Sexuality and Aging

Section 12.1: Sexuality Later in Life

This section includes text excerpted from “Sexuality in Later Life,” National Institute on Aging (NIA), National Institutes of Health (NIH), July 19, 2017.

What Are Normal Changes?

Normal aging brings physical changes in both men and women. These changes sometimes affect the ability to have and enjoy sex. A woman may notice changes in her vagina. As a woman ages, her vagina can shorten and narrow. Her vaginal walls can become thinner and also a little stiffer. Most women will have less vaginal lubrication. These changes could affect sexual function and/or pleasure. Talk with your doctor about these problems.

As men get older, impotence (also called erectile dysfunction–ED) becomes more common. ED is the loss of ability to have and keep an erection for sexual intercourse. ED may cause a man to take longer to have an erection. His erection may not be as firm or as large as it used to be. The loss of erection after orgasm may happen more quickly, or it may take longer before another erection is possible. ED is not a problem if it happens every now and then, but if it occurs often, talk with your doctor.

What Causes Sexual Problems?

Some illnesses, disabilities, medicines, and surgeries can affect your ability to have and enjoy sex. Problems in your relationship can also affect your ability to enjoy sex.

Arthritis. Joint pain due to arthritis can make sexual contact uncomfortable. Exercise, drugs, and possibly joint replacement surgery may relieve this pain. Rest, warm baths, and changing the position or timing of sexual activity can be helpful.

Dementia. Some people with dementia show increased interest in sex and physical closeness, but they may not be able to judge what is appropriate sexual behavior. Those with severe dementia may not recognize their spouse but still seek sexual contact. This can be a confusing problem for the spouse. A doctor, nurse, or social worker with training in dementia care may be helpful.

Diabetes. This is one of the illnesses that can cause ED in some men. In most cases, medical treatment can help. Less is known about how diabetes affects sexuality in older women. Women with diabetes are more likely to have vaginal yeast infections, which can cause itching and irritation and make sex uncomfortable or undesirable. Yeast infections can be treated.

Heart disease. Narrowing and hardening of the arteries can change blood vessels so that blood does not flow freely. As a result, men and women may have problems with orgasms, and men may have trouble with erections. People who have had a heart attack, or their partners, may be afraid that having sex will cause another attack. Even though sexual activity is generally safe, always follow your doctor's advice. If your heart problems get worse and you have chest pain or shortness of breath even while resting, talk to your doctor. He or she may want to change your treatment plan.

Incontinence. Loss of bladder control or leaking of urine is more common as we grow older, especially in women. Extra pressure on the belly during sex can cause loss of urine, which may result in some people avoiding sex. This can be helped by a change in positions. The good news is that incontinence can usually be treated.

Stroke. The ability to have sex is sometimes affected by a stroke. A change in positions or medical devices may help people with ongoing weakness or paralysis to have sex. Some people with paralysis from the waist down are still able to experience orgasm and pleasure.

Depression. Lack of interest in activities you used to enjoy, such as intimacy and sexual activity, can be a symptom of depression. It's sometimes hard to know if you're depressed. Talk with your doctor. Depression can be treated.

What Else May Cause Sexuality Problems?

Surgery. Many of us worry about having any kind of surgery—it may be even more troubling when the breasts or genital area are involved. Most people do return to the kind of sex life they enjoyed before surgery.

Hysterectomy is surgery to remove a woman's uterus. Often, when an older woman has a hysterectomy, the ovaries are also removed. The surgery can leave both women and men worried about their sex lives. If you're afraid that a hysterectomy will change your sex life, talk with your gynecologist or surgeon.

Mastectomy is surgery to remove all or part of a woman's breast. This surgery may cause some women to lose their sexual interest or their sense of being desired or feeling feminine. In addition to talking with your doctor, sometimes it is useful to talk with other women who have had this surgery. If you want your breast rebuilt (reconstruction), talk to your cancer doctor or surgeon.

Prostatectomy is surgery that removes all or part of a man's prostate because of cancer or an enlarged prostate. It may cause urinary incontinence or ED. If removal of the prostate gland is needed, talk to your doctor before surgery about your concerns.

Medications. Some drugs can cause sexual problems. These include some blood pressure medicines, antihistamines, antidepressants, tranquilizers, appetite suppressants, drugs for mental problems, and ulcer drugs. Some can lead to ED or make it hard for men to ejaculate. Some drugs can reduce a woman's sexual desire or cause vaginal dryness or difficulty with arousal and orgasm. Check with your doctor to see if there is a different drug without this side effect.

Alcohol. Too much alcohol can cause erection problems in men and delay orgasm in women.

Am I Too Old to Worry about Safe Sex?

Age does not protect you from sexually transmitted diseases. Older people who are sexually active may be at risk for diseases such as syphilis, gonorrhea, chlamydial infection, genital herpes, hepatitis B, genital warts, and trichomoniasis.

Talk with your doctor about ways to protect yourself from all sexually transmitted diseases. Go for regular checkups and testing. Talk with your partner. You are never too old to be at risk.

Can Emotions Play a Part?

Sexuality is often a delicate balance of emotional and physical issues. How you feel may affect what you are able to do. Many older couples find greater satisfaction in their sex life than they did when they were younger. They have fewer distractions, more time and privacy, no worries about getting pregnant, and greater intimacy with a lifelong partner.

Some older people are concerned about sex as they age. A woman who is unhappy about how her looks are changing as she ages may think her partner will no longer find her attractive. This focus on youthful physical beauty may get in the way of her enjoyment of sex. Men may fear that ED will become a more common problem as they age. Most men have a problem with ED once in awhile. But, if you worry too much about that happening, you can cause enough stress to trigger ED.

Older couples face the same daily stresses that affect people of any age. They may also have the added concerns of age, illness, retirement, and other lifestyle changes, all of which may lead to sexual difficulties. Try not to blame yourself or your partner. You may find it helpful to talk to a therapist. Some therapists have special training in helping with sexual problems. If your male partner is troubled by ED or your female partner seems less interested in sex, don't assume he or she is no longer interested in you or in sex. Many of the things that cause these problems can be helped.

What Can I Do?

Don't be afraid to talk with your doctor if you have a problem that affects your sex life. He or she may be able to suggest a treatment. For example, the most common sexual difficulty of older women is painful intercourse caused by vaginal dryness. Your doctor or a pharmacist can suggest over-the-counter vaginal lubricants or moisturizers to use. Water-based lubricants are helpful when needed to make sex more comfortable. Moisturizers are used on a regular basis, every 2 or 3 days. Or, your doctor might suggest a form of vaginal estrogen.

If ED is the problem, it can often be managed and perhaps even reversed. There are pills that can help. They should not be used by men taking medicines containing nitrates, such as nitroglycerin. The pills do have possible side effects. Other available treatments include vacuum devices, self-injection of a drug, or penile implants.

Physical problems can change your sex life as you get older. But, you and your partner may discover you have a new closeness. Talk to your partner about your needs. You may find that affection—hugging, kissing, touching, and spending time together—can make a good beginning.

Section 12.2: Sexuality and Menopause

This section includes text excerpted from “Menopause and Sexuality,” Office on Women's Health (OWH), U.S. Department of Health and Human Services (HHS), September 22, 2010. Reviewed September 2017.

Sexual Issues and Menopause

In the years around menopause, you may experience changes in your sexual life. Some women say they enjoy sex more after they don't have to worry about getting pregnant. Other women find that they think about sex less often or don't enjoy it as much.

Changes in sexuality at this time of life have several possible causes, including:

Keep in mind that being less interested in sex as you get older is not a medical condition that needs treatment. But if you are upset about sexual changes, you can get help. Don't be shy about talking with your doctor or nurse. They certainly have talked with many women about these issues before.

Lifestyle Changes

Some simple steps may help with sexual issues you face at this time:

Treatment Options

Discuss your symptoms and personal health issues with your doctor to decide whether one or more treatment options are right for you.

If vaginal dryness is an issue:

If sexual interest is an issue:

Talking with Your Partner

Talking with your partner about your sexual changes can be very helpful. Some possible topics to discuss include:

Talking with your partner can strengthen your sexual relationship and your overall connection. If you need help, consider meeting with a therapist or sex counselor for individual or couples therapy.

Section 12.3: Male Menopause

“Male Menopause,” © 2018 Omnigraphics.
Reviewed September 2017.

What Is Male Menopause?

Male menopause refers to a decline in male hormone levels that occurs due to the aging process. Since men aged 50 or older often undergo a drop in testosterone production, this condition is also known as androgen (testosterone) decline, andropause, or simply low testosterone.

Testosterone is a hormone that is found in both men and women. In men, it is produced in the testes and is responsible for the development of male sex organs before birth, brings about changes during puberty, plays a role in sex drive and sperm production, fuels physical and mental energy, and helps maintain muscle mass.

Although menopause affects men at about the same age as women, it is not the same as female menopause. In women, menopause occurs as ovulation ends and hormone production drops off quickly. In men, however, hormone production declines at a slower rate, and this may lead to only slight changes in the way the testes function.

What Are Its Symptoms?

Male menopause can lead to physical, sexual, and psychological problems that may worsen as the person ages.

These problems can include:

Other less common symptoms may include reduced testicle size, tender or enlarged breasts, hot flashes, loss of body hair, and in rare cases osteoporosis.

How Is It Diagnosed?

A doctor will generally diagnose male menopause by asking about symptoms and performing a physical examination. During this conversation, it is vital that the patient inform the doctor fully about issues like sexual problems. Blood tests may be ordered to measure testosterone levels, and in some cases other tests may be required to rule out medical issues that may contribute to this condition.

How Is It Treated?

Symptoms of male menopause are commonly treated through lifestyle changes, such as eating a healthier diet, getting more sleep and regular exercise, and reducing stress. Antidepressants and therapy may be prescribed if the individual is suffering from depression.

Testosterone replacement therapy may also be suggested to help alleviate such symptoms as fatigue, decreased libido, and depression. Much like hormone replacement therapy for women, treatment using synthetic hormones is controversial and comes with potential risks and side effects. For instance, in an individual with prostate cancer, synthetic hormones may cause an increase in the growth of cancer cells. If a doctor suggests hormone replacement therapy, it is advisable to consider both the positives and negatives of this treatment option thoroughly before making a decision.

References

  1. Krans, Brian. “What Is Male Menopause?” Healthline Media, March 8, 2016.
  2. Derrer, David T. “Male Menopause,” WebMD, LLC, August 17, 2014.

Section 12.4: Intimacy and Alzheimer Disease

This section includes text excerpted from “Changes in Intimacy and Sexuality in Alzheimer's Disease,” National Institute on Aging (NIA), National Institutes of Health (NIH), July 13, 2017.

You, the caregiver, may pull away from the person in both an emotional and physical sense. You may be upset by the demands of care-giving. You also may feel frustrated by the person's constant forgetfulness, repeated questions, and other bothersome behaviors.

Most caregivers learn how to cope with these challenges, but it takes time. Some learn to live with the illness and find new meaning in their relationships with people who have Alzheimer disease.

How to Cope with Changes in Intimacy

Most people with Alzheimer disease need to feel that someone loves and cares about them. They also need to spend time with other people as well as you. Your efforts to take care of these needs can help the person with AD to feel happy and safe. It's important to reassure the person that:

The following tips may help you cope with your own needs:

How to Cope with Changes in Sexuality

The well spouse/partner or the person with Alzheimer disease may lose interest in having sex. This change can make you feel lonely or frustrated. You may feel that:

A person with Alzheimer disease may have side effects from medications that affect his or her sexual interest. He or she may also have memory loss, changes in the brain, or depression that affect his or her interest in sex.

Here are some tips for coping with changes in sexuality:

Hypersexuality

Sometimes, people with Alzheimer disease are overly interested in sex. This is called hypersexuality. The person may masturbate a lot and try to seduce others. These behaviors are symptoms of the disease and don't always mean that the person wants to have sex.

To cope with hypersexuality, try giving the person more attention and reassurance. You might gently touch, hug, or use other kinds of affection to meet his or her emotional needs. Some people with this problem need medicine to control their behaviors. Talk to the doctor about what steps to take.

  This information is not a tool for self-diagnosis or a substitute for professional care.