Aging and Sex

Since time immemorial, ‘Aging and Sex’, has been a burning topic. It has acquired more significance in the present context as the average human life span has increased resulting in sizeable number of old age survivors. The advancement in medical sciences has further lent a hand in making people live not only longer, but healthier and active too. And the active lifestyle includes their sex life too. While earlier, sex in old age was considered with a derisive humor and was labeled as lecherous; the perception has widely changed now. The image of the ‘the dirty old man chasing young women’ has disappeared. Gone are the guilt feelings in the so called- oldies, about pursuing sex. And why not! We all are well aware that sex is meant not only for pleasure & propagation. It is well documented now that an active sexual life is important from health point of view too whether it is osteoporosis, memory loss, fertility, feeling of wellbeing, menopause, andropause, potbelly, heart problems and so on & so forth. But of all the reasons to have an active sex life till a person breathes his last, the most important probably is the ‘intimacy’. It is the intimacy that is at the root of ‘loving & be loved’- the two basic spoken & unspoken needs of all homosapiens, which give a meaning to life, if any.

Various studies have revealed that age does not significantly diminish the need and desire for sex; so long as the partner is available & a person’s health permits. In fact, there is a strong evidence to suggest that an active sex life contributes to the physical, mental and psychological well-being. Researches have conclusively proved that physical capacity for male erection, the female lubrication-swelling vaginal response, and orgasm both in male and female continue almost indefinitely. And that achieving orgasm is yearned, even if not always achieved. To achieve the same, the methodology or the sexual behavior may need certain modifications. It involves many aspects.  Not taking partner for granted, keep springing pleasant surprises, verbalizing sweet whispers, willingness to maintain innovate newness in sexual practices, reading or viewing erotica, fantasising, etc., go a long way. But the most important of all, is enhancement of communication which includes verbal and nonverbal, sexual and nonsexual, coital and noncoital communication. It is important to understand that a non-coital orgasm is as pleasurable as the coital. Orgasm is blind to its genesis. It has no way of knowing which way it has come thru’, or what roads have led to this. Orgasm is an orgasm and an end onto itself whatever the means. There is a pressing need to understand the importance to reach an end rather than worrying about the means. It is said that everything under the sun is normal in sex except when it is mutually not consented. The mind-set if needed, has to be changed from penetrative to participative indulgence and a good counselling is of utmost importance.

Contrary to the belief about the end of sexual life with age, many believe that; with the children settled, no career pressures, and availability of plenty of time; the partners in old age are better placed to explore and understand each other physically, mentally and sexually. Their awareness regarding the needs of each other enhances. Their intimacy increases. Thus in effect, the sexual satisfaction may increase as the age progresses. The cause of frustration in aged may be failure to find suitable partners rather than reduced libido, diminished arousal, or failure to achieve orgasm. The studies have unequivocally led to the realisation that, the urge and need for sex continues all through the life, though pattern may become different.

In males, due to decreasing Testosterone with age, the physiological response of the body changes, arousability and erection take longer, erection is less frequent and more difficult to sustain, the refractory period lengthens, the penile tumescence and firmness diminish, ejaculation is less forceful, the ejaculate turns yellow instead of white, the quantity becomes less and the liquefaction is quicker. All these changes however, may not significantly affect the joy of sex. If physically healthy, men are supposed to be virile and can participate in active sex, throughout their lives.

Another important fact which is very controversial in this age for males, is the Andropause- also called male menopause or ADAM (Androgen Deficiency in Aging Man) which is akin to female menopause. It is believed that, like female counterparts who suffer from menopause because of the reduced levels of estrogen, the males too suffer from Andropause that occurs as a result of reducing levels of androgens. Testosterone level decreases by about 50%  between the age of 25 and 75 years, as a result of decline in the Leydig cells (production site) in the testicles and by dysfunction of Pituitary control leading to Hypo-leutinaemia (LH & FSH control the release of Testosterone). But unlike menopause, the reduction of Androgens is very gradual in males and the body keeps getting acclimatized to the reducing hormonal levels. Thus, there are not many takers as yet for the Andropause theory and androgens are still not considered by many as a modality for treatment of reduced urge or erection disorder, especially in view of its likely carcinogenic effect on prostrate. Notwithstanding, the believers of Andropause feel that Andropause is a well established entity like menopause, and it is absolutely safe to give TRT (Testosterone Replacement Therapy) provided it is used judiciously under the strict supervision and a regular follow-up is there. A point to note here is that TRT is warranted only and only if there is a hypoganadism- it should not be instituted in persons with normal levels of androgen just to increase libido or erection.

In females however, menopause is an established entity though ERT (Estrogen Replacement Therapy) again may be a controversial issue. The reduced hormonal levels in the women lead to thinning of the vaginal lining, diminution of the vaginal lubrication and reduced swelling response, causing vaginal chaffing and discomfort during intercourse. Nevertheless like males, females too can enjoy their sex lives all through their life spans if their physical health permits though, the time taken for arousal to achieve orgasm increases in them too. Unlike men however, the fertility ends in women with menopause. In the past, menopause was assumed to mark an end in women's interest in sex which is not true. In fact, it is a well considered view now that women too may have an increased enjoyment of sex because of plenty of time available, less of commitments and, no worries about unwanted pregnancy.

So, the cause of frustration in old age is not the sexual health. It is the physical health which is a matter of concern. Diseases of the heart, circulatory system, liver, kidneys, endocrine system, nervous system, urogenital system; certain medications; some surgeries, drug addiction, alcoholism, smoking, depression etc are the culprits instead of the age. The unfortunate part of Sexual Dysfunction, as a result of these medical problems, is that even if the basic pathology is treated, the symptoms of dysfunction tend to become autonomous and stay till specifically addressed by Psycho-Sexologists. This happens because once people are not able to perform a few times because of the pathology, there develops a ‘fear to perform’. This leads to further anxiety called performance anxiety which in turn affects the performance again; and a vicious cycle sets in. So much so, people tend to pretend unawareness of the sexual advances made by the partner, complain of headache/tension/overwork/fatigue etc. in a bid to avoid participating in the sex.

While in the preceding, primarily the role of treatment of the basic pathology and psychosexual counselling has been discussed; it in no way undermines the role of drugs like androgens, estrogens, Sildenafil, Tadalafil, Verdanafil; nasal sprays; intracorporeal injections like Papaverine, Phentolamine etc.; vacuum devices; sex accesspries (the so called toys); surgeries like penile implantation, vascularisation, correction of venous leak etc., which may act as inescapable adjuncts.

To summarise, it is a hard reality that with advancing age; the sexuality, the sexual behavior and the pattern of sexual interaction; do undergo a perceptible change- both in males and females. Normal aging alters the physical and physiological sexual response to some measure.  But this per-se is not the real concern as it may be offset by modifying certain sexual practices & behaviors. The real culprit besides the ill health, is the apprehension over the declining performance. The fear of performance may be overwhelming and can lead to an irretrievable damage to the sexual relationship and in turn, nonsexual relationship; especially if the other partner is sexually active. An escapist attitude that the ‘one is too old for it anyway’, may further attribute to the deteriorating relationship. Elderly couples with sexual problems often benefit from sexual counselling as the ignorance, the escapism and the inhibited attitudes are amenable to good counselling.

To conclude, the Sexual Dysfunction in old age (like other age groups too) is required to be perceived in its entirety and the therapy needs to be holistic and integrated. We must consider it our sacred duty to help our senior citizens realise their dream of ‘dying young’. This would be a befitting tribute to the septuagenarians and octogenarians of the society.