| The Effects of the Aging Process on
Sexual Behavior, Attitudes and Functioning
Stanley Ducharme, Ph.D.
In this age of pharmaceutical interventions for erectile dysfunction, there has been much written about the prevalence of sexual dysfunction in our society. A few short years ago, it would have been almost unthinkable to consider how relaxed and open we have become about sexual conversations and sexual practices. More than ever before, sex has come out of the closet and has become an acceptable topic of discussion among families and friends.
When a former US presidential candidate such as Bob Dole, becomes the primary spokesperson for Viagra, we can be sure that we have entered a new era in our cultural and sexual history. Today, television commercials regarding various sexual problems are commonplace and hardly evoke a response.
In spite of the medicalization of sexuality, there has been  little written about the sexual changes that naturally occur as we age. For most people these natural changes in physical functioning, attitudes and behavior often complicate an already difficult phase of life. Yet, for all of us, it is important to understand how we change as a natural result of the aging process. Recently, The Association for Advancement of Retired Persons (AARP) obtained some interesting information regarding sexuality throughout the aging process. This survey provides some fascinating insights into our attitudes and behaviors regarding sexuality.
In this short article, I would like to report some of the findings of the AARP sex study as well as some of my own experiences as a sex therapist. Helen Singer Kaplan, one of America's premier sex therapist, once said that Americans love sex surveys for one reason. "They want to know, 'How am I doing?'" She further said, "They suspect that somewhere out there, someone else is having more fun in bed than I am." The desire to compare ourselves with others is never as strong as it is in the sexual area.
Obtaining Treatment
Since Viagra was introduced in the spring of 1998, nearly twice as many men seek treatment for erectile dysfunction (ED) per month than did before Viagra was available.
In addition, men tend to seek treatment quicker than ever before. In spite of this increase however, men still find it very difficult to discuss the topic. One's sexual partner is typically the first person with whom a man is likely to have such a discussion. Most men find such discussions, even with a partner, as extremely stressful and anxiety provoking. The topic for most men is shameful and embarrassing.
Conversations about sexual dysfunction are often avoided for long periods of time. Some men prefer to seek treatment from a doctor before ever discussing such issues at home. More commonly however, it is the sexual partner that ultimately forces the issue and pushes the man to speak to his doctor about this topic. Among older men, few received adequate informati on about sexuality from their doctors and most men were too embarrassed to ask specific questions about sex to health care providers.
Older people have the most difficult time seeking help about sexual concerns. Men, after the age of 50 use books rather than medical professionals as the number one source of sexual information. Women feel more comfortable seeking advice from a physician, especially if the doctor is also a woman. Younger people today use the internet as their first source of information. For these people, finding a doctor, therapist or answering a question is typically done with the help of an online search engine.
In general, men are less fearful about seeking help on sexual matters if they know that their sexual problem is from a physical condition rather than a psychological one. They will downplay any emotional pain or distress caused by this condition. Men are always relieved to learn that the sexual difficulty is physical and not emotional.
Actually, women also are usually hopeful that there will be a biological factor at the root of a sexual dysfunction. Such factors seem more easily understood and can often be treated with medications. When sexual difficulties stem from a psychological basis, individuals often feel inadequate and more confused as to how treatment can be effective. Individuals feel responsible for psychological difficulties where medical issues are often seen as being beyond our control.
The Importance of Sex
Men and women over age 45 tend to downplay the importance of sexuality in their lives.
This group reports that close ties with friends and family are very important to the quality of their life-more important than a satisfying sexual relationship. Women, even today, tend to have a difficult time acknowledging that they enjoy sex or find it important in their relationship. They report that the emotional closeness is equally or more important that the physical satisfaction obtained from sexual activity.
For people between the ages of 45 and 59, "less stress and more time" are the top things that would improve their sexual life. For people over 60, better health for themselves or their partner leads the list. After age 70, women report that finding a partner is the most important factor toward a better sexual life. For this age group, loneliness is the number one cause of emotional distress and feelings of sadness.
 If a couple is not sexually active, it is not uncommon for one member of the couple to feel guilty. The partner often feels rejected and undesirable. Feelings of self blame and inadequacy are common for both individuals. Women often interpret a lack of sex as signifying a loss of attractiveness. Men interpret a lack of sex as being unaffectionate and rejecting. Talking about the lack of sex in a marriage or relationship is probably the only way to reduce the feelings of guilt and hurt. Throughout life, the importance of sex changes and evolves in a relationship. Hopefully, these changes are communicated and understood by both members of the relationship.
Sexual Desire
For people with various medical conditions, medications are often the main reason for a reduced sexual desire after age 50. In this age group, medical conditions can restrict sexual positions, limit movement, and ultimately reduce sexual pleasure. In addition, fears of failure and lack of sexual confidence can make sex seem like work rather than pleasure.
When sex is perceived as a task to be accomplished, the frequency of these activities drops dramatically. About 50% of people between ages 45 and 59 have sex at least once a week. After the age of 60, only about 30% of couples have sex on a weekly basis. If an individual has a partner, at least 70% of couples will have intercourse at least once a month regardless of age.
Physical Changes
Changes in physical functioning are commonplace and generally universal throughout the life span. Sexual difficulties may be progressive depending on the physical health and well being of the individual. As mentioned, medications, pain, physical limitations and hormonal changes may alter sexual performance as well.
For older men, erections will become less reliable, less firm and of shorter duration. Ejaculatory volume and intensity will also typically diminish. Most men experience more difficulty in reaching ejaculation and orgasm and greater amounts of stimulation may be needed to reach the orgasmic platform. Every sexual encounter may not necessarily end in ejaculation and orgasm.
For the older woman, arousal and lubrication are typically  reduced following menopause. Subsequently, sexual intercourse may be painful or uncomfortable without the use of a water soluble lubricant. Like the man, the older woman may notice the need for more stimulation in order to reach an orgasm and her orgasm may be fleeting or diminished. For some older women, sensitivity of the clitoris and vagina may be diminished making touch less pleasurable. Vasocongention of the clitoris, labia and breast may be reduced and physical signs of heightened arousal may be less pronounced.
Conclusions
Enjoying one's sexuality is a lifelong process. Although behaviors and sexual functioning change over time, we can still take pleasure in our bodies and the body of our partner. In addition, being intimate with another person can provide an important emotional connection and sense of well being.
As the baby boom generation continues to age, attitudes and behaviors about sex will surely change as we enter each stage of the life span. Rather than struggle with the physical changes in our sexual functioning, it is important to em brace these changes and to accept them as a natural component of the aging process. As always, communication, honesty and openness with a partner goes a long way in helping us to share our sexuality with another person.
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