Written by: Joann Parliament, Registered Nurse, MS, BSN, RN
“Older adults do not or should not have sexual activity”
What?! This statement is absolutely FALSE! Let’s discuss the real deal-
- Sex, physical intimacy, and emotional intimacy are lifelong needs (no matter how old you are)
- Sexuality is not always about having intercourse – be imaginative – there are other ways to please your partner
- Sexual needs may decrease in frequency but they are still part of a healthy lifestyle
So, how does the body change and how do we maintain a healthy sex life? First, let me break down body changes as we get older-
Physical changes include:
- Decreased estrogen levels (can start in 40’s)
- Decreased libido
- Vaginal Dryness
- Thinning of vaginal wall
- Skin changes – decreased elasticity, muscle tone and subcutaneous fat
- Body changes – many women gain weight in their middle and breasts are not as perky
- Increased facial hair
- Demineralization of bones
- No longer able to have children
- Depression, anxiety
- Feeling uncomfortable with your body
- Decreased testosterone (can start as early as age 40) which causes-
- Decreased muscle tone and bone density
- Decreased sex drive
- Hair loss
- Retrograde (dry) ejaculations, decrease in semen, less forceful and shorter orgasms
- Need for more stimulation to achieve and maintain an erection
- Depression, anxiety
- Isolation related to the changes
The changes above are part of the normal aging process but people do vary. There is no definition of what is normal. My suggestion is to be in tune with your body – don’t assume that absence of sexual desire is normal for you. Some of your lack of desire symptoms may be related to a medical problem. Poor health or chronic health conditions, such as COPD, arthritis, and heart disease may make sex and intimacy more challenging. Certain medications, such as blood pressure medications, antihistamines, acid-blocking drugs, antidepressants, and alcohol can also affect sexual function.
If you are over 65, this is the most important time of your life to have conversations with your physician regarding your sex-drive, activity, etc. Don’t be afraid to bring up these conversations with the physician.
Sexually Transmitted Diseases (STD’s)
Many seniors believe since they can no longer get pregnant so the need for protection during intercourse with a new partner is no longer necessary. Well, that is false! The incidence of sexually transmitted diseases for men and women in the 50-90 age group has doubled over the past decade. HIV, chlamydia, gonorrhea, syphilis and herpes, to name a few, have increased substantially over the past few years in the over 50 age group. The Centers for Disease Control and Prevention note an increase in the number of cases of gonorrhea and syphilis by over 100% between 2014 and 2018. Males over 50 account for 20% of adults accessing HIV care which is also increasing.
While some STDs are easily treated, some are not. Some do not cause symptoms right away and will progress to a more critical stage. See a physician immediately if you develop any of the following symptoms: burning or itching in the penis or vagina; a foul odor or unexplained bleeding from the vagina; yellowish or watery discharge from the penis or vagina; pain in the vagina during sexual intercourse; burning or pain in penis or vagina with urination or in the rectum with bowel movement; sores, bumps, or blisters in the vagina, penis, mouth or anus, or severe pelvic pain.
If you are starting a new physical relationship with someone or have multiple partners it is extremely important to use a condom – this includes for vaginal, anal, and oral sex. Do not feel uncomfortable to bring up conversations regarding condom use and testing with your new partner. Just because you are older, things are the same regarding STDs. Actually, you may be more prone to them as you age because of medical conditions, decreased immune systems, and thinning of the vaginal wall.
How Do Medical Conditions Impact Sexual Activity and What To Do About It
Several medical conditions and bladder disfunction can impact sexual activity. Be in tune with your body and work on ways to improve your performance and pleasure if you have certain conditions. The most important thing is to maintain your health and maintain compliance with your medical management. The following are some suggestions improving sexual activity with certain illnesses:
- Osteoarthritis can cause back pain and joint problems with certain positions and poor coordination. Explore different positions that will be the most comfortable for you and your partner.
- Breast cancer with mastectomy or any other body altering surgery may impact your self-image and confidence. Try using different lingerie or clothing at first until you are more comfortable with your partner.
- Heart and lung disease may impact your endurance level or cause anxiety. Use your oxygen prior to sexual activity and speak with your physician regarding your medications as well as any fears you may have.
- Diabetes may cause erectile dysfunction and decrease orgasm. Again, speak with your physician regarding possible medications to improve this or discuss surgical options if indicated for erection.
- Bladder or bowel dysfunction including incontinence and use of a Foley catheter- It is not impossible to have an intimate relationship in this situation. Always bear in mind that your partner is there to support you especially if trust, friendship and desire have grown between the two of you. Suggestions for dealing with this include:
- Personal Hygiene – of course this is the same for someone who does not have a continence problem, but knowing you are clean and fresh can increase your confidence
- Limit fluid intake a few hours before sex if you can
- Empty your bowel or bladder before sex or change your ostomy device. This will reduce the risk of leakage during intercourse.
- Catheters: If your catheter is connected to a drainage bag you can discuss with your doctor the use of a catheter valve so you can close it off during sex. If you prefer to use the bag – may prefer a bedside bag to prevent lying on it
- Set the mood with some scented candles
- If you are worrying about leakages take the precautions above, but also remember that sexual activity involves bodily fluids, so a small amount of urine leakage will not cause a problem.
- Bed protection- bed pads or an additional sheet for bed protection
- What to do with a catheter:
- Women – Some find it helpful to tape the catheter forward and to one side using medical tape during intercourse. You will have to work with experience to find the best position. Remember the catheter does not go in the vagina (it is entering the urethra) so it will not affect intercourse greatly.
- Men – Bend the catheter back along the penis and hold it in place with either medical tape or a condom, or both. If you wear a condom catheter, remove it before sexual activity and replace with a new one afterwards. (you can cover with a standard condom if protection is needed)
- Suprapubic catheters – should not be a problem since they enter into your abdomen– you may want to tape the tube down with medical tape to avoid pulling.
- Attend to personal hygiene and reconnect catheters. You may want to lie with your partner for a while; quietly get up and attend to your hygiene and then of course return and continue to enjoy the time with your partner.
- If you want support from a group who can offer valuable advice, there is a Bladder & Bowel Community Support Group on Facebook. The group is available 24 hours and covers multiple topics. You may be able to offer theses followers some of your own advice.
Adaptations to Enhance Intimacy:
- Be aware of your physical limitations as discussed above. Pace yourself and enjoy being with each other.
- Set the atmosphere:
- Enhance the atmosphere with candles, soft music
- Sex is not only about intercourse. Intimacy may simply involve hugging, touching and kissing – Do not put pressure on yourself
- Remember alcohol may make you feel more relaxed, but it may impact performance negatively
- Prescription Medications that can enhance performance
- Men – Viagra (Sildenifil), Cialis (Tadalafil), Revatio (Sildenafil Citrate), Levitra or Staxyn (Vardanafil) – speak to your physician to find the best one for you
- Women – Many of the prescription medications contain Estrogen to be used mostly for vaginal dryness and discomfort : Premarin, Estriol cream and suppositories, Estrace (Estriol vaginal cream), Estring 90-day vaginal ring (this can also provide support to vaginal walls in women whose pelvic floor muscles are weak)
- Over the counter products to enhance intimacy:
- Vaginal lubricants – use products without parabens or propylene glycol like Vaseline – Best to use: KY products, Sylk, Natural oils – grape seed, sweet almond, sunflower or apricot oil
- External massagers
- Massage oil – avoid use near vagina
- Avoid over the counter (OTC) medications which include – Yohimbe, Horny Goat Weed, Spanish Fly, Saw Palmetto, Panax Ginseng, Maca Root, and Herbal Preps. There is no federal regulation with these OTC medications, and they can affect hormone levels, as well as interact with other medications that you are tasking.
Always consult your physician first in reference to the above suggestions as each person is different.
In summary, sex may not be the same for you if you are over 65 as it was when you were younger. But sex and intimacy can be a rewarding part of your life. So, Live It Up!