Sex and the ageing process

Most older people want and are able to enjoy an active, satisfying sex life. However, over time, you may notice a slowing of sexual response. This is part of the normal ageing process.

What changes do women experience?

Women may notice changes in the shape and flexibility of the vagina. These changes may not cause a serious loss in the ability to enjoy sex. After menopause, many women will have a decrease in vaginal lubrication that can affect sexual pleasure. Simple lubricants (such as KY Jelly or Replens) can help.

What changes do men experience?

Men often notice more distinct changes. It may take longer to get an erection or the erection may not be as firm as in earlier years. The feeling that an ejaculation is about to happen may be shorter. The loss of erection after orgasm may be more rapid or it may take longer before an erection is again possible. Some men may find they need more stimulation to become aroused.

Older men and impotence

As men get older, impotence — the loss of ability to achieve and maintain an erection hard enough for sexual intercourse (also called erectile dysfunction) — seems to increase, especially in men with heart disease, high blood pressure and diabetic complications. For many men, impotence can be managed and perhaps even reversed.

Effects of illness or disability

Although illness or disability can affect sexuality, even the most serious conditions shouldn't stop you from having a satisfying sex life.

  • Heart disease. Many people who have had a heart attack are afraid that having sex will cause another attack. The risk of this is very low. Follow your doctor's advice. Most people can start having sex again 12 to 16 weeks after an attack.
  • Diabetic complications. Most men with diabetic complications do not have problems, but it is one of the few conditions that can cause impotence. In most cases medical treatment can help.
  • Stroke. Sexual function is rarely damaged by a stroke and it is unlikely that sexual exertion will cause another stroke.
  • Arthritis. Joint pain due to arthritis can limit sexual activity. Surgery and some medicines may relieve this pain.
  • Surgery. Most people worry about having any kind of surgery, especially when the sex organs are involved. The good news is that most people do return to the kind of sex life they enjoyed before having surgery.
  • Hysterectomy. This is the surgical removal of the womb. A hysterectomy should not affect sexual functioning. If a hysterectomy seems to take away your ability to enjoy sex, seek advice.
  • Mastectomy. This is the surgical removal of all or part of a woman's breast. Although her body is as capable of sexual response as ever, a woman may lose her sexual desire or her sense of being desired. Sometimes it is useful to talk with other women who have had a mastectomy.
  • Prostatectomy. This is the surgical removal of all or part of the prostate. This procedure can cause impotence in some cases. If a radical prostatectomy (removal of the entire gland) is needed, surgical techniques can save the nerves going to the penis and an erection may still be possible.

Other issues

  • Alcohol. Too much alcohol can reduce potency in men and delay orgasm in women.
  • Medicines. Antidepressants, tranquillisers and certain high blood pressure medicines can cause impotence. Some medicines can make it difficult for men to ejaculate. Some medicines reduce a woman's sexual desire. Check with your doctor. They can often prescribe a medicine without this side effect.

Emotional concerns

Sexuality is often a delicate balance of emotional and physical issues. How we feel may affect what we are able to do. For example, worrying about impotence can create enough stress to cause it.

As a woman ages, she may become more anxious about her appearance. This emphasis on youthful physical beauty can interfere with a woman's ability to enjoy sex.

Older couples may have the same problems that affect people of any age. They may also have the added concerns of age, retirement and other lifestyle changes, and illness. These problems can cause sexual difficulties. Talk openly with your doctor about this. The important thing is for both members of a couple to find what makes them both happy.

References

1. Mayo Clinic. Sexual health and aging: keep the passion alive [website]. Sep 2009. http://www.mayoclinic.com/health/sexual-health/HA00035/METHOD=print (accessed August 2010).
2. National Institute on Aging. Age Page. Sexuality in later life [website]. Updated April 2010. http://www.nia.nih.gov/HealthInformation/Publications/sexuality.htm (accessed August 2010).
Dr Michael Jones