Topic Overview

Sex and sexuality communicate a great deal: affection, love, esteem, warmth, sharing, and bonding. These gifts are as much the right of older adults as they are of those who are much younger.

Three aspects of sexuality are covered in this topic: the changes that come with aging, suggestions on how to adjust to these changes, and information about sexually transmitted infections.

In most healthy adults, pleasure and interest in sex do not diminish with age. Age alone is no reason to change the sexual practices that you have enjoyed throughout your life. But you may have to make a few minor adjustments to accommodate any physical limitations you may have or the effects of certain illnesses or medicines.

Common Physical Changes in Men

Most physical changes are the result of gradually decreasing testosterone levels. These changes affect energy, strength, muscle and fat mass, bone density, and sexual function.

• A man's sexual response begins to slow down after age 50. But a man's sexual drive is more likely to be affected by his health and his attitude about sex and intimacy than by his age.
• It may take longer for a man to get an erection, and more time needs to pass between erections.
• Erections will be less firm. But a man who has good blood flow to his penis will be able to have erections that are firm enough for sexual intercourse throughout his entire life. For more information, see the topic Erection Problems.
• Older men are able to delay ejaculation for a longer time.

Common Physical Changes in Women

Most physical changes take place after menopause and are the result of decreased estrogen levels. These changes can be altered if a woman is taking hormone therapy.

• It may take longer for a woman to become sexually excited.
• The walls of the vagina become thinner and drier and are more easily irritated during sexual intercourse.
• Orgasms may be somewhat shorter than they used to be, and the contractions experienced during orgasm can be less intense.

Not all women experience these problems. Those who do can experiment to find ways to enjoy sex despite these physical changes.

Cultural and Psychological Factors

In addition to physical changes, there are cultural and psychological factors that affect sexuality in later years. For example, in our culture, sexuality is equated with youthful looks and youthful vigor. Too many people seem to think that as a person ages, he or she becomes less desirable and less of a sexual being. Older adults may accept this stereotype and buy into the notion that they are not permitted or expected to be sexual.

Joy in sex and loving knows no age barriers. Almost everyone has the capacity to find lifelong pleasure in sex. To believe in the myth that older people have no interest in sex is to miss out on wonderful possibilities.

Being single through choice, divorce, or widowhood can present a problem also. As you get older, you may not have as many people in your age group to choose from for partners. Women and men who are single may not know how to deal with their sexual feelings. Generally speaking, it is better to express your desires than to suppress them until you are no longer aware that they exist.

Physical and emotional needs change with time and circumstance. Intimacy and sexuality may or may not be important to you. The issue here is one of choice. If you freely decide that sex is no longer right for you, then that is the correct decision. It is possible to live a fulfilling life without sex. But if you choose to continue enjoying your sexuality, you deserve support and encouragement. You may still find uncharted sensual territories to explore.

Staying Sexual

Just as exercise is the key to maintaining fitness and health, having sex on a regular basis is the best way to maintain sexual capacity.

And just as it's never too late to start an exercise program, it's never too late to start having sex. Many older people who have been celibate for years develop satisfying sexual practices within new loving relationships. For others, self-stimulation (masturbation) is common and poses no health risks or side effects.

You may have sexual changes as you get older. But some changes may be the first sign of a medical problem. So talk with your doctor about any changes that concern you. He or she may be able to recommend treatments that will help you.

Here are some other considerations:

• To enhance sexual response, use more foreplay and direct contact with sexual organs.
• The mind is an erogenous zone. Fantasy and imagination help arouse some people. Try setting the mood with candlelight and soft music, or whatever else "turns you on."
• Many medicines, especially high blood pressure medicines, tranquilizers, and some heart medicines, inhibit sexual response. Ask your doctor about these side effects. Your doctor may be able to reduce your dosage or prescribe different medicines. Do not stop taking prescription medicines without talking with your doctor first.
• Colostomies, mastectomies, and other procedures that involve changes in physical appearance need not put an end to sexual pleasure. Communicating openly about your fears and expectations can bring you and your partner closer together and help you overcome barriers. If needed, a little counseling for both of you can help you adjust.
• People who have heart conditions can enjoy full, satisfying sex lives. Most doctors recommend that you abstain from sex for only a brief time following a heart attack. If you have angina, ask your doctor about taking nitroglycerin before you have sex. Do not take Viagra if you are using nitroglycerin.
• If arthritis keeps you from enjoying sex, experiment with different positions. Try placing cushions under your hips. Also try home treatment for arthritis pain. For more information, see the topic Osteoarthritis.
• Use a water-based vaginal lubricant, such as Astroglide or K-Y Jelly, to reduce vaginal dryness or irritation. Do not use petroleum jelly. A doctor can also prescribe a vaginal cream containing estrogen, which will help reverse the changes in the vaginal tissues.
• Drink alcohol only in moderation. Small amounts of alcohol may heighten your sexual responsiveness by squelching your inhibitions. Larger amounts of alcohol may actually decrease your sexual performance.
• Prescription medicines that can enhance the sexual response are available. Some people find that herbs such as ginkgo biloba and ginseng enhance their sexual function. Both prescription drugs and herbal remedies carry the risk of side effects.

Other Aspects of Sexuality

Sexuality goes far beyond the physical act itself. It is part of who we are. It involves our needs for touch, affection, and intimacy.

Touch

Touch is a wonderful and needed sensation. Babies who are not touched do not thrive. Children who are not touched develop emotional problems. Touch is important to older adults as well. Touch helps us feel connected with others and enhances our sexuality.

• Get a massage. Professional massages are wonderful, but simple shoulder and neck rubs feel great, too. Find a friend who will trade shoulder rubs with you.
• Look for hugs. Everybody needs them. Some people are a little shy about hugs, but it's okay to ask, "Would you like a hug?"
• Consider getting a pet. Caring for a pet can help meet your needs for touch. Some studies have shown that older people who have pets to care for live longer.

Affection

To give and receive affection is a wonderful feeling. If you like someone, be sure to let them know. If someone seems to like you, appreciate it. It is never too late to make new friends and strengthen bonds with longtime companions.

Intimacy

Intimacy is the capacity for a close physical or emotional connection with another person. Intimacy is a great protector against depression.

Talking with a confidant can help ease life's problems. When you lose a loved one, intimacy may be what you miss most. You may not find someone to fully replace a loved one who died, but you can begin to rebuild intimacy in your life in the following ways:

• Turn to your children, siblings, or old and new friends.
• Look for another person who is in the same situation as you are. One of the richest benefits of support groups is that members often find intimacy with one another.
• Be available to others. Just as you need people, there are people who need you too.

Sexually Transmitted Infections

Sexually transmitted infections—also known as STIs or venereal diseases—are infections passed from person to person through sexual intercourse, genital contact, or contact with semen, vaginal fluids, or blood.

Older people may think of STIs as a problem that affects only young people. But because of physical changes related to age, older adults who are exposed to STIs may be more likely than young people to get STIs.

As you age, your immune system is not as strong, so it's harder to fight off disease. And women who are past menopause have thinner vaginal walls and less vaginal moisture than they did before menopause. Using a lubricant, such as K-Y Jelly, may keep you from getting a sore or a tiny cut on your penis or inside your vagina. This can reduce your risk of getting STIs or HIV.

Practice safer sex. For older adults, this means always using condoms and lubricants until you are in a monogamous relationship and know your partner's sexual history and HIV status.

STIs can affect anyone, no matter what his or her age. Talk openly with your partner about STIs, and take whatever precautions are needed to protect yourself before you engage in any form of sexual contact. If you think you may have an STI, see your doctor.

For more information, see:

• Safer Sex
• Exposure to Sexually Transmitted Infections