Maintaining intimacy and sex

A healthy sexual relationship can positively affect all aspects of your life, including your physical health and self-esteem.

A two-way relationship exists between health (physical and psychological) and sex: better sex leads to better health, and better health leads to better sex. Human beings are never too old to enjoy a healthy and happy sex life. For many people, sexual activity and intimacy are important quality-of-life factors and are key components of successful ageing.

Sexuality is an important component of emotional and physical intimacy that men and women experience throughout their lives.

• Research suggesting that a high proportion of men and women remain sexually active well into later life refutes the myth that ageing and sexual dysfunction are linked.

• Multiple studies have shown that, while the prevalence of sexual activity does decline with age, a substantial number of people continue to engage in an active sex life up to age 90 and beyond (see Ni Lochlainn and Kenny’s research paper in the related articles section below).

Age-related physiological changes do not make a meaningful sexual relationship impossible or even necessarily difficult. Many of these physiological changes are modifiable.

• One of the most significant periods in female reproductive ageing is menopause. Women live on average 30 years after menopause. Changes that can arise from loss of oestrogen include decreased vaginal lubrication, vasomotor symptoms, and neurologic and psycho-sexual changes, including mood, irritability, anorgasmia (inability to achieve orgasm), decreased libido, and impaired sexual performance. But, there are various therapies available such as vaginal lubricants and topical or oral oestrogen may also help with vaginal thinning and dryness. Your GP can give you advice on these issues.

• As for men, there are changes in penile structure and the mechanical sensitivity of the penis that come with ageing. Age alone is a known risk factor for erectile dysfunction (ED). There are many causes, and ED can even be an early marker of cardiovascular disease. There are also multiple therapies available, so do ask your GP for advice if this is an issue.

There are some practical ways of addressing sexuality and intimacy in later life. Here are seven strategies that you can think about:

1. Forget the stigma: Sexual activity tends to be a spectrum throughout life. If you are very sexually active in your youth and middle age, there is no reason to believe this will stop, unless you want it to.

2. Communication is key: Speak to your partner about your needs, concerns and desires. Many couples actually find later life an optimal time for intimacy, as children have grown up and moved out, and retirement can mean the stresses and time commitments of working life are no longer a barrier.

3. Be creative: Intimacy does not necessarily mean sexual intercourse. Kissing, holding hands, massage, etc. are all forms of intimacy and closeness.

4. Don’t be shy about sexual dysfunction: Many conditions and medications can affect sexual function. There are various therapeutic options available to patients to achieve maximum sexual capacity in older age which your GP may be able to help you with.

5. Practice safe sex: Older adults are not immune to sexually transmitted infections. Adults in later years are much less likely to wear a condom than their younger counterparts, likely due to no risk of pregnancy. However, the rates of sexually transmitted infections have increased significantly in the over 50s age bracket and this must be taken into consideration (see Calvet’s research paper in the related articles section below).

6. Keep your body and mind healthy: Don’t smoke, drink alcohol in moderation, eat a balanced healthy diet and take regular exercise – easy! Sex itself can be a form of exercise. Psychological wellbeing is closely linked with sexual function.

7. Do not underestimate intimacy in friendship: There is more to intimacy than romance or sexual relations. Whether you have a partner or not, relationships with friends can provide closeness and important emotional support.

• Thinking about sexuality and intimacy, what does intimacy mean to you?

Dr Mary Ni Lochlainn is physician in Kent, England, and a graduate of Trinity College Dublin.

Glossary

Vasomotor symptoms: These are symptoms such as night sweats and hot flushes.