Sexuality and U
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Health-Care Professionals

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Age-Related Health Changes

 

Not only does the aging body experience problems with sexual functioning, but the likelihood of developing other health problems increases in older age with a subsequent impact on relationships and sexuality. Sexual problems may be primarily due to physical limitations, lack of energy, side effects of medications, or poor self-image as a “sick person”.

From minor problems such as decreased energy or strength to major problems such as cardiovascular disease, arthritis, cancer, diabetes and other serious illnesses, the physical decline of the aging body must be faced and accommodated in order to maintain a satisfying sexual life in old age.

The equilibrium of the emotional component of a relationship also changes when one or both partners in a couple become ill or develop chronic health problems. One partner may end up as the nurse or full time caregiver to the other. Even excluding the physical problems, the imbalance of these roles in this case would likely result in sexual problems with one or both partners losing desire.

In keeping with this model of looking at context in order to understand female sexuality, one of the most significant psychosocial or contextual variables that affects women is the impact of their partner having a sexual dysfunction.

Results from the Massachusetts Male Aging Study (MMAS) indicates that by middle age, the majority of men will experience some erectile dysfunction (ED) (Feldman et al, 1994). This was a community based random sample observational survey of men 40-70 conducted from 1987 to 1989 in cities and towns around Boston. Blood samples, physiologic measures, sociodemographic variables, psychological indexes, health status, medications, smoking and lifestyle were collected including a sexual activity questionnaire to assess erectile potency.

The MMAS results showed that by age 40, 40% of the men surveyed experienced mild to severe erectile dysfunction and this increased to 67% by age 70. The results showed a combined prevalence of minimal moderate and complete ED to be 52%. Men who had mild dysfunction in their 40s tend to progress to moderate or complete dysfunction as they age.

In midlife, men begin to experience changes in hormone levels, blood flow, libido, sensitivity, and ejaculation. Those changes may compromise their ability to achieve and maintain erections as well as the quality of the erections. Arousal takes longer to achieve, and the plateau phase is prolonged, delaying ejaculation. In addition, ejaculation may be slow or absent. Overall, with age, blood flow to all organs decreases(Feldman et al., 1994; Schiavi, 1999). However, sildenafil (Viagra) and the two additional PDE-5 inhibitors that are likely to be available soon, offers tremendous help in treating these aging problems.

Although sexual drive does decline with age in both men and women, and some postmenopausal women (particularly following bilateral oophorectomy) may experience a significant decrease in drive directly related to loss of ovarian function, many older heterosexual couples cease being sexual because the male partner’s interest declines, usually due to his experiencing erectile dysfunction. Erectile dysfunction is a major source of poor body image and resulting low desire for men. Many postmenopausal women are abstinent because of their male partner’s erectile difficulties or his decline in drive.

While sildenafil has helped many men overcome erectile dysfunction, a problem to recognize is that it may now cause a shift in a couple’s sexual equilibrium. As women first adjusted to the sexual equilibrium of abstinence due to their partner’s dysfunction, now they must once again accommodate to another change in equilibrium. This creates a challenge. Older people not only require a longer adjustment period to make the necessary accompanying cognitive shift, but older women definitely need time for their bodies to readjust to a partnered sexual life.

However, give a man a reliable erection, and he will typically want to try to use it (that is, unless there are other psychogenic factors contributing to avoidance and low desire other than an unreliable penis). Unfortunately if he and his female partner have not had intercourse for a long time, her aging vagina has likely narrowed and atrophied some and will not immediately accommodate a penis without risking pain and/or injury. This may lead to a secondary female sexual dysfunction of dyspareunia or vaginismus.

For heterosexual postmenopausal women who have been sexually abstinent a long time, they must begin by slowly stretching and “exercising” their vaginas. They need to start by penetration with a finger or dilator and gradually stretch the vagina to accommodate a penis. They cannot return to sexual functioning instantaneously, if sexual functioning for them has always meant intercourse. Furthermore, some of these women may now benefit from androgen replacement. That is, some women may have experienced a hormone related loss of some or all of their sexual drive postmenopausally, but given their nonsexual relationship due to their partners’ erectile or desire problems, there was no need or interest in regaining drive. With their partners’ renewed interest and ability, hormone therapy including estrogen/androgen or estrogen, estrogen/progesterone for genital health may help recalibrate the sexual equilibrium by improving drive in these women.