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People
seem to want and need to be
close to others. We want to
share our thoughts and
feelings with others and to
touch and be touched. Just
being physically near is
important, but many of us
also want to continue an
active, satisfying sex life
as we grow older. However,
over time most people may
find that it takes them
longer to become sexually
aroused. This is part of the
normal aging process.
What Are Normal Changes?
Normal aging brings physical
changes in both men and
women. These changes
sometimes affect one’s
ability to have and enjoy
sex with another person.
Some women enjoy sex more as
they grow older. After
menopause or a hysterectomy,
they may no longer fear an
unwanted pregnancy. They may
feel freer to enjoy sex.
Some women do not think
things like gray hair and
wrinkles make them less
attractive to their sexual
partner. But if a woman
believes that looking young
or being able to give birth
makes her more feminine, she
may begin to worry about how
desirable she is no matter
what her age is. That might
make sex less enjoyable for
her.
A woman may notice changes
in her vagina. As she ages,
her vagina shortens and
narrows. The walls become
thinner and also a little
stiffer. These changes do
not mean she can’t enjoy
having sex. However, most
women will also have less
vaginal lubrication. This
could affect sexual
pleasure.
As men get older, impotence
becomes more common.
Impotence is the loss of
ability to have and keep an
erection hard enough for
sexual intercourse. By age
65, about 15 to 25% of men
have this problem at least
one out of every four times
they are having sex. This
may happen in men with heart
disease, high blood
pressure, or
diabetes—either because of
the disease or the medicines
used to treat it.
A man may find it takes
longer to get an erection.
His erection may not be as
firm or as large as it used
to be. The amount of
ejaculate may be smaller.
The loss of erection after
orgasm may happen more
quickly, or it may take
longer before an erection is
again possible. Some men may
find they need more
foreplay.
What Causes Sexual Problems?
Illness, disability, or the
drugs you take to treat a
health problem can affect
your ability to have and
enjoy sex. But, even the
most serious health problems
usually don’t have to stop
you from having a satisfying
sex life.
Arthritis. Joint pain due to
arthritis can make sexual
contact uncomfortable. Joint
replacement surgery and
drugs may relieve this pain.
Exercise, rest, warm baths,
and changing the position or
timing of sexual activity
can be helpful.
Chronic pain. In addition to
arthritis, pain that
continues for more than a
month or comes back on and
off over time can be caused
by other bone and muscle
conditions, shingles, poor
blood circulation, or blood
vessel problems. This
discomfort can, in turn,
lead to sleep problems,
depression, isolation, and
difficulty moving around.
These can interfere with
intimacy between older
people. Chronic pain does
not have to be part of
growing older and can often
be treated.
Diabetes. Many men with
diabetes do not have sexual
problems, but this is one of
the few illnesses that can
cause impotence. In most
cases medical treatment can
help.
Heart disease. Narrowing and
hardening of the arteries
known as atherosclerosis can
change blood vessels so that
blood does not flow freely.
This can lead to trouble
with erections in men, as
can high blood pressure
(hypertension).
Some people who have had a
heart attack are afraid that
having sex will cause
another attack. The chance
of this is very low. Most
people can start having sex
again 3 to 6 weeks after
their condition becomes
stable following an attack,
if their doctor agrees.
Always follow your
doctor’s advice.
Incontinence. Loss of
bladder control or leaking
of urine is more common as
we grow older, especially in
women. Stress incontinence
happens during exercise,
coughing, sneezing, or
lifting, for example.
Because of the extra
pressure on your abdomen
during sex, incontinence
might cause some people to
avoid sex. The good news is
that this can usually be
treated.
Stroke. The ability to have
sex is rarely damaged by a
stroke, but problems with
erections are possible. It
is unlikely that having sex
will cause another stroke.
Someone with weakness or
paralysis caused by a stroke
might try using different
positions or medical devices
to help them continue having
sex.
What About Surgery and
Drugs?
Surgery. Many of us worry
about having any kind of
surgery—it is especially
troubling when the genital
area is involved. Happily,
most people do return to the
kind of sex life they
enjoyed before having
surgery.
Hysterectomy is surgery to
remove the uterus. It does
not interfere with sexual
functioning. If a
hysterectomy seems to take
away from a woman’s
ability to enjoy sex, a
counselor may be helpful.
Men who feel their partners
are "less
feminine" after a
hysterectomy may also be
helped by counseling.
Mastectomy is surgery to
remove all or part of a
woman’s breast. Your body
is as capable of sexual
response as ever, but you
may lose your sexual desire
or sense of being desired.
Sometimes it is useful to
talk with other women who
have had this surgery.
Programs like the American
Cancer Society’s (ACS)
"Reach to
Recovery" can be
helpful for both women and
men. Rebuilding of the
breast (reconstruction) is
also a possibility to
discuss with your surgeon.
About 1500 American men
develop breast cancer each
year. In them the disease
can make their bodies make
extra "female"
hormones. These can greatly
lower their sex drive.
Prostatectomy is surgery
that removes all or part of
a man’s prostate.
Sometimes this procedure is
done because of an enlarged
prostate. It may cause
urinary incontinence or
impotence. If removal of the
prostate gland (radical
prostatectomy) is needed,
doctors can often save the
nerves going to the penis.
An erection may still be
possible. Talk to your
doctor before surgery to
make sure you will be able
to lead a fully satisfying
sex life.
Medications. Some drugs can
cause sexual problems. These
include some blood pressure
medicines, antihistamines,
antidepressants,
tranquilizers, appetite
suppressants, diabetes
drugs, and some ulcer drugs
like ranitidine. Some can
lead to impotence or make it
hard for men to ejaculate.
Some drugs can reduce a
woman’s sexual desire.
Check with your doctor. She
or he can often prescribe a
different drug without this
side effect.
Alcohol. Too much alcohol
can cause erection problems
in men and delay orgasm in
women.
Am I Too Old To Worry About
Safe Sex?
Having safe sex is important
for people at any age. As a
woman gets closer to
menopause, her periods may
be irregular. But, she can
still get pregnant. In fact,
pregnancy is still possible
until your doctor says you
are past menopause—you
have not had a menstrual
period for 12 months.
Age does not protect you
from sexually transmitted
diseases. Young people are
most at risk for diseases
such as syphilis, gonorrhea,
chlamydial infection,
genital herpes, hepatitis B,
genital warts, and
trichomoniasis. But these
diseases can and do happen
in sexually active older
people.
Almost anyone who is
sexually active is also at
risk for being infected with
HIV, the virus that causes
AIDS. The number of older
people with HIV/AIDS is
growing. One out of every 10
people diagnosed with AIDS
in the United States is over
age 50. You are at risk if
you have more than one
sexual partner or are
recently divorced or widowed
and have started dating and
having unprotected sex
again. Always use a latex
condom during sex, and talk
to your doctor about ways to
protect yourself from all
sexually transmitted
diseases. You are never too
old to be at risk.
Can Emotions Play a Part?
Sexuality is often a
delicate balance of
emotional and physical
issues. How you feel may
affect what you are able to
do. For example, men may
fear that impotence will
become a more common problem
as they age. But, if you are
too concerned with that
possibility, you can cause
enough stress to trigger
impotence. A woman who is
worried about how her looks
are changing as she ages may
think her partner will no
longer find her attractive.
This focus on youthful
physical beauty may get in
the way of her enjoyment of
sex.
Older couples face the same
daily stresses that affect
people of any age. But they
may also have the added
concerns of age, illness,
and retirement and other
lifestyle changes. These
worries can cause sexual
difficulties. Talk openly
with your doctor, or see a
counselor. These health
professionals can often
help.
Don’t blame yourself for
any sexual difficulties you
and your partner are having.
You might want to talk with
a therapist about them. If
your male partner is
troubled by impotence or
your female partner seems
less interested in sex,
don’t assume they don’t
find you attractive anymore.
There can be many physical
causes for their problems.
What Can I Do?
There are several things you
can do on your own to keep
an active sexual life.
Remember that sex does not
have to include intercourse.
Make your partner a high
priority. Pay attention to
his or her needs and wants.
Take time to understand the
changes you both are facing.
Try different positions and
new times, like having sex
in the morning when you both
may have more energy.
Don’t hurry—you or your
partner may need to spend
more time touching to become
fully aroused. Masturbation
is a sexual activity that
some older people,
especially unmarried,
widowed, or divorced people
and those whose partners are
ill or away, may find
satisfying.
Some older people,
especially women, may have
trouble finding a partner
with whom they can share any
type of intimacy. Women live
longer than men, so there
are more of them. In 2000
women over age 65
outnumbered older men by 100
to 70. Doing activities that
other seniors enjoy or going
places where older people
gather are ways to meet new
people. Some ideas include
mall walking, senior
centers, adult education
classes at a community
college, or day trips
sponsored by your city or
county recreation
department.
If you do seem to have a
problem that affects your
sex life, talk to your
doctor. He or she can
suggest a treatment
depending on the type of
problem and its cause. For
example, the most common
sexual difficulty of older
women is dyspareunia,
painful intercourse caused
by poor vaginal lubrication.
Your doctor or a pharmacist
can suggest
over-the-counter,
water-based vaginal
lubricants to use. Or, your
doctor might suggest
estrogen supplements or an
estrogen vaginal insert.
If impotence is the problem,
it can often be managed and
perhaps even reversed. There
is a pill that can help. It
is called sildenafil and
should not be taken by men
taking medicines containing
nitrates, such as
nitroglycerin. This pill
does have possible side
effects. Other available
treatments include vacuum
devices, self-injection of a
drug (either papaverine or
prostaglandin E1), or penile
implants.
There is a lot you can do to
continue an active sex life.
Follow a healthy
lifestyle—exercise, eat
good food, drink plenty of
fluids like water or juices,
don’t smoke, and avoid
alcohol. Try to reduce the
stress in your life. See
your doctor regularly. And
keep a positive outlook on
life.
Resources
The following organizations
and government agencies have
information that may be of
help.
American Cancer Society
1599 Clifton Road, NE
Atlanta, GA 30329
1-800-ACS-2345
http://www.cancer.org
American Foundation for
Urologic Disease, Inc.
1128 North Charles Street
Baltimore, MD 21201
1-800-242-2383
http://www.impotence.org
National Kidney and Urologic
Diseases Information
Clearinghouse
National Institute of
Diabetes and Digestive and
Kidney Diseases (NIDDK)
3 Information Way
Bethesda, MD 20892-3580
1-800-891-5390
http://www.niddk.nih.gov
For a list of publications
from the National Institute
on Aging (NIA) including
information on HIV/AIDS,
contact:
NIA Information Center
PO Box 8057
Gaithersburg, MD 20892-8057
1-800-222-2225
1-800-222-4225 (TTY)
http://www.nia.nih.
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