While it may not be a message we see promoted in the media very often, it is still very possible for older adults to have an interest in sex, and also enjoy active, healthy and fulfilling sexual lives.
In fact, a recent study by the American Association of Retired Persons shows the majority of older adults remain interested and engaged in sexual activity into very advanced age. Indeed, epidemiologic evidence suggests that people who remain sexually active into their older years may live longer than those who are less sexually active.
Unfortunately, because of common cultural misperceptions around sex and aging, physicians often miss opportunities to talk to older adults about sexual health and inform them about avoiding sexually transmitted diseases (STDs). Furthermore, older adults often do not feel empowered to raise such concerns with their health-care provider, and when facing difficulties with sexual health, they may decide to forgo sex rather than investigate what might be causing the problem.
Many common factors of aging can contribute to a decline in sexual activity. For example, some of the most commonly prescribed medications, like anti-hypertensive and anti-depressant drugs, can interfere with sexual function by affecting sex drive or reducing blood supply to the pelvic region.
Illnesses also may contribute to difficulty with sex, and diseases such as depression may reduce sexual desire. Arthritis can make certain sexual positions painful or difficult. Urinary incontinence often causes embarrassment and social isolation, and it may put a damper on the mood during sexual contact. It also can cause pelvic irritation, which may make sex painful. Couples that are challenged by arthritis or other physical conditions can explore alternate positioning or other pleasurable activities.
Many older adults also suffer from partner unavailability, perhaps due to a spouse’s death or physical decline in partners. All of these factors contribute to decline in sexual activity with aging, and several can be treated, or sexual activity may be modified to accommodate challenges while remaining satisfying.
Patients and health care providers both need to examine their own views about sex and aging. Health care providers should be nonjudgmental when obtaining a thorough sexual history from older patients, just as they would with younger patients.
Health providers should also note that because of generational norms, older gay and lesbian patients may feel less comfortable raising concerns about sexual activity. Ideally, providers will approach these discussions using gender-neutral language. When treating any older patient, health care providers should not make assumptions about what they can or cannot do sexually, or whether they prefer to avoid discussing their sexual concerns.
Patients should recognize that a healthy sex life is important at any age. While most individuals would prefer their physician to initiate conversations about sex, they should feel empowered to start a discussion and address their concerns.
Changes due to aging can impact sexual functioning. For most people, sexual desire remains normal until around age 75, when testosterone levels for both women and men often fall significantly. This may diminish sexual desire and can slow arousal.
For aging women, declines in estrogen can contribute to decreased vaginal lubrication. Over-the-counter, water-soluble vaginal lubricants are effective and easy to apply. For older men, erectile dysfunction is incredibly common, but most causes can be treated effectively under a physician’s guidance.
Older women are still capable of multiple orgasms, although these are often less forceful. Similarly, aging results in a lower volume of ejaculate for men. While orgasms may be milder with age, the majority of men and women say they are still pleasing.
Older adults use condoms less consistently than younger sexually active adults. Often older adults believe using condoms is primarily to prevent pregnancy and is no longer relevant for them. However, condom use is important for reducing STDs at all ages. Patients older than 50 account for about 10 percent of newly reported cases of HIV infection, and STDs of all kinds are increasing rapidly in the elderly population. Older adults should protect themselves from getting STDs and should be screened when they have a new partner, or if they have multiple partners.
While there is some decline with aging, sexual activity and the desire for a healthy sex life is far more common in older adults than cultural stereotypes lead us to believe. Not only is sexual activity pleasurable, it contributes to the overall health of older adults. Despite the physical changes and challenges that come with aging, older adults can make adjustments that will allow them to continue to enjoy both coital and noncoital sexual activity.
Content courtesy of Colleen Christmas, M.D., associate professor of medicine at the Johns Hopkins University School of Medicine. Content reproduced with permission of the Office of Marketing and Communications for Johns Hopkins Medicine International. Additional reuse and reprinting is not allowed. The information aims to educate readers and is not a substitute for consultation with a physician.