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Sexuality in the Golden Years 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 ones 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 dont 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 doctors 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 womans 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 womans 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 Societys (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 mans 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 womans 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.
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