Sex Never Dies,’ but a Medicare Option for Older Men Does

Men who have trouble achieving an erection don’t want the whole world to know, so I agreed to identify the 77-year-old from White Plains, N.Y., only as Mr. J. He and his wife married in 1959, he told me, and when his problems began years ago, he didn’t want to relinquish sexual intimacy.

“It’s a part of life,” he said. “Sex never dies.”

On the advice of his urologist, he uses a vacuum erection device, less formally known as a penis pump. It’s cheaper, over time, than erectile dysfunction drugs, and Mr. J believes it’s safer, too. He discreetly leaves the bedroom to use it — “it can be embarrassing at times” — but the pump performs, drawing blood into the penis to enable intercourse.

“It’s a little awkward and inconvenient, and it’s not very romantic,” Dr. Ira D. Sharlip, a urologist at the University of California, San Francisco, said of the pump. “But it can be effective.”

On July 1, however, Medicare stopped covering vacuum erection devices, the result of legislation Congress passed in December. Since 2006, Congress has banned Medicare Part D coverage of medications for erectile dysfunction, too, after Representative Steve King, Republican of Iowa, scoffed at “lifestyle drugs” and said taxpayers wouldn’t foot the tab for “Grandpa’s Viagra.”

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 over 60 — and 70 percent of those in their 70s — experience trouble getting or maintaining erections, often because of diabetes, cardiovascular disease orprostate cancer treatment, said Dr. Eugene Rhee, past president of theCalifornia 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.

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 over 70 had engaged in vaginal intercourse within the previous month, with both 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 over 80 reported having sex, too, but the sample size was too small to draw conclusions about them.)