When a couple has not been intimate for a while due to a sexual dysfunction, they tend to avoid initiating sex. By sexual dysfunctions, I mean diseases that cause sex to fail, such as lack of desire, sexual pain and failure to orgasm, which are the most common dysfunctions in women. Problems that men often experience include difficulties getting or maintaining an erection, premature ejaculation, and a low sex drive.

So, when Erick visited the Sexology Clinic for the sixth time in three months, complaining that his erection problem had not been resolved despite being on treatment, I simply asked if he had tried initiating sex.

"He is very scared and does not want me to touch him," replied Janet, Erick’s wife, bursting out laughing.

Erick looked down timidly. He did not smile or laugh. He looked traumatised.

"What worries me is that by trying, I will give her hope, then fail," he said, "and I don't want that, so it is better not to try."

Read: When a woman blames herself for erectile dysfunction…

The couple had been off sex for two years before they came to the Sexology Clinic for help. Before they stopped, Erick's erections had been dwindling. It started with difficulty getting aroused. It took over 30 minutes of foreplay to achieve an erection. Then, over time, the erection would start to go midway through penetrative sex. He would simply go limp, at which point they would have to stop.

"It's the most traumatising experience I've ever had," he lamented. 'It's not something you'd wish on your worst enemy."

"I was patient and always encouraged him," Janet said, trying to absolve herself, "but he stopped discussing the problem and chose to keep to himself. He has grown distant recently, and our relationship has deteriorated."

I conducted a thorough medical evaluation of Erick and diagnosed low testosterone levels. Testosterone is the hormone responsible for male characteristics and sexual function. When levels are low, a man loses his ability to get an erection as well as his desire for sex.

"And what caused this?" Erick asked. "I have been healthy all my life. I don't understand why this is happening."

While there are myriad causes of low testosterone, Erick’s problem was age-related. He was 70, and his wife was 60. Most men start experiencing age-related testosterone problems in their late forties or early fifties. The problems worsen with age.

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'Maybe it’s time to retire from intimacy,' Erick commented when the diagnosis was made. "At some point, a footballer must hang up his boots and call it a day."

'But how will I satisfy my needs then?"Janet interjected. “Do you want me to find another man at my age?”

So, I started Erick on treatment to boost his testosterone levels. In my experience, couples can remain sexually active well into old age. I have treated 90-year-old men and women at the clinic. In fact, the oldest woman on record to have had an orgasm was 114 years old.

Subsequent testosterone tests showed that the treatment was working and levels were rising. Erick started getting morning erections, which had disappeared long before he came for treatment.

"All signs indicate that your erections are back," I told him. 'All you need to do is initiate sex."

However, Janet also needed to be supportive. You see, women hold the key to restarting sex after a dry spell once treatment has begun. They need to get things going with their partner.

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“Really, how do you jump-start a moribund lorry?” Janet asked amid staccato laughter.

A woman knows what triggers a man’s sexual energy. Erick and Janet had been married for 38 years. They definitely knew each other's erotic triggers. When your partner is feeling uninspired sexually, you know which button to press to get them back on track.

"I see. So Erick is now medically fine, and all that's missing is for me to press the button?" she said, smiling.

The next day, I received a text message from Erick: "Last night was fantastic! I can't believe I managed to play the game. My wife is very happy and sends her regards.”

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