How older adults can benefit from “Sex Ed 2.0”
Today’s seniors may have grown up with the 1960s sexual revolution, but that doesn’t mean they are comfortable with sex now. Numerous studies show that sexual health problems are common among older adults and that people are reluctant to talk about sex with their doctors and romantic partners.
A healthy sex life remains important in the later half of life, but sexual functioning and the need for information may change, says Susan Wysocki, a nurse practitioner and medical adviser for the American Sexual Health Association.
"During aging, we look at a lot of different health factors, but often skip over the most common of the things that keep people happy and healthy," Wysocki says. "Whether it’s sex – or for some adults, fondling or cuddling – that need is the most normal thing in the world."
Seniors are interested in sex, according to one of the most thorough examinations of the issue, published in 2007 in the New England Journal of Medicine. The eye-opening study of more than 3,000 men and women ages 57 to 86, found almost three-quarters of people ages 57 to 64 were sexually active while more than half of people 65 to 74 were sexually active. Among people ages 75 to 85, more than one-quarter were sexually active.
The rates were somewhat surprising given that about half of sexually active men and women reported at least one "bothersome" sexual problem. For women, the top reason was low desire, followed by difficulty with vaginal lubrication. Among men, the major difficulty was erectile dysfunction.
But the reluctance to talk about sex problems can be a barrier to finding solutions.
“Talking about sexual function is much less taboo than it was decades ago, but communication may still be lacking. Who gives a senior a sex talk?” asks Wysocki, who is president of iWomansHealth and past president and CEO of the National Association of Nurse Practitioners in Women’s Health.
The lead author of the 2007 study, Stacy Tessler Lindau, MD, a professor of obstetrics and gynecology and medicine-geriatrics at the University of Chicago and a leading researcher on aging and sexuality, says men may be more likely to discuss sexual health issues with their doctors than women.
"The conversation about sexuality in the context of aging shifted dramatically it the late 1990s with the release of sildenafil and the other erectile dysfunction drugs," says Lindau, the director of the Program in Integrative Sexual Medicine at the University of Chicago, and founder of a website called WomanLab that provides free science-based sexual health information for women, their partners, and their physicians. "There is no question that bringing effective treatments to market for male sexual function really opened the door for conversations between men and their doctors. I think the conversations between women and their gynecologists have increased in number, although the vast number of women would say their doctors don’t raise the topic routinely.”
A recent study of more than 2,000 women ages 45 to 75, published in Menopause, The Journal of the North American Menopause Society, found that sexual health problems can interfere with quality of life. The study found that vaginal atrophy, which causes vaginal dryness and burning and often interferes with intimacy, affects 98% of postmenopausal women. However, many women consider these symptoms part of aging and don’t discuss the problem with healthcare providers, said the authors of the study.
Some people dealing with sexual dysfunction may simply not know where to turn, Lindau says. Urologists, for men – and gynecologists, for women – can help patients with a number of physiological problems linked to sex. Geriatricians are particularly well-trained to help with issues like maintenance and recovery of sexual function, but many lack specific training in treating sexual problems, especially among women, she says.
“The field of geriatrics understands mind and body and looks at the whole person rather than being disease-focused," she says. Geriatricians aim to help older adults preserve or recover bodily functions, whether that’s memory, physical fitness, or sexual function, she explains.
There are solutions to many of the problems that can derail sexual activity in later life, experts say. While erectile dysfunction medications have been a boon to men, drug companies have not produced a similar blockbuster class of medications for women with sexual issues. But several newer medications for women are available, including medications for vaginal dryness and vaginal atrophy, as well as flibanserin, a pill that treats hypoactive sexual desire in premenopausal women. The drug’s mechanism of action is not well understood.
Besides talking to doctors about solutions, couples need to converse with each other about sex over their lifespans, experts say.
“Older men and women may not have the words to say what they need for optimal sexual function,” Lindau says. “The longer you are with a partner, the harder it might be to say ‘That is not what I need for satisfaction’ or ‘as I’ve gotten older, my preferences have changed.’”
A couple’s counselor or sex therapist can often help. For couples with an otherwise strong and loving relationship, just a few sessions of counseling may be very beneficial, Lindau says.
It’s also important for older adults to talk about the risks of sex, especially in new relationships. Rates of sexually transmitted diseases, including HIV, are much lower among older adults, but they do happen.
“There are male and female condoms,” Lindau says. “If you’re starting a new relationship, you want to know if your partner has been tested for infections, and you want to use protection.”
Older adults should not be embarrassed to speak with healthcare professionals or their sexual partners about concerns, questions, and needs, Wysocki says.
“It’s important to be as informed as you can and to recognize that you are not alone," she says. "You are not alone for wanting to connect; to express feelings in a physical way. And you are not alone with having some difficulty being able to do that."