Has anyone out there had a "Prostate Artery Embolization??

I don't think there's a loss of interest.  On the contrary, I suspect it's starting to get more mainstream and most of the questions that could be asked have already been answered.

I had mine nearly three years ago at Southampton (UK).  It has been life changing; I now normally sleep through the night undisturbed, whereas before I was up 5, 6 or 7 times a night.  Other symptoms also massively improved.

Andrew

jjjj, not really. Read and agree w/ Roseland's response. The fact that Medicare, FDA and other private insurance have started to pay for PAE medical procedures tells me it is becoming mainstream as Roseland states. Am new to this and the reason I went PAE first is due to my research and responses from this and other medical blogs. Far from losing interest - remains a hot topic and a very viable solution to BPH. Thanks jjjj

Hi there

I don't think interest has waned,  rather it is becoming more accepted world wide. I had mine done at Oxford Churchill University Hospital under Dr Tapping. iT was a breeze and I had no ill effects whatsoever. In fact I wondered if they had actually done anything as there were no side effects.  I had my 3 months MRI scan and prostate has shrunk by 20% with more shrinkage expected. bph symptoms improved but to be fair they had already improved as a result of taking saw Palmetto and Stinging Nettle root extract I believe. I had  Acute Urine Retention last July so there was definitely a problem before. I would also,urge people to look up FLA, or focal laser ablation performed by Dr Sperling in US. This looks very encouraging also.

Dr. Sperling wants you to deal with your insurance company. He charges $21,000.00 dollars up front. People who have paid him upfront, have complained that Sperling and his assistants are of no help in recouping their money from the insurance companies once they've paid.

That is interesting.  My guess is that the insurance company won't pay because it hasn't been approved for BPH through clinical trial process.

That wasn't what Lilian (Dr. Sperling's assistant) told me. She said that it was a hassle and that he preferred that the patience deal with the insurance themselves.

I had actually thought about doing it myself until I did my due diligence on dr. Sperling online, and saw all of his clients complaining about having their calls returned from his office in regards to their applications to recoup their money from the insurance companies!

All in all, I thrilled to have found Dr. Bagla!

I was involved on my job dealing with insurance companies.   All and all, I had no problem collecting from them.  Something simply doesn't sound right at Dr. Sperling's office.

Not with me at all! Just discovered this forum and am reading through all the posts (up to page 5 right now). This has been so helpful, many many thanks to all who have shared their experiences. My BPH symptoms are not off the charts. They are somewhat controlled by tamsulosin, but I'm having pretty  uncomfortable side effects to the med, persistent cough and sinus congestion. I switched to every other day, and it reduces the side effects but also the effectiveness. I'm definitely investigating PAE especially since my symtoms could get worse. For now I'm looking into natural supplements to see if they might help.

Dr. Sandeep Bagla works at the Vascular Institute of Virginia and has done the greatest number of PAE of any US doc, to the best of my knowledge. Probably hundreds.  He is skilled and compassionate.  You can see his professional profile on LinkedIn. 

Would have it done by someone with lots ot experience.  This is a technically challenging procedure that all interventional radiologists cannot do.  Dr. Bagla told me that he had done around 300 in December 2015.  An experienced doctor will expose you to less radiation from the fluoroscope hopefully by keeping down the procedure time.  The disadvantage to having it done in Portugal is the ability to communicate with someone post-op if you have issues that need addressed. 

Thanks Cam;  

The Lisbon clinic website portrays it as a global medical center with clients from US, China, Ukraine, everywhere.  I agree with you, I'd never be treated there without a solid local post op dr. lined up.

In general I'm skeptical of clinics with non-mainstream treatments.  It seems like celebrities like Steve Jobs often think they can get a better cure than those offerred by mainstream med centers.  Usually doesnt end well.  

You're most welcome.  I was in contact with Dr. Pisco last year and was considering going there.  My sense was that there was a staffing issue there.  You would spend 4 or 6 days there considering your specific needs like an angiogram, urodynamic testing, and stay after the procedure..  Dr. Pisco does PAEs on Thursday.  I finally decided against it.  I had my procedure with Dr. Bagla. He is the most experienced in this country.  He was trained under Dr. Pisco and Dr. Francisco Cesar Carnevale.  I figured I would bank on one of the best in the world.  

Interventional radiologists are highly trained mainstream doctors who do mininally invasive non-surgical procedures for things like tumors, uterine fibroids, stents, bleeding issues and currently PAE.

I think there are times where mainstream medicine fails patients and they look for hope elsewhere.  Sometimes it is alternative medicine or a mix of mainstream medicine and alternative medicine (integrative medicine).   Whatever the case, the modality should be evidence based medicine. 

Camster, you sound like you're very knowledgable regarding PAE.  I wanted to see if you've already had it done and if so how it was.  I searched but couldnt find anything you've written about it.  

Would you be so kind as to summarize your experiences for me or point me to where you've posted it?

thanks

Jeff

Camster, all things being equal I would choose the one with the highest success rate. 

I had my PAE a year ago. I couldn't be happier. I was the third person in Australia to have it done. It was also the third PAE that my guy had done. 

As Dr Schlapoff told me, interventional radiologists are trained to embolise ANY organ in the body. Many years ago, I had an artero venous malformation at the base of my skill. Interventional radiologists embolised it and saved my life. The guy was very experienced but had never done that before....they are trained to embolise Anywhere. That's why I was confident to go ahead with doc Schlapoff. I understand that he has now done over thirty with a high success rate. 

Caringbah, I'm just happy that you found relief for your condition.  BPH really takes a toll on quality of life.  I've been following your comments and know that it worked out well.

I had a consultation with an IR here in Pittsburgh, PA last year.  He does uterine fibroid embolization also.  He said compared to the arteries in the prostate, the arteries for UAE are like a wide open highway.  The arteries for the prostate are very small and can be tortuous.  He thought there were only several IRs in the Pittsburgh that could do PAE.  It is technically demanding.  

Hi Camster and Caringbah,

With the up to date CT SCAN and MRI as well as thinner tubes, Interventional Radiologist are able plan, map and maneuver through fairly narrow arteries and reach deeper into the narrower arteries of the prostate.

That seems to have been in my case. I was nimber 10 at Liverpool hospital NSW AUSTRALIA.

Dr Schlapoff , interventional radiologists Dr Julian Catts, Urologist, were very confident about embolising my prostate. The images from MRI and CT Scan were very clear and their technique has worked with me.

In fact i was able to see the images and understand as much as a lay person can understand about arteries.

It seems that my arteries were so clear around the area of of the intervention that i could be confident that my ateries in other parts of my body would be the same . That was a suggestion from someone who was experienced in embolising and using their skills on all parts of the human body.

It seems that training as Caringbah has mentioned as well as modern equipment and tools as well as techniques used by Interventional Radiolgist are able to overcome some lack of direct experience of embolising the prostate. Plus having experience in other parts of the body also helps of course.

Agreed. Schlapoff told me much the same thing. He seems to have a high success rate with the 30+ he has done to date. 

The point I was trying to make is that I would not be put off by how few he had done but the success rate of what he done. 

In my case there were only two before me. One was successful the other not. I went in knowing he had a 50% success rate. It was also free of charge. If it didn't work I could always try something else. 

Its interesting when I had my AVM embolised ....it was at the base of my skull. It's incredible that they can work inside your head by going in through the groin. They had 5 attempts before they finally nailed it. Same thing very fine arteries. One guy stopped half way . When I woke up he told me he was getting scared...it's tiger country up there he said. :-)

Hi carinbah and others,

I had a pae on 29 march. Its now a month and half post-pae while I continue to read the forum posts full of positive outcomes. So far no noticeable improvements in my wee affairs but the hope survives, knowing that it can take longer for some, there are so many diferences in individual anatomical details. These things are hard to predict even for the pro meds. I wish I could get off tamsulosin, and that might yet be near, who knows.

While waiting I read more about bph. Came across conditions that imitate bph eg pelvic floor dysfunction arising from abnormally tight pf muscles that cause bph like symptoms. The uro who did cystoscopy on me 2 yrs ago had exactly that diagnosis along with over active bladder oab. He sent me off to a PT to learn reverse kegels and bladder training. Either because of or in spite of ( I'll never be sure ), I got into 3rd stage kidney disease for a few months. Off to the uro again and this time he said one word - TURP. And he advised urgency. So wanting to look at other options I went on .4 mg tamsulosin daily and the kidneys came back close to normal filtration as Weeing became easier.

Then I found this forum and had the pae done by the awesome team led by the great IR dr Schlaphof.

Now I am waiting and wondering hmm. Confused about whether the original diagnosis was closer to home.

I truly wish all of us can avoid the butchery of TURP. PAE holds a great promise for all of us.

At the same time I would like to hear from any dudes in this forumwho might have experienced late improvements from pae or have gone thru a similar journry with their wee affairs.

Cheers

Rama

Rama, I believe the tamsulosin rspecifically relaxes the tissue of the prostate and bladder neck (and the similar tissue of the sinus whch can cause  the stufy nose) which allows your stream to return. Does tamsulosin have any effect on the pelvic floor muscles? If not then the bph would seem to be the correct diagnosis. I had two greenlight procedures, the second to resect the bladder neck and remove bladder stones. Then I had a turp which removed the median lobe protruding into my bladder. I'm now taking dutasteride to keep the prostate from growing. It is presently 203g. Even if your PAE doesn't solve your problems it should prevent or limit future growth which eventually will require an additional intervention. Despite the ads the lasers and turps are often just a temporary fix depending on how fast the prostate regrows.

I went to post my general comments on my PAE with Dr. Bagla so others that are considering having it done can get some insight into making a decision.  

I had PAE done on April 27 of this year.  I don't see any real progress as of yet.  My prostate was 37 cc.  Dr. Bagla said to give it 1 to 3 months for peak effect.    

I had no pain or burning at any time.  You are awake during the procedure under sedation for relaxation.  The doctor will ask you to hold your breath from time to time.  I felt mild burning at intervals which was so insignificant that is not really worth mentioning.  I passed some blood in the urine the first couple of days.  I felt the constant urge to move my bowels the first day and a half.  Dr. Bagla said that this would pass in two days which it did.  But I was constipated for more than two weeks.  I drank prune juice and took Miralax.  I don't normally have constipation problems.  I'm weening off the prune juice and Miralax.  This is not mentioned in the clinical literature but others also have this problem.  It was quite difficult to move.  I would suggest asking your doctor about taking Miralax several days before the procedure.  I would also take a probiotic to offset the Cipro's disruption of the intestinal flora with a probiotic overweighted to the bifidobacterium side to prevent constipation.  Bifidobacterium is found more in the colon.  I think the constipation issue needs to be addressed by the doctor so this can be potentially avoided.  Miralax and the probiotic are harmless.  I found the constipation to be an unpleasant side-effect and I was concerned. There was a fear of non-target embolization of the rectum, but Dr. Bagla said this was not the case.  I have found improvement in this area for the last week.

I was not catheterized during the procedure.  There is no reason for it unless one arrives with a catheter.  This reduces the chance of a UTI.

I was in the recovery area for 2 hours.  The nurse takes vital signs every 15 minutes.  There is a bruise where the doctor enters the femoral artery.  I did not the feel entry.  That healed within a week.  

This is a painless procedure in my experience. You are given Medrol, pyridium, Cipro, and ibuprofen within the next five days.  

Any questions, feel free to contact me and I will be glad to help.

Cam

I am about 3 months out from having a PAE at VIV with Dr. Bagla, and my experience had some similarities and some differences from what Camster describes above.  I posted some of it here previously, but to recap-

I had significantly worsened symptoms after having a needle biopsy by my urologist last summer.  I sought out Dr. Bagla for help, and after some delays for his move to VIV from Alexandria, had the PAE done in late winter. My experience at VIV, for the flouroscopy and PAE itself, was exactly as Cam describes.  I was happy that they did not put a Foley catheter to the bladder, and I suspect that they like to avoid it because it could interfere with the flouroscopic images of the prostate vessels needed to do the emoblization.   Dr. Bagla told me to expect improvements in symptoms for 1-3 months, also as Cam describes.   I had a 150 gm prostate at the start (as per ultrasound--the urologists  DRE/finger wave always estimated it at 50 gm) -- so my gland was 4x the size of Camster's.  So maybe that explains some of the differences in our experiences--in contrast to his report, I had pretty quick, dramatic relief of my prostate symptoms.   Probably within a week I had 50-60% of the improvement I have seen, and probably 90-95% had occurred within the first 60 days, with very little change in the past month.  But overall, my quality of life is much better now.   Almost back to "normal" by my standards.  Maybe a little bit of urgency once in a while, and getting up at night about 1x, sometimes not at all.

Unlike what Camster describes, I had essentially normal bowel function after leaving VIV,  And did not see blood in the urine, but that may have been masked by the pyridium during the first few days.   I did develop some gnawing epigstric pain toward the end of the 4-drug regimen (Predisone, Ibuprofen, pyridium and Cipro).  So I stopped the meds 2 days early, contacted Dr. Bagla to confirm, and noted the stomach pain went away over the next 24-36 hrs.  I have had a couple of minor episodes of it since, but none for the past month or so.  I am attributing it to stomach irritation from taking the 4 medications at once--paticularly the prednisone and high dose NSAID (ibuprofen).  

I agree with Cam's  statement that PAE at VIV was essentially a painless procedure, and I would add a good way to avoid invasive surgery. The only other thing I did on my own was to add Vitamin C to the regimen, both before and after the PAE procedure.  Why?  It helps with collagen synthesis and wound healing  (that has been known since 1982--see the Ringsdorf & Cheraskin http://www.ncbi.nlm.nih.gov/pubmed/7038579). ; It worked for me.  

Cam also mentioned a few days ago that "an experienced doctor will expose you to less radiation from the fluoroscope hopefully by keeping down the procedure time."  I agree with that too, and was one reason why I traveled to see Dr Bagla rather than going with a local radiologist who was just starting to do them.  I raised that X-ray exposure issue with Dr. Bagla when I saw him at VIV, and he reminded me that the most evidence for bad long term health effects from radiation (i.e., cancer) is from atom bomb survivors, and very little evidence from medical uses.  And even there, most harm has been seen in the staff who are exposed to small amonts daily.  They (the radiologists/cardiologists/techs) who do the flurouscopic procedures are at higher cumulative exposure, so we patients who get just one relatively brief exposure should have fewer qualms.  

Just my 2 cents.   

Hi Camster, I would have recommended this earlier if I knew the constipation issues would have asted so long. Before and fter my last turp I was hospitalized and constipated for 5 days. I went in for hematuria and had a turp on the third day. Stool softeners several times  day were useles. When I came home I used a dulcolax suppository. It is wrapped in foil and when you unwrap it it looks like a .45 caliber wax bullet. I inserted it into my rectum and the hardest part was plugging my rectum with a finger for 20 minutes while sittin on my hand. Otherwise it kept sliding back out and I had to start the 20 minute clock again. But after 20 minutes it worked to clean me out. I was prepared to use it again the next day but didn't need to. I was recently in hospital for 23 days for other issues and used it once after 3 days of constipation. I found eating total allbran with raisins nd whole milk kept me regular the rest of the stay. I agree with the pro biotics, especially if you are taking antibiotics. My wifes dentist recommended the clinical strength 50 billion cells/14  strains probiotics. I buy them online for her. Expensive, about $1.10 per pill once a day but she hasn't had any gum infctions in more than a year. 

P.S. Camster, Hope you see some progress over the next few months. It works for some but not others. I had 2 greenlight lasers an a turp in 4 years and haven't had any pvr or urinating issues in amore than a year or had to self cath in more than 2 years But my prostate was 203g. 6 months ago. I have been taking dutasteride for abou 6 months to shrink it. Other health issues put the prostate on the back burner for now. I now get up 5 to 6 times a night due to meds I am taking, but I have used a bedside urinal in the dark for several years and always get right back to sleep so getting up hasn't been an issue for me except when occasional nocturia about a year ago, had me getting up more than once an hour.

Thanks Bob.  I didn't have to go the suppository route fortunately.  I tried Colace first and it worked somewhat.  The Miralax helped more.  It seems at the moment I'm getting back to normal.  I just started using psyllium husk and will keep it on hand.  I'm continuing with the probiotics.  I also had bad flatuence which has also resolved.  The day before the surgery, I had GI upset and really bad gas.  I even thought Dr. Bagla might postpone the surgery.  I don't think it was nerves.  I had come to terms with the procedure.  The ibuprofen 600 mg 3x per day that Dr. Bagla had me on can cause constipation.  It is stated on the drug disclosure sheet.  I also confirmed it with a nurse practitiioner and she said yes it can.  

I don't expect to urinate like a teenager, but at least some moderate improvement will be welcome.  I think some people get results immediately from reduced blood supply on the larger prostates.  I don't have much prostate to reduce.  Dr. Bagla thought even if it went down 3cc that I might notice a difference.  

Thanks for your response.  I hope those who are reading our blogs see that constipation can be an issue and it not stated anywhere in the clinical literature.  I didn't expect this.  Will keep you posted on my progress.  Hope your health is progressing.  Thanks again.

Hey Bob, Thanks for your input.

My prostate size was around 60 gm. By no means is there any correlation between size and degree of symptoms, restriction of flow through urethra can be more severe for some with smaller gland.

That's a good point you raised, I couldn't find much to indicate one way or the other as to whether alpha-blockers bind with the nerves of the pelvic floor.

I do agree that nothing's been lost by me having PAE, it could be a good prevention of further worsening of symptoms.

I'm suppressing my urge to go consulting another uro given my recently shaken belief in the general state of this profession, but I may have no other choice.

I might give Doc Schlaphof a call soon to get his take on it.

Two greenlight procedures and a turp is quite a journey. Bladder neck issues caused by protruding prostate lobe sounds like what I was told as well.

I have a growing feeling that the lack of a wholistic diagnosis system is leading some of us down the treatment path which may not be aligned with the root cause. My other problem - the IBS arises out of improper/incomplete bowel emptying, which along with the LUTS sysmptoms is listed among symptoms of pelvic floor dysfunction. 

I'm feel driven do lots of spare time reading on thease matters to try and understand wtf is going on, while I wait and hope that the PAE has done the trick for me.

 

Dr. Bagla told me to give it 1-3 months for peak effect.

Hi Rama,

It definitely would be worthwhile to speak to your PAE Doc again. He should have scans of your prostate so he should know if your median lobe protruded into the bladder. He also may have some insight into why you have not shown improvement in 2 months.

In my case imy median lobe protruded from the side of the bladder mouth but didn't block it. In the ultra scan ithe protrusion seemed to take up the lower 15-20% of my bladder. When I had to cath I could feel about an inch of space between the bladder mouth and where the median lobe pushed the bladder wall inwards about an inch in front of the bladder mouth. In other cases the median lobe can block the opening as you start to urinate and the bladder contracts. The best test for this is for a sonogram to measure your pvr (post void residual). If you are retaining more than 50ml. there is some blockage, if you are retaining more than 250ml, then you get into an area where you may eventually damage the kidney. and bladder. Prior to my first GL I was retaining 400ml. The sonogram will also show the median lobe against the bladder, and the retained urine.

I also agree the uros don't take a holistic approach but rather a cookbook one. It's all trial and error. Maybe that way they can limit the treatments for most people who may respond to the first or second thing they try. For me the first GL was only a partial success. It stopped the complete retention, but within a few months my stream was not great.

A hematuria of the prostate and bladder neck necessitated the second GL, and while there my uro found and removed bladder stones and resected the bladder neck, but left most of the protruding median lobe.

A second hematuria necessitated the turp, which removed the median lobe. None of these procedures eliminated or signigficantly reduced my night time urination, but I do have a good stream, no urgency, and no retention with a pvr of 34ml. But I do have to keep taking dutasteride for life or find another alternative because both my hematurias ocurred when my prostate passed the 300g. mark, so I assume there must be a connection. Of the two procedures it seemed the turp was better in terms of recovery and results. Or maybe it had better results because it was the third rocedure. But the recovery was shorter and less painful and it did allow the tissue to be sent to pathology. With the GL all the tissue is incinerated. So I would rate the turp a better procedure. It did leave me with retro, which I was very worried about, but It didn't effect my enjoymeent so it turned out not to be an issue for me.

Dr. Bagla said he had recently did a PAE in 30 minutes.  

I was in contact with another gentleman who had the procedure with Dr. Bagla and also had constipation for around 2 weeks.  

The high dose ibuprofen can be nasty on the GI tract.

I'm cautiously optimistic because there was concern by Dr. Bagla that the bladder could be an issue.  My urologist felt it was a simple obstruction.  I would have liked urodynamic testing but my urologist didn't feel it was necessary.

Called the company who makes Urolift.  They feel confident that within a year, they will be addressing an enlarged median lobe which is now contraindicated for the procedure.

The constipation is caused by the anesthesia, and is, therefore, a risk in most any surgery. If you are having any surgery, you should give strong consideration to taking a good laxative starting a couple of days before the surgery. You don't want to be dealing with fecal impaction while recovering from surgery (OR ANY OTHER TIME, WHICH YOU WILL KNOW IF YOU EVER HAVE ONE!)

Neal

Thanks Neal.  Great advice to anyone having PAE done.  Dr. Bagla's office doesn't address the problem.  I was really shut down until day 16 after the procedure.  

Bob,

Thanks for your reply.  Your exprience underlines the complexity involved in LUTS cases. A good stream with low pvr and no urgency but no improvement in nocturia sounds perplexing. I have no idea what 

Factors that cause nocturia in spite of good voiding, point to something that comes into effect in supine position. I tend to wee once a night these days with daily tamsulosin, but was upto 3 times without it.

I tried contacting Doc Schlaphof via email but no luck there, just lack of  response. 

Camster, thanks for implicitly advising more patience, I realise that another month or two is no biog deal, while I'v elive this way over 10 years.

While waiting I am going to fish around in other forums. My condition makes it necessaruy to continue medication, I read in another topic inn these forums that cilais might actually be be better than Tamsulosin in some ways for bph like symptoms as it also relaxes the prostate and bladder muscles.

Thanks to all guys who helped my journey by sharing their experiences. I will be back if and when I have some good news from PAE procedure. Otherwise, I guess I might eventually join the minority of PAE cases that show no gains. In either case I will post again as it is still useful to let the forum readers know of some albeit small proportion of cases that may not benefit from PAE. No doubt the procedure promises great results to men as against TURP. It is important to note that TURP  has significant failure rates (as high as 10% I gather). But the worst case outcomes from PAE might be a lot better that teh worst outcomes from TURP.

Will let you guys know whatever I uncover in my onward journey on this.

OUCH

Neal

Hi Rama,

Some more thoughts on nocturia. Due to 20) years of untrated bph, my bladder wall thickened becoming more muscular to push the urine through an increasinlgy blocked prostate, This was shown on the sonograms. Urodynamic testing showed the poitn at which my bladder signalled urgency was a little over 300ml. It could hold more than that, but at 300ml I get the signal to urinate. My uro explained the kidneys produce 100ml per hour, so 3 hours or so at night is the best I can do in any circumstances. I chose to place a disposable plastic urinal by my bedside, so I can stand, unsnap the urinal lid, pee in the dark, and get right back to sleep. Due to other conditions I recently started taking a loop diuretic called lasix about 2:30 in the afternoon, which also shifts the urination cycle to before my bedtime. Last night I got to sleep about 12:30, urinated once at 3:30., and again when I woke about 7:30.

Some thought on daily cialis. A couple of years ago there were coupons for first time users for a 30 day free trial of daily cialis on their website and in magazines, so I tried it. I found it was much less effective than tamsulosin (generic flomax). for bph. Also expensive. The daily 5mg. pills are over $10 each, so $300 a month. Medicare and insurance companies won't cover it. The full 20mg tablets are $40 each, so $320 for 8 tablets. I think their patent expires in 2017, when generics should be sold in the US. A weird side effect of the daily tablet was it put me in a sort of nasty mood. Maybe it was caused by an unsatisfied libido. Unlike the commercials my wife wasn't waiting for me in a lakeside tub in the woods every day. I looked it up online and found a few posts of women complaining their husbands got nasty with the daily pill. It seems a rare side effect but I and and a few others did get it. I stopped using it after about 10 days. 

Don't forget that women's testosterone levels, and therefore libido, decrease as they get older. Your wife might should see an endocrinologist to have her testosterone and estrogen checked. Low estrogen can cause a dry vagina, and therefore painful intercourse. This can also be helped by over the counter lubricants such as KY Warming gel, and even coconut oil. And most important, of course, you aren't going to get where you want to be by being nasty. For some reason, men being nasty doesn't make women feel loving. Discuss all of this with your wife, and perhaps you can work it out.

Finally, like many other people, many doctors are embarrassed to talk about sex, and know nothing about it. Just ask your doctor how much time they spent in medical school learning about it. You'll probably get a blank stare. If your doctor can't help you in this area, and/or doesn't seem comfortable talking about it, ask for a recommendation for one who can.

Neal

I had just brought it up to point out a side effect of the daily cialis. All you say about women's libido's as they get into their late 60's and 70's is true. It's pretty universal in our age group among couples that have been married for decades. Of course a woman has to want to address it. Most don't.  You can lead a horse to water, but you can't make them thirsty.

Well, that's a bad loss for you both. I guess all you can do is discuss it with her and see if she is interested in trying to address these issues. As I pointed out, some of these problems are painful, and others look like they're difficult to solve, but all can be easily solved if the will and information are there. My point is that that there is no rule that love making has to stop at a certain age. It stops because of one of these resolveable issues, a serious medical issue such as heart problems, impotence (which is resolveable with an implant), a power or attitude problem (being nasty), or a lack of interest in the relationship.

I am 74, so I know one can have a great sexual relationship at least at this age. I'm not saying that to make you feel bad, but to try to get you to consider addressing this with your wife to see what she sees as the problem, and address it.

Neal

I think men retain their libido longer than women do. Sex may not stop altogether but often gets less and less frequent. Is your wife around your own age? 

Right now I'm being treated for lymphoma which was just diagnosed about 6 weeks ago. My wife is pretty overwhelmed so probably not a good time for this conversation for her.

It doesn't have to be that way Bob. I'm 71 and my wife is 66. Wer are both fit and active and our sex life is great. My wife is keen and will often initiate sex. It wasn't always that way. 

I learned to woo and romance and pursue her again. Women LOVE romance. There are plenty of tips on the Internet on how to do it. It seems awkward at first but after a while it becomes natural. Try it guys...you'll be pleased. Sex has never been better. 

Thanks caringbah and nealpros. It's good to know the possibility is still there.

That may be true about the conversation with all you are dealing with, but also, it may not, since this may also be a time where closeness of all types is called for.

Other things being equal, age is not a strong direct factor in libido. Testosterone level is, and yes, it can change with age. Yes, women DO normally have testosterone in their bodies, about 10% of what men have. So, it can be a major problem that can be easily fixed. And while we think we are in charge of our bodies, we really aren't. Our testosterone level directly controls our sex drive in the same way that our insulin level controls our blood sugar.

Yes, my wife and I are about the same age. She is 2 years younger than I.

Neal

And I strongly agree with Caringbah. Wooing is ALWAYS called for and helpful in this area. Remember what it was like when you were dating? Do that!

Neal