The increase in life expectancy over the past century has meant that elderly people form an increasingly large proportion of the world's population, yet little attention has been paid to the treatment of sexual dysfunction in older adults.
Views of late-life sexuality are often based on ageist stereotypes. These types of stereotypes and misinformation lead people to take a pessimistic attitude towards sexual relationships and intimacy in older couples. Often elderly people internalise negative stigma concerning sexuality and ageing and develop negative attitudes towards themselves. With reasonable personal health and an available partner, most elderly couples can continue sexual relations well into old age.
There is no doubt that sexual pleasure in an older couple may well be different from that of a younger couple, but that does not mean it has to be less pleasurable.
- libido, early morning erections and frequency of intercourse diminish
- men need more direct and intense stimulation as there is diminished penile sensitivity
- erections take longer to develop, are less rigid, may be difficult to maintain, more difficult to regain than in younger men, and sometimes lost without ejaculation
- the plateau phase, or height of arousal, lasts longer than in young men
- ejaculation is reduced in duration, amount and force
- the refractory period is longer for older men — before being able to have intercourse a second time
An increase in sexual dysfunction in older men is primarily due to an increased rate of health problems rather than old age per se. Decreasing testosterone levels and thinning blood vessels that occur with age will effect a man's erection.
Sex drive (libido) may also decrease. Endocrine, vascular and neurological disorders may interfere with sexual function, as may many forms of medication, diabetes, dementia, arthritis and surgery.
These changes do not have to be a problem if a man and his partner understand that they are normal changes. Erectile Dysfunction (ED) should not be viewed as just a sign of getting older. There are often very treatable causes and all men with ED, whether young or old, have the right to seek treatment.
Because of physical changes in women due to ageing, some women may find that they take longer to become aroused than when they were younger. “As women get older, various factors can affect their sexuality. Menopausal and/or postmenopausal symptoms including vaginal dryness, loss of libido and sexual pain are some such factors.
Physical limitations can also hamper a woman's sex life. These could be conditions such as arthritis or osteoporosis. Illness will obviously also affect a woman's sexuality,” says Dr Caren Hadders of the For Women Only Clinic in Dunkeld West, Johannesburg — a centre specialising in women's sexuality, menopause and wellness.
“Women who are experiencing these symptoms, particularly menopausal symptoms, should consider seeking a treatment such as a vaginal oestrogen which has less of the risk factors than hormone replacement and can provide substantial relief,” she says.
The good news for older couples is that there is a new ‘sexual revolution' of elderly people, who expect their sex lives to remain satisfying for as long as possible. For many, this is a stage where sexual fulfillment may start as there is no fear of pregnancy, stress and work and pressures of finance and family are less, and the couple has more time to enjoy leisure and intimacy (especially after the children have left home) which allows for more enjoyment and the learning of new sensual skills.
In response to the advent of various treatments for ED, notions about ageing and male sexuality in popular culture are changing. In 1999, a study was conducted by American magazine interviewing of 1 682 adults aged 45 years and older about their sexual practices and attitudes.
What this study showed was that there is a revolution in attitude and spirit about sexuality in midlife and beyond. An overwhelming assumption being held by the people interviewed was that health and age-related physical symptoms should be treated and overcome rather than be accepted as part of growing older. Men interviewed in this survey also reported said that the use of an oral treatment available for ED had increased their enjoyment of sex.
Since this study eight years ago, with new remedies and treatment options having become available to treat ED, the proportion of men who have used these treatments have more than doubled.
Couples need to work at keeping their romance alive in long term relationships. Some tips include:
- Find ways to spend time together and enjoy each other — and this should not be limited to birthdays or anniversaries
- Start today — It is never too late to rekindle love and romance in a long-term relationship that may feel somewhat stale
- Sex and Romance — Couples who are healthy and who can sustain an active sex life tend to live healthier and happier lives
- Health and Physical Fitness — Sexual relationships demand energy, and physically fit couples simply have more energy left for each other at the end of the day
- Avoid events that stop intimacy in its tracks — such as a lack of privacy or the sedative effects of a big meal or alcohol
- Have shared goals, and increase physical touch and pleasure to create a mutually satisfactory experience
- Communicate with each other about your likes, dislikes, concerns and discomforts
Intimacy is the essential human drive that underlies sexual relations. There is a great deal of research currently underway to understand the role of intimacy in health, in psychological well-being, in depression and in a number of different areas.
Intimacy is a critical factor in social relationships. The ultimate goal of ED treatment for many health care practitioners is to help couples increase intimacy so as to improve their relationship and their level of satisfaction.
Some simple lifestyle changes may help older people enjoy a healthier and more fulfilling sex life. These include stopping smoking, increasing fitness levels, improving diet, moderate alcohol consumption and reducing stress.
Where ED is concerned, a variety of effective treatment options are now available meaning that there are now even more reasons for older couples to enjoy a healthy sex life later. Called PDE 5 inhibitors and taken orally, they work by stopping the breakdown of a chemical that relaxes the erectile tissue.
The chemical they act on is only produced when a man is aroused, and as such, the tablets only give a reaction in response to sexual stimulation. Clinical trials have found varying success rates of between 57 and 80% with these medicines.
Older couples are urged to speak to their health care practitioner or pharmacist should they have any concerns or queries about issues regarding intimacy and sexual activity.
