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That leaves millions of men with no Medicare option for what we used to call impotence, except far more expensive and invasive penile implant surgery.

Erectile dysfunction is a common problem. About 60 percent of men older than 60 — and 70 percent of those in their 70s — have trouble getting or maintaining erections, often because of diabetes, cardiovascular disease or prostate cancer treatment, said Dr. Eugene Rhee, past president of the California Urological Association.

Not all of them want treatment, of course. “A large proportion of older men have lost sexual interest, don’t have a partner or have other illnesses that preclude sexual activity,” Dr. Sharlip said.

Moreover, some men who opt for treatment can afford to pay out of pocket for Levitra, Cialis or Viagra — the last has a wholesale price of $38 per pill, according to Pfizer — or for vacuum erection systems that retail for $125 to $500.

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But it is fair to say that many thousands of modest-income Medicare beneficiaries will now forgo treatment for erectile dysfunction, and fair to ask if this policy makes sense.

“I think it reflects an antiquated concept about the importance of sexuality in a person’s life,” Dr. Sharlip said.

Many men and women remain sexually active in later decades, given the opportunity. The National Survey of Sexual Health and Behavior, for instance, showed that almost 40 percent of men in their 60s and more than 28 percent of men older than 70 had engaged in vaginal intercourse within the previous month, with smaller and larger percentages reporting other sexual behaviors.

Among older women, nearly half of those in their 60s and more than 20 percent of those in their 70s had been sexually active in the previous six months, University of Pittsburgh Medical Center researchers reported recently. The biggest obstacle was the lack of a partner; among those married or cohabiting, the proportion reporting sexual activity rose substantially, to 68 percent and 41 percent. (Women older than 80 reported having sex, too, but the sample size was too small to draw conclusions about them.)

“Prevalence of sexual activity definitely goes down with age,” said Dr. Holly N. Thomas, an internist and the lead author of the study. “But the proportion is still considerable, and certainly higher than many physicians and the public would guess.”

To answer the obvious question, Medicare covers women’s hormonal creams, rings and suppositories for a “medically accepted indication,” like vaginal atrophy. Some Part D formularies require high co-pay charges for those drugs, however.

“There are multiple, multiple studies showing a strong link between good sex and quality of life in both younger and older individuals,” Dr. Thomas said. But when it comes to financing this particular facet of health care, older adults are pretty much on their own.

https://www.nytimes.com/2015/08/04/health/sex-never-dies-but-a-medicare-option-for-older-men-does.html

Slideshow: Things That Can Deflate Your Erection

Middle-Aged Spread

Carrying extra pounds can impact your sexual performance, and not just by lowering your self-esteem. Obese men have lower levels of the male hormone testosterone, which is important for sexual desire and producing an erection. Being overweight is also linked to high blood pressure and hardening of the arteries, which can reduce blood flow to the penis.

Stress

It's not easy to get in the mood when you're overwhelmed by responsibilities at work and home. Stress can take its toll on many different parts of your body, including your penis. Deal with stress by making lifestyle changes that promote well-being and relaxation, such as exercising regularly, getting enough sleep, and seeking professional help when appropriate.

Medications

The contents of your medicine cabinet could affect your performance in the bedroom. A long list of common drugs can cause ED, including certain blood pressure drugs, pain medications, and antidepressants. But do not stop taking any medicines without talking to your doctor first. Street drugs like amphetamines, cocaine, and marijuana can cause sexual problems in men, too.

Alcohol

You might consider having a few drinks to get in the mood, but overindulging could make it harder for you to finish the act. Heavy alcohol use can interfere with erections, but the effects are usually temporary. The good news is that moderate drinking -- one or two drinks a day -- might have health benefits like reducing heart disease risks. And those risks are similar to erectile dysfunction risks.

Depression

The brain is an often-overlooked erogenous zone. Sexual excitement starts in your head and works its way down. Depression can dampen your desire and can lead to erectile dysfunction. Ironically, many of the drugs used to treat depression can also suppress your sex drive and make it harder to get an erection, and they can cause a delay in your orgasm.

http://www.webmd.com/men/erectile-dysfunction-13/slideshow-causes-of-ed

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