Sexuality

While older adults experience many of the same sexual problems and concerns as younger people, a number of biological, psychological, and social factors influence sexual behavior as people age. In general, physiological changes that accompany the aging process occur gradually among men and women, and vary individually.

Among men, normal physiological changes associated with the aging process include a slower, less firm erection that recedes quickly after orgasm. The force of ejaculation decreases, producing a lower volume of semen and an increase in the duration of the refractory phase (the time needed before it is possible to be sexually stimulated) after orgasm. ‘‘Seepage’’ (semen leaking out rather than being ejaculated) or retrograde ejaculation (ejaculation back into the bladder rather than out through the penis) may occur. Men also may experience a decrease in size and firmness of the testes, a change in testicle elevation, an absence of the sex flush (a rash that appears on the stomach and chest areas in some sexually responsive men), and a decrease in testosterone level (Schiavi and Rehman; Shell and Smith). No clinical consensus exists as to the physiological occurrence of ‘‘male menopause’’ (Morley and Perry), but gradually lowering testosterone levels in men as they age are associated with increased rates of sexual, mood, and cognitive disorders (Gould and Petty).

Normal physiological changes that affect sexual function in women as they age primarily are due to reduction in circulating estrogen after menopause. The rate and amount of vaginal lubrication decreases and a general atrophy of vaginal tissue occurs. In addition, the clitoral, vulvar, and labial tissues shrink, the size of the cervix, uterus, and ovaries decreases, and some loss of elasticity and thinning of the vaginal wall occurs. Intercourse may become painful if thinning of the vaginal walls is significant (Shell and Smith). Hormone replacement therapy can ameliorate this condition, but not without some concerns about possible side effects (Lock).