Aging And Sexuality

As senescence or signs of physiological aging sets in, most individuals get over-cautious about a lot of things; this includes personal as well as social. Additionally, some worries may begin to fade with time. For example, it has been observed that some couples tend to enjoy sex more than their youthful times due to more time, privacy, and lack of worries about getting pregnant.

But regardless of age, the important concern among aging adults is how to maintain a gratifying sexual relationship with their partner.

Physiological Changes With Aging That Can Influence Sexuality

A multitude of changes occur as we age; some of these changes can be problematic for sexual relationships. For example:

Physiological Changes In Women:

• Vagina transforms into a shorter and narrower passage, with thin and stiff walls.
• The weakening of pelvic floor muscles may make orgasms less intense and enjoyable.
• There may be vaginal drying effect as the level of estrogen fall after menopause.

All these changes in the vagina can make sex difficult and less pleasurable. In case of severe trouble, a gynecologist needs to be consulted.

Physiological Changes In Men:

• The most common issue in aging men is impotence or erectile dysfunction (ED).
• There is difficulty in having and sustaining an erection long enough to have a satisfying sexual intercourse.
• The erections are less firm and smaller than what they used to be in younger years. If these problems are occurring too frequently, a doctor’s advice should be sought.

Pathological Causes Of Sexual Problems With Advancing Age

1) Arthritis:

Joint pains can limit the sexual contact between the partners. Physical exercises, warm baths, medicines or joint replacement surgeries can help in improving the quality of results. In addition, change in the position /timing of sex should also be tried.

2) Chronic Body Pains:

Persistent pain can lead to loss of intimacy between older couples. Pain medicines should be taken after seeking advice from your doctor.

3) Memory Loss:

People with memory loss or dementia often respond in unusual ways; some may lose interest in the sexual activities altogther, others may show increased but inappropriate sexual behavior.

4) Diabetes:

In men, diabetes can lead to ED, whereas in women, diabetes aggravates the risk of yeast infections of vagina, causing intense irritation, discharge and itchiness. This may make sex uncomfortable.

5) Heart Diseases:

Females with heart disease may experience a problem in achieving orgasms; whereas men may have trouble with penile erections. A prior heart attack in either of the partners can create fear that sexual activity might cause another attack.

6) Urinary Incontinence:

In older women, loss of strength of pelvic floor muscles and extra pressure on abdomen during sex can cause urinary leakage, causing embarrassment and restriction of sexual activities. This condition can be managed medically/surgically.

7) Stroke:

Weakness or paralysis may limit movements during sex. However, change in position or medical devices can offer some help.

8) Depression:

Depression is common among the elderly which may lead to loss of interest in sex. It can be treated with drugs.

Additional Reasons For Sexual Problems

Surgery:

In females, hysterectomy/oophorectomy (removal of uterus and ovaries) and mastectomy (removal of one or both breasts) may make a woman conscious about her body. In men, prostatectomy (removal of prostate) may lead to ED or urinary incontinence which may interfere with sexual life. Men or women who are about to undergo any of these surgeries should talk to their doctor and seek therapy if needed.

Medications:

Different drugs like anti-hypertensives, antidepressants, tranquilizers and ulcer meds etc. may cause adverse effects like ED and ejaculation problems in men, and vaginal dryness and difficulty in achieving sexual arousal in women. Alternative drugs should be sought if side effects are interfering with the sex life.

Emotional Aspects:

Women may feel that they have become less attractive than before, and men may face issues such as ED, which can bring stressful, negative feelings. Old age brings additional stresses as well, like morbidities, retirement and lifestyle changes. All these should be addressed so that they do not interfere with a satisfying sexual life.

Old Age And Safe Sex:

There is a myth that the risk of STDs is lower in older people. The fact is that old age does not confer protection against STDs. So always practice safe sex, use condoms, and get regular medical checkups.

What to do?

• Always give your partner enough time and understand the natural age related changes. Trying different positions or timings for sex and adjusting to old age may help.
• A doctor should be consulted in case of troublesome changes. ED is treatable with drugs and penile pumps. Vaginal dryness, which may cause a painful intercourse, can be treated with lubricants or vaginal estrogen.

In short, a good supportive attitude and simple acts of intimacy like touching, hugging, and kissing can make a huge difference. Conversing and spending time with the partner can also overcome many problems to a great extent.

References

• Lochlainn, M. N., & Kenny, R. A. (2013). Sexual activity and aging. Journal of the American Medical Directors Association, 14(8), 565-572.
• Millar, A. C., Lau, A. N., Tomlinson, G., Kraguljac, A., Simel, D. L., Detsky, A. S., & Lipscombe, L. L. (2016). Predicting low testosterone in aging men: a systematic review. Canadian Medical Association Journal, 188(13), E321-E330.
• Portman, D. J., & Gass, M. L. (2014). Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and The North American Menopause Society. Climacteric, 17(5), 557-563.