Promoting better sexual health and well-being in older adults
Normal sexual changes with age
Sex and intimacy are important to many of us as we get older, with benefits for health and well-being. But as our bodies change with age, we may experience changes in our sexual lives: our thoughts, desires, ability, and needs. When we know about the sexual changes that can come with ageing, it helps us to understand our situation and decide if we want to seek professional help. We need to be mindful though, what is considered normal for one person may not be normal for another.
There can be differences in our levels of sexual interest, activity, and what we find sexually desirable. Some of us have no interest in sex but enjoy acts of intimacy, whereas others prefer no physical contact at all.
Common changes in women
Women can experience physical sexual changes with age. Due to hormonal changes that come with the menopause, it can take longer for the vagina to lubricate and vaginal tissues become thinner. This can make penetrative sexual activity painful (dyspareunia) and in turn affect sexual desire. Orgasms may become less intense or take longer to reach.
The symptoms of menopause can also have an impact on women's sex lives. Difficulties such as hot flashes, brain fog, and tiredness, can be stressful. The disrupted sleep from night sweats can be exhausting. All of these can affect mood which in turn affects interest in sex. It is not unusual for women to lose sexual desire at this time, but the reason may be a combination of emotional and physical factors. For example, women might have caring duties which can be tiring, particularly if they are still in work.
Some physical changes are less talked about but do affect women’s sex lives. These include vaginal prolapse as a result of decreased muscle tone, urinary incontinence, and genital pain at orgasm due to spasm of the uterus.
Common changes in men
It is not uncommon for men to notice a change in their erections as they get older. Some men find that their erections are less firm and that they take longer to achieve. Some men find that they cannot get an erection, while others cannot maintain an erection for very long.
Changes to orgasm and ejaculation can also occur. In particular, there can be reduced semen at ejaculation, and the chances of experiencing non-ejaculatory orgasm (dry orgasm) increases with age. The ejaculation itself may feel less forceful, and the urgency to orgasm can reduce. The recovery period after orgasm extends which means there is a longer period between orgasms.
Men may experience physical changes that are less common including prostate disease. Some men undergo prostatectomy which can affect their ability to get an erection.
Emotional issues are important to our sexual well-being. Stress, relationship difficulties, grief can influence our sex lives at any age: our desire, arousal, and satisfaction with sex. Also, relationships can change over time, along with our priorities, and adults may find that they place less importance on sex as they get older.
Depression and anxiety can affect sex lives in different ways. Individuals may lose interest in sex or have erection problems. Sexual changes themselves can impact psychological wellbeing, and some women describe feeling less of a woman because they do not desire sex, and some men feel de-masculinised when they cannot get an erection.
People can also can feel differently about their older bodies, especially if they have a visible difference caused by illness or disability. A changed appearance, including the general changes to physical appearance that come with older age (baldness, grey hair, weight gain) can affect self-esteem which in turn can affect interest in sex.
Health conditions and disability
Many health conditions can have an impact on sex lives, including those people are most likely to encounter as they get older, e.g. dementia, stroke, heart disease. Health conditions can affect sexuality in physical and emotional ways. For example, individuals may have a disability that limits the sexual positions they can hold, and they might feel fatigue due to illness which then affects sexual desire.
Many prescribed medicines, including those for long-term conditions and cancer treatments, can have sexual side-effects. For example, they can cause erection problems, ejaculation difficulties, and vaginal dryness. They can also prevent arousal orgasm and reduce sexual desire. Or have other side-effects, such as dry mouth, that affect how we feel about being intimate.
Sexually transmitted infections
Anyone can get a sexually transmitted infection (STI) at any age. Common STIs include chlamydia, syphilis, and gonorrhoea. Some single older adults get tested regularly, but others do not see themselves as being at risk of getting a STI, or may think there is no need to use protection as there is no risk of pregnancy. The chance of catching a STI or HIV should not interfere with sexual pleasure.
It is important to use protection during sex, especially with a partner when their sexual history is unknown. Condoms help to prevent STIs and should be used during oral, anal, and vaginal penetrative sex.
Trans and non-binary
Research on the sexual changes that trans and non-binary people can experience as they get older is severely lacking.
Some research has been carried out with trans women and men not long after transitioning which has found that sexual issues can include difficulty reaching orgasm, pain during sex, and fear of sexual contact. These can relate to the physical effects of gender affirming surgery, or psychosocial factors such as body image, and fear of rejection or being treated differently.
Not all trans people experience sexual difficulties. Indeed, many report positive sexual well-being after transitioning.