Sexuality and Aging: Sex Dies Hard

Andrew Siegel, MD   9/5/15

Affectionate old couple with the wife holding on lovingly to the husband's face. Focus on the husband's eyes. Concept: Elderly love.

(Image attribution: Ian MacKenzie—Flickr– licensed under Creative Commons attribution 2.0 generic license)

“Sexy”—“desirable,” “seductive,” “alluring,” “sensual,” “erotic,” etc.—is a term applied primarily to attractive young people. As we age, we are somehow considered less “sexy”; however, at any age sexiness, sexuality and/or sex (call it what you will) is an important part of life for both women and men who desire closeness and intimacy that is often expressed through sexual means.

Many people have negative attitudes, prejudices and discomfort when considering the sexuality of older people, with a prevailing notion that older people should be asexual. Think about how biased and disparaging are the terms “dirty old man” and “cougar,” referring to older men and women, respectively, with healthy libidos. The thought of one’s parents having sex is disturbing and cringe-worthy for many. How about the notion of one’s grandparents sharing an intimate moment? Why is it so disconcerting to imagine the passionate coupling of aging bodies that have lost youthful suppleness? Why are the adjectives that often come to mind regarding elder sex “ugh”, “creepy,” “repulsive,” etc.?

When I asked my 16-year-old daughter to describe her thoughts on her parents having sex, her response was “disgusting.” When asked about her grandparents, she replied “gross.”

Sexuality is so much more than an act of physical pleasure. For men, it is emblematic of potency, virility, fertility, and masculine identity. For women, it represents femininity, desirability and vitality. For both genders, sex is an expression of physical and emotional intimacy, a means of communication and bonding that occurs in the context of skin-to-skin, face-time contact that gives rise to happiness, confidence, self-esteem and quality of life. In addition to sexual health being an important part of overall health, it also provides comfort, security and ritual that permeate positively into many other areas of our existence.

Time is relentless and the years creep by with great momentum until one day you are 50-years-old and you question how this is possible. However, no matter what our chronological age is, our drive, enthusiasm, spirit and need for physical and emotional and intimacy remain largely intact. Understandably, sex in the golden years is not always possible because of medical issues, absence of a partner or declining sexual interest. However, medical progress in the field of human sexuality has made it possible to maintain sexual activity until an advanced age.

Means Of Staying Sexually Active Until Old Age

First-line strategy is lifestyle “management” (healthy eating, maintaining a desirable weight, regular exercise, avoidance of stress, moderate alcohol intake, sufficient sleep, avoidance of tobacco, etc.). Physical interventions include pelvic floor muscle training and vibratory stimulation (useful for both genders) and the vacuum suction device. Pelvic floor muscle training improves the strength and endurance of the pelvic floor muscles—the “rigidity” muscles that surround the roots of the penis and the clitoris—enhancing penile and clitoral erections, pelvic blood flow and optimizing the muscles that engage at the time of orgasm. Vibratory stimulation triggers the reflex between the genitals and the spinal cord, enhancing genital blood flow and inducing contractions of the pelvic floor muscles. By stimulating this reflex and triggering nerve activity in the brain, spinal cord and peripheral nerves, vibratory stimulation is capable of inducing penile and clitoral erections and ejaculation/orgasm. The vacuum suction device—a.k.a., the penis pump—is a means of drawing blood into the penis to obtain an erection and enable sexual intercourse.

There are a host of pharmacological interventions available including hormone therapy–testosterone replacement therapy for men and estrogen replacement therapy for women. There are numerous oral medications for erectile dysfunction (ED) including Viagra, Levitra, Cialis and Stendra. Other alternatives for men with ED include urethral suppositories, penile injections and penile implants. Suppositories are pellets that are placed in the urethra that act to increase penile blood flow. Injections do the same, although they are injected directly into the erectile chambers. Penile implants are semi-rigid non-inflatable or hydraulic inflatable devices that are implanted surgically within the erectile chambers and can be deployed on demand to enable sexual intercourse.

Addyi (Flibanserin) is a new oral medication for diminished libido. It is currently being marketed largely to females, but is purportedly effective for both sexes. FDA approved on August 18, 2015, it is the first prescription for diminished sex drive, a drug that has been referred to as “pink Viagra.”

Despite all of the advances made in the field of sexual dysfunction, cost has become a major issue. On July 1, 2015, Medicare decreed that they would no longer pay for the vacuum suction device. For almost the past decade, Medicare has not covered the oral ED medications. They have become a very expensive commodity, averaging more than $35 per pill! Many private insurance companies are following suit, with little interest in financing the sex lives of those insured. Whether the government and private insurers should or should not underwrite the cost of maintaining sexual function is arguable. Certainly, as important as sex is, there are other health issues that are more pressing. However, no one can deny the importance of a healthy sex life as a means of maintaining wellness and quality of life.

Bottom Line: As one proceeds through life, he or she comes to the realization that their inner spirit and driving force remains intact, even though there are obvious age-related declines in their physical appearance and function. The notion that sexuality loses importance as we age is incorrect and antiquated. The common practice of sexual ageism should be abandoned. Being able to function sexually means so much more than the physical act of bodies coupling. Physical and emotional intimacy is ageless.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.

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