Sexuality is natural at any age Disputing the myth that there isn’t sex after 65 By Wendy J. Meyeroff The Erickson Tribune “I’m a baby boomer. I was part of the sexual revolution. AND I’m a nurse. Yet when my mother came to get my advice on how to cope with sexual problems she was having with my father, I couldn’t talk to her,” admits Stella Henry, R.N. Henry is founder and director of Vista del Sol Care Center which provides assisted living, nursing home, and hospice care to older people in Culver City, California. Interacting with her patients has made her realize the important role sexuality plays in humans’ lives at every age—and how ill-prepared our society is to deal with it in older adults. Defining sex Part of understanding sexuality in older adults involves broadening the general definition of sex. “Socially, the gold standard for sexual activity is intercourse and having an orgasm,” says Stephanie Buehler, Ph.D., a sex therapist and director of The Buehler Institute. Maybe that shouldn’t be your goal. “Couples may say, ‘We are 80 and that part of our lives is over. It is NOT over, but it may require redefining what is sexual. If you can’t do penile penetration, there are other options,” says Kristen Tyszkowski, M.D., medical director of the Sex Matters Clinic at the University of Michigan’s Geriatric Sexual Health Center. If oral sex isn’t appealing or feasible, there are simpler forms of intimacy. “It can be kissing, touching, holding hands,” says Henry. Her mother found a boyfriend when
she joined Henry’s facility at about age 84. “He would send her flowers, and they would kiss,” she says. Looking for physical problems Assuming you are still with your life partner, one issue to examine is what caused the decrease in your sex life? “There are some women and men who say thanks but no thanks. I had intercourse because I wanted children, but I’m not interested. If that’s you, that’s fine,” says Henry. But for most people, some sort of physical problem related to aging got in the way. “Vaginal stenosis, where the vagina has closed up, and vaginal dryness, which causes penetration to hurt, are two problems older women face,” says Tyszkowski. The anti-impotence “miracle” One of the most common causes of decreased intimacy among couples is impotence, also known as erectile dysfunction (ED). It affects anywhere up to 35 million American men. Today there are several medications for ED. Like all drugs, they have plusses and minuses. The degree of spontaneity you want in your sex life is important in helping you and your doctor decide which medication is best for you. “Viagra and Levitra last an average of four to six hours, Cialis up to 36,” says Ivan Grunberger, M.D., associate chair of Long Island College Hospital’s department of urology. “A couple who knows they want to have sex only on Friday night at a certain time might manage fine with one of the shorter-lasting medications,” says Harris M. Nagler, M.D., chair of Beth Israel Medical Center’s department of urology. If you are
still rather adventurous as a couple, or you are dating, a man might be better served by the medicine that offers him more options timewise. These medications can take some strains off a relationship—but they can increase them too. “They have made people think they have a quick fix, but they don’t work for everyone or don’t work completely. It isn’t the panacea they expected,” says Tyszkowski. Before turning to one of these medications, Nagler urges looking for physical causes, which include diabetes, lowered testosterone levels, and blood pressure drugs. “It is critical to determine if there is another, correctible, cause for ED,” he says. Compatible definitions Solving the physical problem may not resolve a couple’s intimacy issues. “What about the woman who said, ‘Thank heaven that’s over,’” says Henry. When her spouse takes medication and suddenly wants sex again, that can put new strains on the relationship. Maybe another issue, like depression, was the barrier. If medication or therapy helped diminish or eliminate that problem, it can raise another. “The couple may have learned to deal with their lack of intimacy—and suddenly there is this valley of ‘how do we get back together?’ says Tyszkowski. Who is your partner? Many older people have lost the partner, usually through divorce or death, with whom they had most of their sex lives. If you are dating, there are important issues to consider regarding sexually transmitted diseases. (See sidebar.) But as you age, you may face an even more difficult decision. That is when one partner is fairly well, and the other faces severe physical or mental difficulties. If your
partner has had a stroke, new physical positions or some of the other forms of intimacy described here may suffice. What if it isn’t enough for the well partner? Or what if the other one’s illness precludes any real form of contact? “Painful choices may have to be made. The well partner has to decide what will work for them. Is it going outside the relationship? Is it self-stimulation?” says Buehler. “You may have to talk to your religious counselor, but ultimately you have to be able to look at yourself in the mirror,” she says. Your childrens’ role One area that isn’t discussed much is what happens when an adult child is responsible for a parent’s care. How much of their sex life is that child’s responsibility? Henry tells of a time when she got a frantic phone call from an associate who was showing the facility to a couple. “She had knocked on the room’s door but no one answered. Turns out the couple was busy having sex and didn’t hear,” says Henry. “What should I do?” the assistant wanted to know. “Do they seem to be all right?” “Yes.” “Then close the door,” I told her. It sounds funny, but it left Henry with some difficult decisions. Technically the law called HIPAA protects the privacy of these two people with anything relating to their health care. But Henry was their assigned guardian. The female was in assisted living because she was starting to show signs of dementia…so how could Henry or her team be sure the lady understood what she was doing? Ultimately, Henry called the children of each person. “The man’s family was tickled he was still enjoying himself, the lady’s was furious. And the woman herself was angry at me,” she says. The good news is the relationship continued, with the man at the
lady’s bedside at the end. And her children came around, understanding that Mom hadn’t forgotten their dad (which is how a lot of children take a new parental relationship). Health professionals need education Unfortunately, she says, there are no guidelines for these situations. “Our doctors have to learn to ask about their patients’ sex lives, just as they ask about the rest of their history. And we have to train professional caregivers. Many come from other countries where their definition of sexual morality is different,” says Henry. “I think it’s less hard for the older generation to talk about sex than most people would expect. More often it isn’t that they don’t want to talk, the doctor doesn’t ask, especially in geriatrics where there is so much else to handle in one visit,” says Tyszkowski. Tyskowski also urges doctors to be discreet. “When we do our new patient evaluation, we usually have the family exit before we get to the questions relating to the patient’s sex lives and habits,” she says. “Sex is a normal and basic instinct at any age. We remain romantic, our dreams stay intact. With people living to 100, we all have to find better ways to cope with these questions,” says Henry.
Sidebar: The Elephant in the Room: Sexually Transmitted Diseases
Science has been fairly remiss in its evaluating sexually transmitted disease (STD) in older adults. One of the few statistics available is on AIDs: Aprroximately 10%
of AIDs cases occur in adults over 50 and 3% occur in people over 60. 1 This doesn’t include other, more common, STDs, including syphilis, gonorrhea, genital herpes and human XXX (HPV). All are caused by different infections. Some can be easily treated with antibiotics and go away; others have long-term (and sometimes severe) consequences 2. “The good news is most STDs are easily cured and some side effects, like infertility, are not going to be an issue. But HIV is still a problem, says Tyszkowski. Older adults must understand that they are NOT immune to STDs. “Older women are among the fastest-growing group for contracting these diseases. Don’t tell yourself you can’t get pregnant or he’s not sleeping around. Insist on safe sex practices,” says Buehler. A condom is part of safe sex (for both gender) but not always. “It will protect you from HIV and most diseases, but it won’t protect against HPV; the virus is so small it can go through the condom,” says Buehler. One suggestion all the experts offer: talk frankly with a new partner about his/her sexual history. Such conversations aren’t easy and won’t protect you if your partner chooses to lie. Ultimately, let your doctor know you have been or are going to be sexually active and get advice.
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Sexually transmitted diseases in Older patients. www.uspharmacist.com http://www.medicinenet.com/sexually_transmitted_diseases