# Sexual Health/Aging

The aging process involves many normal physical changes, some of which naturally affect the sexual response, but sexuality is much more than a focus on the genital nature of sex. Often aging couples continue to have a mutually satisfying sexual relationship. Partner communication and frank discussion of sexual desires help to maintain a fulfilling sexual relationships as a couple ages. If a spouse is lost due to death or divorce, finding a partner may be difficult.
Changes that influence sexual behavior in older adults include:
* Life choices, financial issues, empty nest syndrome
* Relationship Problems
* Communication problems
* Changing hormone levels
* Menopause
* Fatigue and Stress
* Disease
* Erectile dysfunction due to vascular disease or diabetes
* Medications

## What are some normal changes in your sex life as you age?

Older men may require more stimulation and time to achieve an erection. Some older men will notice that the volume of the ejaculate decreases slightly, and the force of the ejaculate also decreases with age. The older man also loses some of the focus on orgasm. Older men can achieve a great deal of pleasure from sexual intimacy and yet not have an orgasm or ejaculate.
When a woman enters her 50s she goes through menopause which causes a decline in the female hormone, estrogen. The absence of estrogen can result in decreased vaginal lubrication and changes in arousal and desire. Other normal changes in the older woman include a decrease in length, width, and elasticity of the vagina. Recent studies, however, indicate that the older woman has no physical limitation in her capacity to achieve and enjoy orgasm. The vaginal area and breasts may become less sensitive to touch, and that orgasm may take longer.

## How does aging affect an individual’s sex drive?

The need for romance and intimacy does not disappear. Many of the reasons for loss of sex drive are linked to physical changes in the body. Some common reasons for men are erectile issues. For women the reasons are physical and hormonal. As women get older and hormones start to dwindle, many can find themselves “not in the mood” for sex in the way they may have been in the past. And even when they are in the mood, changes in their body can result in vaginal dryness and pain during sex which can make the thought of sex unappealing. Also if women are unhappy in a relationship, if she doesn't feel good about herself, or if it hurts it can affect libido. It's hard to tease all of those factors out," says Judi Chervenak, MD, a reproductive endocrinologist at Montefiore Medical Center in New York City.
Some ways to energize your sex drive include using lubrication, to ease vaginal dryness and to help make intercourse more enjoyable. Exercising. Regular physical activity can boost feel-good endorphins and improve your body image. Kegel exercises (exercises done to tighten the pelvic muscles) can work to enhance sexual sensations and help boost desire. Communicating with your partner. This can help you feel more connected, and more inclined for romance.

## What is the significance of sexual peaks in males/females?

Masters and Johnson discovered that "human sexual response may be slowed by the aging process, but it is certainly not terminated."Finally, "the refractory period," or the time it takes to achieve another erection after ejaculation, increases with age. While a young man of 18 can often recover with an erection 15 minutes after sex, a man in his 50s may require 24 hours or more before he has another erection and he is interested in intercourse again.

## How does sex differ for males/females as they age?
### When Boys Reach Sexual Peak

Boys reach the height of their sexual functioning at about age 18, followed by a slow drop in their capacity for erection and ejaculation from that point on. The drop in male steroid hormones only becomes measurable by about age 30. With declining hormonal production, there is a slow decline in the speed of physiological responsiveness and a lengthening of the refractory period — the time needed after ejaculation for the penis to again be able to achieve an erection.
By age 40, most men begin to experience a decrease in physiological responsiveness, sexual arousability and functioning. There continues to be a gradual decline through the 50s. Although there is wide variability, at this point males generally are only half as sexually active as they were at the peak of their capacity in their late teens and early twenties. During the late 40s and increasing gradually thereafter, the urgency of sexual interest declines, erection is less frequent and more difficult to sustain, the turgidity of the erection diminishes, ejaculation is less forceful, and refractory time is lengthened. After age 40, many men begin to experience periodic inability to achieve an erection and the frequency of this incapacity increases over time and becomes quite common by the 60s. However, although by the 60s all of the changes noted above are quite noticeable in almost all men, the pleasure they derive from sex may not be significantly affected.
Indeed, recent studies show that most men (unless they have certain health problems) are able to participate in and enjoy sex their entire life span, and many are able to produce viable semen until quite late in life (Pablo Picasso reportedly fathered a child at 90 years of age). Thus it is not completely surprising to discover that, in recent years, elderly men in senior housing apartments have become a regular source of clients among prostitutes. Various factors can limit sexual interest and capacity in men as they age. There are a number of organic problems of the heart and circulatory system, glands and hormonal system, and the nervous system that can, to varying degrees, diminish male capacity for and interest in sex. And the side effects of many medications used to treat some of these organic conditions can themselves compound the problem.
Masters and Johnson originally reported that as much as 90 percent of male impotence has a psychological origin. Due to more sophisticated urological testing procedures it is now estimated that only about 40 percent of erectile problems are purely psychological.

### Sexual Response in Women

The capacity for sexual reproduction begins earlier in females than in males, often two years earlier. However, the commencement of puberty varies among girls and may not begin until age 14 or 15. Women differ from men in that the decline in sexual responsiveness with aging is quite gradual.
As women age, hormonal production diminishes, the lining of the vaginal wall begins to thin and becomes more rigid, and the production of vaginal lubrication drops. The latter change, in particular, can contribute to discomfort during intercourse, but a woman's capacity to achieve orgasm can remain at near peak levels well into her senior years, even though the length of time needed to achieve orgasm may increase.
Women who remain sexually active, in fact, may be less likely to experience a drop in available vaginal lubrication. These changes are quite minimal until menopause — the most dramatic organic change that a woman undergoes as she ages.
Menopause usually occurs between 45 and 55 years of age, although it may begin earlier in women who have had a hysterectomy. A significant drop in the production of the hormone estrogen brings on menopause. With menopause, ovulation (the production and release of eggs), menstruation and fertility end.

## What are some pros and cons of aging as it pertains to sexual activity?
### Good points

* Reduced frequency of sexual desire
* Likely to have more leisurely lifestyle, with more time for sex
* Likely to know each other very well, so greater understanding of each other's sexuality
* Although less frequent, sex may be more enjoyable

### Bad points

* Reduced frequency of sexual desire
* Arousal takes longer, and needs more genital stimulation
* Reduced lubrication (women)
* Poor body image (a feeling of being unattractive and undesirable)
* Erections less hard and ejaculations less powerful (men)
* More likely to be taking medication for other medical conditions (for example, blood pressure) which may affect their erections (men)
* More likely to have conditions that can affect sexual activity or cause anxiety about having sex
* Emotional 'baggage'
* Lack of privacy if not living in own home
* More difficult to find a new relationship

## Are you ever too old to have sex?

Generally, this research has found that age typically does not significantly diminish the need and desire for sex, that regular sexual activity is standard when a partner is available, and that most elderly believe that sex contributes to both physical and psychological health.
Furthermore, studies have shown that physical capacity for male erection and male and female orgasm continue almost indefinitely, and that achieving orgasm is desired but not always achieved. Research has also found that sexual practices are varied and include masturbation and oral sex, in addition to intercourse, and, for many, sexual satisfaction increases rather than decreases as individuals enter into their senior years.
In terms of problems, impotence and failure to achieve orgasm as well as failure to find suitable partners are important sources of frustration. These studies have led to the realization — now generally accepted among psychologists and sex therapists—that sexual interest and the need for sexual contact continue throughout the life cycle, although patterns differ somewhat for women and men.
Differences in sexual patterns between males and females are found throughout the life cycle. While capacity for erection in males begins while they are still in the womb, reproductive ability (i.e., the production of semen) begins at about age 13, but may not start until the boy is 16 years of age. As this suggests, there is considerable normal variation among males, as well as females, in the onset of various changes in sexuality.

## Physical changes
### Aging and Sex on Male Impotence

The majority of causes of male impotence have their origin in hormonal, vascular or neurological factors. Regardless of the causes of erectile difficulty, there is always a psychological effect on the male. Men who experience an inability to achieve or sustain an erection on several occasions may be so anxious about inadequacy that a self-defeating process is initiated that causes them to avoid sexual situations and sexual arousal. Other psychological factors, including depression, lowered self-esteem associated with overall loss of physical strength and the onset of physical signs of aging, anxiety, and substance abuse can all contribute to male impotence.

### Women's Changes
#### Physical Changes

* vaginal lining thins
* muscle tone and elasticity of the vagina is lost

#### Desire

* thoughts of sex and fantasies decrease

#### Arousal

* clitoral sensitivity decreases
* arousal is slower

#### Orgasm

* may or may not occur
* does not come on as strong as it did when they were younger

#### Resolution

* return to unaroused state quicker

### Men's Changes
#### Physical Changes

* testosterone levels decrease
* blood flow to the penis decreases
* sensitivity reduced

#### Desire

* thoughts of sex and fantasies decrease

#### Arousal

* erection takes longer and more effort to be achieved and maintained

#### Orgasm

* takes longer
* ejaculation is smaller and weak
* orgasm is not as strong

#### Resolution

* need more time between erections

## Tips

Top 10 Sex Tips for the Older Woman
* Talk With Your Partner
* Lubricate
* Experiment with Positions and Times
* Deal with Erectile Problems
* Feel Beautiful
* Take Care of Your Health
* Sex After Surgery
* Safe Sex
* Talk to Your Doctor
* Vibrators and Masturbation
Top 10 Sex Tips for the Older Man
* Talk Openly With Your Partner
* Manage Your Health Conditions
* Talk To Your Doctor
* Experiment With Positions and Times
* Expand Your Concept of Sex
* Avoid Alcohol and Smoking
* Expect Difficulties
* Eat Healthy and Lose Weight
* Stay Sexually Active
* Safe Sex

## References

* http://health.discovery.com/centers/sex/sexpedia/ageingandsex_03.html
* http://www.embarrassingproblems.co.uk/sexage.htm
* http://www.healthandage.com/public/health-center/29/article/2853/Sex-and-Aging-Fact-Sheet-for-Women.html
* http://www.malehealthcenter.com/c_agingsex.html
* http://www.wooster.edu/psychology/moreinfo.html
* http://www.everydayhealth.com/sexual-health/regain-sex-drive.aspx
* http://longevity.about.com/od/healthyagingandlongevity/tp/sex_tips_men.htm
* http://longevity.about.com/od/healthyagingandlongevity/tp/sex_tips_women.htm