| Safer Sex | Microbicides | Commentary/Research | Sexuality and Aging | Sexuality and Disability | Sexual Assault and Violence | Sexual Education | GLBT | Intersexuality | Sexual Terminology | Resource Information |

| What is sex? | What changes can be expected for men and women as they age? | Ways of Adapting to Change | But I Don't Have a Partner (Self-Loving) | A New Partner and Dealing with Sex | Safer Sex Basics | References | Bibliography |

The Fire Still Burns Within

More and more studies are confirming what many older Americans already know, age does not necessarily impact desire for sex. In fact, many people report that the best sex of their lives occurs after 50. While there are some sexual issues that are unique to older people, if one's sexuality is constant throughout life, the biological changes associated with aging are less pronounced and sexuality is usually less affected. However, if sexuality has not been a constant in one's life, being older does not have to be a deterrent. No time like the present to rediscover, or discover for the first time, the joy of being a sexual person.

Sexuality is as normal and natural in old age as it is early adulthood. Sadly, our culture promotes the idea that sex is for the young. While we see lots of examples in the media of young love, we seldom see examples of older people enjoying sex just as much. This attitude is also fostered by many health providers' inability to acknowledge the importance of sex in their patients' lives. However, sexual health is beneficial to the overall health of all persons, regardless of their age.

The purpose of this pamphlet is to help persons over 50 understand more about sexuality so that it is possible to achieve and/or maintain sexuality as long as desired.

What is sex?

The million dollar question. Sex is different to different people, let alone to different couples. It is first and foremost about intimacy. Sleeping in the same bed locked in an embrace, holding hands, kissing, gazing into one another's eyes for an hour, a massage, or even a long walk on a deserted beach in November can be as exciting and stimulating as vaginal or anal intercourse, masturbation or oral sex. It is really up to the individual and couple to define for themselves what they mean by sexuality. As we age, we often redefine what we mean by sex, not necessarily because of an inability to perform certain activities, but more because we have a better understanding of what it means to us.

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What changes can be expected for men and women as they age?

While there are physical changes that men and women both undergo as a result of aging, factors such as alcohol use, medication (diuretics, hypertension and cardiovascular drugs, antidepressants just to name a few), injuries, illness, depression, and a history of assault (particularly if it was at a young age) can have a major impact on sex regardless of age.

Physical Changes in the Male: There are several normal changes that occur as a male becomes older. These include:

• A decreased production of testosterone which stabilizes around age 60.
• Size and firmness of the testicles may be reduced because of the testosterone stabilizing
• Reduction in sperm which means a lesser chance of impregnating a female.
• Increase in the size of the prostate (prostatitis) is common and easily treatable with antibiotics and massaging the gland. If there are tumors, surgery may be required. This can cause problems such as a lack of erection because of the absence of hormones from the prostate gland. New surgical procedures can eliminate this threat.
• The sexual response cycle changes. In the beginning of having sex (excitement phase), the erection may be delayed. Therefore, more direct stimulation of the penis is required. The erection may not be as firm when younger.
• A longer time before ejaculating (plateau phase) is common, which can be an asset for the female because of the extra stimulation which can help her achieve an orgasm.
• The orgasm for the male is shorter than when younger. The urgency to ejaculate is reduced along with reduction in seminal fluid.
• The time right after orgasm (resolution phase) when the male returns to the non excited phase is of a shorter duration.
• The time that it takes a male to regroup (refractory period) can take anywhere from 12 to 24 hours or longer before he can achieve another orgasm. This period increases as the male becomes older.
• Men who remain sexually active in their youth and middle years tend to have less issues with continued sexuality in older age.
• There are indications that for men who stop having sex in their 50's and 60's, the chance of becoming impotent is greater. It's important to remember that masturbation is sex, and that while a man may not have a sex partner, he can continue to be a sexual person through self-loving.
• By using techniques that rely heavily on genital stimulation, many men will be able to stay sexually active well into advanced years.

Physical Changes in the Female: Even though the physical changes in women are not as great as for men, there are still changes which can impact sexuality. Women are more likely to have experienced assault (sexual and/or domestic violence) and so may find that as they age, their interest in sex declines, or that changes brought about by menopause are societally acceptable reasons to cease sexual activity. Changes for women include:

• Menopause occurs after the age of 45-50. With the elimination of pregnancy as an issue, many women find sexual desire to increase. However, there are others who find there is no purpose in sex. Hot flashes can occur because of hormonal imbalances. The vagina can become thinner and change to a lighter pinkish color. The expansive ability of the vagina is diminished during sexual arousal; the length and width is decreased. In addition, there is a reduction in lubrication. This can result in painful intercourse (dyspareunia).
• Lubrication begins slower and the amount is less.
• Sensitivity in the clitoris and nipples remain the same as when younger.
• The sexual tension that mounts right before orgasm (plateau phase) is less dramatic then when younger, however, the constrictions in the vagina and clitoris withdrawing under the hood is the same as with younger women.
• At the time of orgasm (orgasm phase), the contractions are less and some women may find them painful. This can be treated with hormone therapy.
• The phase after orgasm (resolution) occurs more rapidly for the post-menopausal woman, but she is still capable of achieving multiple orgasms as in her earlier years.

• Death of spouse/partner
• Divorce
• Retirement- This can be a very stressful time as this situation can result in many changes including: being together more, loss of meaning in one's life, change in living situation.
• Strict religious or moral upbringing can impact a person's ability to seek out help and information
• Societies attitude that older people should not be sexual. This is especially true for women. Our culture places a high value on physically attractiveness. Therefore women are viewed unfavorably at an earlier age than men, and therefore, society expects them to be nonsexual earlier than their male counterparts.
• Partners who see the normal sexual decline in their mate as rejection, may provoke anger as a false basis for being distant in the relationship. If the partner becomes angry because the man can not have an erection, then having an erection becomes a remote possibility.
• While self loving is fine, many people want to be involved with another person as they age. Finding a partners becomes more difficult, particularly for women.

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Ways of Adapting to Change

The most important first step is to be affirming. You are a sexually attractive person. You are sexually capable. You deserve the pleasures and joy of being a sexual person. Repeat this daily and you just might start realizing it's true. Studies show that older people prefer someone of their own age as a sexual partner. Don't let the media, society, your kids, friends or anyone else define for you who and what you are and what you need.

Some suggestions for the technical side of things include:

• Slower but longer sexual activity which includes longer foreplay, more intense stimulation of the genitals, and the use of lubrication gels.
• Using sexual positions that account for physical needs, oral stimulation, fantasy sharing and mutual masturbation.
• While hormone replacement therapy can help restore the vagina to the pre menopausal state, women can also assist in keeping the vagina flexible by inserting a well lubricated dilator or dildo in the vagina. Since both dilators and dildoes come in many shapes and sizes, it is possible to start with a very small one and increase the size until the vagina is flexible enough that penetration with a partner is comfortable. (Your medical provider can help to arrange for the dilators while dildoes can be purchased through a variety of mail order catalogues).
• Viagra has certainly been a major benefit to men who suffer from erectile dysfunction ( impotence). A note of caution, discuss your medical conditions with your provider before taking this medication as there have been adverse effects, including death, in some men. Women should not take Viagra.
• Explore some of the Eastern arts of sexuality-tantric, Taoist sex. These spiritual approaches to sexuality often offer more intimacy and fulfillment than what we have come to believe as traditional sex practices. Books such as "Sacred Sex: Ecstatic Techniques for Empowering Relationships" by Jwala and "Tao of Love and Sex: The Ancient Chinese Way to Ecstasy" by Joan Chang may be helpful.
• Communication, communication, communication! Learn what satisfies your partner and be willing to discuss your likes and dislikes. Remember it is up to you and your partner to define what you mean by sex. There is no standard or definition that you must meet.

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But I Don't Have a Partner (Self-Loving)

Finding a partner that is compatible with you at any age can be difficult. However, your first sexual partner is often yourself and it may be your most constant partner. Self-loving, sex for one, or masturbation, is an excellent way to stay sexually healthy and remind your body that you do love and enjoy it. If you've never engaged in self-love, or feel guilty about it, read Betty Dodson's "Sex For One: The Joy of Selfloving." The author is now in her 70s and shares openly her experiences with sex as she has aged.

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A New Partner and Dealing with Sex

While many people do age together, there are many others that couple after 50. In forming a new relationship, making the decision to proceed with sex is as big a step today as it was in high school. A sexual relationship involves a level of intimacy and understanding that not all couples are comfortable with. Before the relationship proceeds to this level, it is important that both parties are clear about their interests and desires. If you can't discuss sex with your prospective partner, then you shouldn't be doing it.

In high school your chief concern was pregnancy. Today, besides all of the physical changes discussed, there are other concerns. One of the single biggest issues facing all couples who choose to become sexually involved is sexually transmitted disease (STD). There are many different STDs, ranging from gonorrhea to HIV, the virus that causes AIDS. Even forms of hepatitis are sexually transmitted. In fact, at least 20 disease have found to be STDs and it is estimated that more than 10 million American men and women are infected with one. Because not all STDs have recognizable symptoms, many people are not aware that they are infected with a transmissible disease.

Contrary to popular belief, HIV, the virus that causes AIDS, is rapidly occurring among older Americans. It does not mean that older people are more prone to HIV but rather, not a lot of information has been given to them as the myth exists that older people aren't sexual. If someone says I'm fine and I've never had any disease, that unfortunately may not be true. Therefore, it is important that all couples, regardless of age, practice safer sex (activities which reduce the likelihood of becoming infected with HIV or another STD).

While contraceptive is generally not an issue for most older couples, if you are a man involved with a younger woman, be sure that contraception is part of the discussion. Not many men are really going to be comfortable becoming a father in their 60s or even older.

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Safer Sex Basics

Confine sex to a mutually faithful partner. Be selective when you choose a sex partner. Be aware of smooth talkers; have sex only with a partner who will make you feel secure about health concerns; and know the name and phone number of your partner. Talk with your partner about sex before the heat of passion. Don't let your partner remain silent. Find out about your partner's health and sexual history. Make conversations about health a natural part of your sexual relationship. Alcohol or mood-altering drugs can be dangerous as it may lessen your ability to make responsible choices as well as hinder sexual performance.

The highest amounts of HIV are found in blood and semen. HIV is present in smaller amounts in vaginal and cervical fluid (especially if a woman has a vaginal or cervical infection). Very little HIV is present in saliva, sweat, and tears; these almost certainly cannot transmit AIDS. Anal and vaginal intercourse account for most documented cases of sexually transmitted AIDS, while oral sex accounts for relatively few cases. These cases occurred in situations where an infected man ejaculated into a partner's mouth when another STD was present, or there was bleeding gums.

Activities that are high risk include: unprotected anal intercourse; unprotected vaginal intercourse; and sharing needles (for drugs, piercing)

Lower risk activities include: unprotected oral sex on a man; unprotected oral sex on a woman; vaginal or anal intercourse with a condom; sharing sex toys without protection.

No risk activities include: Masturbation (alone or with a partner), hugging, touching, massage, kissing, fantasy, using sex toys (don't share unless you use a new condom or clean thoroughly before using again).

Latex condoms should be used with a water based lubricant (K-Y, Astroglide) for vaginal as well as anal intercourse. Both condoms and lubricant are readily available at drug stores and even places like Wal Mart and K Mart. Many health clinics have both available for free. Do not use oil based products like Crisco, Vaseline, Baby oil as they can destroy the condom. If you are allergic to latex, there are condoms made of polyurethane (Avanti) that are very good. The female condom, which is made of polyurethane, is also a good idea as it allows for some spontaneity (it can be inserted up to eight hours prior to intercourse) and it eliminates the problem of the man sustaining an erection while putting it on. Many clinics carry samples of the female condom.

If you have been exposed to someone with a sexually transmitted disease, go to your doctor, clinic, or health department for testing and treatment. Urge your partner to be treated at the same time. Do not have sex until you and your partner have been tested and are considered disease-free.

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References

Shopping Guide: There are a number of companies that provide excellent sexually related products (books, toys, videos) in a discrete manor. You can place an order and no one will ever guess that you are receiving sex products in the mail. Some of the companies mail under a name other than the one they are best known by. For example, Good Vibrations ships under the name of Open Enterprises. By calling the 800 number, all of these companies will send catalogues that you can enjoy in the comfort of your home. If you have access to the internet, you can go to their websites and do cyber shopping. Don't be afraid to talk to the sales representatives at any of the companies listed below. They are very knowledgeable of both the products they sell and the needs of their clients.

• Good Vibrations
• Grand Openings
• Toys in Babeland

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Bibliography

A Woman's Guide to Overcoming Sexual Fear and Pain, by Aurelie Jones Goodwin, Ed.D and Marc E. Agronin, MD 1997 New Harbinger Publications, Inc. Detailed and reassuring discussion of the sexual facts of life for women.

The New Good Vibrations Guide to Sex, Cathy Winks and Anne Seamans, 1997, Cleis Press A Sex positive approach to loving.

Love and Sex After Sixty Robert Butler and Myrna Lewis, 1993 Ballantine. Good discussion of how aging affects sexual desire and lovemaking.

My Parents Never Had Sex: Myths and Facts About Sexual Aging Doris Hammond Prometheus Books, 1988. A discussion of how culture, religion and society have created certain stereotypes around sex and aging.

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