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 Sexual
Response and Aging
 Women
and men have the capacity for sexual desire and sexual activity throughout
their lives—there is no reason why one cannot express one’s
sexuality well beyond the “reproductive years” (the ages during
which men and women are fertile). In fact, women and men who have been
sexually active throughout their adult lives seem to be more sexually
responsive in old age than those who have not. The key to maintaining
sexual function in later years is to continue a pattern of regular sexual
activity over a lifetime.
Many cultures have strong
biases against sexual activity among the middle-aged and elderly, and
expressions of sexual attraction among the elderly are sometimes treated
with disdain. In much of the world, “sexy” is synonymous with
“young”—media images of young, sexually vibrant people
abound, while images of healthy sexuality among those middle age and beyond
are nearly nonexistent.
These attitudes can keep middle-aged
and elderly people from receiving adequate health care. For example, health
care providers often neglect to deal with issues related to sexually transmitted
infections when they are treating older clients because they mistakenly
assume that older clients could not be engaging in risk-taking sexual
behaviors. Similarly, providers who do not consider the effects of chronic
medical conditions and medications on sexual response when dealing with
older clients may not anticipate these clients’ dissatisfaction with
services and discontinuation of treatment if side effects occur.
Although sexual activity can
continue well into one’s 90s and beyond, the aging process does
have an effect on sexual responses and function. In general, the response
cycle slows down: the stages of response take longer to achieve, the intensity
of sensation may be reduced, and the genital organs become somewhat less
sensitive. Sexual excitement and orgasm are diminished, yet pleasurable.
Despite somewhat diminished
response, a woman in her 30s or 40s may actually achieve orgasm more readily
than she did in her younger years, possibly because of a greater familiarity
with and understanding of her body and its responses. In older women,
menopause results in drastic drops in estrogen and progesterone, causing
physiologic changes that affect sexual function. These hormone-related
changes include thinning of the vaginal lining, reduced elasticity, and
decreased lubrication, often resulting in discomfort or pain during intercourse.
Urinary incontinence may also occur (because of reduced estrogen), as
well as loss of libido (because of reduced testosterone).
Normal physiological changes
include the following:
Desire:
- A decrease in libido may
be experienced, particularly for postmenopausal women.
Excitement and Plateau:
- In women: Delayed
nipple erection; reduced labial separation, labial swelling, and vaginal
expansion; delayed and/or reduced lubrication during excitement; decreased
elevation of the uterus; and reduced muscle tension. Women who have
experienced multiple vaginal deliveries experience more relaxed vaginal
tone, which may result in less stimulation during vaginal intercourse.
- In men: Delayed
and less-firm erection; delayed nipple erection; longer excitement stage;
decreased preejaculatory emissions; longer interval from excitement
to ejaculation; reduced muscle tension; diminished lifting of the scrotum
and testes; shorter phase of impending orgasm. More direct stimulation
may be required to achieve and maintain an erection.
Orgasm:
- Women experience a reduced
spread of sexual flush. In men, ejaculation time is shorter, with reduced
volume of ejaculate and fewer ejaculatory contractions.
Resolution:
- In women, there is no dilation
of the cervix.
- Men experience a more rapid
loss of erection and a significantly longer refractory period, though
with a more rapid return to the preexcitement state. Nipple erection
lasts longer after orgasm.
One’s later years can
offer a rich sex life without the worry of pregnancy and the inconvenience
of contraception. However, it is important to remember that the risk of
acquiring HIV and other STIs is not reduced with age.
© 2007 EngenderHealth
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