Sex and the Elderly

Information and Resources

Sex and the Elderly - There seems to exist a myth that seniors do not or should not have sex.

Not only is this not true, but this view by society about sex contributes to seniors feeling it is unacceptable to be interested in and enjoy their sexuality.

Though many people enjoy sex past their 70's, many more would likely enjoy their sexuality if they felt it was more acceptable.

The opportunity to develop or maintain an intimate relationship can be challenging for elderly people. Women in particular can have more difficulty finding a sexual partner because there are more elderly women than men, especially over the age of 75 when there are approximately 1.3 women to every man.

Elderly people may also have impacting factors such as loss of ability to drive, increased fear of going out at night, fixed budget - all of which can lead to social isolation. Finding and enjoying an intimate or sexual relationship under these circumstances can be difficult.

On the upside, retirement communities often have singles clubs, dance groups and social mixers. This seems to reflect the sexual interest and needs of residents and provides ample opportunities for meeting other people and developing relationships.

Elderly Health and Sexuality

Declining health can be significant barrier to sex and the elderly. If health begins to fail, there is resulting loss of independence that can take heavy emotional toll.

General health decline may result in a decline in sex and the elderly. Seniors report that better health for themselves and their partners is one of the most important factors in improving their sexual satisfaction.

One barrier to a healthy sexual relationship (elderly sex) is that elderly people do not always seek treatment for ailments that affect their sexuality due to embarrassment.

Though there are specific physiological changes in the sexual responses of postmenopausal women and aging men, there is no biological reason for healthy adults to stop having sex.

Factors that might affect elderly sex drive are a decrease in physical energy or increases in physical discomfort.

The most common difficulties experienced are related to sexual arousal and orgasm. Even if sexual activity becomes uncomfortable or impossible, though, other sexual activities can be pleasurable and rewarding in themselves.

Possible Physical Changes in Men:

• Decrease in the amount of testosterone which may result in decrease the size and firmness of testicles
• Reduction in sperm
• Increase in size and condition of prostate
• May take longer to get an erection
• May require more manual or oral stimulation of the penis to produce erection
• Erection may not be as firm or as large
• May experience a longer time before ejaculating
• May take longer to get a second erection after the first

As men age they are more likely to have erectile dysfunction - be unable to have and maintain an erection. This often goes unreported due to embarrassment. The following might put them at higher risk for erectile dysfunction:

• Vascular difficulties could affect blood flow to the penis to produce or maintain erection
• Heart disease/ drugs for heart disease
• Hypertension
• History of coronary bypass surgery
• Nerve damage from Diabetes or prostate surgery; often the first sign of Diabetes in older men is decreasing firmness of erections
• Many prescription drugs to treat other conditions
• Decreased emotional engagement surrounding sex
• Decreased supply of oxygen to the penis
• Lack of exercise
• Sleep deprivation
• Smoking
• Sexual abstinence
• Physical injuries

Possible Physical Changes in Women:

• Lowered levels of estrogen hormones after menopause
• Decrease in testosterone produced after menopause which can, but does not always, result in a drop in sexual desire
• Decrease in vaginal lubrication
• Decrease in vaginal expansion during arousal
• Changes in the shape and flexibility of the vagina - should not affect the ability to enjoy sexual activity

Many illnesses common among the elderly might affect sexuality.

Certain chronic conditions may affect sex and the elderly, such as:

• Cardiovascular Disease - including: 1) Heart Attack. Though blood pressure does increase during sexual activity, as long as the condition is under control as deemed by a physician, sexual activity should not be hazardous. Sexual activity is only prohibited by physicians in severe cases. After a heart attack or other cardiovascular event, a physician should be consulted prior to returning to sexual activity. 2) Arteriosclerosis, or hardening of the arteries, is a common cause of erection problems.
• Stroke - or cerebrovascular accident (CVA). Common problems are erectile dysfunction in men and poor vaginal lubrication in women.
• Arthritis - can contribute to fatigue, weakness, pain and limited movement Ð all of which could affect sexual activity. Pain and stiffness in the hip joints are the most common cause of sexual difficulty. On top of this, some of the drugs taken for arthritis have shown to decrease libido. For seniors suffering from arthritis, it is important to find positions that avoid or reduce pain and pressure on affected joints such as side lying or using furniture for support in laying, kneeling or standing.

Other Factors That Affect Sex and the Elderly:

• Alcohol and Drugs: Chronic, heavy alcohol or drug use
• Medications: Medications, prescription and over-the-counter. Many medications may impact sexual arousal or performance. Discuss with your physician and pharmacist if there are any alternatives available.
• Surgery: Many types of surgery can cause short-term difficulties. Surgeries that involve sex organs or glands may have more long-term effects. Some common surgeries such as hysterectomy or mastectomy should not impair sexual activity. If they do, consult your physician and consider counselling to address the emotional concerns associated. Surgical removal of all or part of the prostrate does not necessarily end a mans physical capacity for sexual activity. The capacity for erection and orgasm after a prostatectomy should return to pre-surgery level. If not, consult your physician.
• Living situation: If your loved one lives in an extended care unit or nursing home, often elderly sex and masturbation are discouraged which limits their ability to express sexuality. When dementia is a factor, there can be concerns around mutual consent. All these issues can be discussed and resolved with the health care team at the nursing home.

Treatment Options

Even though there are many new drugs and hormone treatment available for sex and the elderly, only a small percentage of seniors that are having difficulty with sex have actually tried them.

Those seniors that have tried these treatments report the satisfaction with their elderly sex life has improved. An added bonus is the report that this also often improves the relationships with their partners.

Sex and the Elderly Treatments for Men:

• Medications such as Viagra as prescribed by your doctor
• Vacuum device
• Surgical penile implant
• Sex therapy focus on awareness of feelings and enhancement of mental arousal with decreased focus on penile cues
• Discuss medications with your physician and pharmacist and if the medications and interactions of different medications might impact sexual activity. Discuss alternatives.

Sex and the Elderly Treatments for Women:

• Vaginal lubricants are readily available and effective
• Sex therapy to focus on intimacy
• Discuss medications with your physician and pharmacist and if the medications and interactions of different medications might impact sexual activity. Discuss alternatives.

Most adults, regardless of their age, are interested in sex, find sex satisfying and consider sex to be an important part of their lives. Sex and the elderly can still be enjoyable though bodies change and elderly people may respond more slowly or differently to sexual relations.

Seniors may benefit from slowing down and focusing on intimacy, not solely the act of sexual intercourse. They may spend more time hugging and cuddling, fondling and caressing to express affection.

Adults of any age should be able to enjoy the gratification of pleasurable and fulfilling sexual relationships.

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