Sexual Problems and Aging

Aging brings changes in many aspects of life. There are emotional, social, and physical changes and diseases that may occur in later life. These changes also affect sexuality.

Social and Family Changes

Social and family changes can affect sexual function. As we age, we may have to adjust goals and desires. Goals set earlier in life may no longer be realistic. In middle age and beyond, most of us must learn to accept our limitations as well as our successes. Unrealistic expectations put a heavy burden on relationships. Those who cannot adjust to changing circumstances may be frustrated and depressed. They may withdrawn from sex and the relationship.

Examples of stresses and disappointments that might affect sexuality in older adults are:

• trouble adjusting to retirement
• worry about children or a partner's health, finances, or life choices
• illness and disability
• the death of friends or family members.

Empty nest syndrome refers to the grief that many parents feel when their children move away from home. Empty nest syndrome can affect both parents, but women seem to be most often affected. The empty nest may cause an identity crisis for women. Once the last child moves out, the mother may feel worthless, disoriented, and unsure of what meaning her future may hold. She may become too focused on herself or overly concerned with her health. She may become sexually assertive for the first time. Her partner may either welcome the change or feel threatened by it.

Relationship Problems

Many older couples have to deal with problems of sameness and boredom in their relationship. This can affect sexual interest.

The quality of your relationship is also related to the quality of your communication skills. Good communication means that you are not afraid to express what you really think and feel and that your partner trusts you the same way. This can help an intimate relationship stay satisfying for both of you.

Sexual problems may reflect a lack of self-satisfaction. Sudden loss of interest in sex in a close relationship may be a sign of depression. In such cases, psychotherapy, medicine, and sexual therapy may help. Couples may benefit most by seeing a therapist together.

Problems from Physical Changes

Body changes also affect sexuality. Men and women have lower levels of hormones as they grow older. This change in hormone levels can affect the uterus, vagina, breasts, penis, and testicles.

After menopause occurs, usually in the late 40s or early 50s, women have much less of the hormone estrogen. This causes some vaginal dryness. It may take longer for a woman to become sexually aroused and lubricated.

Estrogen hormone therapy may help prevent vaginal dryness, hot flashes, and osteoporosis. However, there are risks that go along with taking hormones. Discuss the risks and benefits with your health care provider.

Some health problems, such as problems with circulation, affect a man's ability to have or keep an erection. Sometimes older men have low testosterone levels, which can lead to loss of muscle mass, osteoporosis, and depression.

Fatigue and stress also may cause sexual problems. If you are very active during the day, you may be too worn out to perform sexually at night.

Use of alcohol or other drugs can lead to sexual problems. Avoiding alcohol and drugs for a time may help you know whether they are causing sexual problems.

Problems from Disease

From 80% to 90% of problems getting or keeping an erection (erectile dysfunction) are caused by problems in the blood supply to the penis. This is often due to diseases such as hardening of the arteries and diabetes. Ask your health care provider about ways to treat the problem.

Some medicines, chemotherapy, or surgeries may also affect sexual function. Tell your health care provider about any sudden or worsening sexual problems, such as erectile problems or vaginal dryness. This is especially important if you take heart or blood pressure medicine or medicine for emotional problems. Be specific about the changes in your sexual function. Your health care provider may order a medicine that is less apt to cause the sexual problems. If you cannot take another medicine for your condition, counseling or other forms of treatment may be helpful.

After a heart attack you may leave the hospital concerned about overdoing it. You may be especially worried about having sex. You may fear that sex will cause another heart attack or even death. Research has shown that sex puts less of a strain on the heart than most people think. Sex is a normal and healthy part of relationships and is important to self-esteem. To avoid needless fear and worry, ask your doctor about sex after a heart attack before you leave the hospital.

Arthritis is a chronic illness that causes joint pain, inflammation or redness of joints, and fever. It can change the way you feel about yourself. It may increase your dependence on others. The fear of hurting or being hurt may also limit the ability of you and your partner to share physical closeness. Discuss your concerns with your health care provider.

Summary

Some short-term sexual problems are common. You need not worry about sexual problems if they only last a short time. However, if the following problems persist, discuss them with your health care provider:

• problems getting or keeping an erection
• early ejaculation (discharge of semen before desired during sex)
• not enough vaginal wetness
• pain with intercourse
• trouble having orgasm.

Improve sexual communication by following these guidelines:

• Set realistic goals and expectations for your relationship.
• Make quality time with your partner a priority.
• Learn more about the emotional and physical aspects of sexual response, how those responses change with age, and how to deal with those changes.
• Discuss changes, share suggestions, and talk about fantasies.
• Don't ignore the importance of intimacy, love, and sexual pleasure for well-being.
• Tell your partner, and show your partner by guiding his or her hands, what feels good and how you like to be touched.
• Become more comfortable with each other and enjoy the freedom to express your desires.