We are sexual beings, throughout the lifespan. This includes the later years of life, which are often overlooked in discussions of sexuality. In this article I want to address some misconceptions about aging and sexuality; report some survey information on sexual behavior among seniors; describe physical, psychological and medical changes that may accompany aging; and suggest positive and affirming ways for seniors to continue to enjoy their sexuality to the fullest.
I. Some Myths about Aging and Sexuality
Many cultural "truths" convey the message that sexuality is for the young. If seniors are interested in sex there is something wrong with that. How many of the following myths and stereotypes have you heard?
- Older people don't have sex, don't want sex, don't think about sex.
- It's perverted for an older person to have sexual thoughts; perhaps he is a "dirty old man".
- Women don't want sex, aren't interested in sex, and are only going along with what men want.
- When you get "old", you can't have sex.
- Sex is for younger adults. (I saw a cross-stitched sampler once which said "Kissing don't last - cooking do".)
- If you can't have sex like a porn star, you have no business trying it at all.
These are all misleading and incorrect stereotypes. It is important to recognize that sexuality is a central part of healthy living - all our lives!
II. Survey Information: What's Happening Out There?
Three recent national surveys of older Americans have focused on sexuality and sexual behavior. "Healthy Sexuality and Vital Aging" (1998) was funded by Pfizer and sponsored by the National Council on the Aging (NCOA) and surveyed over 1300 people. The American Association of Retired Persons (AARP) sponsored national surveys in 1999 and again in 2004. "Sexuality at Midlife and Beyond" looked at a nationally representative group of 1700 adults aged 45 and older.
The NCOA survey found that almost half of seniors over sixty are sexually active; 39% want sex more often. The majority of respondents reported having sex less often now than when they were in their forties - 82% of men and 63% of women.
61% of men and 62% of women find sex equal to or more physically satisfying than it was in their forties. With regard to emotional satisfaction, 76% of men and 69% of women found sex to be at least as emotionally satisfying as in their forties.
72% of men and 47% of women consider sex important to their relationship with their partner. Men, however, were more than twice as likely as women to report wanting sex more frequently. This was true in all age segments - even in men 80 and older.
The AARP study found that the proportion of men who've tried potency-enhancing medicines, hormones, or other treatments has doubled since 1999. The majority (68%) report the treatments have increased their sexual satisfaction. Their wives also reported increased pleasure for themselves.
63% of men and women with partners described themselves as either extremely satisfied or somewhat satisfied with their sex lives. 51% of men and women surveyed reported having sexual thoughts, fantasies, or erotic dreams at least once a week.
50% of women in the 45-49 age range reported that they masturbate; 20% of women 70 and older said they masturbated. A majority of all women - even those 70-plus - told AARP that self- stimulation is an important part of sexual pleasure at any age.
Both these surveys, based on scientifically randomized samples, indicate that seniors are having sex, thinking about sex, enjoying sex - and taking steps to increase their enjoyment and pleasure. Clearly sexuality is important to older Americans, contrary to popular stereotypes!
III. Natural Changes Occurring With Aging
Most of us reading this are not twenty years old any more! Our bodies are constantly changing - though many of us are in denial. Orthopedic medicine is one of the fastest-growing medical specialities, treating rotator cuff injuries, tennis elbow, injured backs, torn cartilage, blown ACLs - in aging baby boomers. We're not ready to give it up!
Your body changes as you age, and these changes can affect your sexual relationships.
A. Physical Changes
Testosterone regulates your sex drive whether you're a man or a woman. Most aging men and women produce enough testosterone to maintain their interest in sex, though patches and creams can provide an alternative source of the hormone to boost desire if needed.
Men and women experience different changes in their bodies as they age.
-- Women --
Most physical changes are linked to menopause and reduced estrogen levels. As you age, it takes longer for your vagina to swell and lubricate when you're sexually aroused. Your vagina also loses some elasticity. Together these can make intercourse less comfortable or even painful.
What to do:
- Longer foreplay increases natural lubrication.
- Use water-based lubricants, such as Astroglide, Probe or Silk.
- Estrogen creams or hormone replacement therapy can rejuvenate vaginal tissue.
- Regular intercourse helps maintain lubrication and elasticity.
- Do Kegel exercises to keep the pelvic floor muscles toned.
- If you haven't had intercourse for a while, realize it takes time to stretch out - go slowly!
- Minimize any pain or discomfort. Desire usually returns once any discomfort is relieved.
-- Men --
As you age, it might take longer to achieve an erection; it may be less firm and it may not last as long. Aging also increases the time between possible ejaculations.
What to do:
- Relax, stop worrying about it! Anxiety makes it worse.
- Let go of performance expectations. American media is filled with messages implying that masculinity and virility is equated with youthful performance.
- Kegel exercises are very helpful for men also, to tone the pelvic floor musculature.
- Take longer with sexual activities. You may also need more direct physical stimulation.
- Try different positions, for comfort and extra stimulation.
- Focus on pleasurable sensations, rather than on hurrying towards orgasm and ejaculation.
- Viagra, Cialis or Levitra may help intensify erections.
- Other medical devices, such as pumps, drugs and implants have been developed. I would encourage a natural and relaxed exploration of sexual possibilities before submitting to an expensive and invasive medical procedure.
Intercourse is Not the Only Way to Have Sex!
Helen Gurley Brown, author of Sex and the Single Girl, has said, "When people say they can't have sex because they have a bad back, or arthritis, or all of the things that can affect our bodies as we get older, I think what they're really saying is they're looking for an excuse not to have sex. When you care, you find that there are all sorts of ways to express sensuality."
Sexual ignorance, cultural values and media images combine to "sell" the story that sex = intercourse - and having an orgasm is the way to tell if you're accomplishing anything!
This mindset gets everything backwards. The purpose of having huge concentrations of nerve endings and pleasure receptors in our genitals is to experience pleasure. While orgasms are wonderful, when sex becomes goal-driven to "achieve" climax, it short-changes both partners' pleasure and places enormous performance expectations and demands - which can turn sex from playful, spontaneous, pleasurable sensual intimacy between two people who care about each other into something like a chore.
I highly recommend Marty Klein's book Let Me Count the Ways: Great Sex Without Intercourse as an excellent guide and encouragement in your creativity. (For more information about Marty Klien's book look on: http://www.books4selfhelp.com/sexuality.htm )
Passionate kissing, oral sex, mutual masturbation, telling erotic stories to each other, massage, hugging, touching, cuddling -- all of this can be great sex!
What is most important is pleasure - giving and receiving physical and emotional pleasure. We are all hungry to be touched. We need touch. Without touch, babies do not thrive, and may even die. Grownups need to be touched too. (If you're reading this and do not have a partner in your life, remember that self-pleasure can be a very important aspect of self-care and nurture. It is always possible to choose pleasure for oneself!)
B. Psychological Changes
The aging process may have psychological and emotional effects - particularly as we live in a culture that glorifies youth and extols youthfulness as the epitome of physical beauty. (I would remind us all that this is market-driven: marketers learned long ago that younger people are more likely to spend disposable income, and are more influenceable by advertising.)
- We may be embarrassed or ashamed of our sexual needs as an older adult.
What to do: Get over it! Join the party. You deserve pleasure in your life, from birth until the day you die.
- Changes in appearance affect how we feel about ourselves. Bodies no longer match the idealized body images we see in advertising and the media.
What to do: Realize that media has created the youthful ideal of beauty. Celebrate and love the body you have! Every wrinkle, stretch mark, gray hair, rounded contour, ache and pain is a mark of your ever-increasing maturity and wisdom! Bette Midler once said that if you are a woman and consider yourself unattractive -- visit another culture for a wake-up call. American stereothypes of physical attractiveness are insane dreams invented by marketers who are playing on our anxieties and insecurities in order to sell us more products.
- Worrying about sexual performance may actually reduce the body's ability to perform sexually; men may experience erectile dysfunction, women an inability to lubricate.
What to do: Relax! Relax... Enjoy your partner. Look into his or her eyes. Breathe together. Cuddle, stroke, gently massage each other. Sexuality is about pleasure, playfulness, and spontaneity.
- Depression may reduce energy, optimism and desire.
What to do: Exercise, do pleasurable activites, get sun on your face every day. Talk with your doctor about an antidepressant medication. See a therapist. Talk with your friends. Write your feelings in a journal. Any positive action taken - even drinking a glass of water! - is a step towards moving out of depression.
C. Changes Due to Medications and Surgery
Chronic pain or surgery and illness that cause fatigue can make sexual activities more challenging or painful.
What to do: Talk about it. Slow down, focus on simple pleasureable activities. Experiment with different positions or activities to discover what is most pleasureful.
Some commonly used medications can interfere with sexual function. High blood pressure medications can reduce desire and impair erection in men and lubrication in women. Some antihistamines, antidepressants and acid-blocking drugs can have side effects that affect sexual function.
What to do: Talk with your doctor about how to minimize these effects. It may be possible to substitute alternative medications that work as well as the original, but without affecting sexual function.
IV. Improving Sex as You Age
David Schnarch, in his book Passionate Marriage emphasizes that people become better lovers as they age. This runs counter to cultural stereotypes which hold that sex is for the young. Older persons have learned a few things over time, and no longer struggle with youthful anxieties and ignorance about sexuality. (For more information about David Schnarch's book, look on: http://www.books4selfhelp.com/intimate-relationships.htm )
With age and maturity, it is more possible to slow down and deeply experience all the pleasure that sensual sexuality has to offer. It is possible to learn how to combine deep relaxation with high states of arousal in order to have more intense, longer-lasting sexual experiences.
- Expand your definition of sex. Sex is more than intercourse!
- Communicate with your partner. Talk about what you need and what you like. Discuss the changes you're going through. Ask your partner about his or her needs and how to be accomodating. Communication itself can be arousing!
- Make changes to your routine. Change the time of day in which you have sexual activity. Mornings or afternoons may be better than at night when you are tired or achy. Take more time to set the stage for romance: romantic dinners or an evening of dancing or a special time or place for lovemaking. Try a new sexual position.
- Manage your expectations. If you didn't have sex very often as a younger adult, don't expect to have lots of sex as an older adult. Partners who enjoy frequent sex when they are younger are more likely to continue that as they age.
- Take care of yourself. Eat a healthy diet and exercise regularly, at least 30 minutes a day. Avoid alcohol as it decreases sexual function in both men and women. Do your Kegel exercises every day.
- Practice safe sex. If you have a new partner, get tested. Use condoms. People over 50 make up about 10% of AIDS cases in the United States
Most of all, simply enjoy the pleasureful sensations which your body is amply equipped to experience. Take time to nurture your relationship with your partner so that you are feeling emotionally connected. Approach your sexual relationship with playfulness, humor, patience and love.
Sexual pleasure is part of the birthright of being human - and it is a lifelong resource for joy, health and personal growth.
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