Sex and Aging – Use it or Lose It

​Little empirical information exists about sexuality among older persons, despite the progressive aging of the population.  What available information is self-reported and so subject to some bias.  The baby boomers, a generation that matured when sexual mores were starting to evolve, will likely continue in more evolved behaviors well into their old age.

​Interesting facts relating to the post-65-year-old population:

• Sexual activity is associated with greater enjoyment of life.  
• Sexuality is closely linked to health at older ages, more so for men than for women.
• Most older adults (76%) agree that sex is an important part of a romantic relationship. Men were more likely to agree (84%) than women (69%).
• The likelihood of being sexually active declines steadily with age and is lower among women than among men.
• Being in a relationship dramatically increases the likelihood of sexual frequency.  In one large study among those who were not in a relationship, only 22% of men and 4% of women reported being sexually active in the previous year.
• The prevalence of masturbation declines as a person ages and is higher among men than among women.
• Over three-quarters, (78%) of men rated their most recent sexual experience with a partner as either extremely or "quite a bit" pleasurable.  About two-thirds (68.2%) of the women in that age group rated their most recent experience with a partner that highly.
• By the time a man is in his 40’s, he has about a 40% chance of having some form of erectile dysfunction, and this increases about 10% per decade thereafter.
• Nearly one in five men (18%) and 3% of women reported they had taken medications or supplements to improve sexual function in the past two years.

For women, the increase in the proportion of widowed is a significant factor in sexual frequency decline.  Among men, both poorer physical health at older ages and a decrease in its association with occurrence are significant factors in the decline.  A change in the association between contentment and frequency is also a significant factor for men. Reverse causality may explain the joy–occurrence findings for both men and women.

​Older women are less sexually active than men of the same age and the gender gap widens as they get older.  Women are less likely than men to be in a marital or intimate relationship, and even more so with age, seemingly because men tend to die at a younger age than women.  About one in 20 women who were not in a relationship reported being sexually active in the previous year, compared with about one in five men who were not in a relationship.

​Half of both men and women reported having at least one sexual problem, and almost one-third reported having at least two sexual problems.  For women, the most common sexual problems were low libido, difficulty with lubrication, inability to orgasm, finding sex not pleasurable, and pain.  Among men, the most prevalent sexual problems were difficulty in achieving or maintaining an erection, low libido, climaxing too quickly, anxiety about performance, and inability to climax.

​‘Use it or lose it’ is a phrase more properly referred to as disuse atrophy, a medical term used to describe the loss of normal healthy tissue and worsening function after a prolonged period of lack of use.  This applies to all systems of the body and most people are best familiar with this in exercise and fitness although this also applies to genitals.  

Erectile Dysfunction Medications are Cheap and Widely Available

When atrophy of penile tissue occurs the smooth muscle shrinks, creating a loss of length and girth and often poor response to erectile dysfunction drugs.  Early and aggressive treatment of impotence with oral or injection medication or possibly a vacuum erection device may improve and speed up recovery of erectile function.  

The clinical definition of erectile dysfunction is the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance.  The first consistent success in the treatment of this ailment were penile implants of various engineering designs and they are still used albeit infrequently.  Pfizer hit the jackpot with the licensing of Viagra in 1998 and revolutionized sex and the elderly population, making it possible for many to have intercourse once again.  Since that time several other similar drugs have come on the market including Cialis, Levitra, and Stendra. 

A significant proportion of men with angiographically documented coronary artery disease had erectile dysfunction and that this latter condition may become evident before angina symptoms in almost 70% of cases.  This suggests erectile dysfunction is related to coronary issues.

Vaginal atrophy most often occurs during menopause because of a decrease in the hormone estrogen.  Only half of women who enter menopause suffer from vaginal discomfort or lack of lubrication. Regular stimulation of vaginal tissue helps maintain blood flow, which in turn increases lubrication and elasticity.  Women who have had a long sexual hiatus are more likely to experience vaginal dryness than women who are regularly having intercourse.  Topical estrogen application or systemic hormonal treatment is effective in managing vaginal atrophy.

​What helps keep an older couple sexually active?  Older adults with satisfying sex lives engage more frequently in open sexual communication and setting the mood for sexual activity.  An expansive sexual repertoire, as measured by the number of sexual activities used during the last sexual encounter, is also associated with greater sex frequency and sexual satisfaction.