Introduction
Finding
Your Sexual Expression
Changes
in the Body
The
Key to Continued Pleasure: Flexibility and
Willingness
Adaptations
for women
Adaptations
for men
Medications
Positions
to Try
Conclusion
Introduction
The best-loved nonagenarian
George Burns quipped that it’s “like
shooting pool with a rope”. Jokes abound about
the rapaciousness of senior females in quest of
a male functional enough to engage in it. And my
teenage son wrinkles up his nose and says “Eewww!”
when he hears about it. What is it? It’s sex
in the elderly, of course.
But what about sex in
the elderly? Media coverage of aging
baby-boomers and their older cousins would have
us believe that seniors are a homogeneous group
jumping into bed and “hooking up” with great
regularity. Sex is the newest Fountain of Youth.
In fact, the level of sexual interest and
activity among people over the age of 65 is as
diverse as the individuals who make up that
population.
The
statistics
A recent survey of married men
and women showed that 87% of married men and 89%
of married women in the 60-64 age range are
sexually active. Those numbers drop with
advancing years, but 29% of men and 25% of women
over the age of 80 are still sexually active.
So clearly, the older years
can be a time of relief that children are no
longer lurking in nearby bedrooms, and there is
no longer a need to jump up early in the morning
for work. For some, older age is a time of
freedom to explore sexual expression in ways
never before realized. A time to cast away the
“shoulds” of earlier years, the societal
expectations. For others, they are more than
happy to forget about sexual performance, and to
seek other forms of companionship and
interpersonal sharing.
Sexual
expression means many things
One of the most significant
losses with advancing age is the loss of
intimacy. Many seniors have no opportunity for
physical contact, affectionate dialogue,
snuggling, or shared secrets. The actual act of
intercourse is only one possible form of sexual
expression. The continuing development of your
sexual identity and the evolution of your own
form of sexual expression with advancing years
represents, in many ways, the most basic
expression of your self.
Sex is good
for you!
One fascinating recent study
showed that men who have more than two orgasms
per week have lower mortality statistics. But
these numbers only demonstrate a correlation
between sexual activity and longevity, they do
not prove that sex prolongs life. What is
probably true is that people who are well, and
vigorous enough to engage in sexual activity are
also healthier in general. But I believe that
sexual activity, in its many forms, can be
physically, intellectually, and even spiritually
fulfilling. It is often a good form of exercise,
and it can stimulate the brain and promote good
mental function. For some, sexual expression
represents the most elemental manifestation of
true self.
Finding
Your Sexual Expression
What is most important is to
find the type of sexual expression that suits
you best.
Self-stimulation
Some people, either by choice or
by necessity, find much gratification in sexual
self-stimulation. There may be some resistance
to this form of self-exploration by people who
were raised with the idea that self-stimulation
is “dirty” or perverted. But many who have
overcome this resistance have been exhilarated
by a whole new experience.
Sharing
sexual experience in new ways
Others explore sexual sharing in
new ways with a longtime partner, or with a new
partner. And still others, especially elderly
women, have discovered new intimacies with
same-sex partners, even after spending most of
their adult lives in heterosexual relationships.
Again, the key to satisfaction and fulfillment
with sexual experience in later life is
individual choice.
Changes
in the Body
There are many changes that
happen in our bodies as we age, and some of
these changes can modify sexual experience in
later years. Both women and men experience
slower arousal responses. This can lead to
anxiety in people who do not understand that
this change is normal.
Women’s
changing bodies
Women’s bodies change is some
of the following ways:
Chronic Diseases
Many chronic diseases that
elderly people experience can also modify sexual
expression.
Coronary
artery disease: Coronary artery
disease may lead to chest pain with sexual
activity, or fear of having a heart attack
during sex.
Chronic
lung disease: Chronic lung disease
can lead to breathlessness.
Arthritis:
Arthritis may impair the ability to
use some positions for sex.
Embarrassment:
Some older persons may find that
embarrassment over the loss of a breast, or the
presence of a colostomy bag or some other
apparatus, may inhibit free sexual expression,
especially with a new partner.
Medications:
For other people, medications taken
for many chronic diseases, especially
hypertension and heart disease, may cause either
a loss of libido or impaired performance.
The
Key to Continued Pleasure: Flexibility and
Willingness
So is all of this enough to
make older people pack it in and forget about
sexual activity? Of course not! The key is a
willing spirit and the ability to be flexible
and adapt to change. Here are some of the
numerous ways men and women can adapt to aging
changes and continue to be, or become, a sexual
person:
Slow
down: Realize that sexual arousal
takes longer and requires more manual
stimulation.
Make
the most of foreplay: Take all the
time that you often didn’t have in your
younger days to pleasure each other or yourself.
Communicate:
Share what makes you feel good with
your partner.
Use
your sensory skill: Take time to
explore in great detail all the tactile, visual,
auditory, and even olfactory aspects of being
intimate.
Play
with the mood: Take time to set the
stage for a special experience –
experiment with lighting, music, candles, oils,
perfumes, and incense. Try a new place.
Adaptations
for women
Here are some suggestions for
older women:
Lubrication:
Make adequate lubrication part of
your routine, to avoid irritation of the vagina
or painful intercourse. The first part of
lubrication is adequate stimulation, but an
over-the-counter lubricant can be a very helpful
adjunct. A water-based lubricant, such as
Astroglide, K-Y Jelly, or Today, is best;
oil-based lubricants and petroleum products such
as Vaseline may be difficult to flush out of the
vagina, and may cause irritation or infection.
Applying the lubricant yourself can be a good
way to get in the mood. You could also make
applying the lubricant part of your lovemaking
routine!
Vaginal
estrogens: Some women with extreme
vaginal dryness and irritation may benefit from
a short course of vaginal estrogens, but
remember that estrogens are absorbed through the
vagina, and the systemic effects of estrogens,
both positive and negative, should be considered
and discussed with your doctor. If you use
estrogen cream, use as little as is effective
for as short a time as possible to get the
desired effect. Of course, you may be taking
oral estrogens for other reasons, in which case
you will also experience beneficial effects on
the vagina.
Adaptations
for men
Here are some thoughts for older
men:
Be
patient: Realize that more
stimulation is required to achieve an erection.
If you can’t achieve a satisfying or effective
erection despite prolonged manual stimulation,
you may be one of many men who experience
erectile dysfunction. But don’t give up. See
your doctor, who may either treat you
her/himself or refer you to a urologist (see
‘Medications’ below).
For
men with heart disease: Men who have
heart disease may be particularly concerned
about whether sex will put too much strain on
their heart, and men who have had a heart attack
or heart surgery wonder when or if they can ever
resume sexual activity. You should discuss this
with your doctor. For the most part, sexual
activity may be resumed within about two to four
weeks after a heart attack. If you can climb two
flights of stairs without chest pain or
shortness of breath, you should be able to
engage in sexual activity without concern, as
this is more vigorous exercise than having sex.
If you are prone to chest pain with sex, discuss
taking a nitroglycerine tablet under the tongue
before sex, and experiment with positions to
find one that is less physically demanding for
you (see below).
Medications
If you are taking medications
and think that one of them may be impairing your
sexual performance, be sure to discuss it with
your doctor. Let him or her know that sexual
activity is important to you. Frequently, other
medications can be substituted that have less
effect on sexual activity.
Testosterone:
If you would like to be more sexually
active, but find that your libido is impaired,
you might possibly benefit from testosterone. I
think that testosterone has been greatly
overblown as a potential enhancer of strength,
energy, and overall well being, but it has been
shown to improve sexual performance in men who
have low testosterone levels, and to increase
libido when taken in small doses by women. Ask
your doctor about whether you should be
evaluated for this option.
Viagra:
If you are suffering from one of many
treatable medical conditions that cause
impotence, a medical evaluation is indicated,
and you can be helped. Some examples of diseases
that interfere with sexual response are
diabetes, thyroid disease, and depression. Once
you have had a thorough medical evaluation, you
may well benefit from a medical treatment for
impotence. The one everyone has heard about and
is interested in is Viagra. Viagra is a chemical
substance called silendafil, which acts by
inhibiting the action of a phosphodiesterase,
which ends erection. The phosphodiesterase works
by breaking down cGMP, the substance that
relaxes penile muscles, thereby drawing blood
into the penis and causing erection. Viagra has
been shown to be very effective for many
different types of erectile dysfunction. It is
relatively safe, except that it cannot be taken
by men who use nitrates for heart disease.
Alternatives
to Viagra for men: If Viagra is not
an option for one reason or another, there are
other medications that can be tried. Some
involve application into the urethra, or
injection into the penis. Some men benefit from
a vacuum pump device to aid in erection, and
others may choose the surgical implantation of a
penile prosthesis. If you are considering any of
these options, be sure to see a urologist who is
expert in this field.
Positions
to Try
Experiment with different
positions if pain, strength, or endurance is an
issue for you. Some options are: