Sexuality

Sexuality is most often regarded as the province of younger adults. Older adults, especially women, are rarely regarded as sex symbols or even as sexually active persons. But many older adults do indeed have healthy sex lives that contribute to their overall physical and psychological well-being.

Stating that sexual expression persists into later life is different from stating that sexual expression remains the same across adulthood. Indeed, although [Page 515]there are no longitudinal studies of sexuality that are representative of the population, the several large-scale, representative, cross-sectional studies of sexuality that exist suggest that sexuality changes with age. Sexual desire is greater in younger people than in older people. Younger people have more frequent partnered sex and engage in more frequent masturbation than do older people.

The lack of longitudinal evidence leaves researchers in the realm of speculation about the reasons for the differences observed across age groups. Some differences are probably due to cohort effects. For example, norms about the behaviors that constitute healthy sexuality (e.g., masturbation) have likely changed with the generations. But most differences are probably due to age effects.

The natural course of aging can present challenges to sexual expression. For women, the hormonal changes of the climacteric (the transition period surrounding and including a woman's menopause; i.e., last menstrual bleeding) represent the largest influence of physical aging on sexual function. Postmenopausal women experience atrophy of reproductive tissues, including those in and around the vagina. During sex, older women experience less blood flow to and lubrication of the vagina than do premenopausal women. These changes may produce reduced sensitivity to stimulation and/or dyspareunia (pain during sex), especially for women who have sex infrequently. For aging men, hormonal changes are not as dramatic as they are for women, but they do occur. Older men produce less testosterone than do younger men, resulting in decreased sensitivity to stimulation. During sex, older men may take longer, and may need more physical stimulation, to attain an erection. Both men and women retain the capacity for orgasm into old age, but orgasms may be less intense.

In addition to normal aging, age-related illnesses can produce changes in sexual functioning. Some chronic illnesses, such as cardiovascular disease, diabetes, arthritis, and benign prostate conditions, are commonly associated with sexual problems in older people. For example, insofar as cardiovascular disease causes problems in the circulatory system, it will adversely affect blood flow to genitalia. An enlarged prostate leads to difficulty with urination and painful urinary tract infections—symptoms that obviously reduce men's eagerness for sex.

The negative effects of an illness can be compounded by its treatment. Although it would seem that treatment should reverse the negative effects of illness, medications often have effects above and beyond those that are intended (side effects). Antihypertensive (blood pressure–reducing) and psychiatric drugs are most often implicated in the development of sexual problems, including difficulty in attaining orgasm for both women and men. The specific causes of these sexual side effects are unknown but appear to be related to the effects of the drugs on the nervous system. Sex hormone-related cancers (e.g., prostate cancer, breast cancer) may be treated with drugs that stop or slow sex hormone production, resulting in atrophy of sex organs as well as the cancer.

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