Sexual Health and Aging: FAQs Explained by A Geriatrician

Better

Why talk about this topic?

Because people generally don’t. And yet it can be so important for quality of life and part of the human experience, at all ages.

What does sexual health mean as we get older?

That really is in the eye of the beholder. For some, it may mean physical intimacy with simply being close to a loved one. For others, it may mean intercourse, oral sex, or masturbation. It also includes ideas of self-image, emotional expression and personal identity.

That’s fine, but what’s normal?

Studies show sexual activity does decrease with age, but continues for many people into their 80s and 90s. This suggests what’s normal is really specific to you. If you’re a 68 year old and sexually active, you are normal. If you’re a 68 year old and not sexually active, you are normal. Stacy Lindau and colleagues did a survey of roughly 3,000 adults in the US aged 57-85.2 For men, 84% of 57 to 64 year olds, 67% of 65 to 74 year olds, and 38% of 75 to 85 year olds had sexual activity with a partner in the last 12 months. For women, 62% of 57 to 64 year olds, 40% of 65 to 74 year olds, and 17% of 75 to 85 year olds had sexual activity with a partner in the last 12 months.

What can be challenging about sexual activity as we age?

Finding a partner can be a challenge, particularly after the loss of a loved one. Issues of privacy can become more difficult too if you live with your children or in a facility. Then there are common physical and mental challenges. Dr Lindau’s survey found, of those sexually active, roughly half reported a sexual problem, including erectile dysfunction, lack of interest, climaxing too quickly, performance anxiety, and inability to climax for men and lack of interest, lubrication issues, inability to climax, finding sexual activity not pleasurable, and pain associated with activity for women.

Some of these issues can be a normal part of aging. But they can also be complicated by medical problems, particularly diabetes, high blood pressure, heart disease, prostate problems, back pain, lung problems, depression, anxiety, obesity, smoking, and alcohol intake. And, as people age, we tend to accumulate more of these chronic conditions. Often times chronic diseases come with longer medication lists, and, surprise, sexual dysfunction can be a common side effect of many medications as well.

Can anything be done?

Sometimes. There are pills, lubricants, and creams available by prescription and over the counter, depending on your particular issue. There are also sex therapists. If a medication side effect is contributing, an alternative medication may be available. And you can work hard to control your contributing chronic medical conditions. It is important to know these options exist and that your doctor can help you navigate what may be specific to you. But we also run the risk of over-medicalizing sexual health and setting the wrong expectation that all frustrations can be fixed and you’re abnormal if you aren’t wanting to be sexually active in your later years. The focus should be less on what’s “normal” for your age, and more on how do you feel about your overall sexual well being.

I encourage you to think about what sexual wellbeing means to you. If you have a partner, ask about their wellbeing too. Many people are hesitant for various reasons to bring these issues up with their doctor, but, if you wish things were different, you should bring it up with your physician as help can be available.

 

References:
1 Lochlainn MN and Kenny RA. Sexual Activity and Aging. Journal of the American Medical Directors Association (JAMDA), 14 (2013): 565-572.
2 Lindau S et al. A Study of Sexuality and Health among Older Adults in the United States. New England Journal of Medicine (NEJM). Aug 23, 2007. 357:762-74.
3 Taylor A and Gosney M. Sexuality in Older Age: Essential Considerations for Healthcare Professionals. Age and Ageing 2011; 40: 538–543