McKesson Clinical Reference Systems: Women's Health Advisor 2002.2

As you grow older your need for and comfort with sexual communication may decrease because of the psychological, social and physical problems and diseases that may occur in later life.

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 failures as well as our successes.

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

• difficulty adjusting to retirement
• failure of a child in college or the family-owned business
• child's or partner's drug or alcohol dependency
• illness and disability
• the death of friends or family members.

The empty nest syndrome may cause an identity crisis for women. The difficulties of facing a changing family role may mean a period of close self-examination. Some become too focused on themselves or overly concerned with their health. Some women may become sexually assertive for the first time. Their partners may either welcome the change or feel threatened by it. It is not easy to develop a new identity, and partners need to be supportive of and share in the decisions a woman may make in pursuit of that goal.

While many people have little difficulty adjusting aspects of their lives due to changes in circumstance, some continue to expect or demand perfection where sex is concerned. That places a heavy burden on intimate relationships. It can result in frustration, depression, and withdrawal from sex and the relationship.

Relationship Problems

All too often, sexual problems are a mirror of our emotions. They reflect our lack of satisfaction with ourselves.

Often visits with a therapist can help. Couples will benefit most by visiting the therapist together.

Sudden loss of interest in sex in a close relationship may be an early sign of depression. In such cases, psychotherapy, treatment with medicine, and sexual counseling may be helpful.

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.

However, menopause does not have to mean a drastic change in lifestyle. Women should educate themselves about menopause by talking to their health care providers. They can learn about the benefits of hormone replacement therapy and its role in preventing vaginal dryness and irritation, hot flashes, and possibly osteoporosis. Hormone therapy may also help women to preserve energy and drive and to avoid mood shifts, irritability, tension, headaches, and insomnia during menopause.

A man may develop problems with circulation or other health problems and be unable 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.

The partner with a physical problem that affects sexual performance usually tries to avoid sexual contact. Couples often stop touching each other rather than confront failure. In their pain, some people even stop talking to each other. Others resort to using words as weapons. Sexual intimacy can be enhanced if, instead, partners share their desires and expectations.

Problems from Disease

From 80% to 90% of problems getting or keeping an erection (erectile dysfunction, or impotence) are caused by problems in the blood supply to the penis. Diseases such as hardening of the arteries and diabetes are often responsible. Ask your health care provider about ways to treat the problem. Disease also can cause sexual problems by damaging organs in your body or affecting their normal function.

Some medicines, chemotherapy, or surgeries used to treat illnesses 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. Medicines used to treat cancer, arthritis, and neurologic problems have side effects that may cause sexual 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.

Caution about physical activity after recovery from a heart attack may lead you to mistakenly believe that sex is risky and that you should avoid it. However, intercourse and orgasms require no more exertion than climbing a flight of stairs or running the vacuum cleaner. Most people treated for heart problems can safely resume having sex, as well as other forms of physical activity. Consult your health care provider if you are concerned about your ability to safely resume physical activity.

Arthritis is a chronic illness that causes joint pain, inflammation of the joints, and fever. It can change the way you feel about yourself and may limit your physical ability to share affection without the fear of hurting or being hurt. Discuss any concerns you have with your health care provider.

Summary

If you have any of the following problems, 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.

Of course, some short-term sexual problems are common. You need not worry about rare, isolated incidents of sexual problems. However, if they persist, consult your health care provider.

Improve sexual communication by following these guidelines:

• Increase your understanding of crises that occur in the lives of older adults.
• Set realistic goals and expectations for your relationship.
• Plan quality time with your partner, like a date or a vacation, when nothing else will be as important as the attention you give to each other.
• Increase your understanding of the emotional and physical aspects of sexual response, how those responses change with age, and how to reduce the impact of those changes.
• Discuss changes, share suggestions, and talk about fantasies.
• Tell your partner, and show your partner by guiding his or her hands, what feels good and how you like to be touched.
• Upgrade the importance of intimacy and let sex be first more of the time. Don't suppress your desires until all your daily chores are done.
• Become more comfortable with each other and enjoy the freedom to express your desires.

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.