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Sex and the Senior Citizen

Americans are getting older. The senior citizen population is growing faster than any other age group. Between 1980 and 1995, the total U.S. population increased by 11%. At the same time, the 85 and over age group grew by 41% and the 75-84 year old age group increased by 33%. As a result of the Baby Boomers "coming of age", and leading more active lives, they are also concerned about sexual health.

A starting point for understanding sexual health of older Americans is to understand some of the myths associated with sexuality and the elderly. This article is intended to shed light on five myths associated with sex and the elderly.

#1 Older people aren't interested in sex

False. The truth is that older people stay sexual until the day they die. It's an ageist concept that you're a dirty old man or a dirty old lady if you want to have sex after a certain age. The reasons that women are not active sexually have less to do with age and changes after menopause but more to do with perceptions of their sexual health, and with the availability of a functional partner. Simple demographics pose the greatest obstacle to sex for women. By age 65, there is only one single man for every four single women. Bottom line: Sex can continue in the elderly, barring intervening medical conditions, and it is a reasonable and expected form of behavior.

#2 Older people can't perform sexually

False. The facts are otherwise: 70% of men and 35% of women older than 70 years of age remain sexually active with their spouses or partners. Getting old doesn't automatically mean becoming asexual. The prevalence of chronic illness and use of multiple medications is higher among older adults than it is in the younger population, and these can interfere with normal sexual function. For men the major determinants of sexual activity are ability to have erections and their overall health as well as the availability of a partner. Erectile dysfunction is more common in older men but it is not a necessary consequence of aging. Just as high blood pressure becomes more common as people age; it is not considered a normal part of aging.

Older women experience a decrease in their estrogen levels and a loss of tissue strength and flexibility and reduced vaginal lubrication, which can make intercourse more difficult. But it is more like "use it or lose it" as women who remain sexually active, even without estrogens, still maintain some stretchability of the vagina and some vaginal lubrication compared to women who are not sexually active.

Sexual problems can also occur in men and women as a side effect of medications, which if not addressed by the doctor may cause additional problems. Therefore, if you are experiencing sexual side effects of medication, such as loss of sexual drive or libido or loss of erections in men, be sure to mention this to your doctor as he\she can adjust the medication or change to another class of drugs that is less likely to have sexual side effects.

#3 Sexual dysfunction in the elderly can't be treated

False. Usually treatment for nearly all men and women with sexual dysfunction can be treated. For example, men with erectile dysfunction or impotence can use Viagra and can achieve an erection adequate for vaginal intercourse. Medications, prostheses, and sexual assistive devices can remedy the majority of sexual problems. Usually treatment is possible providing the problem is diagnosed properly.

#4 Sex is possible only for the healthy

False. Although sex is a little more difficult for the elderly with impairments of their physical and mental capabilities, these men and women with medical infirmities are still able to engage in sexual intimacy. It may require some modification, creativity, and patience, but those with limited cardiac and pulmonary reserve, those with bone and joint limitations, and even those with cognitive disorders, such as Alzheimer's disease, are able to participate in sexual activities. There are nonsexual ways of expressing one's self and this should be encouraged in those men and women who are unable to engage in intercourse. Many men and women can still be intimate without being sexually active: touching, holding hands, taking long walks together, dancing, massages, listening to music are just a few of the methods for maintaining intimacy without having sexual interacourse. These are ways in which couples can enjoy a sense of closeness that results in enjoyment and mutual satisfaction.

#5 Older people can't get sexually transmitted diseases

False. "Safe-sex" also applies to older men and women. People older than 50 now account for 10% of AIDS cases. While the number of new AIDS cases among younger people has dropped steadily, new cases among older people are on the upswing. The risk factors are the same for younger sexually active couples: multiple sex partners, failure to use a condom, a partner with a known risk factor, or a history of blood transfusions between 1977 and 1984. So practice safe sex regardless of your age.

My take home message

Sexual expression is a healthy, normal behavior that should be encouraged in the elderly. It is the icing on the senior's cake. If you are a senior citizen and have questions regarding sexuality, be sure to ask your doctor. If the doctor doesn't know the answer, he or she can certainly direct you to resources. For starters, I suggest reading, Love and Sex After 60 by Robert Butler, Ballantine Books, 1993.

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Reprinted with permission from Neil Baum, neilbaum.com

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