--- title: "Sexual Health & Aging for Men | FrankTalk Therapy" description: "Sex therapy for men in midlife and beyond with Paul Nelson, LMHC. Changing function, medication side effects, and redefining sex on your terms." lang: en json-ld: | [ { "@context": "https://schema.org", "@type": "Person", "name": "Paul R. 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Nelson", "url": "https://franktalktherapy.com/about" }, "founder": { "@type": "Person", "name": "Paul R. Nelson" } }, { "@context": "https://schema.org", "@type": "FAQPage", "mainEntity": [ { "@type": "Question", "name": "Is this just going to be about ED medication?", "acceptedAnswer": { "@type": "Answer", "text": "No. Medication is one tool and it may or may not be right for you. That's a conversation with your physician, not with this practice. Therapy handles what pills don't: the anxiety, the couple dynamic, the identity piece, the redefining of what good sex actually is now." } }, { "@type": "Question", "name": "I'm on several medications. Could they be the whole problem?", "acceptedAnswer": { "@type": "Answer", "text": "Frequently, yes. Antihypertensives, antidepressants, prostate medications, and others all have sexual side effects. The right move is a conversation with your prescriber about alternatives, not stopping on your own. Therapy addresses what remains after the medication piece is optimized." } }, { "@type": "Question", "name": "My partner and I haven't had sex in over a year. Are we too far gone?", "acceptedAnswer": { "@type": "Answer", "text": "No. Long dry spells are common at this stage and they are reversible. It takes intentional, gradual work rather than a switch that gets flipped, but it is very much doable." } }, { "@type": "Question", "name": "Is this only for men in long relationships?", "acceptedAnswer": { "@type": "Answer", "text": "No. Men who are dating again after loss or divorce also come with a lot of these questions, and they are just as workable." } } ] } ] --- [![FrankTalk Therapy](/__l5e/assets-v1/791852f2-474d-4294-bfbf-c5ac6322a947/franktalk-logo.png) ](/) [Home](/) Services [Therapy for Men](/therapy-for-men)[Sex Therapy](/sex-therapy)[Consulting](/consulting)[Couples & Partners](/couples-and-partners)[What We Help With](/specialties) Guides [All Guides](/guides)[How to Last Longer in Bed](/guides/how-to-last-longer-in-bed)[How Long Do Men Actually Last?](/guides/how-long-do-men-actually-last)[The Start-Stop Technique](/guides/start-stop-technique)[The Squeeze Technique](/guides/squeeze-technique)[Pelvic Floor Training for Men](/guides/pelvic-floor-training-for-men) Service Areas [Where We Serve](/areas-served) New York [Online Therapy in New York](/online-therapy/new-york) Connecticut [Online Therapy in Connecticut](/online-therapy/connecticut) Practice [About Paul](/about)[What to Expect](/what-to-expect)[Fees & Insurance](/fees-and-insurance)[FAQ](/faq) [Waiting Room](https://doxy.me/franktalktherapy)[Talk to Paul](/contact) # Sexual Health & Aging [Home](/)/ Sexual Health & Aging Specialty ## What it is Somewhere in the late forties, fifties, or sixties, most men notice that the equipment doesn't behave the way it used to. Erections take longer to arrive and are less reliably at attention. Recovery time between rounds stretches. Morning erections fade. Ejaculation changes, sometimes weaker, sometimes delayed, sometimes different in sensation. Desire itself gets more contextual, less spontaneous. Meanwhile, a growing list of medications for blood pressure, cholesterol, mood, prostate, or sleep is quietly making all of the above harder. None of this is a personal failure and none of it is the end of a sex life. It is biology, and biology has always shifted over decades. What tends to make it into a crisis is not the change itself but the story attached to it, usually some version of "if it doesn't work like it did at twenty-five, it doesn't count." That story comes from the culture, from pornography, and from the fact that almost no one teaches men what a good, adult, second-half-of-life sexuality actually looks like. The medical picture matters and it should not be skipped. Vascular health, hormone levels, diabetes control, sleep, medication side effects, and pelvic floor functioning are all real players. A therapist is not a substitute for a urologist or a primary-care physician, and we coordinate with both when it's warranted. What therapy does is the piece the physicians don't have time for: the anxiety layer, the couple dynamic, the identity piece, the grief about a body that is changing, and the work of building a sex life that fits the man you are now rather than mourning the one you were. The Approach ## How therapy helps We start with an honest assessment of what's actually happening, and where. Alone versus with a partner. Erection quality, arousal, orgasm, desire, frequency, mood. Medications on board and their known sexual side effects. Sleep, alcohol, stress, couple conflict. Most men have never sat down and mapped this out plainly, and plenty of the confusion comes from working with a picture instead of the actual data. From there, the work often has three lanes running in parallel. The medical coordination lane: getting you in front of the right physician for the parts that need a physical workup, and communicating with your prescriber about medication alternatives when side effects are a driver. The behavior lane: adjusting what happens in the bedroom, from pacing, foreplay, and arousal runway to position and use of tools, to fit the body you actually have now, not the one from 1995. Very often the sex improves substantially just from this piece, because the men have been trying to run a twenty-five-year-old script on a fifty-five-year-old body. The third lane is the meaning lane. What does sex mean now, and what do you want it to mean? For a lot of men in this phase, sex becomes deeper, slower, more relational, less about proving something, more about a specific kind of contact that only long love produces. Getting there requires letting go of an older definition, which most men can do once they have somewhere honest to talk about it. This is where a long-term partner is often invited into a session or two, if welcome, because the change is easier when you're making it together. None of this is about pretending nothing has changed. It's about refusing to let the change decide the whole story. There is a lot of real sex on the other side of this work, and there are decades to live it. The second half of a sexual life can be the better half. It just doesn't run on the same fuel. You're not alone. FAQ ## Frequently asked questions Is this just going to be about ED medication? No. Medication is one tool and it may or may not be right for you. That's a conversation with your physician, not with this practice. Therapy handles what pills don't: the anxiety, the couple dynamic, the identity piece, the redefining of what good sex actually is now. I'm on several medications. Could they be the whole problem? Frequently, yes. Antihypertensives, antidepressants, prostate medications, and others all have sexual side effects. The right move is a conversation with your prescriber about alternatives, not stopping on your own. Therapy addresses what remains after the medication piece is optimized. My partner and I haven't had sex in over a year. Are we too far gone? No. Long dry spells are common at this stage and they are reversible. It takes intentional, gradual work rather than a switch that gets flipped, but it is very much doable. Is this only for men in long relationships? No. Men who are dating again after loss or divorce also come with a lot of these questions, and they are just as workable. Still have questions? [Contact us](/contact) Book a Session ## Ready to update the script? A 50-minute session to look honestly at what's changed and start building a sex life that fits the man you are now. [Talk to Paul](/contact) Related ## You may also want to read [ ### Erectile Dysfunction (ED) The concern that most often brings midlife men in first. Read more ](/specialties/erectile-dysfunction)[ ### Sex After Prostate Cancer For the specific set of changes after prostate treatment. Read more ](/specialties/prostate-cancer-recovery) ### Appointments are generally available: Mondays 5pm–9pm, Fridays 9am–6pm, & Saturdays 9am–1pm ![FrankTalk](/__l5e/assets-v1/0e01afa1-3c85-4757-973c-932f613785ce/resources_footer-logo.png) You have come to the right place to find help! - [](https://www.instagram.com/franktalkwithpaul/) - [](https://maps.google.com/?cid=1028244695779196009) ### Explore - [Home](/) - [About Paul](/about) - [Therapy for Men](/therapy-for-men) - [Sex Therapy](/sex-therapy) - [Consulting](/consulting) - [Couples & Partners](/couples-and-partners) - [What We Help With](/specialties) - [Guides for Men](/guides) - [What to Expect](/what-to-expect) - [Fees & Insurance](/fees-and-insurance) - [FAQ](/faq) - [Areas Served](/areas-served) - [Join Waiting Room](https://doxy.me/franktalktherapy) - [Contact](/contact) ### Contact - Email: [paul@franktalk.org](mailto:paul@franktalk.org) - Call Anytime [(646) 535-3133](tel:+16465353133) - Community site [www.franktalk.org](https://www.franktalk.org) ### Email Newsletter Subscribe to our newsletter to receive the latest news about FrankTalk Therapy Company I am not a robotSign Me Up! © Copyright 2023/2024 by [FrankTalkTherapy.com](https://franktalktherapy.com) [Privacy](/privacy.html)[Terms](/terms.html)[Cookies](/cookie.html)[Disclosures](/disclaimers.html)[Good Faith Estimate](/good-faith-estimate.html) Talk to Paul