The Marlboro man just doesn't keep it up like he used to.

Men: Troubleshoot Your Sex Life

Follow these 5 steps to improve your sexual vitality and performance as you get older.

Reviewed by Michael W. Smith, MDBy Neil Osterweil
WebMD Feature

The Marlboro man just doesn't keep it up like he used to.

On the outside, he may still look like the epitome of the rugged American male -- a man's man. But inside, it's another story: years of cigarettes, liquor, and steak and eggs can do a number both on a man's heart andsexual vitality.

Well, it didn't have to happen. Sure, men experience a drop in levels of the sex hormone testosterone as they age. Many a man finds that he's no longer the young buck, bed-wise, that he was in his randy youth.

But if you're worried that your sexual life is headed off into the sunset as you approach midlife, rest easy. You can maintain -- even boost -- your sexual vitality by making a few smart decisions now.

"Healthy men can have erections at any age," says Michael Castleman, a sex educator and health writer based in San Francisco. "Once you hit about 50, erections change. They are slower to rise, they don't rise from fantasy alone -- you need manipulation and direct sexual stimulation. What happens to a lot of men is that they notice these changes and they flip out and think, 'Omigod, I've reached the end of my sexual road.' Well, things aren't over, they've just changed."

The problem is that most men don't know that many of these changes are preventable. They don't do anything about maintaining sexual vitality until a problem occurs, and by then it's closing the barn door after the horse has bolted, says a leading expert in erectile dysfunction (ED).

"The emphasis in this field has been on the treatment, not on the prevention," says Irwin Goldstein, MD, professor of urology and gynecology at Boston University School of Medicine in Boston, in an interview with WebMD.

As a result, doctors know that several medical conditions are associated with erectile dysfunction. About 40% of men with diabetes have some erectile dysfunction. Problems with erections are also common in men with cardiovascular disease, especially those with angina or after a heart attack. And they can be caused by medications used to treat such conditions as high blood pressure. Many doctors think that reversing these problems would also boost a man's sexual vitality. But they don't know for sure.

Your best bet? Prevent the problems before they affect your sex life.