Source: Reis Family

The world's population is aging at an unprecedented rate. According to the World Health Organization, the number of people in the world over the age of 60 will double in the next 30 years to nearly a quarter of the world's population. And with advances in medical technology and general biosocial information, people are living longer. But that doesn't mean we're living better. Many products and strategies are marketed to help older adults feel more vital and younger, but there really isn't much discussion about how to achieve healthy aging. Sexuality is a fundamental aspect of human life that we also don't talk about enough, and it undergoes significant changes as we age. Aging is associated with a variety of physiological, psychological, and social changes that affect an individual's sexual health and well-being. Recognizing and addressing these factors is critical to promoting sexual well-being and healthy sexual expression throughout life.

Aging and Sexual Functioning and Satisfaction

The aging process has a tremendous impact on sexual functioning and satisfaction. In addition, as we age we tend to have more medical issues and many medications can impact sexual function. As we age, we often experience changes in our sexual behavior, desire, what we find arousing, and overall sexual well-being. Some of the biological changes we experience as we age involve hormones: When cisgender women reach middle age, they experience menopause. This happens because the body stops producing estrogen. Some of the results of decreased estrogen production include vaginal dryness, decreased lubrication, and loss of elasticity in the vaginal tissues. This often leads to discomfort and even pain during intercourse. In some cases, there may be a decrease in nipple and clitoral sensitivity.

For cisgender men, however, this is not an event with a beginning and an end, but rather a gradual process of decreasing testosterone levels. This is often called "andropause." It's important for health-care professionals to be able to distinguish between typical age-related declines in hormone levels and when there may be a problem with hormone production, a condition called hypogonadism.

Another area of biological change has to do with changes in the genitals themselves. Cis men may experience a decrease in the frequency and firmness of their erections, as well as a longer time between erections. It's also important to note that while changes in sexual function with age are normal, problems are not. While it is typical to require more or different stimulation to get an erection, and those erections may be less frequent and less firm, erectile dysfunction is not considered a normal aspect of aging. Unfortunately, we don't have much information about sexual aging in transgender men and women, especially those who are able to take external hormone treatments throughout their lives.

Psychological and Cognitive Changes

There are also a number of psychological and cognitive changes that occur as we age. Body image and self-esteem can become real issues for people. Physical changes such as gaining weight, developing wrinkles and gray hair, and experiencing what gravity can really do to certain parts of the body can lead to feelings of self-consciousness, feeling less attractive thanks to society’s idea of what constitutes beauty, and decreased sexual satisfaction, which can further lead to depression and isolation. Learning how to address body image concerns and understanding the importance of self-acceptance and open communication can have a positive impact on sexual well-being. In addition, there are other issues that can have a more indirect impact on sexual satisfaction, such as decreased concentration and memory decline. Desire exists in the mind, so difficulty concentrating and experiencing mental arousal can also affect an individual's sexual responsiveness and satisfaction. Maintaining good cognitive health and regular mental stimulation as part of a healthy lifestyle can help alleviate some of these challenges.

 

Source: Reis Family

Emotional Connection and Relationships

In addition to these physiological and psychological changes, there are a number of age-related changes that occur in the dynamics and availability of emotional connections, whether in an existing relationship or in seeking new ones. One thing that can affect sexual well-being is experiencing a major change in one's relationship status. This change may be related to the loss of the relationship (e.g., divorce or death) or to coping with a partner's illness or disability that forces the relationship to transition into something different. Adjusting to new sexual dynamics, negotiating changing sexual needs, and developing or maintaining open communication become central to maintaining sexual satisfaction and emotional intimacy. In fact, a number of studies have shown that more than 70% of people over the age of 65 still believe that sexual satisfaction and intimacy are important to their quality of life. Yet few people talk about it. Fostering intimate connections, trust, and communication can often compensate for physical changes or limitations, enhancing both sexual satisfaction and relationship quality.

A Holistic Approach

Maintaining optimal sexual wellness requires a holistic approach that includes health care, psychosocial care, and lifestyle management. Having a relationship with some healthcare professionals, such as gynecologists, urologists, functional medicine practitioners, or more holistic practitioners, can help individuals better understand and manage any age-related challenges they may be experiencing. If an individual or couple is having difficulty coping with relationship or sexual changes they may be experiencing, more psychosexual interventions, such as sex therapy, can provide a safe and understanding place to discuss their sexual concerns, explore new sexual techniques, and improve their sexual communication skills. Of course, nothing is more important than adopting and maintaining a healthy lifestyle that includes regular activity or exercise, a balanced diet, and adequate sleep. This is the trifecta for both sexual function and overall well-being. Lifestyle changes that include smoking cessation and managing chronic health conditions also contribute to improved sexual health in older adults.

The Role Society and Culture Play

To make matters worse, all of this occurs within a context of ageism and negative cultural stereotypes that result in a lack of guidance and resources for older adults related to sexual health and well-being. These negative social and societal attitudes can contribute to older adults feeling shame and guilt about their sexual desires and activities. Nowhere is this more obvious than with regard to aging and elderly LBGTIA+ individuals, who are members of populations that can get become further marginalized in mainstream elder-care systems and communities. As we need to do for all people at all ages, we need to do a better job of providing sexual health information and resources for older adults so that sexual satisfaction and well-being can truly be a lifelong process.

Don’t Forget the Positive

Let’s also remember the good part of aging and sexuality. Many feel more comfortable in their own body, know what they want sexually, and are more assertive at asking for it. There can be a sexual freeing and openness that comes with aging which can enhance our sexuality and sexual satisfaction.

Sexual changes in aging are a normal and natural part of our developmental process, influenced by several factors. Understanding these changes and the challenges that often accompany them is critical to promoting sexual well-being in an aging population. By continuing to advocate for open communication, comprehensive education, and appropriate medical and psychological interventions, we can better address the unique and changing sexual needs and concerns of older adults. A holistic approach to sexual health in aging will also contribute to a more inclusive and supportive society by ensuring that all older adults can maintain fulfilling and satisfying sexual lives.