Washington - Ask a roomful of men in their 60s whether they have any kind of sexual dysfunction - such as problems with erections, sex drive and overall satisfaction - and about 60 percent should raise their hand, studies suggest.
They probably won't, since the topic is fraught with stigma, shame and fear of rejection, but statistically they are likely to be a part of this unhappy club.
That's cold comfort to people like me, because I would have to - if I were to be honest - raise my own hand.
I didn't have to wait until I was 60, though, to join the club. I got in about 35 years ago as a side effect of cancer surgery. Picture me then, sitting on a cold examination table at Memorial Sloan Kettering Cancer Center in New York, in a hospital gown that didn't cover my backside.
Having just confirmed my testicular cancer diagnosis, the oncologist went on to tell me about a common side effect called "retrograde, or dry, ejaculation," in which things don't flow where they should during sex - instead of exiting my body, semen would flow into my bladder. He did assure me that it wouldn't diminish my sexual pleasure.
I was 26 at the time, and I felt completely alone. Sexual dysfunction isn't usually considered a young man's issue, and this was long before there were online support groups for every disease known to humankind.
More men with low-risk prostate surgery are forgoing aggressive treatment
My oncologist's prediction didn't matter much because I entered a years-long period of celibacy in which I tried to get comfortable with my "new normal." At the time, I was less confident in myself and didn't have the language to explain my condition.
"For many of these treatments, whether it's surgery or radiation and whether it's prostate cancer or bladder cancer, about 85 percent of men will report some difficulty with erections," says Christian Nelson, chief of the psychiatry service at Memorial Sloan Kettering. "The most prominent sexual dysfunction we see related to those treatments are difficulty with erections, or erectile dysfunction."
Nelson wasn't surprised to learn I had been celibate for a number of years after surgery. He has learned that when things don't work as they should for many men, "there's upset and sometimes shame . . . that can lead to avoidance." His practice helps guys identify and use the medications and penile injections that will "help them re-engage sexually, re-engage in dating, re-engage in intimacy."
But you don't need cancer treatment to get into the sexual dysfunction club. Admission can be granted through smoking, diabetes or hypertension, but mainly through growing older, says Brant Inman, the co-director of Duke Prostate and Urologic Cancer Center who has studied male sexual function.
His study found that erectile dysfunction hit two percent of men ages 40 to 50, six percent ages 50 to 60, 17 percent ages 60 to 70 and nearly 40 percent ages 70 and older. A Canadian study showed even higher rates among all age groups.
Inman says that for men under 40, erectile dysfunction is more commonly caused by psychological issues (anxiety, depression, stress), while for older men it is more likely caused by "vascular, impaired blood flow to the penis."
I spoke with several men for this column, all of whom asked me not to use their names for privacy reasons. One of them, a 60-year-old art dealer from Manhattan, told me he hasn't been able to achieve an erection for years, which he finds "incredibly frustrating and embarrassing." He says he tells partners that it is because of his meds, which it may well be (he has taken antidepressants that can have sexual effects). One partner told him, "it's not the destination that's important. It's the journey" - a gentle acceptance that, as he put it, helped him to relax.
A 45-year-old advertising executive said he was too embarrassed to talk to his doctor about erection problems that had begun to plague him and instead bought Cialis and Viagra from a friend. The Cialis helped somewhat, but he still couldn't reach orgasm - and even then, he wasn't comfortable talking to his doctor, especially after having obtained his drugs through a murky way.
Inman says he understands the embarrassment, but asked, rhetorically, "Would you buy your cholesterol or blood pressure lowering medication from a street vendor?" Of course not, he says, because you can't be sure of the dosage (milligrams of active agent) or quality (active agent vs. filler), which could be dangerous.
It's not just with doctors, however, that full disclosure can be fraught for men experiencing sexual dysfunction. When and how to tell a partner feels like a big issue, one I faced as a young man. Before undressing? Post-intimacy? It depends, Nelson says.
It's certainly easy enough to take a pill without telling your partner, he says, but if performance is unpredictable or for other types of treatment, such as injections to help with an erection, it's dicier.
"I certainly have some men who haven't told new partners that they use injections," he says. "They step into a bathroom, inject, and 10 minutes later they engage in sexual relations." But he recommends a discussion beforehand when someone plans to use an injection so there are no last-minute surprises
Sometimes, being frank about your own sexual dysfunction leads to a discovery that you're not the only one. That's what happened to me with a man I dated for a while. After we had gotten to know each other, he told me he'd had radical prostate cancer surgery and needed injections to have sex. This led me to talk about my own condition. The result was a deeper level of intimacy - and less anxiety.
Recently, after a divorce, I reentered the dating pool and discovered I was no longer so alone in terms of sexual issues. My anecdotal evidence with guys my age or older indicates many are challenged by some form of sexual dysfunction, some minor (slower to get going) some more serious, needing medical intervention.
"People are just afraid" to talk about many of these issues, including doctors, Inman says. It's important to try to destigmatize the issue. Indeed, it's still a delicate subject, and someone has to raise his hand to start the talking.