Sexuality

A number of factors influence mature people’s interest in and capacity for sex as they age. Common medical conditions of older adults—hypertension, heart disease, osteoporosis, arthritis, rheumatism, urinary incontinence, diabetes, prostate enlargement, and emphysema—can reduce their sexual interest and functioning. Furthermore, medications that are prescribed to treat these and other problems can adversely affect erectile function and libido (Hernandez-Lopez). Other clinical factors that impact older persons’ sexuality include surgical procedures such as mastectomy, hysterectomy, colostomy, prostatectomy (removal of all or part of the prostate gland), angioplasty, and heart surgery.

Social factors such as excessive alcohol use, depression, and poor self-esteem also can exert a toll. Fear and lack of understanding about normal genital changes can impact sexual expression. Attitudes, both individual and social, can negatively affect sexual activity. Among men, retirement can lead to a loss of self-esteem, depression, and subsequent loss of interest in sex. Women’s negative early experience with sexual activity, in some cases sexual abuse, can affect sexual interest and behavior in later years. Also, religious sanctions that restrict sex for any purposes other than reproduction strongly influence sexual behavior in later life.

Although it is not the only means for treating sexual dysfunction in men, the prescription drug Viagra has received much professional and popular attention (Lamberg; Morgentaler). The majority of those in the AARP study who were taking Viagra reported that the drug improved their sex lives. Among women, estrogen has been used to increase desire and arousal, and testosterone has been prescribed to address more generalized sexual dysfunction. Meanwhile, alprostadil (Caverject, Muse) is used to treat erectile dysfunction in men, and some amphetamines, such as methylphenidate (Ritalin), have been used to increase sexual responsiveness in women. In addition to prescription medications, many older adults turn to alternative herbal remedies such as gingko biloba, ginseng, and ma huang to address sexual dysfunction, although no controlled studies have been published on these supplements and they are not approved by the U.S. Food and Drug Administration (Knowlton).

While research continues to find new medications and remedies for treating sexual dysfunction, many sex therapists believe that the problem often is psychological, and should be treated using behavioral strategies. Considerable evidence, however, suggests that organic causes underlie erectile dysfunction in 80 percent of the men who experience the condition for longer than a year (Morgentaler). Moreover, psychogenic responses that inhibit sexual arousal may result from an inability to perform with a partner rather than cause it. The best predictor of sexual behavior in later years is the pattern of sexuality in younger years, barring any physical limitations (Tichy and Talaschek). Attitudes that predispose an individual to enjoy sexual activity in youth and young adulthood typically continue across the larger stages of the life course.