Sex in the Senior Years

Why function, comfort, and desire may change—and what you can do about it

There's a perception that sex tends to become less of a priority in life with age. Maybe that's true for some. But many people maintain a healthy sex life long into their later years. According to a 2017 survey, 40% of men and women ages 65 to 80 are still sexually active.

Sexual activity is an essential measure of the quality of life for many adults. But, over time, problems can arise that make sex difficult. Common senior sex issues include erectile dysfunction (ED), vaginal dryness, incontinence, and uterine prolapse (when the uterus drops down to the vagina).

Carefree senior couple dancing in the living room - stock photo

andrewsd / Getty Images

In addition to sexual health issues, physical ailments like aches and pain can hinder sexual activity. Medication side effects and emotional struggles can also factor in.

This article explores sex in older age and problems that can affect your sex life. It also discusses treatment options and ways to maintain or even jumpstart your sex life in your later years.

Who Has Sex More in Older Age?

Men are almost twice as likely as women to still have sex or masturbate in their later years. A British study found close to 60% of men ages 70 to 80 and 31% of men ages 80 to 90 are still sexually active. In women, those figures drop to 34% and 14%, respectively.

This lower rate of sexual activity in older women may be due to a lack of opportunity rather than a lack of desire. Research shows that older women are less likely than men to have partners, sometimes referred to as "the partner gap."

Sexual Problems in Older Men

It is common for men to start experiencing sexual problems after age 40. Reasons for this include a natural decline in testosterone levels, health issues like diabetes and heart disease, and problems with the prostate, which is the small gland between the penis and the bladder.

Erectile dysfunction and premature or delayed ejaculation are common sexual problems in senior men.

Erectile Dysfunction (ED)

ED is also called impotence. It is the inability to achieve or maintain an erection firm enough for sexual penetration and long enough to achieve orgasm.

While erectile dysfunction is more common in older men, aging does not cause the problem. ED is commonly caused by another health condition. It can be a symptom of clogged blood vessels or nerve damage caused by diabetes, for example.

If you experience erectile dysfunction, talk to your healthcare provider. It is important to get a physical to find the cause and get an accurate diagnosis.

Lifestyle changes can help treat the causes of ED. Erectile dysfunction medications such as Viagra (sildenafil), Levitra (vardenafil), and Cialis (tadalafil) may also be prescribed to help increase blood flow to the penis.

Hormonal treatment, penis pumps, and penile implants are other treatments that can help restore firm erections.

Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia is the clinical name for an enlarged prostate. This is one of the most common health problems in men over age 50.

BPH can affect sexual functioning—delaying ejaculation, for example—and cause symptoms including:

  • Difficulty or hesitancy starting to urinate
  • Frequent urination
  • Waking up to pee in the middle of the night (nocturia)
  • Urinary urgency, leaking, or dribbling
  • Urine that looks or smells unusual

Medications and procedures used to treat BPH can also impact sexual functioning.

If you experience symptoms of BPH, talk to your healthcare provider. While BPH does not increase the risk of prostate cancer, the symptoms are similar.

Recap

Sexual health problems in senior men include erectile dysfunction (ED) and benign prostatic hyperplasia (BPH). If you experience difficulty achieving or maintaining an erection, talk to your healthcare provider. They can evaluate you to make sure it's not a sign of a more serious health concern and suggest possible treatments that may help.

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6 Lifestyle Changes to Treat Erectile Dysfunction

Sexual Problems in Older Women

More than a third of older women experience sexual problems. These are typically due to menopause when estrogen levels decline. Hormonal changes can lessen sexual desire and make it harder to become aroused.

Sexual organs also change as you get older. A woman's vagina shortens and narrows. The vaginal walls become thinner and less flexible, tearing more easily. Vaginal lubrication lessens. As a result, intercourse can become painful.

Here is a closer look at common sexual problems in senior women and some solutions that may help.

Low Libido

Having a low sex drive (libido) is clinically known as hypoactive sexual desire disorder (HSDD). Difficulty becoming aroused is a common issue among older women.

A medication known as Addyi (flibanserin) is used to treat HSDD in women. It is currently approved only for pre-menopausal women. However, research shows Addyi can improve libido in older women as well.

While not approved in post-menopausal women, your healthcare provider can prescribe it for off-label use.

Vaginal Dryness

Vaginal dryness is uncomfortable and can make sex painful. Over-the-counter (OTC) remedies that may relieve irritation and itching from dryness include:

  • Lubricants, such as K-Y Jelly
  • Suppositories, such as Replens

There are also plant-based products that have estrogen-like effects on the vaginal tissue, such as black cohosh These should be used with caution in women who have had or are at risk for breast cancer, however.

If OTC remedies don’t solve the issue, talk to your healthcare provider. Estrogen cream can be prescribed for vaginal dryness. There are also estrogen-containing vaginal rings and vaginal suppositories.

Painful Intercourse

Painful intercourse is more likely in older women. Thinning vaginal tissue can tear more easily and hurt. Treatment for vaginal dryness may help ease pain during sex.

If that is not effective, talk to your healthcare provider. Prescription medications Osphen (ospemifene) and Prasterone (dehydroepiandrosterone) treat thinning vaginal tissue.

Pelvic Organ Prolapse (POP)

The pelvic floor muscles and tissues hold the bladder, uterus, cervix, vagina, and rectum in place. POP occurs when the pelvic floor becomes weak and pelvic organs are pulled down by gravity.

POP can cause painful intercourse, pelvic pain and pressure, and incontinence.

Pelvic organ prolapse is often treated with pelvic floor physical therapy. In some cases, surgery may be needed.

Recap

Sexual health problems in senior women include a decrease in libido, vaginal dryness, painful intercourse, and pelvic organ prolapse. Talk to your healthcare provider if you experience any of these issues. There are treatments available that can help improve your post-menopausal sex life.

Other Health Problems That Can Affect Sex

Chronic medical conditions become more common with age. Some of these can interfere with your sex life.

Some common senior health issues that can hinder sexual activity and possible solutions are reviewed here.

Arthritis and Chronic Pain

Arthritis, osteoarthritis, and other chronic pain conditions can make sex more difficult. In addition, opioid pain medication can lower testosterone levels and contribute to ED.

Physical therapy can help to strengthen muscles and improve flexibility. As a result, you should experience less pain and be better able to have sex.

Depending on the type of pain you or your partner experiences, trying different positions may help. For example, having your partner on top may be easier for you if you have a bad back.

Diabetes

Diabetes can cause sexual dysfunction in men and women. This can be due to circulation problems, medication side effects, or nerve damage.

Sexual issues related to diabetes include:

Talk to your healthcare provider if you experience any of the above. Maintaining normal blood sugars can help prevent or alleviate diabetes-related sexual problems.

Heart Disease

Heart disease causes arteries to narrow and harden. This reduces blood flow, causing arousal problems for both men and women.

Heart disease is the leading cause of erectile dysfunction in men. It can also cause women to have difficulty achieving an orgasm.

People with heart disease may also be nervous to have sex for fear of a heart attack. While sexual activity is generally safe, talk to your healthcare provider if you are concerned.

Obesity

Research shows that women who are obese are more likely to experience sexual dysfunction than non-obese women.

In addition, obesity increases the odds of erectile dysfunction in men. This may be due to higher rates of diabetes—and related nerve damage—among people who are obese.

Incontinence

Incontinence is the loss of bladder control or the leaking of urine. This becomes more common with age, especially in women.

Incontinence can be embarrassing and make sex awkward. Women who experience stress incontinence may be afraid to orgasm. Extra pressure on the abdomen during intercourse can cause urine to leak.

If you deal with incontinence, empty your bladder prior to sex. Changing sexual positions can also help prevent leaking during sex.

Pelvic floor physical therapy can often help improve incontinence.

Cancer

The physical and psychological effects of cancer can lead to sexual problems. Some types of cancers and some cancer treatments may not affect your sex life, while others may have a significant impact.

Some cancer treatments can alter hormone levels, affect how sex organs work, or damage nerve function.

Side effects of cancer treatments, including fatigue, can also sap a person’s sexual desire. This may subside once treatment is complete. However, post-cancer sexual problems can linger.

Talk candidly with your healthcare provider about the sexual side effects of cancer treatments.

Medications

Several medications have sexual side effects for men and women. These include:

  • Antidepressants and other psychiatric medications
  • Antihistamines (allergy medicine)
  • Chemotherapy
  • Diuretics (water pills)
  • High blood pressure medicines
  • Parkinson disease medications
  • Opioid painkillers

Recap

Medical issues can cause significant barriers to your sex life. Health concerns that commonly affect senior sex include arthritis, cancer, chronic pain, diabetes, heart disease, and incontinence. In addition, several medications can have sexual side effects.

Impact of Lifestyle and Mental Health

Lifestyle habits and mental health issues can also contribute to sexual problems in older adults. While some health issues that impact sex may not be fully in your control, you may be able to influence your lifestyle in ways that improve or maybe even resolve your issues.

Alcohol and Drugs

For some people, drinking a glass of wine helps them relax and get in the mood. However, too much alcohol or chronic drinking can impact sexual function.

Alcohol can inhibit a man's ability to become erect, cause premature ejaculation, or delay orgasm. In women, too much alcohol can make it difficult to climax.

Recreational drug use can also cause sexual problems. Opioids in particular can lower testosterone in men and cause erectile dysfunction.

Depression

Age itself is not a risk factor for depression, but several risk factors are more common in older adults. Health conditions, sleep problems, and limited function are just a few examples.

In depression, neurotransmitters—chemical messengers that send signals between the brain and body—are out of balance. This can affect sexual desire, arousal, and orgasm. Medications used to treat depression can have the same effects.

It's worth noting that older adults' depression is often overlooked or misdiagnosed by healthcare providers who associate depression symptoms with an illness or a life change.

Stress

Stress can be a contributing factor to sexual dysfunction. Financial worries and health concerns are common worries for many seniors.

To relieve stress, and the effect it can have on your sex life, consider learning to meditate. Research shows practicing mindfulness and meditation can ease the effects of stress.

Seek the assistance of professionals such as financial advisors, health advocates, and others, depending on your stressor(s). That may help take some of the weight off of your shoulders.

Relationship Issues

Lack of sexual intimacy is often related to relationship problems. If you are and your partner are not connecting emotionally, it can lessen your desire to be intimate with them.

While this issue is not unique to older couples, many people find talking to a marriage counselor can help them to work through issues. This, in turn, can help restore sexual chemistry in the relationship.

Self-Image

With age can come weight gain and other body changes that may affect one's sense of their physical attractiveness. Self-consciousness can spill over into the bedroom and inhibit someone enough to impact their sex life.

A 2019 study on women ages 45 to 60 explored this. It found that those who felt self-conscious about their bodies noted decreased sexual satisfaction. But some women in the group had the opposite experience: an increase in self-acceptance during mid-life and a more satisfying sex life. The same can be presumed to be true of older adults as well.

Recap

Lifestyle choices and mental health issues can contribute to sexual problems. Depression, drug and alcohol abuse, obesity, stress, and relationship problems are common causes of sexual dysfunction in older adults.

How to Maintain a Healthy Sex Life

The benefits of maintaining your sex life as you age are physical and emotional. Being sexually active is associated with a decreased risk of medical conditions and longer life. It's also associated with a greater sense of happiness and overall well-being.

If your sex life has become stagnant and you'd like to rev it back up, consider these ideas.

Communicate

Good sex begins with good communication. Couples who have been together a long time often think they know what the other is thinking. But no one is a mind reader.

Talk to your partner about any concerns you have. You may feel as though your mate is no longer attracted to you because sex has become infrequent, when in fact they are experiencing a decline in sexual interest.

In addition, as sex organs change with age, what felt good before may no longer feel good or may even be painful. Be open with your partner about these changes.

Communicating about sex can be challenging at any age, however. If you and your partner struggle to talk about sex, consider seeing a sex therapist.

Redefine Sex

Sex, as you get older, may need to change. But different can still be good, if not better. With an empty nest and possibly retirement, there’s more time and privacy to explore.

Research shows older adults have a broader definition of sexual activity than younger adults. In other words, they better understand that there is more to sex than just intercourse. Foreplay on its own can be quite satisfying.

Be creative and willing to try new things.

Rethink Intimacy

Sex isn't just physical. It’s an emotional expression of intimacy. As you grow older, sexual intimacy changes. What this means to you and your partner may need to be redefined.

Emotional intimacy can be expressed through non-sexual physical touch. Examples of non-sexual physical touch include:

  • Backrubs
  • Cuddling
  • Holding hands
  • Hugging
  • Placing your hand on your partner's shoulder or arm
  • Playful nudges
  • Sitting next to each other
  • Touching feet under the table

Another non-sexual way to build emotional intimacy is spending quality time together. Things you can do:

  • Go out on dates with other couples
  • Look through old photos and reminisce
  • Play cards, board games, or word games
  • Read aloud to each other
  • Play music together
  • Travel, explore new places
  • Visit with friends or family

Just Do It

Instead of waiting for the desire to strike, experts recommend that older adults just go for it. This is because sex has physical and emotional benefits. Orgasms release oxytocin, a hormone that induces a state of calm and improves sleep.

Even if you’re not in the mood, having sex can set the stage for more sex in the future. This is especially true for women. Having sex regularly helps increase natural lubrication and vaginal elasticity.

Practice Safe Sex

For older adults who are not part of a long-term monogamous relationship, remember to practice safe sex. You may no longer need to worry about an unplanned pregnancy, but sexually transmitted diseases (STDs) are another story. You are never too old to get an STD. In fact, STD rates in older adults have risen in recent years.

Older adults who are sexually active should be tested for STDs prior to having sex with new partners.

Recap

Communication and a willingness to try new things can help you reshape your sex life into something that both suits your needs as an older adult and satisfies you.

Summary

Various body changes, conditions that are more common with age, lifestyle choices, and mental health concerns can impact your desire and your ability to have sex. But that doesn't mean that you need to accept your situation.

Seeking treatment for issues like diabetes, erectile dysfunction, incontinence, and depression can help, as can reframing your thoughts about your body and what sex "should" be like.

Keep the lines of communication open with both your healthcare provider and your partner so you can identify ways to address what can be managed and write a next chapter that brings you satisfaction.

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