Enhancing your Sexuality

Content provided by the Faculty of the Harvard Medical School
Excerpted from a Harvard Special Health Report

In a society firmly skewed toward the young, sexuality among older people is often dismissed or even ridiculed. Yet pleasurable sexual activity — such as caresses, intercourse, and masturbation — continues far longer in life than many young people think. One study of people ages 80–102 found that 83% of men and 30% of women indulged in intimacies other than intercourse. Seventy-two percent of the men and 40% of the women masturbated. The sexual act people tend to engage in less often as the years add up is intercourse, for some of the reasons discussed below. Of course, the popularization of drugs like Viagra, Cialis, and Levitra may change this for some folks.

If you enjoyed sex in your younger years, there is no reason you shouldn't keep treading that path, although it's certainly true that you may need to leap some barriers as you grow older. Among men, for example, erectile dysfunction affects about 25% of 65-year-olds, and, according to some studies, more than half of those over age 75 are impotent. The problem is often tied to illnesses such as hypertension and atherosclerosis, which affect blood vessels, or diabetes, which affects nerves and blood vessels. Medications or treatments for hypertension, depression, prostate cancer, or benign prostatic hypertrophy can play a role. Psychological issues such as depression or changes in self-image may dampen sex drive. Much more rarely, a marked dip in sex drive may be due to low testosterone levels. It's also worth noting that one Harvard study found men who invest 30 minutes a day in exercise are 40% less likely to develop erectile dysfunction than sedentary men.

Among women, one common reason for hesitance about intercourse and other intimate acts is a lack of desire — possibly also due to a downswing in testosterone, although this is unconfirmed. Another is painful intercourse, called dyspareunia; as estrogen levels dip because of menopause, vaginal tissues may become uncomfortably dry and thin. A partner's technique, vaginal irritation, the fear of spilling urine during sex, or a woman's own frame of mind or changes in self-image may also be factors.

Opportunity also counts at any age. Privacy is sometimes an issue if older children have returned home to roost or a parent is sharing a child's home or lives in a nursing home. Your partner's interest, health, and ability matter, too. And, of course, not everyone has a partner.

So what can you do to enhance or revive your sexual life? Here are some tips:

•Explore what brings you pleasure with or without a partner.

•Try to open up with your partner about pleasures, desire, and possible roadblocks to sexual activity. Simple changes in venue or timing, or just admitting that loss of libido or a crimp in ability doesn't equal a loss of love, may make a difference.

•Be willing to try new intimacies when old ones pale or, worse, bring on pain or seem more a chore than a joy.

•Consider whether you can be more affectionate and warm outside of the bedroom. Over time, small gestures sometimes change moods and minds.

Be open with your doctor about barriers that might be affecting your interest and abilities. Often, a solution can be found. It may mean changing medications or adding one (see "The latest on Viagra, Levitra, and Cialis," below), identifying the underlying cause of discomfort or loss of interest, considering different techniques and toys, or adding something as simple as a water-based personal lubricant or an estrogen cream or ring to treat vaginal dryness.

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Which of the following is one of the changes your may experience during menopause?