When impotence is relatively advanced, and perhaps accompanied by nerve damage, it still may be possible for a man to have an erection by using certain assisting devices.
One of these is the 'vacuum assistive device', a simple mechanism placed over the penis so that a vacuum is produced. The result is a slow, progressive filling of the penis with blood, so that the organ can then maintain an acceptable rigid state. A couple of rubber bands are slipped over the penis and secured at its base. The bands prevent a runoff from the engorged penis, and satisfactory intercourse becomes possible.
A more familiar device is the permanently implanted 'prosthesis', a rigid or flexible rod inserted into the penis in an operative procedure. This has the drawback of producing a permanent rigidity, which some consider obtrusive. The most popular version permits the device to be bent down or up, as needed. It is thus less likely to be noticeable.
Many times, though, it is not necessary to resort to these artificial devices. For many men, the most important point to remember is the fundamental fact that the male erection is not an all-or-none phenomenon, so less drastic means may be used to produce an erection. Manual stimulation may do wonders to firm up a less than total erection. From a purely mechanical view point, a lubricant is usually necessary for effective manual stimulation of the penis. And remember: It almost always takes longer for the aging male to attain a full erection than it does for the youth.
Another important consideration is timing. Things may be much smoother — and sexier — in the morning after a refreshing sleep, than at night, when the day has been long, frustrating, and tiresome. Relaxation is extremely important to successful sexual performance. Of course, relaxation and little playfulness are important, and a mutual shower may help in this regard. Other couples like to engage in mutual massage. Women, in particular, are more responsive when their husbands give them a little rubdown before beginning to engage in sex. Older women also tend to find that arousal and lubrication of the vagina are slower, especially if they are not taking estrogen. When an older woman is not taking hormones, there tends to be shrinkage in the entire vaginal area. This, together with diminished lubrication, may result in some difficulty and even pain during intercourse. Lubricants are very useful to correct this problem, and they may also be desirable for women who are having estrogen therapy. Sometimes a vaginal cream containing a hormone, is prescribed.
If a woman complains of a lack of sexual desire in the later years, small doses of the male hormone testosterone can be prescribed. Interestingly, this approach can restore sexual interest and response, though the doses have to be kept well below the level at which a masculine effect, such as increased body hair, can be observed. Furthermore, the increase in libido often persists after the medication is discontinued. The male hormone can also be given in an ointment locally, if desired.
To sum up, then, sexuality, like other basic functioning of the body, undergoes changes in the later years. Understanding what is normal about these transformations is important for too often, people panic and say, "It is all over, all over! I am old before my time!" But for most people, that is not simply true! Rather, some adaptations and perhaps a few visits to the doctor is all that is needed to open the door to a satisfying and successful sexual life in the later years. Above all, if you feel you have a problem, do not let it go unresolved. You should realize by now that a lot of progress has been made in this field. There are more answers around than you must have probably dreamt of, so take advantage of them.