Sex and Aging

Nothing is more irritating to author Connie Goldman than the stereotypes out there about older people and sex -- especially the one about seniors not having sex. "People see an older couple that has just gotten married or who are holding hands, and they say, 'Oh, how cute,' " says Goldman, a former public radio producer. "It's belittling."

At age 76, Goldman spends a great deal of her time trying to counter those stereotypes. "There is this idea that all old people are alike, but my experience in interviewing hundreds of seniors is that each relationship is unique and different," says Goldman, whose recent book, Late-Life Love: Romance and New Relationships in Later Years, features interviews with 22 couples about their relationships.

"I can tell you that sexual attraction and sensual feelings do not go away with age. It may not be that very hot passionate feeling that you had when you were 19, but it certainly isn't gone," Goldman says. "We find a way to express our sensual feelings, not to mention our affection."

Surveys back her up. A 2004 poll conducted by the AARP found that sexual desire runs deep among people in their 50s, 60s, 70s, and beyond. Many older people are able to put those feelings into action as well: About one out of three people over 70 who have regular partners said they have intercourse at least once a week.

Of the 1,600 people surveyed, just 4 percent agreed that "sex is only for younger people."

At any age, sex can help strengthen intimate relationships while easing stress and boosting overall health. For seniors, sex can also restore feelings of vitality, says Erica Goodstone, PhD, a certified sex therapist and licensed mental health counselor in Boca Raton, Florida, who works with many older couples and singles. "It's part of being truly alive."

Unfortunately, many older people miss out on sex and all of its benefits, even if they crave this type of physical intimacy. They may have physical problems that make sex difficult or painful, or they may have simply lost their interest and desire. But these obstacles aren't as serious as they used to be. Thanks to new treatments -- and a new appreciation for the importance of sex in later years -- older people often choose to make sex an enduring part of their lives.

Obstacles of age

Of course, sex for today's 70- and 80-year-olds is likely not the same as before. As reported by the Medical Clinics of North America (MCNA), the inevitable bodily changes of aging can affect the sexual lives of all seniors. Older men and women tend to need extra time -- and extra touching -- to become aroused. Both men and women may also need extra time to reach orgasm, and the orgasms themselves may not be as intense as they used to be.

Hormones are partly to blame. Secretion of testosterone, a hormone that helps fuel sex drive in both men and women, gradually declines with age. Postmenopausal women also lose estrogen, a biological change that can affect women's sexuality.

"My sex drive is different," observes Connie Goldman, who has been with her current partner, age 79, for about six years. "I was surprised at the changes, but I've learned to embrace them along with the other changes that come with the years."

One's definition of "sex" may also broaden over time, Goldman says. "Because of some physical limitations, I wouldn't say that my partner and I have the same kind of intercourse that we were able to have at one time," she notes, "but it makes no difference because we're able to satisfy each other in other ways."

So even as hormones drop, desire can remain strong. "The brain is the largest sex organ," says therapist Goodstone. At any age, expectations for good sex can be a self-fulfilling prophecy, she says. And as reported by the MCNA, some postmenopausal women actually have more interest in sex than ever before, because they don't have to worry about becoming pregnant.

Other physical changes can be far more noticeable -- and troubling -- than a drop in hormones. Men may have extra trouble achieving or maintaining erections. "Erectile dysfunction," as the TV ads put it, isn't really an inevitable part of aging, but it's so common that men often accept it as a fact of life. Men are especially likely to develop ED if they have diabetes, atherosclerosis, or high blood pressure. Many medications can also lead to ED, including beta blockers and antidepressants.

Women face problems of their own. With age, the vagina becomes drier and loses muscle tone, which can make sex uncomfortable or even painful. Goodstone worked with one older woman who was so susceptible to pain that she didn't even want a doctor to touch her. "I assured her that doctors have ways to treat pain," she says. "[Being in] pain isn't normal."

Sexual problems may be embarrassing to discuss; however, it's important that your physician give careful consideration to your concerns. Your physician may want to check hormone levels with blood tests to be sure they are not below normal for your age.

Sexual healing

For many older men and women, a trip to the doctor could be the first step toward a more active, pleasurable sex life. For some men, doctors can prescribe drugs to treat ED, such sildenafil (Viagra). These medications have started a sexual revolution for the many men who had given up hope of ever having a sex life again. The 2004 AARP survey found that 22 percent of men had tried one of the medications -- up from 10 percent six years before. Men aren't the only ones who appreciate the pills: Women in the survey generally enjoyed sex more when their partners got treatment for ED.

Viagra and similar drugs improve erections, but they don't enhance desire (libido). Older men who lose interest in sex may want to have their testosterone levels checked. If the levels are low, testosterone gel or patches might renew the sexual spark. Some research suggests that women -- specifically women who have had a hysterectomy or had their ovaries removed -- may also benefit from low-dose testosterone patches if other causes of low libido have been ruled out. (Prescribing testosterone for women's sexual health after menopause is still controversial in the United States. The Food and Drug Administration has not approved any testosterone drugs for women's sexual health, although some doctors prescribe these products off-label.).

Women who feel pain or discomfort during sex should definitely bring up the matter with their doctor. For some women, the solution is as simple as a water-based lubricant (such as K-Y jelly). While there are some recent concerns about taking estrogen tablets, some women may find relief with estrogen vaginal cream.

Sexual passion ebbs and flows over time, and some experts believe that periods of low libido may be related to aspects of life that have become imbalanced. The imbalance could be, for example, an increase in stress, no longer feeling a close connection with a partner or spouse, or having low self-esteem. In her book Reclaiming Your Sexual Self, therapist Kathryn Hall suggests that addressing such problems can help to rekindle desire.

In the later years, good sex takes cooperation, Goodstone says: "As you get older, having a partner that you can communicate with becomes more and more important." Working together, couples can find the positions and techniques that give them both maximum satisfaction without tiring each other out or putting too much stress on sore joints.

"One of the great things about getting older is that there tends to be this freeing to say exactly how you feel, and what it is you want and need," says Goldman. "We know that there's a life cycle and that we're not here forever. We are here today, though, so we don't waste time: We talk about what we need to talk about and get on with it."

Of course, there's more to intimacy than sex. Goodstone encourages older couples to be affectionate and touch each other often. Massages, foot rubs, and holding hands can build closeness at any age. She also recommends occasionally getting a professional massage. People feel sexier when their bodies feel better, she says.

For Goldman and her partner, cuddling has become a crucial component of their intimacy repertoire. "We cuddle when we go to bed, we cuddle when we wake up, and we cuddle during the night when we bump into each other," Goldman says. "It's a form of intimacy that gives us pleasure and connection in many ways similar to intercourse. It's not the same feeling of excitement, but it is intense intimacy."

References

Interview with Connie Goldman.

Interview with Erica Goodstone, PhD.

America Association of Retired Persons. Sexuality in midlife and beyond: 2004 update of attitudes and behaviors.

Ginsberg, T.B. Aging and sexuality. The Medical Clinics of North America. 2006. 90: 1025-1036.

Nusbaum, M.R.H. et al. Addressing the physiologic and psychological sexual changes that occur with age. Geriatrics. September 2005. 60(9): 18-23.

National Institute on Aging. Sexuality later in life. Last updated April 2010

Hall, Kathryn. Reclaiming Your Sexual Self: How You Can Bring Desire Back Into Your Life. John Wiley & Sons, Inc. 2004.

Patching up low libido: Study examines testosterone in women. University of Michigan Health System. February 2, 2004.

Kingsberg S., Testosterone treatment for hypoactive sexual desire disorder in postmenopausal women. J Sex Med. 2007 Mar;4 Suppl 3:227-34.

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