Local physicians answer general questions and dispel myths regarding desire and aging, while couples share the benefits of having a fulfilling sex life after the nest is empty.

by Holli W. Haynie

“Am I too old to be interested in sex?”

While the younger generations may rush to cover their ears at the sound of the question, physicians and sex therapists agree – the answer is “no.”

Deanna* and Pat* have been married 54 years and they enjoy making love on a regular basis.
“We have a healthy sex life,” says Deanna, 71. “We’re not going at it like dogs like we used to but it’s still very nice.”

Changes in the intensity of desire are not uncommon, explains Mohan Gehi, M.D. internist and geriatrician at Memphis Internal Medicine. As people age, their hormone levels drop, the body is moving a little slower, and often people are on medications that may affect their ability to perform, such as those used to control blood pressure, or antidepressants.

“There is a certain natural decrease in desire as people age, but it becomes a problem when it is far beyond that and is causing a conflict in the relationship,” Gehi says. “That’s when patients want to know if there is something that can be done about it.”

The body indeed undergoes physical changes as we age, but there is no set expiration date on desire. Sex is not just a young person’s game. In the past decade, the senior set has experienced their own sexual revolution of sorts. The advent of pills like Viagra and Cialis, along with increased media attention on senior sexuality, is shining a light on the fact that sex remains a priority throughout life.

Deanna says they had a bit of a lull in their late 50’s, early 60’s. Sex became painful for her, which is typical of post menopausal women, and Pat also developed a lower libido around that time. Deanna says after she began using over-the-counter lubricants and he started the testosterone shots, they were right as rain. Now they have intimate time together about once a week.

“It doesn’t stop because you get older,” she maintains. “And it’s nice to not have the same worries you did when you were younger, like getting pregnant.”

The benefits don’t end there. In fact, it has been shown that seniors who are sexually active are generally happier and more pleased with their life, explains Gehi.

“Expressing one’s sexuality is an inexpensive pleasure, it’s relaxing, and it helps them forget their everyday woes for the time period,” he adds. “I certainly encourage my patients that if they would like to have sex at any age, there is certainly no reason not to go ahead and express themselves.”

This idea that the need for sex diminishes with age is a complete myth, explains Candace Brown, PhD, certified sex therapist and women’s ealth specialist with the University of Tennessee Health Science Center. She’s also the director at the Center for Sexual Health and Wellness in Germantown.

“The greatest predicator of how a person is going to feel sexually throughout life is how he or she felt when they were younger,” she says.

The main difference between then and now is time, and how well people maintain their health as the years pass.  Brown counsels individuals and couples who are having problems in their relationship due to libido issues. What patients typically talk about is,  for women – the changes taking place during and after menopause, and for men – erectile dysfunction (ED).

“Peri-menopausal women are undergoing changes in estrogen production that can cause physical symptoms like night sweats, hot flashes and vaginal dryness, as well as irritability and anxiety,” Brown explains. “It’s not just something they’re experiencing, but their partner is as well.”

Yet menopause is different for every woman. While the drop in hormones is universal, the symptoms are far from it. That is why hormone replacement therapy is not a guaranteed solution. Some women never experience hot flashes and night sweats, while others never experience a decrease in desire, clarifies gynecologist Yvonne Moore, M.D., of OB-Gyn Specialists P.C.

“It’s the disparity in desire that will usually bring a woman to the doctor,” Moore says, adding the typical scenario seen in her office is a woman being asked by her husband to see a doctor about her loss of interest in sex.

When it comes to problems with sex, Moore, who also holds a Masters in counseling, advises her patients about the various causes of low libido. Loss of sexual desire may be a symptom of underlying emotional problems or interpersonal conflicts in the relationship.

“Her response time may be less; his response time may be less. If both partners are not communicating that to each other, they both may think the other isn’t attracted to them,” Moore explains.

One of the first things that can happen in a long-term relationship is erectile dysfunction (ED), says Moore. Often, rather than admitting or addressing it, the man starts to avoid sex.

“He is not as aggressive and she wonders what has happened,” Moore notes. “Then she doesn’t initiate because she’s afraid of being rebuffed.”

Commonly observed in the clinical setting, says Brown, is how women have an improvement in libido when her partner begins treating his ED.

“A lot of times ED is hard for men to accept,” notes Brown. “But getting treatment shows he is willing to accept he is part of the problem. That alone can make a woman more responsive because she won’t just blame herself.”

Equally important for some women is body image. If a woman doesn’t feel confident about her appearance, she won’t feel sexy. Physicians agree; exercise and proper diet are the best ways to stay healthy and confident.

“Exercise is a big factor,” says Moore. “People who are more active don’t have as much of a problem with hormone imbalance or body image.”

Physical changes of aging – Questions and answers

The mind may be willing, but the body is limited. The good news is physical symptoms are fairly easy to fix. As long as there isn’t an emotional or interpersonal problem that has not been addressed, a variety of medications and tools can help people enhance their sex life.

“The person you are sexually is a refection of your overall health,” explains Moore.

Doctors insist that patients not feel embarrassed to bring up these questions in an office visit. If it’s out of the realm of your primary care physician, he or she will send you to the proper specialist.

Here are a list of common concerns that physicians hear from their patients, and the solutions they suggest.

Women

It is painful when I have sex.

During menopause, women experience a decline in production of  hormones such as estrogen and testosterone. Men produce 10 times as much testosterone; however that small amount plays a vital role for women.  During and after menopause, the drop in hormones can lead to vaginal dryness and vaginal atrophy (a thinning and inflammation of the vaginal walls). Doctors can prescribe a vaginal estrogen cream, ring or tablet, which placed locally help estrogen reach the bloodstream. According to Mayoclinic.com, treating vaginal dryness and atrophy is more effective with topical estrogen rather then oral estrogen, which can decrease testosterone levels that are important for healthy sexual function. Also, simple over-the-counter lubricants can help.

I’m afraid I will lose bladder control during sex.

Urinary incontinence affects millions of people, and contrary to popular belief, it isn’t a normal part of aging in post menopausal women. It is a medical condition with many possible causes. In most cases, it can be stopped, and if not, modern products and methods of managing urinary incontinence can ease discomfort. Treatment ranges from behavioral techniques like pelvic floor strengthening, to medications, devices, and as a last resort, surgery. There is no reason to put up with urinary incontinence. Talk to your doctor.

I am not as interested in sex as I used to be, what’s wrong with me?

Nothing is wrong. Some women are not affected by the drop in hormones during menopause, while other experience a lack of desire. If it is causing a problem in your relationship; that is when it’s time to seek help. A possible culprit could be antidepressants, some of which can cause up to 70 percent of women to have a low libido. A 2008 study in the Journal of the American Medical Association (JAMA) found that women on antidepressants who used medicines like Viagra had an increase in desire. While female use of medications like Levitra and Cialis are completely off-label and carry risks that must be considered with a doctor, Moore cautions, selected patients have taken the pills and received the desired effect.

Currently there are no FDA approved treatments for women with low sexual desire, although there are some compounds currently in clinical study for approval. To learn more about a national desire study that has local participating clinics, visit www.bloomstudy.com.

Men

I’m having trouble getting an erection. Should I start taking drugs like Viagra, Cialis or Levitra?

Between 1999 and 2005, the proportion of men who’ve tried potency-enhancing medicines, hormones or other treatments doubled.

According to MaleHealthCenter.com, in most instances, older men require a longer time in order to achieve an erection. What took only a few seconds to a few minutes in a 19-year-old now requires 10-15 minutes in an older man.

If you are having trouble obtaining or sustaining an erection beyond that, the likely cause is a vascular problem. Those medications increase blood flow to that vital area. All three work by a similar mechanism, but have differences in how quickly and how long each drug works. Men who have diabetes or high blood pressure usually have more problems with impotence.

“It’s very easy sometimes for physicians to just pull out a prescription pad and write a prescription for one of the drugs like Viagra, without really addressing the problem in any detail, and many of these cases are bound to fail again,” cautions Gehi. “It’s important that they don’t go in there with false expectations. They need more education than thinking you just take a pill and something magical is going to happen.”

“We want to make sure they truly have an erection problem,” adds Gerald Dang, M.D., urologist with Southeast Urology Network. “Medications are expensive and insurance doesn’t cover them.”

Other options include a vacuum erection device (pump), and pills injected into the urethra. By placing it directly into the organ, blood flow is increased at a greater level than oral medication.

“The main thing is for people to recognize that they don’t have to deal with these problems,” adds Dang. “There are solutions out there.”

My wife complains that I’m no longer interested in sex. Should I get testosterone shots?

There is no cure-all or blanket diagnosis for decreased libido, and low testosterone is not always the culprit, explains Dang. Many men have no drop in testosterone but still have low libido, while others have a decrease in testosterone with no change in libido. Talk to your doctor about possible causes and treatments for low libido.

What are my options if I’ve had prostate cancer or prostate removal?

Medications for ED can help in these situations. Some of the same solutions to treat impotence are available for men who have had prostate cancer. Typically the more serious the case or surgery, more drastic measures can be taken, including a penile prosthesis.

“Quality of life is important,” explains Dang. “We’re not just here to cure cancer but to get you back to living a normal life.

The Bottom Line – Communication and Connection

When it comes to senior sexuality, health issues – such as arthritis, diabetes, hypertension, depression and prostate cancer, and the medications used to treat them – can get it in the way. But overall, sexual desire and performance have much more to do with relationships, and open communication, than physical health. That is why physicians work with patients to get a full history and rule out interpersonal issues before simply throwing hormone therapies or drugs at them.

“Being creative, being open minded, and being willing to communicate, it’s possible to enjoy sex at any age,” says Gehi.

Daniel* and Roxeanne* were married a little over a year ago. He’s 80, she’s 62. Finding love later in life was not something they expected, but so far they’ve had a whirlwind romance, and they both put in extra effort to keep the flames burning.

“We swore we wouldn’t become like other couples and get so busy with our lives that we end up as ships passing in the night,” says Roxeanne. “We decided to do a cocktail hour everyday. It doesn’t have to be mad passionate athletic trysts, but having wine and music, appetizers and talking together, that is the goal.”

Of course they don’t make cocktail hour every night, but they make spending time together a priority.
“You know the decades slip away, but you still think of yourself as 18,” Roxeanne notes. “If you have a full life and you work out, you’re still 18 in your mind, and yet sex is better than when you’re 18 and you popped in and out of bed.”

For Roxeanne, being with an older man has brought her more sexual satisfaction than at any other time in her life.

“Older men have experience.” she declares. “It’s not just about the physical stuff. He woos me with words.”

To clarify, says Roxeanne, “We have to use substitutes and be creative. You have to be open to see what’s pleasurable. You can’t really just go into direct intercourse. When you’re younger positions are no object. Now you have to be willing to experiment.”

And as for the body issues, they’re over it.

“You get to a point where you don’t give a damn,” quips Roxeanne. “You stop worrying about the bulges.  By this time they’re never going to go away.”

Adds Daniel, “Confidence is sensuality. Younger people have these very high expectations for themselves and their mate too. You realize you don’t have to be a movie star to be sensual, to be desirable.”

Roxeanne says she works to set the tone. A little candlelight, some wine and holding hands helps build the connection, whether it ends up in lovemaking or not.

“Many women don’t necessarily need an orgasm for sexual satisfaction,” Brown notes. “It’s nice when they happen, but because they’ve created this intimacy, they may not need an orgasm to feel sexually satisfied with their partner.”

Recommends Moore, “It can be the best sex of your life if you’re willing to do the things you need to do.”
Time of day can also be a factor, explains Gehi. If seniors are more energetic in the morning; that may be a better time to initiate love making.

“If you’re willing to explore and find ways of satisfying each other, couples can have a very sexually rewarding  relationship even without intercourse,” echoes Gehi. “The desire for sex persists through every decade of life and there is no upper age limit for expressing sexuality.  If you take care of yourself – if you’re physically active, exercise and maintain functional capability – gradually growing older can be more of a pleasure and a privilege. There’s no reason why individuals cannot enjoy a healthy relationship.”

*Names have been changed to protect the privacy of story participants.