With society's burgeoning population of elderly men and women, open discussions about sex and aging are particularly important for maintaining a high quality of life. As a nurse and therapist in private practice, specializing in therapy for individuals and couples who have sexual concerns, I have a special interest in promoting a positive, healthy view of sexuality.
There are a number of ingredients for intimate sex that apply to adults of all ages and these key ingredients are worth reviewing. Then by explaining some of the changes in sexuality which accompany aging, I want to encourage the kind of discussion which can build a new image for sexual interaction as an activity to be enjoyed throughout life.
The good news is that as we grow older and mature we are able to develop the capacity as individuals to truly show and share ourselves with a partner, thereby being intimate in ways that are not possible for young adults. Rather than focusing on a biologically-driven sex urge, we can focus on an intimacy driven sex urge. Although our bodies change as we grow older and there may be an increase in health problems that can have an impact on our sex lives, the autonomy and wisdom that can come with aging not only increases our potential for intimacy, it also allows us to enjoy more intimate and erotic sex.
Sex is one of the most sensitive barometers of a relationship. Often part¬ners can continue to function in other areas, but if there are underly¬ing relationship problems, these will show up in the sexual arena. We must always pay attention to what is going on in our relationship and seek to understand each other. Talking is a prime vehicle to gain understanding of one another. Seniors generally have more time available for each other because the children are grown up and they may be working less outside the home. However, many seniors are active and busy. They may find great benefit from setting aside some time to be intimate with one another.
How Aging Affects Sexual Function
Let's examine the physiological ramifications of aging as it pertains to changes in sexual functioning for women and for men.
For Women:
Postmenopausal changes in women may include reduction of vaginal lubrication and some atrophy of the vagina and loss of elasticity in the surrounding muscles. These changes are caused by the reduction in the hormone estrogen. In cases where the woman's symptoms make intercourse uncomfortable, an estrogen cream or an oral estrogen supplement may be prescribed.
If a woman is sexually active, she is less likely to develop symptoms and less likely to need hormone replacement. Sexual desire need not change if general emotional and physical health is good. Usually, a longer period of sexual stroking is required before vaginal lubrication develops. Although swelling of the clitoris and labia during arousal is lessened with age, there is no change in the sensory capacity of the clitoris. Multiple orgasms are still a possibility, if this is something that a woman has formerly experienced. During orgasm, there are fewer vaginal contractions, but because the intensity of the orgasmic experience is subjective, the level of satisfaction need not change.
For Men:
Unlike the period of menopause that women experience, men's changes are due to a slow progressive decline in the testosterone level. As a man ages, his penile erection may be somewhat less firm, and getting an erection may require more time than when he was younger. It may also be more difficult to regain an erection when stimulation has been interrupted. It is especially important to understand that older men will likely require more direct genital stimulation to achieve erection.
What is often perceived as an advantage of the aging process is control of ejaculation, which allows a man to maintain the plateau level of sexual pleasure for longer periods.
Semen is reduced in quantity, the ejaculation is not as forceful, and penile contractions are fewer in number and intensity. The interval after ejaculation when the male is not able yet to regain an erection becomes longer (i.e., the resolution phase).
Aging Couples Do Have Sex
It is becoming clearer that aging couples can (and do) engage sexually with more frequency than our societal myths would have us believe. However, some individuals experience problems from chronic illness or changes in mobility. In therapy, I often help couples resolve a discrepancy in sexual desire by helping each partner talk about desires and abilities, so that they can resolve their differences. Often both realize that they are able to express and enjoy their intimacy in ways which each had been unsure that the other partner might enjoy, ways which did not involve intercourse, but which satisfied both partners.
I once spoke with a man in his early seventies, a widower for ten years before, who had recently begun sexual activity with a new partner. The man felt very disturbed by being unable to have more than a partial erection (not sufficient for intercourse) with his lady friend. It seems that he had not yet been comfortable encouraging the woman to provide direct penile stimulation. He had not realized that due to the aging process more stimulation was now required than he had received from kissing and holding his partner. Once adequate stimulation was provided, his erection function was sufficient for satisfying intercourse.
Recent medical advances have improved the sex life of many older men and women. For example, for men we now have the PDE5 Inhibitors (Viagra, Levitra and Cialis) to orally treat erectile dysfunction, and for women we have several different kinds of local estrogen therapies to treat vaginal dryness due to post-menopausal estrogen depletion.
Properly prepared with the knowledge of those sexual changes which may normally occur with aging, a person can proceed with a positive sexual self-image and high esteem, finding many creative ways to continue sexual expression. There is great variability among aging people regarding their sexual values, sexual interest, and sexual capabilities. Ideally, all of us can grow as individuals, sexually and otherwise, and meet in our own creative ways the challenges of aging.