In The Elderly
Patricia Bloom, MD - Mount Sinai-New York University Medical Center
ABC News, March 16, 2000
The best-loved nonagenarian George Burns quipped that it’s “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.
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
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!
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.
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
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
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
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
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
chronic diseases that elderly people experience can also modify sexual
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
The Key to Continued Pleasure: Flexibility and
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
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
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 (see
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 (see below).
If you are taking medications and think that one of them 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: 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 and is
interested in is Viagra. Viagra is a chemical substance called silendafil,
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 has 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 for men: If
Viagra 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
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.
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!