Sex After 65 and Other Aging Facts

Original article by Dr. Lenny Powell, Family Physician, Geriatrics Fellow

“Aging is not a reason for despair, but a basis for hope, not a slow decline but a gradual maturing, not a fate to be undergone, but a change to be embraced.” – Fr. Henri Nouwen

“I guess I’m just getting older.” You’ve heard it before – from your parents, your grandparents, or maybe you’ve even said it yourself. While it’s true that we change as we age, there are some parts of aging that are not normal and should serve as red flags for you to discuss with your doctor.
While we chronologically age, some of us physiologically (and pathologically) age faster than others. As we age, we may develop multiple chronic medical conditions and be on several medications.  In addition to keeping on top of chronic medical conditions and screening exams (colonoscopy, mammogram, vaccinations, and DEXA scan, to name a few), there may be other factors that should be discussed with your doctor should they arise.

Depression

Depression is real, and older adults often suffer from depression. Some may have a lack of energy and attribute symptoms to old age or other physical conditions, and often neglect discussing their symptoms with their doctor. The deaths of friends or family members, or changes in established routines may also trigger grief and subsequent development of depression. A simple screening instrument called the PHQ-2 (Patient Health Questionnaire 2) can be used by your doctor to determine if further investigation is necessary. This questionnaire asks two questions:

1. In the last 2 weeks, have you had little interest or pleasure in doing things?
2. In the last 2 weeks, have you been bothered by feeling down, depressed, or hopeless?

Did you answer “yes” to either of these questions? If so you should discuss your feelings with your doctor.

Falls

Falls are not a normal part of aging and are the leading cause of accidental death in persons over age 65. A fall is defined as an event during which an individual comes to rest on the ground without a known loss of consciousness. They can be caused by poor balance, weakness, medication side effect or interactions, or a lack of environmental supports such as poor lighting or loose carpets. Falls can lead to serious medical conditions like hip fractures or other preventable injuries. Often, a fall is a non-specific indicator of an acute illness and should be discussed with your doctor. A fall with a loss of consciousness is often indicative of a more serious event and should be investigated immediately.

Sexual Dysfunction

First of all, sex IS okay after 65! In fact, it is a normal part of life. Dr. Terrie Ginsberg notes that, overall, the majority of surveyed older adults reported to have had physical and sexual experiences in the past year such as touching/holding hands (60.5%), embracing/hugging (61.7%) and kissing (57%) daily to at least once a month; mutual stroking, masturbation and intercourse were experienced ‘not at all’ by 82% or more. For all activities except masturbation, participants wanted to participate in sexual activities more often than they did. The most important barrier to sexual activity was lack of a partner. But, sexual dysfunction can occur in both men and women.

In men, the inability to achieve a sufficient erection for intercourse affects nearly 70% of men by age 70. Some common causes of erectile dysfunction include diabetes, alcoholism, psychogenic, medications, or diminished amounts of testosterone. Treatment options include the often-advertised medications like Viagra, Cialis, or Levitra. Testosterone replacement may also be an option if testosterone levels are deficient.

In women, reduced sex drive, a dislike of sexual activity, difficulty with arousal, an inability to achieve orgasm, or pain with intercourse (dyspareunia) may occur. A pelvic exam will assess for causes such as vulvovaginitis (inflammation/infection), vaginal atrophy, cystocele, and rectocele, to name a few. Water-soluble lubricants or estrogen creams are often useful.
Keep these factors in mind when you see your doctor and discuss any concerns that you may have.
Bottom line? Sex is okay after 65! Enjoy!

_{References: Ginsberg, T. B., et. al. Age Ageing. 2005 Sep;34(5):475-80. Epub 2005 Jul 25.}