Sexual Health for Seniors

Let me be honest about this topic, talking about sex is uncomfortable. It’s even more awkward when you talk about it with your grandmother! However, I think it’s important to discuss sexual health no matter your age. There seems to be more openness and acceptance that sexual intimacy really does happen past the age of 40. I think it goes back to the fact that no matter the age, all humans desire some sort of intimacy.
 
There are some normal changes to expect with age. Let me break it down by gender…

Females, unfortunately, have much of our sexuality is dictated by menopause. There is a two to 10 year scan of time when women’s ovaries are slowly starting to decline in their hormonal function which is called perimenopause. The average age for perimenopause is around 47 with menopause taking place around age 51-52. Menopause is complete halt of menses (aka periods) for 12 month period. Most of the time, we doctors make this diagnosis retrospectively so if you ask your doctor if you are going through menopause, we can’t really tell you without your period history. Periods stop because ovaries are no longer producing follicles (or eggs) which produce the needed hormone, estrogen.

Because of the lack of estrogen, genital tissues begin to atrophy (or thin), vaginal lubrication and elasticity decrease and arousal becomes more difficult. Along with these changes, women start to have a decline in libido (or desire for sex), develop dyspareunia (or uncomfortable intercourse), hot flashes and new-onset depression.

Sounds great, does it?! Well, if you understand the process, you understand why senior women have the issues they do with sex. Sex is no longer feels comfortable or natural. Make sure to talk with your doctor about lubrication and topical estrogens to see if you are a candidate for treatment. This is not “an end-all-cure-all” but it could improve things.

Now for the guys. Men typically don’t experience a life-changing event like menopause. Instead, many men start to experience gradual changes related to decrease in testosterone production. Though sexual desire decreases in female, it stays relatively intact in men. However, erections are less attainable and lasting leading to diagnosis of erectile dysfunction. By middle age (around 40), testosterone levels begin to decline 1-2% a year (1).  But the big question right now is whether testosterone replacement in older men should be started because we don’t know if it truly reverses the age-related decline or if it worsens other diseases like prostate issues. I will leave this debate up to the urologists. But talk with your doctor about treatments for erectile dysfunction that might help.

My main reason for writing this article was that I saw a statistic from the CDC (Center of Disease Control) that stated that, “Approximately 10 percent of new cases of HIV infection occurred in individuals 50 years and older, with older white men having the highest rate, 12% (1).” Another fact that caught me off guard was “that at older men and women are less likely to use condoms because the perceived risk of STDs only occurs in younger individuals.” News flash! The facts…about 2% of all STDs are reported in individuals 50+. STDs can and will occur despite your age.

Health in Aging Foundation (which is the official foundation of the American Geriatrics Society) gives a checklist for having and enjoying safer sex practices for seniors:

• Do a Background Check: talk about your sexual histories, whether you’ve been tested and if you ever injected illegal drugs.
• Get Tested First: the best way to protect yourself is to be tested for HIV and other STDs before becoming intimate.   
• Use a Condom (and Lubricant) Every Time: a condom should be a no-brainer. However lubricant is over looked. They can lower the odds of getting small trauma or cuts on either partner that could increase the risk of getting STDs.
• Talk to Your Healthcare Provider: Your doctor may offer additional advice about STDs and treatments for common sexual problems.

Now despite all the bad, awful things of aging, I encourage you to look at the other side too. Aging couples find that they have more time together and therefore more possibilities for intimacy. There are no longer crazy work schedules to manage, children to raise, or fewer chores that must be cared for on a daily basis. Older couples actually have more time to go out on dates, vacation, and spend time together. Let me also remind, intimacy does not equal sex. Simply holding hands, kisses and/or other physical touch is a very real and genuine form of sexuality.

I found a brief handout on Sexuality in Later Life published by NIH (National Institute on Age) that is also very educational and straightforward.

I’m not going to get into all the different medications, medical conditions and emotion hang-ups there are that can disrupt activity. I would encourage anyone who believes they may have a problem to consult your physician or a relationship counselor.

Be Well!

“Sexual dysfunction in older adults.” Marc Agronin MD Accessed through UpToDate 11 August 2014