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 muscles, lower blood pressure, and even reduce the 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? Many of us wonder about this very thing, especially as the number of birthday candles on our cake grows. As it turns out, plenty of changes can affect our sexual health over time. And knowledge is power.

“It’s so important to understand what these changes are, so that you can put your own experience into context,” explained Amanda Krisher, Associate Director, Behavioral Health at NCOA’s Center for Healthy Aging. “If you’ve noticed unwelcome changes to your sexual function and libido, but don’t realize what’s causing them, you may assume there’s nothing you can do about it. And that can make you depressed—which further impacts your sexual health.”

When you learn about the age-related factors that affect sexual health, you take an important step toward a more fulfilling sex life. “And it helps you know what to ask your doctor about, too,” Krisher added.

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

Menopause

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, in some cases 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. These issues can affect body confidence and cause anxiety, both of which can interfere with sexual intimacy.

Erectile dysfunction

Men also can experience a decline in sex drive after 50, although the exact cause is not clear. Still, “one of the most disheartening sexual side effects of aging for men can be erectile dysfunction (ED), or impotence,” Krisher explained. “Men who experience this can feel the loss of youth and vitality pretty acutely—just as many women going through menopause do.”

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.

Prostate changes

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 (like 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 and 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 and 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. They can also interfere with erections and ejaculation. Some blood pressure drugs cause feelings of depression and lower testosterone levels.
• Antidepressants can cause reduced libido, ejaculation failure, and ED.
• Benzodiazepines, since they have a sedative effect, can lessen sex drive and interfere with testosterone production. They’re also linked to problems with ejaculation.
• Statins and fibrates can hinder estrogen and testosterone production—both essential sex hormones. These drugs can also cause a breakdown of muscle tissue which, 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 manage sexual health after 50 alongside your changing body?

“Aging can certainly throw a wrench into our sexual enjoyment—but that doesn't need to be the final word,” Krisher observed. “There are many 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. That’s because health care providers are well versed in age-related physical and sexual health changes. They can help uncover the root cause or causes of any issues you’re facing, which is doubly important. Since sexual difficulties sometimes indicate a more serious health problem, talking to your doctor could even save your life.

Once you’ve talked to your doctor and identified the factors affecting your sexual health, it’s time to explore treatment options. For example:

• If chronic pain is getting in the way of your sexual enjoyment, physical therapy or surgery might help address the issue.
• If urinary incontinence is disrupting your sexual activity, medication or a pessary (a device placed in your vagina that lifts your bladder) can be effective. Surgery may be an option, too.
• If menopause symptoms interfere with your sexual desire or intercourse itself, hormone therapy (HT) may help. Be sure to discuss this option thoroughly with your provider first, because there are risk factors that depend on your age, health conditions, and other factors.
• If you're unable to achieve an erection because of a health issue, certain ED medications or a vacuum pump device could be options. 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,” Krisher said. “Advocating for your own health can help you enjoy your sexuality to its fullest—well into your later years.”

 

Sources

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