Aging and Sexuality

Normal Physical Changes with Aging

Many of the physical effects of aging on the female reproductive system are related to the decrease in levels of female hormones, particularly estrogen, due to menopause. As a woman ages, her breasts become less firm, more fibrous, and tend to sag while the ovaries and uterus shrink. The vagina shortens and narrows, the vaginal walls become thinner and stiffer, and it may take longer for the vagina to swell and lubricate. Decreased muscle tension in the pelvic region and decreased uterine contractions during climax may diminish the intensity and length of orgasm (Potter, 2007). These changes may make intercourse less pleasurable and even painful.

Longer foreplay, estrogen cream, or estrogen-replacement therapy may help stimulate your body’s natural lubrication, or you can try a lubricant. Regular vaginal penetration helps maintain lubrication and elasticity and studies have found that less sexual activity tends to lead to decreased interest in sex (Nusbaum, Lenahan, & Sadovsky, 2005). So remember, you either “use it or lose it!”

Psychological Aspects of Aging

In addition to physical changes, psychological concerns may also affect your ability to have and enjoy sexual activity. Normal aging-related changes in appearance may make you feel less attractive and reduce your sex drive because you think that your partner will not find you attractive. Similarly, worrying about how you will perform may lead to a lack of arousal. Misunderstanding about normal age-related changes may exacerbate psychological insecurities and sexual difficulties may lead to feelings of failure, loss of self-esteem, disappointment, or anger. Furthermore, stressful life events beginning or worsening in midlife, such as retirement, divorce, and illness, can lead to diminished desire and sexual difficulties.

It is also important to keep in mind the impact that relationship issues can have on sexual health. Studies have found that relationship troubles are a major contributor to the decline of sexual activity in older adults (Wiley & Bortz, 1996). In fact, a partner’s sexual difficulties is a common concern among aging women (Nusbaum, Helton, & Ray, 2004; Nusbaum, Singh, & Pyles, 2004). It may also help to note that a gradual decline in libido, often associated with menopause, is normal (Potter, 2007).

Sexual therapy, or open discussions with your partner, may be helpful for interested couples. Those without partners may benefit from medical and psychotherapeutic interventions that promote solitary sexual activity. Discussing your concerns with your doctor often helps individuals adjust to age-related physical changes.

Other Causes of Sexual Difficulties:

Hysterectomy: This surgery to remove the uterus does not physically impact a woman’s sexual functioning, although it may affect sexual activity if it leads her or her partner to view her as “less feminine.”
Mastectomy: This surgery to remove all or part of a woman’s breast may make you lose your libido or sense of being desired, but it does not affect your body’s ability to respond sexually.
Privacy may be a particular concern for those who are living with family members or in assisted living communities.
Chronic pain and joint pain from arthritis may interfere with sexual activity. Try changing the position or timing of sexual activity and talk to your doctor about ways to manage these health problems so that they don’t keep you from having a sex life.
Incontinence, the loss of bladder control or leaking of urine, becomes more common as we age. It may be worse when there is stress on the body from exercise, coughing, sneezing, or pressure on the abdomen during sex. Some women may avoid sex because of this condition, but it can usually be treated by your doctor.
Some medications, including those for diabetes, cardiovascular, and pulmonary disease, can cause sexual problems. For example, medications used to control high blood pressure can reduce libido and lubrication in women. Antihistamines, antidepressants, and acid-blocking drugs, as well as alcohol, may also affect sexual function.

What Can I Do?

As you age, sexual activity other than vaginal intercourse, such as oral sex, masturbation, sensual touching, or cuddling, may be more satisfying.
Discuss your changing needs and ways your partner can accommodate them during sex. You my need to try different positions and/or sexual activities.
Adjust your routine to your changing lifestyle. As you age, you may get fatigued more easily or take longer to get aroused so try to have sex when you have the most energy and be sure to set aside enough time for sex.
Some older people may prefer to engage in masturbation, especially if they are unmarried, widowed, divorced or have a partner who is ill or away.
Although it does not work for everyone, some women respond to sildenafil, or Viagra, with heightened arousal and lubrication as well as increased blood flow to the vagina and clitoris.
Stay healthy

Estrogen and Sexual Function

Although estrogen is effective in reversing some of the symptoms of menopause, it generally does not restore sexual functioning in women. Supplemental estrogen may protect vaginal tissue from the effects of aging, but it can also reduce levels of testosterone, the hormone that regulates sex drive in men and women. While most aging individuals produce enough testosterone to maintain their libido, women with low testosterone levels may respond well to supplemental testosterone (Davis, 2000). After a hysterectomy, women who take supplemental estrogen and testosterone can have greater libido that those taking only estrogen or a placebo (Sherwin & Gelfand, 1985).

Safe Sex at Any Age

A woman’s periods become more irregular as menopause approaches, but she can still get pregnant. Pregnancy is still possible until you are past menopause, which means that you have not had a menstrual period for a full year. Additionally, age does not protect you from sexually transmitted disease such as syphilis, hepatitis B, and HIV/AIDS. According to the Centers for Disease Control and Prevention (CDC), approximately 19 percent of people diagnosed with AIDS in 2005 were over 50 years of age. Always use a latex condom during sex and talk with any new potential partner about being tested for HIV.

The Sexual Response Cycle (Nusbaum, Lenahan, Sadovsky, 2005)

Desire. Environmental, psychological, cultural, and physiological processes all play a role in this phase. Physiologically, desire involves neurotransmitters, the senses, and various hormones such as androgens, testosterone, and DHEAS. A man’s testosterone level begins to decline in his 50s, while DHEAS levels begin to decline in both men and women when they are in their 30s. Lower levels of androgens can decrease breast and genital sensitivity. Desire may be affected by age-related changes in the senses, such as smell or sight. Additionally, various illnesses and medications may change the levels of hormones and neurotransmitters and thereby decrease desire.

Arousal and Plateau (peak of arousal). These two phases depend on the nervous system and vascular system. Increasing blood flow to the genitals leads to vaginal lubrication. Age-related changes in nerves and blood vessels may impair this flow of blood.

Orgasm. Aging women are still able to have multiple orgasms. However, they may tire sooner, have less sensation because of decreased muscle tone, and require longer direct physical stimulation to achieve an orgasm.

Resolution. As we age, this phase occurs more quickly.

For more information, visit:

http://www.niapublications.org/agepages/sexuality.asp

http://womenshealth.gov/ow/index.cfm?style=large