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Sex and the Eldery

Interview with Laura Berman

Is there an age when people stop having sex?
No, it is natural to have a consistent desire to feel close to someone. That doesn’t necessarily mean that you want to be swinging from the chandeliers every time. You can do equal harm putting pressure on people to maintain some crazily active sex life if they are not interested in it. The bottom line is that the message should be that sex is ok and “normal” at any age and to any degree, whether you want to be just cuddling and holding hands and spending time together, or you want to be more physically, sexually intimate with each other in other ways.

A main thing to know is that options are available to aid you in your sex life. You should demand that your doctor give you the answers that you are looking for and not let him or her brush you off if you want to pursue sex.

Your sexuality, just like in the rest of your life, is going to continue to shift and change as you age and you may need to keep redefining and fine tuning your approach to sex based on your own desires as well as what’s happening with your body. You’re going to have to shift and change your sexual formula or your sexual experience as time progresses, depending on your situation and your emotional and your physical state of mind.

What can aid older people wishing to maintain an active sex life?
I see lots of age-related erectile dysfunction or arousal disorder, the medical terms for these conditions. From the standpoint of such physical limitations or different medical reasons why people have sexual problems, it usually boils down to either something related to blood flow to the genitals or something related to hormones.

So when you are looking at blood flow, Viagra, Cialis, Lavetra and those families of drugs which basically increase blood flow to the genitals will increase the man’s ability to have an erection and the woman’s ability to become aroused, if, indeed, her arousal problems are related to diminished blood flow.

And then the hormones primarily for women would be estrogen and testosterone. Estrogen is related to blood flow, which is a key part of lubrication. For older women, especially as they get their menopause, their estrogen disappears so they have dryness, thinning of the vaginal walls, and a harder time getting aroused, in general. And then as their testosterone declines, they may have low libido, low general sense of well being, low energy, low genital sensation. There is a lot of controversy around hormone replacement therapy since the Women’s Health Initiative study came out last year. I think there is a role for it. It’s something that women should consider and talk to their doctors about because there are options for replacing hormones that are diminished, and that can really allow a woman to have a healthy and satisfying sex life forever.

And you certainly can use lubricants, which can play a key role for older couples by combating dryness. There are a lot of great lubricants on the market now, right in the drugstore. It used to be that there was only KY jelly, but now even KY has come out with much better incarnations of lubricants that are easily accessible to people like Ultra Jell.

There is also a role for vibrators. As women age they often need more stimulation during intercourse or during sex in general.

And there are some herbal, non-medical options out there. It’s hard to make sense of which ones really work and which ones don’t. There are two that have been tested in clinical trials and have been shown to be pretty effective. One is called Zestra, which is a herbal oil that women can put on their genitals to get a tingling, warming sensation, but it’s not menthol. The other is called Argenmax, which is a supplement. Just because they are herbal doesn’t mean they are necessarily safe because depending on what the ingredients are they may interact with other medications you are on. In a population that might be on a lot of medications and also might have other contraindications, they should talk to their doctors before they take any herbs.

We do see some low libido and antropause in men. Antropause is when their testosterone levels get really low, and they have low libido. But more often I see low libido associated with depression or anxiety.

Research supports that most always the best prognosis is when there is a combination of medication and some talk therapy. People are sort of under the misperception that talk therapy is only for people who are “nuts” or for when things are drastically wrong and you are on the cusp of a major crisis. That’s especially true of our older generation. They don’t realize often enough that therapy or counseling can have an educational or guiding role. It can be short term just to help you reorient things or redefine things, or get you sex life back on track. It doesn’t mean that there is something critically or deeply wrong, or that you are going to be like Woody Allen, in therapy for the rest of your life.

Will you talk at all about the special circumstances of trying to have a sex life inside a nursing home?
Right, the complaints that I’ve had through the years have been that couples are not allowed to spend the night in the same room or in the same bed. So there is sort of this curfew element; there’s this lack of privacy with regular visits by nurses and staff; there’s a lack of opportunity. And then you are also living in this group environment where there really is not privacy from the standpoint of everyone else knows what you are doing.

Have you found either in your practice or just in the literature that doctors are or are not sensitive to people’s desire to have sex in late life, but would prescribe meds for other conditions?

No, in general I don’t think they are sensitive at all, really, and in fact, they are often not sensitive with people who are aging or elderly or people who are even chronically ill. For instance, breast cancer survivors have told me that they’ve been told by their doctor “you know you are lucky to be alive, you know, what are you worrying about sex for,” and I think there is sort of a cavalier and complacent attitude of among doctors with regard to older women and older men as well.

A lot of the medication older people are prescribed like cholesterol meds, antidepressants, can cause sexual side effects. If you are a 20 year old the doctor might be thinking about your sex life, if you’re lucky, but not often with an older person. You can investigate possible sexual side effects for medicines at www.newshee.com.

An overarching theme is that there really isn’t a good model of older people being sexual. There’s Mrs. Roper from “Three’s Company” or Blanche from “Golden Girls,” but they are hyperbolic caricatures. There’s no real expectation or acceptance or comfort with older people being sexual. So its not just doctors, but the unfortunate social norms we live with.

If you are an older man being sexually desirous is somehow perverse and if you are an older woman with sexual desires you are a horny seductress.
Right, like a comedic caricature. Pathetic cornball.

So, why is that?
On some level we see these people as parents or grandparents, and it’s really uncomfortable for most people to think about their parents or grandparents being sexual. It’s also a matter of struggling with our own sense of mortality, of our fear of getting older,

The media affect our expectations or definition of beauty too, that it’s just not sexy to be old. I used to show a video of an older couple having sex to my students. It’s one of my desensitization tools, and my students would get physically grossed out. They just thought it was so unattractive to see. People find older bodies and wrinkles unsightly. We live in an age of botox and suction and everything else that people are doing to themselves to attempt to prevent their bodies from ageing, and so when people combine natural aging bodies with sex it becomes really disturbing. We need to combat these social barriers.

Can we still
have sex?

»Interview with Laura Berman


Additional resources

Intimacy and aging: Tips for sexual health and happiness

Sexual dysfunction in women: Find your way back to intimancy

Sex After 60: A Natural Part of Life

Sex in America
According to an AARP study of the sexual attitudes and practices of Americans 45 and older, the Boomers are creating a second sexual revolution

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