We may not talk much about it, but many studies have demonstrated that a large number of older adults are still interested in sexuality and intimacy. In fact, more than 50 percent of those age 65-74 and 26 percent of those age 75-85 said they were sexually active in the last 12 months. Sexual desire and activity continue for many people throughout life. With advancing age, some changes occur that may impact sexual relationships, but many of these can be remedied.
Q: Nancy, IL - What are some of the misconceptions about sex in the older years?
A: Dr. O'Neil - There are numerous myths about sex in the older years. Some of these are: Impotence is a natural consequence of aging; sexual activity is dangerous for the elderly; the sex drive inevitably diminishes with advancing years for both men and women; sexual activity for older persons is immoral and suggests a “dirty mind”; sexual desires cease with menopause; sex is only for the young.
Q: Carol, IL - How does menopause affect sexual function in women?
A: Dr. O'Neil - Menopause occurs when the ovaries cease producing estrogen, the female hormone. Menopause is usually heralded by menstrual irregularity and then cessation of menses. Many women experience hot flashes as well. Menopause may be associated with decreased sexual interest, decreased responsiveness, and decreased frequency of intercourse. Estrogen deficiency may lead to vaginal dryness, pain with intercourse, urinary frequency and discomfort with urination. If these symptoms occur, it is important to discuss with your doctor since effective treatments are available.
Q: Sally, CA - What are your suggestions regarding safe sex practices?
A: Dr. O'Neil - Many seniors have ignored the public health warnings related to safe sex, thinking that it does not apply to them. However, sexually transmitted diseases are growing among the over 55 age group. While pregnancy is not a concern, things like AIDS, genital herpes and even gonorrhea are possibilities. Some partners may not be forthcoming about previous sexual contacts. The advice for most is to use condoms as a protective measure until a conversation about past sexual partners and a medical check up have been accomplished.
Q: Jean, IL - What are the most prevelant STD's in the age group 60+?
A: Dr. O'Neil - The knowledge of sexually transmitted diseases is critical and active protection is required. Herpes virus infections are highly contagious, wide spread and chronic. Syphilis and Gonorrhea still occur and other conditions that may be transmitted sexually include Hepatitis B, HPV, and HIV. Recent studies have shown that HIV is actually growing faster in individuals over 50 than in younger people. Part of the reason for this is that many older adults do not realize they may be at risk, do not use condoms, or have received little guidance from their health providers. If sexually active, especially with multiple partners, it is important to discuss this with your doctor or health care provider.
Q: Mary, MA - What are the Sexual Transmitted Diseases that we need to know about as older adults?
A: Dr. O'Neil - These diseases called STDs include gonorrhea, syphilis, HIV, human papillomavirus (HPV), and others. More than 65 million Americans are living with an incurable STD. About 65,000 Americans over age 50 are living with HIV or AIDS. Persons over 60 account for 2% of cases. It is important to use safe sex practices especially if one has multiple partners or if one is unfamiliar with the sexual history of their partner. Remember that HIV/AIDS is not a disease specific to gay men; it occurs in heterosexuals as well. Lesbians are not immune to STDs.
Q: Mary, MA - What is the best approach to asking a partner about their sexual history? I do not want to scare them away.
A: Dr. O'Neil - Mary, I would suggest you say something like this “as educated adults it is important for us to mutually understand that some diseases can be transmitted sexually. For that reason, I think it is important that we be honest with each other and disclose if we have a potentially sexually transmitted disease if we have been treated for one in the past.” If one or the other partner is or has been treated for an STD, it is important that it has been cured or is in remission. Hopefully, your partner will have the integrity to share that information with you. If there is any concern, consultation with your health care provider is advised. Use of safe sex practices is best until you know for sure.
Q: Eric, IL - What are some of the reasons for sexual problems in men?
A: Dr. O'Neil - In the aging male decreased sexual activity may be associated with: poor health. social issues, partner availability, decreased desire, and erectile dysfunction (ED). While ED is not a normal part of aging it does become more common with age. Many things can contribute to ED including relationship difficulties, medications (particularly for high blood pressure or diabetes), certain surgical procedures, hormonal imbalances or psychological issues.
Q: Francis, MA - How important is it to have intimate relationships in your older years?
A: Dr. O'Neil - Interaction and intimacy with friends can be as important as a sexual relationship. Not all intimacy has to include a sexual relationship. Sometimes friends can be quite intimate by sharing their lives together and understanding each others stories. Often intimacy can be experienced with close family members like children and grand children. Nothing is better for our health than to love and be loved. However, sexual relationships in the older years may not only be quite fulfilling but may also lead to stress reduction that can lead to lower risk of stroke, heart attacks and other stress related conditions.
Q: Francis, MA - What are some of the sexual dysfunctions that women have? What causes them?
A: Dr. O'Neil - Female sexual dysfunction (FSD) does not have one simple reason. The four categories of dysfunction are: 1.) diminished sexual desire: persistent or recurrent lack of sexual thoughts or feelings; 2.) sexual arousal disorder: a persistent inability to obtain or maintain sexual excitement (may be associated with poor vaginal lubrication, a decrease in vaginal sensation, and poor muscle relaxation of the vagina and pelvic sidewalls); 3.) orgasmic disorder: long-term loss of orgasmic potential after sufficient sexual stimulation; and 4.) sexual pain disorder: chronic pain associated with sexual activity.
Treatment for FSD depends on the cause. Most women can be helped by competent health professionals. The most important thing is to not be embarrassed and to candidly discuss your sexual concerns with your doctor or health care provider.
Q: Sharon, OH - Is it true that having had a breast removed for cancer can cause sexual problems?
A: Dr. O'Neil - Yes, 20-40% of women experience sexual dysfunction after mastectomy for breast cancer. Possible causes include: disruption of body image, family or marital problems, spousal reaction, chemotherapy or radiation therapy, and psychological impact of the cancer diagnosis. Counseling with a psychologist or psychiatrist can be very helpful before and after treatment for breast cancer.
Q: Dorothy, AZ - How common is it for older adults to be sexually active?
A: Dr. O'Neil - The facts are: At least half of adults over 60 engage in some form of sexual activity at least monthly; 71% of men and 51% of women in their sixties report they are sexually active; and about � of adults over 80 are sexually active. Sexual activity in older years is not only desirable but has some positive health benefits.
Q: Dan, CA - What causes erectile dysfunction (ED)?
A: Dr. O'Neil - Achieving an erection sufficient for intercourse requires a complex interplay of many factors such as psychogenic stimuli, hormones, and the vascular and nervous systems. Disorders of any of these factors may impair normal sexual response. One of the most common causes of impotence (inability to achieve an erection) is diabetes due to the impact that diabetes has on the peripheral nerves and the blood vessels. Certain drugs may impair sexual function. Atherosclerosis (hardening of the arteries) may impair normal blood flow to the penis. Deficiencies of testosterone, the male hormone, may cause a decrease in libido and inability to get an erection. Proper diagnosis of the cause of ED requires an evaluation by a doctor.
Q: Francis, MA - Does Prostate cancer negatively effect one's sexual drive?
A: Dr. O'Neil - Prostate cancer per se especially if localized may not necessarily affect sexual drive: however certain procedures such as TUR (transurethral resection) and or prostatectomy may affect the nerves and blood supply resulting in difficulty obtaining an erection. IN addition, prostate cancer can sometimes have some psychological consequences that can impact sexual function. Some fo the medicines used to treat prostate cancer may have an adverse effect on libido and erectile function. If these problems occur it is important to discuss with your primary care doctor and or your urologist.
Q: Mary, MA - How does sex reduce stress?
A: Dr. O'Neil - There are several reasons for this, one is the physical activity itself may trigger release of endorphin which is a natural pain relieve and “feel good substance” and may help preserve brain levels of serotonin which helps keep our mood elevated. Intimacy can also be associated with reduction in blood pressure and have a quieting effect on the nervous system. It can help reduce anxiety and actually is good as a sleep aid.
Q: Charles, MI - What is your advice concerning gay, lesbian, bisexual, and transgender (GLBT) persons who are considering moving to a retirement or an assisted living community?
A: Dr. O'Neil - Several studies have now demonstrated that GLBT persons have more social support when they are open about their sexual orientation. Many older adults in retirement communities accept GLBT adults quite readily, and sexual orientation should not dissuade one from researching the attitudes of the community one is considering. One important issue is that GLBT persons who have had children should make clear who they desire for their health care proxy and DPA (durable power of attorney), so there is no misunderstanding in a crisis.
Q: Fred, TX - Are the drugs used to treat ED such as Viagra safe?
A: Dr. O'Neil - These drugs are generally safe when used as directed by a physician. However, they are contraindicated in persons on nitrates which are drugs commonly used to treat persons with heart disease. The combination can cause an unsafe drop in blood pressure. Some other side effects may include facial flushing, headache, and indigestion. Transient color blindness has been rarely reported and if this occurs, your doctor needs to be notified.
Q: Harry, NY - What can a man do if drugs are not effective in treating ED?
A: Dr. O'Neil - Other options for management include insertion of tablets into the urethra (penile opening) or injections directly into the penis of vasodilators (medicine that increases blood flow), vacuum tumescent devices that work by using pressure to draw blood into the penis, and surgery to insert a penile implant.
Q: Susie, TX - Can some medications adversely affect sexual function?
A: Dr. O'Neil - Absolutely. The most common drug that may impair sexual response is alcohol. Although alcohol can sometimes heighten the desire, too much alcohol can actually impair the ability to get an erection in men and decrease sexual responsiveness in women. Other commonly prescribed drugs that sometimes may affect sexual response include: antidepressants, antihistamines, some blood pressure medicines, diuretics, and some pain relievers.
Dr. O'Neil - The need for intimate physical and emotional connection is ageless. In fact, sharing your life in a fulfilling intimate relationship, which may include a healthy sexual relationship, can have positive effects on virtually every aspect of your life, from physical health to self-esteem. But for many, the best aspect of a close relationship is having the opportunity for affection and companionship. Focus on sharing common interests and friendship and let the rest take care of itself is the advice of some older adults. Even those without partners have a desire for close emotional bonds. Developing intimate relationships with friends by sharing the deeper issues of life can meet the need for many. Hugs and caring touch are important for everyone so practice them as often as you feel comfortable. Massage is a great way to enjoy the benefits of physical touch. At any age, the need for intimacy and closeness is part of the human experience. Enjoy it!
I look forward to being with you again next month when we will discuss some of the issues related to optimal aging.
Best wishes for an Optimum Life! - Dr. Kevin
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