Sex When You're Elderly

When it comes to sex and the older woman or older man, you can still have a good sex life but adaptation to change is the key.

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 sex when you're elderly was "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:

• The lips of the vagina (the labia) and the tissue covering the pubic bone lose some of their firmness.

• The walls of the vagina become less elastic.

• The vagina itself becomes drier.

• The clitoris can become highly sensitive, even too sensitive.

• Uterine contractions with orgasm may at times be painful.

Men's changing bodies

The entire male sexual response tends to slow down in the following ways:

• There is a delay in erection.

• There is a need for more manual stimulation to achieve an erection.

• The "plateau" phase, or period between erection and ejaculation, is prolonged.

• Orgasm is shorter and less forceful.

• The penis loses its firmness rapidly after ejaculation.

• The "refractory period", or time interval before erection is able to be achieved again, can be quite long, even up to a week in very elderly men.

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.

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.

Medications

If you are taking medications and think that one of the medications 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 (sildenafil citrate), Levitra (vardenafil HCI), Cialis (tadalafil): 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 is Viagra (sildenafil citrate). (sildenafil citrate) is a chemical substance called sildenafil, 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 (sildenafil citrate), along with it's newer cousins and Cialis (tadalafil), have 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 (sildenafil citrate) for men: If Viagra (sildenafil citrate) 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:

• The "spoon position", in which both partners lie on their sides, the woman with her back to the man, is great for intimacy with or without intercourse.

• The woman on her back and the man at a right angle to her on his side.

• The person with less strength or endurance on her/his back, with the stronger partner kneeling above.

Conclusion

If you are interested in being sexually active, with or without engaging in intercourse, and the above suggestions are not sufficient to help you achieve the level of activity you desire, ask for help. Your primary care doctor, urologist, or gynecologist may be able to help, or may refer you to a sex therapist.

Don't fall into the ageist trap of thinking that sex is only for the young. Sexuality in your older years is all about breaking down stereotypes, open communication, individual choices, and embarking on a path of wonderful self-discovery. Enjoy!