Sexuality

from Aging, 2nd Edition, Salem Health
by Cathleen Jo Faruque, Bonnie Kellen, , PsyD

Relevant Issues: Health and medicine, psychology, sociology, values

Significance: The study of sexuality among senior citizens is a growing field of interest as people are healthier and living longer, and those over the age of 65 are a fast-increasing segment of the world population. Sexual activity is now considered as a normal function of aging and an area of active research.

Our current social narrative is that 60 is the new 40, 70 is the new 50, and 80 is the new 60. Images of youthful, active, and attractive seniors bombard our advertisements. Sexually appealing images sell images of Viagra, which create and sustain erection. All put pressure on not acknowledging what really happens with aging and sexuality. Most people don’t think about older people and sex until they themselves get old. What is the truth about sexuality and aging?

The Boomer Generation, which is comprised of those born from 1946-1964, are now senior citizens. They have been through the sexual revolution of 1960s, including the advent of the birth control pill in 1960, the rise of Viagra in 1998, and the introduction of the Internet and social media. Individuals in their 50s and 60s are in many ways different from those in their 70s, 80s, and 90s, and, therefore, should not be lumped together as one “senior group.” There are roughly 46 million seniors in the United States today.

The Changing Physiology of Aging and Sexuality for Both Sexes

There is no doubt that aging is an uphill battle. Although the field of medicine continues to offer improvements and aides, the progression of ageing is inevitable. The Age Lab at MIT has created AGNES, or the sudden aging suit to simulate the experience of aging. “These include yellow glasses, which mimic the yellowing of the ocular lens that comes with age. A boxer’s neck-strengthening harness reduces the mobility of the cervical spine and makes it harder to retain one’s posture. Bands around the elbows, wrists, and knees gave the impression of stiffness. Gloves added to the picture, reducing tactile acuity while addressing resistance to finger movements” (Coughlin, The Longevity Economy ; 173). With age, everything is an effort. The suit helps people appreciate the ease of movement that comes with youth.

Besides the stiffness, lack of mobility and aches, the volume of serious diseases increases. These include arthritis, diabetes, cancer, heart disease, and cognitive decline. All of the above have sexual repercussions. Most adults are on medicine. Some of these, including antidepressants, stimulants, blood pressure meds, and antihistamines can interfere with sexual response.

Women and Physiological Changes

The onset of menopause is usually between 45-65. Known as “change of life,” it is marked by the ending of both menstruation and the ability to get pregnant, and, most importantly, the production of female hormone estrogen ends. Estrogen keeps the vagina moisturized, elastic, and supplied with blood, which leads to engorgement and orgasm. The depletion of estrogen and other symptoms of menopause can negatively affect a woman’s sexuality by causing vaginal dryness, decrease in libido, and a decrease in sensation and orgasm. Some women experience pain and vaginal atrophy.

Many women choose Hormone Replacement Therapy (HRT) to counteract these symptoms; though these treatments are FDA approved, there is still controversy surrounding their use. Other women use natural supplements, and some do nothing. This is a personal and medical decision.

There are many lubricants on the market. Hormonal topical creams and vaginal inserts are available by prescription. Pharmaceutical companies are working to create a female Viagra. So far, only Addyi has been FDA approved. Addyi changes brain chemistry to increase sex drive or the desire to have sex. Unlike Viagra, which is taken as needed, Addyi must be taken daily. It does not guarantee the ability to achieve orgasm. There are some side effects to be aware of and use requires strict medical supervision.

Professionals often recommend various vibrators and sex toys for women who have issues with desire, arousal, and orgasm. Vibrators may do the trick, but over time create a lack of sensitivity to human touch, which may affect relationships.

Men and Physiological Changes

Like women, men undergo a physiological mid-life change called Andropause. This is the slow but continuous decline of testosterone production throughout a man’s remaining lifetime.

These changes directly affect sexual function. Symptoms include the decrease of psychogenic erections that do not require physical stimulation (fantasies, mental images). Men will now need physical stimulation to have an erection and when they get an erection they will have difficulty holding it. Some men are upset about the decrease in volume in ejaculations. Feelings of shame generally accompany this new erectile dysfunction (ED). Men may also develop body image and ego problems due to the loss of hair, muscle tone, and physical strength. There have been groundbreaking medical advances to combat these issues.

Viagra, Cialis, and Levitra are popular medications. These drugs must be used under strict doctor supervision and cannot be mixed casually with other medicines or the use of alcohol. Surgical pumps and implants are also available. Another option is testosterone therapy.

Many older men are watching porn, which is easily available through the Internet in the privacy of their homes. Men (and women) should be aware of the legalities of ethical porn: It must be between consenting adults of legal age (over 18). These criteria are hard to discern while casually exploring porn sites, and seniors could find themselves unknowingly in trouble, especially with sites that use teens or the word young as a seduction. Child porn is under the legal age of 18.

Optimistic New, Older?, “Cooler” Ideas for Sexuality in Later Years

The MIT AGELAB has discovered that seniors dislike the use of the word old and do not respond positively to it. They prefer adjectives like cool, amazing, and fun (Coughlin). Whatever it is called, we must create a theory of sexual life span developmental psychology. As physiological and emotional maturity progresses, the definition of sex must evolve to include the sexual self, the erotic self, the sensual self, and the intimacy self.

The journey of sexual development is lonely for most seniors because the societal narrative is not up to date. Many are living with standards for themselves from the “good old days.” For those who can accept the new realities, many options exist.

Sexologist Lawrence Siegel suggests that in lifetime sexual development terms, seniors often revert to a stage similar to adolescence. This stage is marked by kissing and heavy petting. Holding hands, hugging, cuddling, lying next to each other, and perhaps kissing can be all that is needed for closeness. This non-penetrative sex was given the name outercourse by Dr. Marty Klein. In his book Let Me Count the Ways: Discovering Great Sex without Intercourse, he offers many creative ideas for seniors to try.

Both women and men mourn the loss of the spontaneous desire of their youth. It is now believed that Desire can be cultivated during sexual activity. All that’s needed to start is Willingness. This is quite a liberating concept for older adults. There is an emerging movement about techniques that intensify the sexual, sensual, erotic experience that can help seniors be more responsive.

Positive Attitudes and Behaviors That Work

1. Be present! Discipline yourself to be totally in the moment.

2. Turn off distracting thoughts during sex. Whether it be trivial rumination about your day or something more important, it is critical to focus on the moment.

3. Whether it is critical self-judgment about yourself or your partner’s performance, negative judgment is a killer of enjoyment.

4. Be playful; don’t be too serious.

5. Do not be solely focused on performance or orgasm.

6. Get comfortable talking and communicating about sex in a loving manner.

Techniques for Accessing Your Erotic Nature for Both Men and Women

1. Erotic Mindfulness: The intention of this technique is to get in tune with the sensations of your body without distractions. The goal is to more intensely experience sensual pleasure. Dr. Lori Brotto gives a full program of exercises in her book Better Sex Through Mindfulness.

2. Sensate Focus: Weiner and Avery-Clark offer a mindful, structured program of progressive touching from non-genital, to exploring the entire boy, to coitus in their book Sensate Focus and Sex Therapy...the Illustrated Manual. It can be helpful for both couples and individuals.

3. Nicole Daedone teaches the art of slow sex in her book Slow Sex: The Art and Craft of the Female Orgasm. One of her tips is very slow, soft stroking of the upper left quadrant of the clitoris for 15 minutes. Women who thought they were “dead” were surprised at how “alive” they could get.

4. Andrew Goldstein, MD, and Marianne Brandon, PhD, teach a broader program for sexual preparedness and sexual health in Reclaiming Desire: 4 Keys to Finding your Lost Libido. Their program encompasses physical health including hormone adjustments and adaptations to physical difficulties such as arthritis. It also emphasizes emotional resilience, intellectual stimulation, and spiritual practice. Dr. Goldstein is the founder of the comprehensive Sexual Wellness Center in Maryland and New York.

Sensuality for Seniors

Taking time to indulge the sensual self whether alone or with a partner can be a satisfying and relaxing experience. Being sensual involves the pleasure of developing all 5 senses: seeing, hearing, feeling, tasting, and smelling. Whether it be an aromatic candle, sexy music, or massage can all contribute to the experience. Many sensuality workshops are available online, where one learn to get in touch with and awaken one’s sensual self.

Finding A Partner

Many seniors find themselves alone due to death of a partner, divorce, or other circumstances. Whether with the same partner, a new partner, or alone, seniors are seeking connection. Many new opportunities for meeting others have emerged.

Obviously the Internet offers many dating sites, which advertise romance or marriage. Seniors can benefit from help navigating the roller coaster of high hopes, exaggerated profiles, and rejection. For the resilient, connections can be made.

Many seniors find themselves not attracted to prospects. Instead of giving up on a possibly good person Dr. Bonnie Eaker Weil suggests a 30 second kiss and 30 second hug to get the oxytocin going in her book Make Up Don’t Break Up: Getting the Magic Going. Thus a possible relationship with an otherwise good match can be saved. Dr. Ruth Westheimer gives many good tips for safe use of the Internet and other ways to meet people in Dr. Ruth’s Sex After 50: Revving up the Romance Passion, and Excitement!

Many seniors just feel lonely and want connection and platonic friends. Not everyone is seeking romance. Some seniors want to meet others in the hope of finding someone to talk to, watch TV and movies with, and accompany them on trips. Honesty of intention is the best policy.

There is a growing trend for seniors to downsize and move into 55+ communities. One attraction to this lifestyle is the increased opportunities for activities and connection.

Some older men and women look for casual hook-ups on sites like Tinder and Craig’s List. STIs are becoming more common among seniors due to unprotected sex.

The Dream Team

All of the above is not easy. There is little information out there geared to seniors and most seniors are embarrassed to talk about sex and intimacy. Professionals are often not trained in this area.

Sexologist Ricky Siegel suggests building your own Dream Team of support. This includes a Gynecologist or Urologist trained in Sexual Health and a qualified Sex Therapist to guide your process and help you feel comfortable talking about sex.

Additionally, Pelvic Floor Physical Therapists are able to do manual physical therapy to the vulva area, which increases blood flow and flexibility in soft muscles of the area.

They also assist men with issues of early ejaculation and pain.

A regular massage therapist can help aging people keep their body supple, while a relationship therapist can help seniors navigate the complications of relationships.

LGBTQ+ Older Adults

The LGBTQ+ (lesbian, gay, bisexual, transgender and queer) population, which now includes around 3 million people in the United States, faces more problems due to discrimination and lack of children.

How to Talk to Seniors About Sexual Health

How Do They Feel?

Seniors may find aspects of age-related changes to their sexual health challenging. Bodily changes can make sex seem difficult or unappealing. Because seniors become more easily fatigued than younger adults, they may despair at being unable to perform exactly as they did in their younger years. They may suffer from lack of self-esteem, worrying that they are unattractive or unsatisfying to their partner. At the same time, older adults—like anyone else—want to be desired. This can cause frustration, anxiety, and even depression. A senior’s other health issues, or those of their partner, can also take time, energy, and focus away from relationship matters. This stress can lead to a loss of important feelings of closeness and intimacy.

On the other hand, many seniors take advantage of the opportunity to enjoy an active sex life. Amore mature perspective on life and relationships can lead to a sense of freedom and fulfillment. Those who learn of treatments for common sexual problems can be excited and relieved to be able to enjoy sexual activity again. For women especially, moving past menopause often brings a new surge of energy and self-acceptance. The lack of worrying about getting pregnant can also be liberating. However, some older adults may tend to not be aware of or ignore guidelines regarding safe sex.

How Do I Start The Conversation?

When you raise the topic of sexual health with seniors, it is important that you do so in a respectful way and are reasonably informed about the topic yourself. If your approach is seen as rude, intrusive, overbearing, or uninformed, it will likely be ignored or resisted. There may be specific issues you feel are important to focus on depending on an individual’s situation:

• Being proactive about sexual health, including regular doctor checkups
• Safe sex and STDs
• Normal aging changes versus illnesses or other conditions
• Remedies and treatments, and consulting a doctor or therapist
• Maintaining closeness and connection with a partner

Discussions can be had one-on-one or in a group setting, depending on comfort level. For many people, sexual health is a very private and sensitive subject, so special care should be taken not to upset. For some caregivers, it might be best to hold a group lecture or talk, with a question-and-answer session as appropriate. This provides seniors with general information in a nonthreatening way, and personal issues can be addressed later. For other caregivers or family members, engaging in a frank but respectful conversation may be more appropriate. If the senior is reluctant to discuss the subject, you might try relating a story of someone else who successfully dealt with a sexual health issue. Use gentle questions to better understand the person’s situation and steer the discussion toward possible solutions.

In all cases, actively listen to seniors and be empathetic to their point of view. If their responses indicate a lack of knowledge, gently supply information or suggest reading material or other resources. Make it clear that talking to their health-care practitioner will be helpful. However, avoid being judgmental or telling them what they “should” or “must” do. Instead, support them in their own efforts to address personal sexual health concerns. Your efforts at effective communication will also help establish a framework for how they can effectively communicate with doctors or partners. Sexual health includes a major psychological component, so keeping older adults comfortable and fostering self-esteem throughout the discussion is beneficial.

Your conversation can also highlight how seniors can be proactive in taking care of their general health, which will, in turn, positively affect their sexual health. Encourage them to boost energy levels by participating in physical exercise and eating a healthy diet.

— Leah Jacob

Social connection is key to counteract isolation. Help is more available in locations that have a large LBGTQ population. However the new addition of Gender Studies at many universities and training institutes gives hope for more resources in the future.

Nursing Homes and Dementia

Many nursing homes and dementia facilities are grappling with issues of sexuality amongst their population. Issues of consent and competence are in the forefront. However, these facilities are gravitating toward providing more opportunities for privacy and closeness. Increased dialogue about sexual feelings and expression would help residents.

Sexual activity later in life is better viewed on a continuum of sexual development throughout the lifespan. As physiological, mental, and emotional maturity progress, the definition of sexual behavior evolves into what is realistic and practical. A more expanded view would put more emphasis on intimacy, erotic and sensual experiences, and feelings of closeness. This is a divergence from the focus on performance and orgasm. Because our culture discourages the discussion of senior sexuality, this journey can often be lonely and discouraging. For those who accept the reality with positivity, many options exist. A support team of Sexual Health professionals can help in this uphill battle.

See also: Ageism ; Change: Women, Aging, and the Menopause, The ; Cohabitation ; Communication ; LGBTQ+ ; Loneliness ; Marriage ; Men and aging ; Menopause ; Psychiatry, geriatric ; Reproductive changes, disabilities, and dysfunctions ; Sexual dysfunction ; Social ties ; Stereotypes ; Widows and widowers ; Women and aging

For Further Information Better Sex Through Mindfulness. Greystone Books, 2018. In this accessible, relatable book, Brotto explores the various reasons for sexual problems, such as stress and incessant multitasking, and tells the stories of many of the women she has treated over the years. Brotto, Lori A., PhD. Reclaiming Desire: 4 Keys to Finding Your Lost Libido . Rodale, 2009. Presents the holistic approach used to successfully treat women with low libido.

• Better Sex Through Mindfulness. Greystone Books, 2018. In this accessible, relatable book, Brotto explores the various reasons for sexual problems, such as stress and incessant multitasking, and tells the stories of many of the women she has treated over the years.
• Love Worth Making: How to Have Ridiculously Great Sex in a Long-Lasting Relationship. St. Martin’s P, 2018. This acclaimed, paradigm-shifting guide turns traditional sex therapy inside-out to reveal the hidden rules for great sex.Snyder, Stephen, MD.
• Reclaiming Desire: 4 Keys to Finding Your Lost Libido. Rodale, 2009. Presents the holistic approach used to successfully treat women with low libido. Goldstein, Andrew MD, and Marianne Brandon, PhD
• Dr. Ruth’s Sex after 50: Revving Up the Romance, Passion, and Excitement! Quill Driver Books, 2006. Westheimer, world-famous sex therapist, guides the reader through the physical and emotional challenges of sex after 50, revving up the romance, passion and excitement. Westheimer, Ruth K.