Sex After 50: How Our Changing Body Affects Our Sexual Health

As we get older, it pays to keep the passion alive. Sexual health is a vital part of our overall well-being, and its health benefits are well-studied. Sexual activity with or without a partner can help burn calories, strengthen your muscles, lower your blood pressure, and even reduce your risk for heart disease. It’s also been linked to better sleep, a stronger immune system, and relief from headaches.

The role of aging in sexual health

What happens to sexual activity as we age? This question likely crosses all of our minds as the number of birthday candles on our cake gets bigger. Plenty of changes can affect our sexual health over time.

What kinds of changes happen to our bodies as we age?

For women, dramatic dips in the hormone estrogen are a precursor to menopause. Although we may think of menopause as hot flashes and night sweats, it's much more than that. Many women start experiencing early menopause symptoms in their 40s, during a period called perimenopause. This transition period can last up to 10 years for some women. The estrogen loss associated with perimenopause and menopause can cause issues such as:

• Hair loss
• Sleep disruptions
• Weight gain
• Changes in vaginal shape and lack of lubrication, leading to painful penetration
• Decreased libido, also known as Hypoactive Sexual Desire Disorder (HSDD)

Although they're not linked directly to estrogen changes during menopause, women may also experience incontinence and pelvic floor dysfunction as they get older.

Men can also see a decline in sex drive after 50, although the exact cause is not clear. One of the most disheartening sexual side effects of aging for men can be erectile dysfunction (ED), or impotence. With ED, a man may take longer to achieve an erection, and it may lack potency and longevity. Premature ejaculation (also called orgasmic dysfunction) is also common.

Additionally, older men may deal with prostate changes that impact sexual health. The prostate is a gland that usually gets larger with age. When it does, it can cause urinary symptoms, such as a frequent urge to urinate. Inflammation of the prostate (prostatitis), enlarged prostate (benign prostatic hyperplasia), and prostate cancer also occur frequently in older males. Sexual side effects may result from the condition itself or from therapies used for treatment (e.g., hormone therapy).

What effect does physical health have on sexuality?

Sexual health and our overall health are closely intertwined. Certain health problems—and the medications we take to remedy them—can have a direct effect on our libido, our state of arousal, and our ability to achieve an orgasm. Some specific examples are below.

Chronic diseases/conditions

• Diabetes can cause vaginal yeast infections in women and ED in men.
• Heart disease can affect blood flow to organs, leading to problems with arousal.
• Incontinence in women can disrupt sexual activity since it places added pressure on the abdomen, which may cause urine to leak out.
• Arthritis/chronic pain can make sexual contact painful or uncomfortable.
• Obesity may cause physical limitations that make sex more difficult. It can also negatively affect self-esteem and self-confidence in both men and women, which may hinder a person's ability to feel aroused. Obesity is also linked with chronic health conditions—like diabetes and microvascular disease—that can cause secondary sexual side effects.
• Depression may cause a loss of interest in sex and intimacy.

Medications

• Blood pressure medications can hamper blood flow, leading to lower libido. It can also interfere with erections and ejaculation. Some blood pressure drugs cause feelings of depression and lower testosterone levels.
• Antidepressants have been shown to cause reduced libido, ejaculation failure, and ED.
• Benzodiazepines, since they have a sedative effect, can lessen sex drive and interfere with the production of testosterone. They are also known to cause ejaculation issues.
• Statins and fibrates have been shown to hinder the production of estrogen and testosterone—both essential sex hormones. They can also cause a breakdown of muscle tissue that in turn leads to fatigue and joint pain.

Medical treatments

• Hysterectomy, or removal of the uterus, can diminish sex drive and cause pelvic floor weakness. If the ovaries are removed, vaginal dryness can result as well.
• Prostatectomy, or removal of the prostate, has been associated with ED and urinary incontinence.
• Hormone therapy for prostate cancer is known to cause reduced libido, breast enlargement, and shrinkage of the penis and testicles.

How do you maintain sexual health after 50 despite your changing body?

While aging can certainly throw a wrench into our sexual enjoyment, it doesn't need to have the final word. There is a vast range of safe, effective treatments for issues of all kinds. The first step to improving your sexual health is to have an honest conversation with your doctor; they can help you determine the root cause of the issue. Since sexual difficulties are sometimes indicative of a larger problem, exploring all potential causes could even save your life.

Once you receive a thorough check-up and your doctor pinpoints the likely cause of your troubles, it’s time to explore treatment options. For example:

• If chronic pain is impeding your ability to enjoy sex, you may benefit from physical therapy or surgery to rectify what's triggering the pain.
• If urinary incontinence is disrupting your sexual activity, you could benefit from medication or a device placed in the vagina that lifts the bladder. Surgery may be an option as well.
• If menopause is causing symptoms that interfere with your sexual desire or intercourse itself, hormone replacement therapy (HRT) may help. HRT should be avoided if you have certain risk factors, so be sure to discuss this treatment thoroughly with your provider first.
• If you're unable to achieve an erection because of a health issue, certain ED medications or a vacuum pump device can help. If the root cause of your ED is psychological, counseling may help you overcome the emotional roadblocks that are interfering with arousal.
• If penetration is painful, water-based lubricants, vaginal moisturizers, and estrogen cream can provide relief. Trying new sexual positions may also make a world of difference.

There's still a societal stigma associated with talking openly about sexual health, and bringing up the topic with your doctor may feel awkward at first. But your sexual health matters, and it’s a conversation worth having.

Remind yourself that no matter what you're experiencing, you're not alone. Advocating for your own health can help you enjoy your sexuality to its fullest—well into your later years.

Source

1. National Council on Aging. Aging Mastery Program (AMP). Sexual Health: An Overview.