Senior Sex

As we age, most people desire the need to be close to others. Moreover, as we approach the “golden years” many of us also want to maintain satisfying, active physical and sexual relationships.. Unfortunately, the aging process also may cause some undesirable changes in our bodies. The normal aging process brings many physical changes in both men and women. As we age we also sometimes develop conditions that may require medications. These changes and obstacles can sometimes affect one's ability to enjoy a healthy sexual relationship with another person. This slideshow of pictures explores healthy sexual relationships among individuals as we approach and reach our “golden years,” and how to overcome these obstacles in order to have a healthy and enjoyable sex life as you age.

Sexual Changes in Women

Some women find sex more enjoyable as they age. After menopause or hysterectomy they may no longer fear an unwanted pregnancy, and may feel freer to enjoy sex. For some women gray hair or wrinkles don't make them feel less attractive to their sexual partner. But if a woman believes that looking young or being able to give birth makes her more feminine, she may begin to worry about how sexually desirable she is no matter what her age,and that may make sex less enjoyable for her. A woman also may notice changes in her vagina. As a woman ages and hormones decrease, the vaginal wall thins and becomes drier and irritated. Due to these changes she may have pain with sexual intercourse. Microtears in the vaginal wall from the friction of intercourse generally cause the most pain, and at times bleeding. These changes do not mean she can't enjoy sex; but a woman should talk with her health care professional if she is experiencing these symptoms because there are prescription medications and over-the-counter lubricants that can increase vaginal lubrication and make sexual relations more pleasurable.

Sexual Changes in Men

As men age, impotence (erectile dysfunction or ED) becomes more common. Erectile dysfunction is the loss of the ability to have and keep an erection hard enough for sexual intercourse. By age 65, about 15% to 25% of men have this problem at least one out of every four times they have sex. This may occur in men with heart disease, high blood pressure, or diabetes - either because of the disease or the medication used to treat the condition.

A man may find it takes longer to get an erection. His erection may not be as firm, as large, or as hard as it used to be. The amount of ejaculate may be smaller. The loss of erection after orgasm may happen more quickly, or it may take longer before an erection is again possible. Some men may find they need more foreplay before sexual intercourse.

What Causes Sexual Problems as We Age?

Illness, disability, or the drugs you take to treat a health problem can affect your ability to have and enjoy sex. But, even the most serious health problems usually don't have to stop you from having a healthy and satisfying sex life. We'll take a look at some of the more common causes and helpful solutions for healthy sexual relationships on the next slides.

Sexual Problems as We Age - Arthritis

Joint pain due to arthritis can make sexual contact uncomfortable. Joint replacement surgery and drugs may relieve this pain. Exercise, rest, warm baths, and changing the position or timing of sexual activity may be helpful.

Sexual Problems as We Age – Chronic Pain

In addition to arthritis, pain that continues for more than a month or occurs on and off over time can be caused by other bone and muscle conditions, shingles, poor blood circulation, or blood vessel conditions. This discomfort, can in turn, lead to sleep problems, depression, isolation, and difficulty moving (mobility). These chronic pain conditions can interfere with intimacy between older people. Chronic pain does not have to be part of aging, and can often be treated.

Sexual Problems as We Age – Diabetes

Many men with diabetes do not have sexual problems, but this is one of the few illnesses that can cause impotence (erectile dysfunction or ED) and retrograde ejaculation. In most cases medical treatment can help.

Women with diabetes may experience sexual problems as well. Examples include vaginal dryness, painful intercourse, decreased libido, or an absent sexual response.

If you have diabetes and are experiencing sexual problems, talk with your health care practitioner as there are medications for both men and women, and over-the-counter lubricants for women that may be helpful.

Sexual Problems as We Age – Heart Disease

Narrowing and hardening of the arteries (atherosclerosis) can alter blood vessels so that blood does not flow freely. This can lead to problems with erections in men, as can high blood pressure (hypertension). Some people who have had a heart attack are afraid that having sex will cause another heart attack. The chance of this is very small. Most people can start having sex again 3 to 6 weeks after their condition becomes stable following a heart attack, if their doctor agrees. Always follow your doctor's advice.

Sexual Problems as We Age – Incontinence

In both men and women, bladder dysfunction can affect the ability to have a healthy sexual relationship. Common bladder problems in men and women that can cause leaking urine include.

• 1. Overactive bladder
• 2. Poor control for sphincter muscles
• 3. Urine retention
• 4. Urinary tract infections

Loss of bladder control or leaking of urine is more common as we age, especially in women. Stress (urinary) incontinence happens during exercise, coughing, sneezing, or lifting, for example. Because of the extra pressure on your abdomen during sex, incontinence might cause some people to avoid sex. The good news is that these conditions can usually be treated.

Sexual Problems as We Age – Stroke

The ability to have sex is rarely damaged by a stroke, but problems with erections are possible. It is unlikely that having sex will cause another stroke. Someone with weakness or paralysis caused by a stroke might try using different sexual positions or medical devices to help them continue having sexual intercourse.

What About Surgery and Drugs for Sexual Problems?

Many of us worry about having any kind of surgery - it is especially troubling when the genital area is involved. Happily, most people return to the kind of sex life they enjoyed before having surgery.

Sexual Problems in Women as We Age - Hysterectomy

A hysterectomy is a surgical procedure to remove the uterus. Hysterectomy does not interfere with sexual pleasure or orgasm. If a hysterectomy seems to take away from a woman's ability to enjoy sex, a counselor may be helpful. Counseling may also be helpful for men who feel their partners are "less feminine" after a hysterectomy.

Sexual Problems as We Age - Mastectomy

A mastectomy is a surgical procedure to remove all or part of a woman's breast. Your body is as capable of sexual response as ever, but you may lose your sexual desire or sense of being desired after mastectomy. Sometimes it is useful to talk with other women who have had this surgery. Programs like the American Cancer Society's (ACS) "Reach to Recovery" can be helpful for both women and men. Rebuilding of the breast (reconstruction) is also a possibility to discuss with your surgeon.

About 1500 American men develop breast cancer each year. In men, the disease can make their bodies produce extra "female" hormones. These hormones can greatly lower a man's sex drive.

Sexual Problems as We Age - Prostatectomy

A prostatectomy is surgical procedure that removes all or part of a man's prostate. This procedure is performed for several conditions or diseases including BPH (benign prostatic hyperplasia), acute urinary retention, urinary tract infection, hemorrhage or recurrent hematuria, bladder outlet obstruction, or renal insufficiency. Prostatectomy may cause urinary incontinence or erectile dysfunction ((impotence or ED). If removal of the prostate gland (radical prostatectomy) is needed, surgeons can often save the nerves going to the penis, so an erection may still be possible. Talk to your doctor before surgery about any concerns you have that may affect sexual intercourse.

Sexual Problems as We Age – Medications or Alcohol

Some drugs can cause sexual problems. These include some blood pressure medications, antihistamines, antidepressants, tranquilizers, appetite suppressants, diabetes drugs, and some ulcer drugs such as ranitidine (Zantac). Some medications can lead to impotence (erectile dysfunction or ED) or make it difficult for a man o ejaculate. Some drugs can reduce a woman's sexual desire. Check with your doctor since she or he can often prescribe a different drug without these side effects.

Too much alcohol can cause erection problems in men and delay orgasm in women.

Safe Sex and Pregnancy

Having safe sex is important for people at any age. As a woman gets closer to menopause, her periods may become irregular. But, she can still get pregnant. In fact, pregnancy is still possible until your doctor says you are postmenopausal (the definition of menopause is not having a menstrual cycle for 12 consecutive months).

Safe Sex and STDs

Age does not protect you from sexually transmitted diseases. Young people are at most risk for diseases such as syphilis, gonorrhea, chlamydial infection, genital herpes, hepatitis B, hepatitis C, genital warts, HIV, chancroids, ectoparasitic infections, AIDS, LVG (lymphogranuloma venereum), HPV, urethritis, crabs, pubic lice, and trichomoniasis. However, STDs can and do occur in sexually active older people.

Safe Sex and HIV/AIDS

Almost anyone who is sexually active is also at risk for becoming infected with HIV, the virus that causes AIDS. The number of older people with HIV/AIDS is growing. One out of every 10 people diagnosed with AIDS in the United States is over age 50. You are at risk if you have more than one sexual partner, are recently divorced, widowed, and have started dating and having unprotected sex. Always use a latex condom during sex, and talk to your doctor about ways to protect yourself from all sexually transmitted diseases (STDs). You are never too old to be at risk to contract an STD).

Can Emotions Play a Part in Sexual Satisfaction?

Sexuality is often a delicate balance of emotional and physical issues. How you feel may affect what you are able to do. For example, men may fear that impotence (erectile dysfunction or ED) will become a more common problem as they age. But, if you are too concerned with that possibility, you can cause enough stress to trigger impotence (erectile dysfunction or ED) . A woman who is worried about how her looks are changing as she ages may think her partner will no longer find her attractive. This focus on youthful physical beauty may get in the way of her enjoyment of sex. Older couples face the same daily stresses that affect people of any age. But they may also have the added concerns of age, illness, retirement, and other lifestyle changes. These worries can cause sexual difficulties. Talk openly with your doctor, or see a counselor. These health care professionals can often help.

Don't blame yourself for any sexual difficulties you and your partner may have. You may consider talking with a therapist about the problems. If your male partner is concerned about impotence (erectile dysfunction or ED) , or your female partner seems less interested in sex, don't assume they don't find you attractive anymore. There can be many physical causes for problems with sexual intimacy.

Senior and Single

Some older people, especially women, may have trouble finding a partner with whom they can share any type of intimacy. Women live longer than men, so there are more available older women than men. In 2000 women over age 65 outnumbered older men by 100 to 70. Participating in activities that other seniors enjoy, or going places where older people gather are ways to meet new people. There are numerous activities single seniors can participate in to meet men or women with similar interests, for example, mall walking, senior activity centers, adult education classes at community colleges, day trips sponsored by your city, or county recreation departments.

Talk To Your Doctor

If you do seem to have a problem that affects your sex life, talk to your doctor. He or she can suggest a treatment depending on the type of problem and its cause. For example, the most common sexual difficulty of older women is dyspareunia, painful intercourse caused by poor vaginal lubrication (vaginal dryness). Your doctor or a pharmacist can suggest over-the-counter, water-based vaginal lubricants to use. Or, your doctor might suggest estrogen supplements or an estrogen vaginal suppository or cream.

For men, if impotence (erectile dysfunction or ED) is the problem, it can often be managed and perhaps even reversed. There are medications that can help, for example, sildenafil (Viagra, Revatio), tadalafil (Cialis), and vardenafil (Levitra, Staxyn). These medications should not be taken if you are taking medications that contain nitrates, such as nitroglycerin. These medications also have possible side effects. Other available treatments include vacuum devices, self-injection of a drug (either papaverine or prostaglandin E1), or penile implants.

What Can I Do To Have An Active Sex Life As I Age?

There are several things you can do on your own to have an active sex life - remember that sex does not have to include intercourse. Follow a healthy lifestyle - exercise, eat healthy food, drink plenty of fluids like water or juices, don't smoke, and avoid alcohol. Try to reduce stress, see your doctor regularly and keep a positive outlook on life.

More Reading on Senior Health

• Senior Health: Successful Aging
• Senior Health - Choosing a Doctor
• Aging and Alcohol Use and Abuse
• Seniors: Shots for Safety
• Exercise for Successful Aging
• Dementia: Disorders of the Brain
• Alzheimer's Disease: A Caregiver's Guide