Staying Sexual Into the Golden Years

Written by:
Dagmar O'Connor, PhD - Columbia University
Patricia Bloom, MD - Mount Sinai-New York University Medical Center
David Kaufman, MD - Columbia University, College of Physicians and Surgeons

ABC News, March 25, 2000

In many people's eyes, advanced age and sexual intimacy go together like oil and water. But sexuality can be an important part of any loving relationship, no matter how old you are. Below, experts in issues of elderly sexuality discuss popular misconceptions, as well as why -- and how - these misconceptions should change.

Are there benefits to being sexually active in older age, or is sex a health hazard in for older people?
PATRICIA BLOOM, MD: Absolutely not. There are a lot of benefits to being sexually active, if one wants to be sexually active. Sexual activity is one of those stimulating kinds of activities that may promote brain function in elderly people. There's even some data to suggest that men who have many orgasms may live a longer life, although I suspect that what's really true is that men who are healthy enough to be very sexually active don't have underlying severe diseases, and therefore do live a longer life. I don't think that the sex causes you to live longer, but I think it's correlated with living longer.

When we talk about sex, are we talking about more than intercourse?
DAGMAR O'CONNOR, PhD: Hopefully we are. As they grow older, many couples stop having sex, because they only consider sex to be intercourse. They end up in my office saying, "Well, we can't have intercourse any more." And I find that they both masturbate separately and I ask them, "Well, why don't you bring that together and start having some sex life?" They say, "No, no, no, we can't do that. We must have intercourse." And I say, "How many more children are you planning to have? How important is this? It's a reproductive activity."

Touch is important, we know that we live longer when we have touch. Little babies die when they're not touched.

PATRICIA BLOOM, MD: One of the most serious losses of aging is the loss of physicality and physical intimacy. I think it's absolutely true that when you talk about sex in elderly people, you shouldn't focus just on intercourse, but on all of the other physical intimacies that people may derive great benefit from without necessarily engaging in intercourse. Some choose to have intercourse, but to think that that's the only aspect of sexuality in the elderly would be leaving out a lot of rich activity that some elderly, at least, find a great deal of pleasure in.

How can we, as a society, embrace sex in the elderly, and get rid of the taboo about Grandma and Grandpa having sex?
PATRICIA BLOOM, MD: When I mention sex in the elderly, my teenage son goes "Ewww!" There's still this thought that it's not something that's okay for elderly people to do. People get nervous thinking about it.

I think it's true that we are going through a revolution, partly due to Viagra. A lot of elderly people grew up thinking that sex was something that was secret. You didn't talk about it. If you're interested in sex when you're an older man, you're a dirty old man. So just having brought it more out into the open, I think, has been helpful.

I think they're getting much more out front in expressing their interests and their desires, and talking about sex. Of course, that can create some problems too, because there can be a mentality that you have to be having sex in order to be a "with-it" old person. Some elderly people are just not particularly interested in having intercourse, but, again, I think back to the point that they may be interested in some other aspects of sexuality which they just haven't had occasion to participate in.

DAGMAR O'CONNOR, PhD: There is something called an incest taboo. Many parents don't approve of children's sexuality. In the same way, many children don't approve of parents' sexuality, and parents and children do not approve of grandparents' sexuality. So I will be working with these grandparents in sex therapy, and they are doing weekly touching sessions, and then suddenly their children come to visit. They come to therapy and say "We can't do anything." And I say, "Do you realize that it's your responsibility to lock the bedroom door and have privacy?" You will give your children and your grandchildren permission to be sexual when they grow older because they will remember that when they were younger, your bedroom door was locked, and there was some privacy in there. That's important, that every generation will do that.

Does it become increasingly difficult to achieve a good erection for older men?
DAVID KAUFMAN, MD: There is some recent evidence that we have in our urologic literature that the more you use your erection, the better it will become. That has a lot to do with the oxygenation of the smooth muscle that is really the basis of an erection. The benefit is, the more sex you have, and the better blood flow that results from this sex, the better quality your erection's going to be.

That's why we've actually been using drugs like Viagra as treatment for improving spontaneous erections. There are doctors who prescribe Viagra to be taken on a nightly basis without sex being involved in that night's activity, just to improve the blood flow to the penis during the night, improve oxygenation and, as a result, we have found that people's spontaneous erections are improved.

For men and women whose sexual lives are suddenly revitalized, by Viagra for instance, is there any associated risk of heart disease and lung disease?
DAVID KAUFMAN, MD: Viagra has certainly gotten a bad rap by the lay press. I think the point that needs to be made is that people are not dying from Viagra. They're having myocardial events because they're suddenly engaging in strenuous activities that they weren't engaging in because they were impotent.

If that same individual went outside and shoveled snow, he'd have the same heart attack he's having as a result of Viagra. So members of the medical community need to be careful, and make sure that they're prescribing Viagra to people who are physically fit enough to participate in sexual relations.

There are also some pharmaceutical contraindications to Viagra. Nitroglycerine compounds found in cardiac medications are absolutely and definitively contraindicated in somebody who's taking Viagra. So we should not prescribe Viagra to anybody who either is taking, or might need to take, a nitroglycerine compound.

How should a doctor address the sexual issues with older patients?
PATRICIA BLOOM, MD: It's very important that the doctor ask each and every patient if they're sexually active. If so, are there any problems? If they're not sexually active, is that a problem for them?

If we discover that a person is having a problem, then sometimes a door will open to a medical diagnosis of conditions that need to be treated in order to allow that person to be more sexually active. Sexual function is highly related to other medical conditions, and needs to always be considered when you're treating other medical conditions.

What does the future look like for pharmaceuticals that offer people sexual help and hope?
DAVID KAUFMAN, MD: There is a whole sexual pipeline of pharmaceuticals that will be coming out. Viagra was really just the first of the lot. Within the next year, we're going to see at least two more coming out, dealing specifically with this issue.