Taboo #6 – Sex. (Updated September 2019)
Sex? ….errr Yes!
The expected population explosion doesn’t seem to have happened in lockdown, unlike during the war we have electric light and Netflix so aren’t fumbling in the dark for entertainment quite so much! The young have been kept apart physically as well as socially and psychologically. It’s rather more difficult to engage in conversation and arrange a date on-line for all it’s ‘social’ attributes. Psychologically there will be the fear factor of going out and getting up close and personal could potentially add another disease to the myriad of STDs. I have to say I really feel for them, they say youth is wasted on the young, however they don’t even get the opportunity to waste it in a pandemic. Schools, Colleges and Universities have been closed or only open for some. The opportunity to make friendships let alone close relationships has been hugely hindered. Even those in their middle years are often working from home and again isolated from the real world and porn sites are apparently doing a roaring trade. Those co-habiting have not always fared better and the pandemic is seeing relationships reach breaking point with the incidence of domestic violence on the rise. So for those of you surviving and in a good relationship how’s life between the sheets? I suspect having a bit more time and being able to pause Netflix gives couples more of a chance to play, but who knows?!
So getting back to us elders do the older generation have sex? My experience as a doctor is yes…..and no.
Those that do seem to be doing it a lot, those that don’t, don’t. This may be for a number of reasons from lack of desire/libido to medical conditions many of which can be addressed if help is sought. (Menopausal Atrophic Vaginitis for women can be helped with HRT and ED in men can often be helped with a medication review – many Anti-Hypertensives can cause or worsen erectile function. There are drugs such as Viagra and Cialis which can do the opposite. Vacuum pumps especially after prostate surgery can help a great deal too! – So if you both want more sex you only have to ask, each other and then your doctor.)
Do older people have sex? Really? YES REALLY! In fact, evidence suggests that it is the young who are having less sex whist the rise of Sexually Transmitted Diseases (STDs – and thus presumably more sex with more partners?!) is on the rise in the older generations! This could well be because today’s young people are well-educated about sexually transmitted infections, porn is never more than a few clicks away and they don’t need sex to entertain them thanks to the likes of social media. (No physical intimacy with your face staring at a screen!) Also, and this could be relevant to those with adult children, many still live at home. (15 percent of 20- to 24-year-old Americans haven’t done the deed since the age of 18, compared to only six percent of Generation X-ers when they were the same age. I only include this as there is the popular belief that the young are at it like rabbits whilst the older generations just don’t!)
According to a 2013 Saga survey, 71 per cent of over 50’s reported having a healthy sex life, up from 65 per cent in 2007. Sex as you get older can help keep you feeling good and is often better than it was when you were younger. In fact, many postmenopausal women report they can reach arousal much faster than they could before and their sexual satisfaction increases as they get older. For both sexes those who reported sexual activity as important had higher scores for psychological quality of life. The National Commission on Ageing (NCOA) shows that women, in particular, find sex over 70 as or more physically satisfying than they did in their 40’s. Sex was also shown to be more emotionally satisfying for both genders.
There are however studies that suggests not only that many older people are still sexually active, but that, like every other age group, they have worries and concerns about sex and relationships. Not surprisingly, ageing and failing health affect sexual activity but that this can be both positive and negative.
The difficulties most frequently reported by sexually active women related to becoming sexually aroused (32%) and achieving orgasm (27%), while for men the main difficulty was erectile function (39%).
Other studies have reported that the sexual health concerns most commonly reported by women relate to their level of sexual desire (11%) and frequency of sexual activities (8%) whilst among men common concerns were level of sexual desire (15%) and erectile difficulties (14%) with the likelihood of reporting sexual health concerns tending to decrease with age in women, whilst the opposite was seen in men.
Poor sexual functioning and disagreements with a partner about initiating and/or feeling obligated to have sex were associated with greater concerns about and dissatisfaction with overall sex life.
So it is clear that as we age the functioning of much of our equipment will change too. We may have less energy, more pain and stiffness, hormonal changes that are often negative and other physical and psychological issues BUT it’s not all bad – Read on!
In the Longitudinal Study of Ageing, 31 percent of British men from the ages of 80 to 90 still masturbate and have sex and just under 60 percent of men between the ages of 70 and 80 are still sexually active. However only 14 percent of women between the ages of 80 and 90, and 34 percent of women between 70 and 80, regularly engage in sex or masturbation. A study conducted by researchers at Indiana University’s Center for Sexual Health Promotion showed similar results. 46 percent of men and 33 percent of women over 70 reports that they masturbate and 43 percent of men and 22 percent of women in the same age bracket say they engage in sexual intercourse.
An important point is that sexually transmitted infection (STIs) don’t stop being a problem once you have retired. Recent data has shown that rates of common STIs in the 65 and over category have risen in England during the past decade. You should always practise safe sex whatever your age. Infection is a bigger risk than you might think so look out for abnormal bleeding during or after sex, sores, blisters, rashes and discharge as these are all signs that something could be wrong, but don’t panic! In the UK, tests and treatments for STIs are available at genitourinary medicine clinics (GUM). HIV was once thought to be a disease of only homosexuals and the young, however in 2013, one in five heterosexuals diagnosed with HIV was over 50. Remember that even if pregnancy is no longer a possibility you should always use a condom with a new partner to protect your health as well as theirs.
Arthritis and other causes of pain can affect sexual intimacy.
To help relieve joint pain:
- Experiment with different positions to take pressure off your joints.
- Use pillows or adaptive equipment for support.
- Take painkillers before sex.
- Have a bath before sex.
- Experiment with other forms of stimulation, such as masturbating each other.
To help with fatigue:
- Think of ways to reduce your daily workload.
- Make sure to rest during the day.
- Share household chores with your partner.
Sex won’t make your arthritis worse, so if sex is a regular part of your relationship then you can try to keep it that way. There is a big difference between ‘hurt’ and ‘harm’ – It may hurt but it won’t harm you so addressing it with medication as well as trying to focus on the sex and not the discomfort may well improve your experience.
For more advice, including images of helpful sexual positions, read Sex and Arthritis from Arthritis Research UK.
Menopausal symptoms include:-
- Irregular periods
- Vaginal dryness
- Hot flushes/Chills
- Night sweats
- Sleep problems
- Mood changes
- Weight gain and slowed metabolism
- Thinning hair and dry skin
- Loss of breast fullness
- Loss of libido
So, it’s unsurprising that sex may not be high on the agenda. However, some women say they feel more relaxed about sex after the menopause because they no longer have to worry about contraception. Hormone Replacement Therapy (HRT) can alleviate some or all of these symptoms but is not without risk and should be used for the shortest possible time and stopped once symptom relief is not required.
Tips to relieve vaginal dryness:
Nature has evolved effective cleansing and anti-infective mechanisms so avoid soap, bath oils and shower gels which can aggravate dryness by removing the natural oils which are designed to protect. Instead, use lukewarm water alone or with a soap-free cleanser.
If sex is uncomfortable try using a vaginal moisturiser or lubricant. These are available from pharmacies without a prescription. However some women may need topical oestrogen to ‘rejuvenate’ the vagina and a discussion with your GP or gynaecologist might be worthwhile.
A lower sex drive is often temporary and being able to talk things through with an understanding partner may be all that’s needed.
A lack of sensitivity in the penis is a normal part of ageing. It can make it more difficult for some men to get an erection and reach orgasm. Masturbate to exercise your penis by having daily erections (even if it’s not for sex) and try more direct stimulation of your penis during sex to improve your erection with sex toys. If you stop smoking, lose weight and exercise more this can often can help by improving blood flow to the penis. (see below)
Testosterone is often thought of as the “fountain of youth” hormone. But naturally declining testosterone levels don’t cause signs and symptoms of ageing as such. However, low testosterone levels can cause changes in sexual function, including:
- Low Libido /reduced sexual desire
- Fewer spontaneous erections – those Early Morning Erections (EMEs) – Morning Glories
- Erectile dysfunction (ED)
Other signs of decreased testosterone levels include changes in sleep patterns, emotional changes, such as low self-confidence or lack of motivation, physical changes, like increased body fat, reduced muscle bulk and strength, and decreased bone density. So although testosterone levels decrease throughout life normally there is little evidence that it is THE major cause of sexual dysfunction in the older man. Keeping healthy avoiding the risk factors that can cause heart disease and diabetes (Smoking, high blood pressure, raised cholesterol and obesity etc.) will protect those all-important penile blood vessels and nerves that are required for erections. Viagra and the like help improve blood flow and can help but prevention is better. The reverse conclusions have now been shown to be very important, that is if you are suffering with non-psychological (performance anxiety etc.) erectile dysfunction this may be an early warning sign of cardiovascular disease risk in future and there may be a window of opportunity to address this – see your doctor as not only is there help for ED but that addressing other risk factors may actually save or at least prolong your (sex) life.
If you’ve lost self-confidence talk to your partner, possibly more difficult for men however your partner may not realise how you feel but being your loved one will in all likelihood be only too willing to help. Many men often feel some pressure to perform ‘now’ and not having an erection able to sustain penetration (yet) can be disheartening and frankly counterproductive and self-defeating. All this whilst the woman takes longer to achieve arousal and is almost certainly not after a ‘wham-bam thank you mam’ experience. She will undoubtedly prefer time spent on her, for her there isn’t such a rush so take your time!
As we age we are prescribed more medications many of which are designed to protect us and increase our well-being and longevity. Most people don’t suffer from most of the listed side effects – in fact what makes a good drug is that most patients don’t get any. However in an effort to help medications can often have unwanted effects and many medications especially those to control blood pressure can have an effect on sexual function. Many doctors may not ask about this so you would be advised to and maybe ask Dr Google too!
The future? – Apparently there is a sexual revolution going on in nursing homes with dementia causing lowering inhibition and increased sexual interest. There are of course consequences that we need to consider with an ageing population and issues with our own sexual codes – but giving granny condoms when she arrives at the care home may not be altogether a bad idea! (Discuss…)
Dorree Lynn, author of Sex For Grown-Ups Says that people over 50 are now buying the largest number of vibrators. “Sure, sex changes as we age. We have to learn to deal with this, because we’re living longer. For some people, it gets better, because they can slow down and experience the real joys of what sex is about.This slowing-down gives us the opportunity for real intimacy and real communication. Foreplay actually starts once we’re older.”
Lynn adds that our ageing population needs a refresher course in sex education.
“Over 50 percent of people over 50 are now divorced or widowed, and they need to learn how to use condoms. They need to learn about ‘the joys of toys.’ We use eyeglasses. We use hearing aids. We use false teeth. Why not use vibrators? Older people don’t lose desire. They just lose their inhibitions. Young doctors don’t want to think about these old people having sex, but it’s happening. Sex is a birthright.”
Q. Have you or yours had positive or negative experiences?
Q. Is sex important to you and yours? If so is there some disparity in desire or function?
Q. As we age does sex get better? Are you having the Time Of Your Life?
Let me know your feelings, ideas and comments!