECTIONS

I put Richard on an exercise regimen and dieting. He needed to cut down his weight by 18kgs. This was not only good for his erections but also to prevent diseases such as high blood pressure and diabetes. Further, I put him on testosterone replacement therapy.

When the body has failed to produce enough testosterone, sometimes it is necessary to just give the hormone in the form of medicine. To ensure that his erections resumed soonest, he was also put on erection stimulating medicines. “Can’t I just get my erections back with the hormone treatment? I hate being put on many drugs,” Richard protested.

“Well, in a situation where a marriage is at risk of breaking, it sometimes forces us to revive erections as a matter of urgency and so multiple treatment cannot be avoided.,” I said. The hope was that once the body weight normalised, Richard’s body would possibly improve its natural testosterone production and the need for medicines would reduce.

It took close to six months for Richard to lose 18 kg but even then his hormones did not normalise and he had to continue the testosterone replacement therapy.

His erections were weak without the stimulating drugs and so he had to continue with them as well. “I have to come to terms with the fact that I can’t get an erection without help!” Richard said on his last visit to the clinic, “but I would rather have the medicine than face the stress of failure in bed.”