Sexuality and Aging

By OBOS Sexuality & Relationships Contributors | October 1, 2011

It is a myth that sexual desire and activity automatically fade as a natural, irreversible part of aging. While it may be necessary to accommodate changes that can make sexual enjoyment more challenging (such as arthritis or vaginal dryness), with good communication — as well as more creativity — women can continue to give and receive pleasure as they age.

Sexual feelings often depend more on how we feel about our bodies and our relationships than our age. Some women enjoy sex more in middle and later life, in part because they no longer have to deal with other potential stressors, such as becoming pregnant.

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During partnered sex, it can be difficult to overcome years of conditioning to initiate sex or to consider alternatives to routine patterns. Changing old habits and assumptions can be made easier by talking and exploring together:

My libido was down, as was Tom’s. We were having less frequent sex, and I was waiting for him to take the initiative. Finally, I said to myself, “I can do something about this, I am a sexual being” — and I began to initiate sex and we had a great time.

In  her book “Better Than I Ever Expected: Straight Talk About Sex After Sixty,” author Joan Price writes about the importance of planning for sex:

We’ve discovered that sex works best when we schedule it, make time for it, clear away our busy calendars for it. We turn off our computers and phone ringers. We make dates, anticipate our times together, plan for them, fantasize about them, and tantalize each other by phone by murmuring about what we’d like to do. What we give up in spontaneity, we make up for with constant mental foreplay.

Inhibitions often lessen with age. We may make peace with parts of our bodies we have hated for years. We may give ourselves more freedom to experiment in relationships — to date a younger man, for example, or to engage in sexual relationships with women — or to be more open about them. Sometimes our idea of what a “typical” relationship should be  continue a lifelong enjoyment that has brought much happiness and satisfaction:

The biggest reason my sexual life remains so vital is that I have multiple partners. My relationship with my husband has been nonmonogamous for all of our 32 years together. This is a very complex lifestyle and not for everyone; it has been a great challenge and brought much richness to my life. Sexual freedom has been incredibly liberating for me and has contributed to my staying younger in mind, body, and spirit. It has enriched my relationships with all my various partners, whether short or long term. I got the impression from my mother that at this age she was tolerating sex, but it was not a life-giving activity in her life. How sad for her!

Of course, not everyone wants to be sexual. A 73-year-old woman writes:

I frankly don’t need it, and I don’t miss it at all. I had a very, very full sex life, and I was mad about my husband, which is a nice way to be. When he died, it was a real shock. I haven’t discovered another person that I had that desire for in 25 years now. I’m used to my life the way it is now, and I don’t think that my life is incomplete.

Our partners may lose interest, too. Adjustments, disruptions, or feeling less sexual can also result from chronic or acute illness or surgery. It can take a while to adjust to new circumstances and resume a pleasurable sex life. But there are many ways to have sex and experience sexual pleasure, regardless of relationship status or physical capacity.

Physical Changes That Affect Sexuality

A 2010 Harvard Medical School Special Health Report, Sexuality in Midlife and Beyond, identifies the following possible age-related sexual changes for women:

  • Physical changes: decreased blood flow to genitals, lower levels of estrogen and testosterone, thinning of the vaginal lining, loss of vaginal elasticity and muscle tone
  • Desire: decreased libido, fewer sexual thoughts and fantasies
  • Arousal: slower arousal, reduced vaginal lubrication and less expansion of the vagina, less blood congestion in the clitoris and lower vagina, diminished clitoral sensitivity
  • Orgasm: delayed or absent orgasm, less intense orgasms, fewer and sometimes painful uterine contractions
  • Resolution: body returns more rapidly to a non-aroused state

For those of us with male partners, age-related effects on men’s sexuality matter as well. Men over age 50 may have difficulty getting an erection sufficient for intercourse, and erections may require more direct stimulation.

In addition, the need to ejaculate is less urgent, and the rest period between erections grows longer.

Such changes may affect sexual relationships. It can be common, for example, to worry that vaginal dryness, less intense orgasms, or erection difficulties mean a partner is feeling less attracted to us or losing interest in sex. These perceptions can trigger feelings of rejection and resentment. (“Am I no longer sexually attractive?” “Is he having an affair?”)

If you are starting a new sexual relationship after divorce or the death of a spouse, it is also quite common to fear that you will not become aroused or will not be able to have an orgasm with a different partner. Or you may be self-conscious about baring your changing body in front of someone new.

You could also simply tire more easily. A 65-year-old woman writes:

I still need about the same amount of clitoral stimulation as in my earlier years, but I get tired so much more quickly. I joke with my partner that we will need to get a vibrator soon if he finds that his hands start getting too tired. Sometimes I start to fall asleep even as I am getting quite aroused. That would never have happened a few decades ago!

A 2007 study on sexuality and health among older adults found that the most prevalent sexual problems cited by older women were low desire, difficulty with vaginal lubrication, and inability to climax. Only 22 percent of women (and 38 percent of men) reported having discussed sex with a physician since turning 50.

Many women are reluctant to talk about sexual difficulties with their gynecologists or other health care providers; it’s also probable that physicians are uncomfortable discussing sexuality with older patients — particularly women, since we are often perceived as sexless — and need more training about older women and sexuality. One woman notes that her doctor never brought up sex after a recent surgery:

I had a stent put in last summer, and I was concerned about resuming sexual activity with my husband. The doctor didn’t mention sex in his long list of dos and don’ts. I had to bring it up.

In a separate 2007 study on older women’s sexual desire and agency, many of the women interviewed had internalized societal assumptions that led them to value their male partners’ sexual needs over their own. We all deserve positive relationships with partners who love us for who we are and who care about our fulfillment.

Practical Approaches to Age-Related Sexual Changes

Declining health or bodily changes can affect sexuality. Chronic illnesses such as diabetes can decrease blood flow to the genitals; arthritis, back pain, and limited mobility can restrict the range of comfortable sexual positions; and medications for chronic diseases such as hypertension and heart disease can affect energy levels and sexual functioning.

It is also common to feel initial embarrassment over the loss of a breast, or over a colostomy bag or some other apparatus, especially with a new partner.

In a 2004 AARP survey, respondents ranked better health for themselves or their partners at the top of a list of features that might improve their sexual satisfaction.

At the same time, sexual activity has health benefits. If one moves and expends energy during sex, the heart and joints get a workout. Active sex can also cause the brain to release endorphins, which help to reduce stress.

Sexual activity may help people sleep better, owing to the release and sedative effects of oxytocin and endorphins, and can temporarily decrease pain.

The clenching and unclenching of vaginal muscles during sex and orgasm condition the vaginal walls and work the muscles of the pelvic floor (known as the pubococcygeus, or PC, muscles). The movement also strengthens these muscles and may help delay or minimize incontinence.

Having orgasms regularly can help to maintain vaginal lubrication, and regular vaginal penetration can help to maintain vaginal elasticity.

While I was married there was never an issue about “using it or losing it,” as we had sex at least two to three times a week, and that kept my vaginal tissues well lubricated. After my husband died, I didn’t have a regular sexual partner for more than a decade, but I did enjoy having orgasms while by myself and also discovered along the way that taking cod liver oil daily had a major impact on keeping my vaginal tissues lubricated.

If the sensitivity of your nipples, clitoris, or vagina changes, you may want to adjust the intensity of stimulation and possibly experiment with the use of a vibrator. Shifting positions and bed cushions can protect joints and tissues and lead to more comfortable sex, especially if you have problems with mobility, flexibility, or painful joints.

More time and stimulation may be needed for arousal and reaching orgasm. Set aside a time that works best for you. Some people use late afternoons for sexual activity, for example, because medications have kicked in and fatigue hasn’t.

Loss of Desire

Most women experience fluctuations in levels of desire throughout their lives. There are many reasons for experiencing less sexual desire: overwork and anxiety; the loss of newness in a long-term relationship; a past history of abuse; gradual changes and accommodations reached in a long-term marriage; or the fact that somebody we’re dating for companionship just isn’t attractive in that way.

Sometimes lack of sexual desire or responsiveness can be caused by medications, lower hormone levels, or other medical problems, such as low thyroid function or cardiovascular disease.

If you want to be sexual but are experiencing difficulty, or if you’re experiencing pain or anxiety about sexual activity, talk to a health care provider or counselor and let that person know that sexual activity is important to you. Depending on the cause, there may be steps you can take to improve your sexual experiences, including modifying your medications.

If you think your relationship is causing the problem and communication with your partner is difficult, consider getting help together or alone, if your partner is unwilling to go for counseling. A licensed sex therapist or counselor specializing in relationships and sexuality may provide useful advice or recommend workshops or support groups on older women’s sexuality. If no workshop or support group is available, consider organizing one.

Couples can learn to handle changes in desire. A woman writes of having “no libido” at 63:

I did the creams (which worked wonderfully) but now want to be as drug-free as possible. On the fingers of my wonderfully patient and determined husband, or on my very occasional own, any oil-based cream works wonders on the clitoris. Combined with plenty of skin-to-skin coziness as we sleep, this is plenty of satisfaction for me.

While the aging process often brings unwanted changes in sexuality, understanding these changes and clear communication with our partners can help us recreate or hold on to a satisfying sexual life.