Sex and the elderly

Press, 14 August 1978, Page 12

Sex and the elderly

Bv

JANE E. BRODY,

, of the “New York Times”

NEW YORK. Despite the professed sexual liberalism of the day, when it comes to sex among the elderly, Victorian attitudes persist. Society’s disapproval of sexual activity in senescence is reflected in such common expressions as “dirty old man,” “old goat,” or “lecherous old fool” to describe a man who pursues sexual interests into his twilight years, or “robbing the cradle” to describe an older person who selects a much younger mate. Grown children have difficulty seeing their parents as sexual beings and many flatly refuse to believe that parental sexuality could persist into the 60s and beyond. Yet, every so often,' news reports refute the notion that sex must precede the body to the grave: a man in his 70s will be said to have fathered a child; unmarried couples in retirement communities will be described as “living in sin”; sexual “hankypanky” will be revealed among the residents of homes for the elderly. Scientific studies of sexual activity have shown that the sexual urge exists for many more elderly people than society realises or acknowledges. Up to the age of 70, one-half to two-thirds of men remain potent and sexually active. Among women, most of whom are without partners by this age, one in three reports an interest in sex, one in four masturbates occasionally, but onlv one in five actually has a sexual relationship. The studies show that for healthy people, regardless of age. sexual interest and activity can continue throughout life. The best promise of continuing sexuality into old age is regular expressions of sexuality’ in the preceding years.

Even if there is a prolonged interruption in sexual activity, possible because of illness or death of the spouse, full sexual functioning can often be restored.

In their studies of sexual response, Dr William Masters and Virginia Johnson say that a man who notices changes and

thinks they herald the end of his sexual ability may create a self-fulfilling prophecy. Fear of failure is the greatest inhibitor of potency. According to Dr Masters and Mrs Johnson: “Loss of erective prowess is not a natural component of ageing.” They found that, barring illness of psychological blocks, a man should retain his ability to have erection well into his 80s. The changes in a woman’s sexuality with age are fewer. Although some women decline in sexual interest with age, this may be more psycho-

logical than physical. From a physiological standpoint, menopause should not cause a decrease in desire. In fact, for some, libido is enhanced during the menopausal years.

Unlike men, women retain indefinitely the potential for reaching orgasm two or more times in quick succession. However, as with men, the build-up to orgasm may take longer; and, because of anatomical changes after menopause, it is more likely that discomfort or pain will interfere with a woman’s orgastic ability.

In fact, for a number of reasons, the “golden years” may well be the golden age of sex for some people. And if it were not for myths and misunderstandings about sex among the aged, manv more people than actually do might continue to be sexually active into their 70s, 80s and beyond. Sometimes the very professionals who should help to counter misinformation about sex for the elderly instead compound it. A woman in her mid-

50s who asked her gynaecologist for help because intercourse had become less satisfying was told: "What do ’ you expect for someone your age?”

The same comment was made by a physician to a man in his late 60s who expressed concern about potency problems. More often than not, anticipating disapproval, rebuff or even ridicule, older patients

won’t say anything at all to their doctors about sexual problems and fears. The fall-off in estrogen production after menopause results in a thinning and flattening of the walls of the vagina. Less lubrication is produced, a longer period of stimulation before intercourse may be needed for the vaginal walls to moisten. The shape of the vagina may change and its size and elasticity diminish, resulting in increased pressure on the urinary tract. Some women after menopause have painful spasms of the uterus at orgasm. There is also an increased

tendency to develop vaginal and urinary infections, which can cause pain during intercourse.

A woman’s external genital organs also change after menopause. There is less fat and other tissue protecting the clitoral area and the clitoris —the seat of a woman’s sexual response—is more likely to become irritated than stimulated by direct manipulation. Vaginal discomfort after menopause may be relieved by estrogen cream prescribed by a physician. However, oral estrogens must be used with caution and frequent gynaecological checks are necessary because these hormones may increase the risk of developing uterine cancer.

Dr Masters and Mrs Johnson found that the best antidote to the effects of ageing on the vagina is to maintain an active sex life throughout middle age and beyond. Contrary to common belief, ordinary sexual activity does not end an old person’s health. Experts say that heart patients who can perform moderate physical activity, such as climbing a flight or two of stairs, can safely have sex. The heart beats faster during a brisk walk or heated argument than during sexual intercourse.

In at least 70 per cent of men who have prostate surgery, potency is retained. Congestion of the prostate commonly results from sexual abstinence and

is actually relieved by frequent orgasm. Diabetes can eventually interfere with potency in men and with orgastic ability in women. But impotence in a diabetic who is untreated is usually reversed by medical control of the diabetes. Various drugs commonly taken by the elderly, including tranquillisers, antidepressants and certain high blood pressure medications, can impair sexual functioning in men and women. If the drug is necessary, the doctor often prescribes a substitute medication that does not affect sexual performance. If an elderly couple encounters a sexual problem, they should not assume that it’s the inevitable consequence of age. Even long-standing sexual problems can often be resolved through sex therapy, Dr Masters and Mrs Johnson report. There’s no reason, they say, for older people to be condemned to continuing sexual dysfunction for the rest of their lives.