Sex in Your 60s, 70s, and 80s…Really?

This article was written for Prosayla, the patient information site offered by ISSWSH, the International Society for the Study of Women’s Sexual Health. Links to Prosayla and to the ISSWSH website are provided below.

The Prosayla site contains a wealth of information about sexual health and sexual challenges, including medical conditions and pain. ISSWSH offers a nationwide directory of providers with expertise in sexual health and sexual difficulties.

PART 1: GETTING A GRASP OF THE ISSUES

GENERAL DISCUSSION

In popular media as in the public perception, we don’t hear or see much about older adults being sexually active. If we do, it’s often negative or disbelieving, hence the title of this article. This can make it difficult for older adults to know what is normal, and to have the courage to seek out information about sex and sexuality at this stage of life.

Contrary to cultural messages of sex being for the young, we have good information to show that a large percent of adults are sexually active into their 70s, 80s, and beyond. In a 2007 survey of over 3000 US adults aged 57 to 85, 73% of those under 65, 53% of those 65-75, and 26% of adults 75-85 reported being sexually active. In several other studies, sexual activity has been shown to have benefits for physical, psychological, and relationship health. A majority of older adults surveyed nationally in 2017 felt that sex was important to their overall quality of life, and three quarters of those who were partnered felt it was important to their relationship.

The 2007 survey also noted that over half of older adults reported at least one sexual problem, but that less than 1 in 3 had ever talked about a sexual problem with a physician. Of those, most discussions were initiated by them and not their doctor. Unfortunately, many healthcare professionals do not routinely inquire about sexuality with their older patients.

Of course, many older adults are perfectly happy not to be sexually active. For those who do want to continue sexual expression as they age, whether partnered or not, there’s plenty of good news and there are numerous helpful resources.

SIGNS & SYMPTOMS

There are two domains to consider when rediscovering sexual expression in the later part of life: physical changes and psychological adjustments. These include not only internal psychological changes, but shifts in intimate relationships and in social roles.

CAUSES

Physical changes affecting sexual function are unavoidable with aging. Some of the most common sexual difficulties are partner erectile dysfunction; loss of genital sensation, making orgasm more difficult to attain; and the thinning and drying of the vulva and vagina known as the genitourinary syndrome of menopause (GSM). In addition, a host of common health conditions, and often their treatments, can interfere with enjoyable sex: arthritis, diabetes, heart disease and breathing difficulties are just a few examples. Cancer and surgeries can severely impact sexuality. Many common medications, like those for depression and hypertension, and many others, can have sexual side effects.

Psychologically, with aging often come changes in self-image and perceived attractiveness, as well as a struggle to feel relevant as work or careers wind down. Those in long-term partnerships may feel unfulfilled sexually, but afraid to have the discussions that might change their situation for the better. Or they may have a partner who is chronically ill or otherwise unable to meet their sexual needs.

AFFECTED POPULATIONS

Changes to sexuality related to aging can be seen as early as the late 40s, but become more prominent in the late 50s and after, beyond the completion of menopause., with some related to aging, while others are hormone/menopause dependent.

DIAGNOSIS

The diagnosis of sexual problems or difficulties rests on the concept of distress. While changes in sexual experience with aging will not be troublesome to some individuals and couples, the same changes might be deeply distressing to others. Each individual and couple decides what is normal for them, and often distress arises when there is discordance within a couple. For example, one partner may want more sexual activity, and the other may want less or none at all.

PART 2: FINDING SOLUTIONS

STANDARD THERAPIES

Resources abound to address the physical changes of aging. Sometimes all that is needed is education as to what is the “new normal”. As noted below, it’s common to fall into sexual “scripts” or habitual routines and expectations of how sexual activity should happen. With the changes of aging, many of these routines are no longer adequate, whether to get and maintain an erection, or to achieve arousal, lubrication, or orgasm. Other times, novelty is needed to combat the boredom of always following the same sexual pattern.  Several medications and procedures can help improve erectile function, and there are sex toys that can help provide stimulation of the penis even without erection. There are well established and safe treatments for GSM (see the Prosayla article devoted to this topic). Loss of vulvar and clitoral sensation can be overcome at least in part by the use of lubricants, hormones or other medications, and also with the help of sex toys such as vibrators, that provide more intense and longer lasting stimulation of the clitoris without exhaustion.  When arthritis or breathing difficulties make favorite sex positions less practical, “sex furniture” from pillows and supports to sofas and chairs can help people find greater comfort in old or new positions. If medication side effects are suspected, this can be discussed with a healthcare professional. Resources for exploring all of these options are provided at the end of this article.

Psychologically, many older adults are limited by the sexual scripts developed in their youth. Some common examples of these scripts are that the only “real sex” is penis-in-vagina intercourse, that a sexual encounter isn’t satisfying or complete unless it ends in orgasm, that sexual desire should be spontaneous, and that planning for sex is unsexy. Many older LGBT individuals grew up with strong cultural prohibitions against expressing their sexuality, and echoes of these barriers can persist as well.

Unlearning these scripts can be liberating. Just as our definition of a good meal, a good vacation, or a good movie has likely changed since we were in our twenties, the definition of good sex can, and frequently must change as well. Shifting one’s sexual script from goal-oriented to pleasure-oriented is a healthy adaptation. A playground analogy is helpful: kids don’t have a specific order in which they set out to enjoy the playground equipment, nor is the session required to end with a trip down the slide. Likewise, sex can be approached as a session of fun, exploratory play without a specific endpoint. It can also be planned in advance, allowing for anticipation and desire to build.  The self-knowledge that comes with years of life  experience and in particular shared life experience, can be an asset: many older women report that knowing what they like sexually, and having the confidence to ask for it, has made sex more enjoyable in later life than when they were younger.

When older adults are no longer able to live independently, their sexual needs are seldom taken into account.Some resources addressing this problem are provided below.

Special mention needs to be made of the unique psychological challenges faced by LGBTQ older adults. In addition to higher levels of depression and loneliness, they may  risk prejudice and discrimination by caregivers and institutions. The SAGE coalition provides advocacy for LGBTQ elders, and features on its site a list of facilities with inclusive policies.

There is increasing awareness in the medical and psychotherapy communities, as well as among the general public, that we are sexual beings throughout our lives. Articles have appeared in diverse medical journals, calling for professionals to embrace the idea of sexuality as part of normal aging and encouraging sexuality research that includes older adults. Numerous consumer information sites, podcasts, blogs, articles in the popular press, and excellent books have appeared in recent years and are referenced below.

For help in finding medical and mental health professionals knowledgeable about sexual concerns, several organizations should be mentioned. ISSWSH, the sponsor of this site, offers a “find a provider” function on their home page. Sex therapists and sexuality educators can be found on the AASECT (American Association of Sex Educators, Counselors, and Therapists) website. Sex therapists help individuals and couples to work through sexual challenges, while sex educators and counselors provide information and strategies, often online. The Menopause Society offers a list of Certified Menopause Practitioners; many of these providers have expertise in addressing the sexual concerns of their patients.

With so many helpful voices spreading the word, and such a wealth of quality information available, it is absolutely possible for women to find a path to healthy sexuality in their 60s, 70s, 80s, and beyond…really!

SUPPORT AND RESOURCES

The American Association of Sex Educators, Counselors, and Therapists (AASECT), www.aasect.org

The American Association of Retired Persons (AARP), www.aarp.org. Search “Sexuality” for multiple articles.

Aging with Pride study, Goldsen Institute, https://goldseninstitute.org/health/nhas/ This is a study of aging LGBTQ individuals. Enrollment of participants is still open at this writing. Information from earlier studies is available on the site.

Fleishman, Jane, 2019. TEDx talk, “Is It Okay for Grandma to Have Sex? Lessons from an Aging Sexuality Educator”, available at www.ted.com  or on YouTube at www.youtube.com.

Goldstein, A., MD, and Brandon, M. (2018). Reclaiming Desire: Four Keys to Finding your Lost Libido. New York: Clarkson Potter/Tenspeed. Dr. Goldstein is one of the leading U.S. specialists in sexual medicine. He and Brandon offer a whole-person view of desire and what nourishes it.

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The International Society for the Study of Women’s Sexual Health (ISSWSH), www.isswsh.org

Jones, M. “The Joys (and challenges) of Sex after 70”. New York Times, 12 Jan. 2022, https://www.nytimes.com/2022/01/12/magazine/sex-old-age.html

Kleinplatz, Peggy, and A. Menard. (2020). Magnificent Sex: Lessons from Extraordinary Lovers. Oxford, New York: Routledge. Kleinplatz’s interviewees for this book included plenty of older adults who share their perspective and wisdom.

Let’s Talk About Sex: The University of Michigan National Poll on Healthy Aging, 2017. Available at www.healthyagingpoll.org.

Liberator, www.liberator.com. This site sells sex toys, but is especially useful for its wide selection of sex furniture and positional aids.

Mayo Clinic monograph on erectile dysfunction: www.mayoclinic.org. Search “erectile dysfunction” under “diseases and conditions”

MiddlesexMD: www.middlesexmd.com.  OBGYN physician-curated information on sex toys, lubricants and more, with a focus on sex in middle age and beyond.

Naked at Our Age blog, by author Joan Price, www.NakedAtOurAge.com

Our Better Half Podcast: about sex in the second half of life, by PhD sex therapist Rosara Torrisi and PhD sexologist Jane Fleishman. www.ourbetterhalf.net.

Price, Joan. (2011). Naked at Our Age: Talking Out Loud About Senior Sex. New York: Seal Press. A wonderfully frank and positive discussion about the reality and joy of sex in later life. The author has also published on sex after grief and loss.

Rosy app and website, www.meetrosy.com. An OBGYN physician-curated site and app with extensive information and resources on women’s sexuality.

SAGE: Advocacy for LGBTQ Elders, https://www.sageusa.org. SAGE offers a smorgasbord of resources for LGBTQ older individuals, including a Long Term Care Equality Index evaluating LTC facilities for inclusive policies.

Sexuality and Aging in Adults, National Institute on Aging. Several helpful articles here. https://www.nia.nih.gov/health/sexuality/sexuality-and-intimacy-older-adults

The Menopause Society, www.menopause.org . This is an organization of healthcare professionals with interest and/or expertise in menopausal medicine. They publish the peer-reviewed journal Menopause.

REFERENCES

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The Journal of Sexual Medicine, 7, 1336–1361.

Faubion, S. and Kingsberg, S. et al. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020 Sep;27(9):976-992

Fleishman, J. (2020). The Stonewall Generation: LGBTQ Elders on Sex, Activism, and Aging. New

York: Skinner House Books.

Gore-Gorszewska, G. (2023). ‘Why would I want sex now?’ A qualitative study on older women's affirmative narratives on sexual inactivity in later life. Ageing & Society, 43(10), 2347-2371.

Gott, M., & Hinchliff, S. (2003). How important is sex in later life? The

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Grabovac, I, & McDermott, D (2023). Sexuality and Sexual Activity in Older Age: an Age Old Issue? The Lancet Regional Health – Western Pacific, published online July 13, 2023

Hinchliff, S., Tetley, J., Lee, D., & Nazroo, J. (2018). Older adults’ experiences of sexual difficulties: Qualitative findings from the English Longitudinal Study on Ageing (ELSA). Journal of Sex Research, 55,

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Kessler A, Sollie S, Challacombe B, Briggs K, Van Hemelrijck M. The global prevalence of erectile dysfunction: a review. BJU Int. 2019 Oct;124(4):587-599.

Kleinplatz, P. J. (2010). "Desire disorders" or opportunities for optimal erotic intimacy? In S. R. Leiblum (Ed.), Treating sexual desire disorders: A clinical casebook (pp. 92–113). The Guilford Press.

Lindau, S. T., Schumm, L. P., Laumann, E. E. O., Levinson, W., O’Muircheartaigh, C. A., & Waite, L. J. L. (2007). A study of sexuality and health among older adults in the United States. New England Journal of Medicine, 357, 762–774.

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Potts, A., Grace, V. M., Vares, T., & Gavey, N. (2006). “Sex for life”? Men’s counter-stories on “erectile dysfunction,” male sexuality and ageing. Sociology of Health and Illness, 28, 306–329

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