Healthy Aging: Better Sex After 50

As we age, the hope for a good sex life doesn’t have to change as our bodies naturally transform. But for older people having sex, challenges often arise for both men and women related to medical problems, surgeries, and changes in body appearance both in oneself and one’s partner. Unfortunately, spicing up our sex lives sometimes takes a back seat to facing the new reality of our aging bodies. But it’s never too late to regain the vigor and excitement of past sexual pleasure. Learn to overcome worrisome health obstacles for a gratifying and enjoyable sex life, no matter your age.

As women age they may notice sexual changes as well. Some of those changes are welcome, and others not so much.

Sex Challenges for Women as They Age

An older woman may also notice unwanted sexual changes as well. Her appearance may change with the arrival of wrinkles or gray hair, making her feel less attractive as she ages. That can impact her sexual desire. In addition, physical changes can occur. As women age, hormones decrease, causing the vaginal wall to become thinner, drier, and more irritated. This can make sex unpleasantly painful. Friction from intercourse may cause micro-tears in the vaginal wall, which can cause pain and bleeding. Prescription medications and over-the-counter lubricants can help. Talk to your doctor if this is a concern for you.

Sex Benefits for Women as They Age

Some sexual changes that come with aging can be positive for women. Older women have often learned what excites them, and may be more inclined to share that with their partners than a woman who is younger and less experienced. For an older woman, her sexual experiences can also transform into body confidence and sexual prowess. In addition, the worry of an unwanted pregnancy disappears after menopause or following a hysterectomy. In this way, many older women enjoy sex more freely.

Men will also start to notice changes in their bodies with age.

Sex Challenges for Men as They Age

Along with sex benefits, older men may find aspects of sexuality more challenging than they used to. It may take longer to get an erection, and erections may not be as large or firm as they used to be. Men may need more foreplay for an erection to occur. They may produce less semen. After ejaculation, loss of erection may happen more rapidly, or it can take longer to get another erection.

Erectile dysfunction (ED), or the loss of ability to get or maintain an erection, occurs in up to 65% of men over age 65. Men who have heart disease, high blood pressure, or diabetes may find that these conditions contribute to impotence, either because of the health problems themselves or the medications used to treat them.

Sex Benefits for Men as They Age

Age comes with experience, and an experienced older man is often more attuned to the importance of foreplay in turning on their partners. Older men are more likely to know that slowing down and paying attention to a partner’s pleasure is a crucial part of good sex. Older men may also last longer and take longer to orgasm as an adjustment to their bodies’ slower arousal period.

There are several causes of sexual problems that can occur with age. Illness, disability, and even medications used to treat medical conditions can affect sexual performance and enjoyment. However, most people can have a satisfying sex life even with medical issues. On the following slides we will discuss some of the more common causes of sexual dysfunction associated with aging and offer tips for solving those issues.

Arthritis causes joint pain that can make sexual intimacy uncomfortable. Exercise, rest, warm baths, and experimenting with different positions may alleviate this pain. If pain is severe, talk to your doctor as medications may help, or joint replacement surgery may be needed.

Sex Positions for Arthritis Sufferers

• For men with back pain, a side-by-side sex position takes pressure off the back and other joints. In this position, both partners lie facing one another with their legs interlaced. This position is also good for people who have recently had hip replacement surgery, particularly if that person’s leg is on top.
• For a woman with arthritis in the hips or knees, she may be more comfortable lying at the edge of the bed with her partner either standing or kneeling in front of her.
• If a man has arthritic knees, he may experience less painful sex if he lies down while his partner straddles him on top.
• If both partners have painful, arthritic hips, they may want to have the woman lie on the bottom with pillows propping up her bent knees. The man lies between her legs and himself in a “push-up” position with bent knees and straight arms.

Other conditions that cause chronic pain can interfere with sexual function as well. Bone and muscle conditions, shingles, poor blood circulation, or blood vessel conditions can lead to sleep problems, depression, isolation, and difficulty moving (mobility). All that can lead to difficulty with sexual relations between older people. Many of these issues can be treated. Talk to your doctor if you experience chronic pain.

In men, diabetes can cause erectile dysfunction (ED, also called impotence). Diabetes can also cause retrograde ejaculation, causing semen to travel backward into a man’s bladder instead of out of the penis. Medical treatment can help.

In women, diabetes can cause sexual problems including vaginal dryness, painful intercourse, decreased libido, and lack of sexual arousal and orgasm. Over-the-counter lubricants can sometimes help.

Men and women with diabetes should talk to their doctor if they experience any sexual symptoms due to their illness, as there are medications that may be helpful.

Heart disease is another medical condition that can lead to sexual problems. Hardening and narrowing of the arteries (atherosclerosis) can impede blood flow, and high blood pressure (hypertension) also impairs blood flow, both of which can lead to problems with erections in men.

Heart disease can lead to a heart attack. Most people can eventually resume sexual activity following a heart attack about three to six weeks after their condition becomes stable again. Follow your doctor's advice regarding sexual activity after a heart attack.

Bladder dysfunction in men and women can affect one's sex life. Common problems include overactive bladder, poor control of sphincter muscles, urine retention problems, and urinary tract infections (UTIs). Sexual activity can cause pressure on the bladder, which may cause incontinence (leakage of urine), a problem that makes many avoid sex. These conditions can usually be treated.

Stroke doesn't usually affect a person's ability to have sex, but it may cause problems with erections. Communication problems could arise from aphasia (loss of speech), and these may be reduced by learning to communicate with touch.

Drugs prescribed for people with stroke such as tranquilizers, sleeping pills, and high blood pressure medication can sometimes interfere with sex. In the case of high blood pressure medications that may cause impotence, one solution may be to plan for sex before taking the medication. For women on birth control, a change in birth control medication may make sex less difficult.

Stroke can also impact one's sense of touch. If this is the case, remind your partner of areas that may be paralyzed and ask him or her to approach you in places that are not affected. If a stroke results in weakness or paralysis, different sexual positions or medical devices can make sexual intercourse possible.

Sex Positions After a Stroke

The missionary position may not be ideal following a stroke, particularly if a man has experienced weakness or paralysis on one side of the body. Instead, consider having sex side by side, with both partners facing one another and legs interlaced. Also, a position with the affected man’s partner on top may be best following a stroke.

Surgery may cause stress and pain in the short term. However, most people can resume their normal sex life after surgery—even after genital surgery. Talk to your doctor about when you can resume sexual activity following surgery.

As women age, some will need a hysterectomy, a surgery in which the uterus is removed. For many women, a hysterectomy can make sex less painful, which may lead to more orgasms and better sexual satisfaction for women who have fully healed from their surgery.

In contrast, about 20% of women report a less pleasurable sex life following hysterectomy. This may be related to whether a woman prefers vaginal or clitoral orgasms. While the surgery is unlikely to impact the nerves that allow for clitoral stimulation, hysterectomies may damage or sever nerves that stimulate the vagina and cervix.

How Long to Wait for Sex After a Hysterectomy

Immediately following a hysterectomy, women are often advised not to have sex for a period of 6 weeks or more, after the approval of a doctor. Having sex before the doctor has approved may lead to complications; it is better to follow the advice of a doctor who can see the potential problems.

Counseling Options

If a woman feels she can no longer enjoy sex after a hysterectomy for reasons that are not physical in nature, or if a man feels his partner's femininity is affected by the surgery, counseling may help.

As a woman ages, her likelihood of having breast cancer increases. In some cases of breast cancer, a mastectomy is needed to remove all or part of the breast.

When a woman is treated for breast cancer, the surgery and related chemotherapy, tamoxifen medication, and chemically-induced menopause can disrupt sexual arousal and orgasm.

How Can Mastectomies Affect Body Image?

A woman may lose her desire or feeling of being desirable following a mastectomy. After the surgery, many women may question what it is that makes them feel feminine. Support groups can help, as can programs like the American Cancer Society's "Reach to Recovery." Breast reconstruction can also be performed.

While less common, men can also develop breast cancer, and the disease makes their bodies produce more female hormones which can lower a man's sex drive.

Certain health conditions that men can develop as they age include prostate cancer, BPH (benign prostatic hyperplasia), acute urinary retention, urinary tract infection (UTI), hemorrhage or recurrent hematuria, bladder outlet obstruction, or renal insufficiency. These conditions may require surgery to remove all or part of the man's prostate. This is called a prostatectomy.

Can I Have Sex After a Prostatectomy?

Following surgery, men may develop urinary incontinence or erectile dysfunction (ED, also called impotence). If total removal of the prostate gland is required (radical prostatectomy), talk to your surgeon about options to save the nerves that go to the penis so an erection will still be possible following the procedure.

Along with physical changes, a man may have psychological fears that accompany a prostatectomy. While some of those fears may be justified, many are not based on fact. It is important to remember, for instance, that you cannot pass on cancer through sexual activity. Erections are still safe if you are using a catheter. If you have had prostate cancer, having sex won’t impact your chances of the cancer returning one way or the other.

A common cause of sexual problems can also be side effects of medications such as blood pressure medications, antihistamines, antidepressants, tranquilizers, appetite suppressants, diabetes drugs, and ulcer drugs. Other drugs can lead to erectile dysfunction (ED, or impotence) or cause difficulty ejaculating in men, and some drugs can cause loss of sexual desire in women. Talk to your doctor if you experience side effects from medications you are taking. Your doctor may be able to prescribe a different drug.

Alcohol in excess can cause erectile problems in men and delayed orgasm in women.

Even though older women may be approaching menopause and have irregular periods, pregnancy is still possible. Sexually-transmitted diseases (STDs) continue to pose a risk no matter what age you are.

Can I Get Pregnant After Menopause?

Until a woman is post-menopausal (no period for 12 consecutive months) pregnancy is still possible.

Sexually-transmitted diseases (STDs) are possible at any age. While young people are more likely to become infected, older people having sex are vulnerable to STDs. Types of STDs include:

• Chancroid
• Chlamydia
• Pubic Lice (Crabs)
• Ectoparasitic Infections
• Genital Herpes
• Genital Warts (HPV: Human Papillomavirus)
• Gonorrhea
• Hepatitis B and C
• HIV/AIDS (Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome)
• LVG (Lymphogranuloma Venereum)
• Syphilis
• Trichomoniasis
• Urethritis

Older women are more likely than younger women to have been infected with Trichomonas, a parasite spread during sexual intercourse.

Medicare offers no-cost STD screenings for seniors. Practice safe sex to reduce your risk of STDs.

The number of older people who are diagnosed with HIV/AIDS is increasing. People over age 55 account for one quarter of people living with HIV/AIDS in the U.S., according to the US Centers for Disease Control and Prevention (CDC). Older Americans are also more likely to be diagnosed with an HIV infection later in the course of the disease.

Those at risk of HIV infection include those with more than one sexual partner, people who are recently divorced, widowed, and are having unprotected sex. Always use a latex condom during sex to protect yourself from HIV/AIDS and other sexually-transmitted diseases (STDs). Medicare offers no-cost STD screenings for seniors.

Sexuality is often tied into both our physical and psychological well-being. Men may fear that erectile dysfunction (ED) will be a problem, and that worry in itself can trigger episodes of impotence. Women may become concerned their looks make them less desirable to their partner. That can affect her enjoyment of sex. In addition to normal daily stressors, older people may be concerned about aging, illness, retirement, and other life changes, which can affect performance sexually. Help is available. Talk with a doctor or counselor about your concerns.

If you are senior and single you may find it more difficult to find a partner with whom to share intimacy. Women live longer than men and outnumber men as we get older. Meet new people by participating in social activities you enjoy and where other seniors will be present. Look for local senior centers, adult education classes, or county recreation activities.

Online Dating for People Over 50

There are lots of dating sites online designed to help singles over 50 connect. Setting up an online dating profile lets you reach more potential dates and can help you get to know someone first before deciding to meet face-to-face. Keep safety in mind and don’t reveal anything too personal at first, such as your address or place of business. It’s also a good idea to meet in a safe, public place for your first date.

If your sex life is not what it used to be, talk to your doctor. Depending on the cause, there may be a treatment. For older women, the most common problem is dyspareunia, which is painful intercourse caused by a number of different conditions including poor vaginal lubrication (vaginal dryness). Vaginal dryness may be treated with over-the-counter lubricants or estrogen. For men, erectile dysfunction (ED) is a common concern and there are a number of prescription medications that can help. Maintain open communication with your doctor and let him or her know your concerns.

It's possible to have a healthy, active, great sex life as you get older. A key component of that is to maintain a healthy, active body. Exercise, reduce stress, eat a balanced and nutritious diet, drink lots of water and juice, and don't smoke or drink. See your doctor for checkups regularly. If you care for your body, you can maintain a healthy sex life as you age.