Sexual Health and Aging Guide: Tips to Maintain Sexual Health Over 65
Sexual health is an essential part of mental and physical health. Sadly, stereotypes about aging, ageism, and lack of education about sexual health in older adulthood for older adults and professionals create a perfect storm keeping older adults from getting their sexual health questions answered.
What percentage of older adults are sexually active?
People all throughout their lives enjoy sex and intimacy. In fact, a recent survey1 of more than 1,000 adults between 65-80 years old, found that 50.9% of men and 30.8% of women reported being sexually active. Yet, in this same survey, when it came to discussing sexual health with health care providers, only 17.3% of adults aged 65–80 reported speaking to their health care provider about sexual health in the past two years and of those, the vast majority (60.5%) initiated the conversation.
Researchers2 have found that sex among older adults is often viewed as stereotypically “shameful, disgusting, laughable, and nonexistent”, which can lead to internalized stigma and increased sexual problems for older adults.
It’s time we shift the narrative about aging and sexuality toward a more accurate and holistic view. There are many benefits to sexual relationships over 50, including physical, cognitive, relational, psychological, and spiritual3. The sooner we can remove negative beliefs about aging from conversations around intimacy and sexual health, the better.
How does sex drive change throughout adulthood?
Women tend to have the best sex drive in their 20s. As you approach your late 30s, your ovaries start making less estrogen and progesterone and fertility declines. As you approach menopause, sex drive is known to change. In your 40s, your menstrual cycle may become longer or shorter, heavier or lighter, and more or less frequent, until eventually your ovaries stop releasing eggs, and you have no more periods. When you have no more periods for 12 months, you have reached menopause. During perimenopause (the period leading up to menopause), and menopause, many women report a lower libido though a small percentage report a higher libido.
As a woman ages, changes in hormones, structural changes in the vagina itself (vagina can shorten and narrow, the vaginal walls can become thinner and a little stiffer), and in the body’s ability to lubricate the vagina can all result in a reduction in sex drive. These changes could make certain types of sexual activity, such as vaginal penetration, painful.
Many women find benefit with lubricants and some women work with their doctors to use hormone therapy to treat menopausal symptoms and report an improvement in sex drive.
Just like with women, hormone changes also happen in men, but for men, changes like a reduction in testosterone happen slowly over time. This is a process called “andropause” – a natural lowering of testosterone with age.
Testosterone increases sex drive and production of sperm.
Signs of low testosterone may include:
- Less desire for sex
- Problems generating erections
- Decrease in muscle mass
- Feeling tired or irritable
- Problems thinking or focusing
- Poor mood
Some men with sub-optimal levels of testosterone work with their doctors for testing and may consider testosterone replacement often reporting improvement with sex drive.
How do medical conditions and medications affect sex drive?
For both men and women, decline in the libido may be related to medical and mental health concerns, like:
- Heart disease
- Chronic pain
- Parkinson’s Disease
- Dementia disorders
- Excessive alcohol use
If the medical condition itself was not enough, medications used to treat medical and mental health conditions may also affect sexual functioning.
Working with your doctor to treat or manage these conditions or discuss sexual side effects of medications can help you to have a more informed treatment plan- one that includes your sexual health.
Tips for couples experiencing sexual health differences
I was recently asked the question, “what tips do you have for couples in which one partner’s sex drive has changed over time, but the other’s hasn’t?”
In answering this question, I was reminded me of a recent study4 looking at couples in which one person was living with Parkinson’s Disease and the other was not. (Parkinson’s Disease significantly impacts sexual health and sex drive.) In this study, both partners continued to desire intimacy, yet expression of these feelings were reduced. This study found that the partner was not as dissatisfied with their sex life as the person living with Parkinson’s Disease.
My takeaway: is the more we can help couples adjust to illness and communicate about their intimacy needs and goals, the better. Intimacy cannot cure Parkinson’s Disease, but can indeed help a couple feel less alone and more connected in the context of a lot of painful changes.
Bottom Line: Talk about it. Respect where one another is at and see if you might be able to meet each other in the middle. Explore all types of intimacy, not just physical intimacy, such as:
- Engage in shared interests: Read a book together, go on a walk, get curious about each other.
- Cultivate a sense of compassion and positive regard for one another
- Text each other throughout the day to share that you appreciate and are thinking about the other.
- Share in affectionate touch – even if this touch does not include or end in intercourse
- Reminisce about the most connected and intimate times in your relationship
How can we boost our sex drive as we get older?
- Maintain a healthy diet: the healthier your body and mind, the healthier your sex life. A healthy diet rich with fruits and vegetables and void of processed foods is key for a healthy libido
- Exercise: Studies show that exercise correlates with a higher sex drive and better sexual function
- Manage your stress. It’s easier to get in “the mood” from a relaxed state
- Communicate with your partner: if you are noticing changes in your body, so, too is your partner. It can help to talk about it.
- Talk with your doctor if you have a problem that affects your sex life. If you’re over 65, based on research, you may be the one who has to initiate the conversation.
- Set yourself up for success. Identify when you are at your best (physically, emotionally, energetically), and prioritize intimacy during these times.
- Continue to have sex especially during and after menopause. This is an important point as sexual activity helps to prevent vaginal atrophy. Vaginal atrophy frequently affects menopausal and postmenopausal women. It’s a condition where the lining of the vagina gets drier and thinner from a lack of estrogen and can create a host of other problems (e.g., burning, itching, spotting and pain with sex, frequent urination, urinary tract infections)
- Adjust your “sex”pectations. Shifting your expectations about what sex “should” look like can help and changing your focus from what your body “cannot” do to what your body “can” do will help. For example, I have worked with couples who were no longer able to have penetrative intercourse, which was their primary method of sexual intimacy. When we looked out what their bodies were able to do and broadened the view of what sexual intimacy included (e.g., oral sex, fondling, touch, fantasy talk), they had a more opportunities.
- Get creative I have worked with people with physical disabilities and life altering medical conditions for decades. There’s a saying that people who have disabilities make more creative lovers. So, become playful, don’t take each sexual encounter so seriously and enjoy the process of finding a new more creative love making experience.
- Get professional mental health care if needed. This can be especially helpful if changes in sex drive are due to a mental health or medical condition. Living with a medical condition that affects your sexual health is quite a big adjustment. It takes some time to come to terms with the medical condition and all of the physical and emotional changes that come with it. At times it can help to get some professional support, so please don’t hesitate to reach out for mental health care when you need it.
Above all- Don’t give up. Instead…
Talk with your doctor if you have a problem that affects your sex life and/or see a therapist who specializes in sexual health and couples therapy. Remember: If you’re over 65, based on research, you may be the one who has to initiate the conversation.
- Nnenaya Agochukwu-Mmonu, Preeti N. Malani, Daniela Wittmann, Matthias Kirch, Jeff Kullgren, Dianne Singer & Erica Solway (2021) Interest in Sex and Conversations About Sexual Health with Health Care Providers Among Older U.S. Adults, Clinical Gerontologist, 44:3, 299-306, DOI: 10.1080/07317115.2021.1882637
- Syme, M. L., & Cohn, T. J. (2016). Examining aging sexual stigma attitudes among adults by gender, age, and generational status. Aging & mental health, 20(1), 36–45. https://doi.org/10.1080/13607863.2015.1012044
- Roni Beth Tower, 2017, https://www.psychologytoday.com/us/blog/life-refracted/201707/benefits-sex-after-50
- ADPA: https://www.apdaparkinson.org/what-is-parkinsons/symptoms/sexual-effects/