Sex and Aging

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A couple of weeks ago, the media was all a buzz about pop icon Miley Cyrus’ interview with Matt Lauer when he asked, “Is this a phase? Is the sexual side of you that we’re seeing a lot of right now something that’s going to be around for a while and then you move onto something else?” Cyrus replied, “I heard when you turn 40, things start to go a little less sexual, probably around that time. I heard that’s when people don’t have sex anymore.” The 55-year old Today Show host couldn’t contain his dismissive smile as he shook his head and said “don’t say that.”

It’s unfortunate in our youth-obsessed society of today that ageism still exists, perpetuating the notion that the fruits of sexuality, our sensual thoughts, desires, and actions are only for the youth to savor. The need for intimacy and connection is ageless. Through sexual activity, we are able to establish and maintain intimacy and to express our affection for our partner. Yet, it is still sometimes difficult for “younger folks” to think about “older folks” as sexual beings. As J. LoPiccolo wrote, “Sexuality in the elderly is a ‘dark continent’ that most people, including physicians, prefer not to think about.”

Most health professionals now understand that sexuality remains important to patients in the fall and winter seasons of life. For all of us, engaging in sexual activities can reduce stress, improve sleep, strengthen blood vessels, burn calories, ease certain forms of pain, diminish symptoms of depression, and boost the immune system. But as we age, our bodies change and our risk for health problems increase, contributing to an overall decline in the frequency of sexual encounters. Many older adults currently take one or more prescribed medication that may directly affect their sexual response cycle. Conditions such as cardiovascular disease, depression, anxiety, endocrine problems, high blood pressure, diabetes, dementia, and arthritis all take a toll on sexual functioning and/or the availability of a healthy sexual partner. Too often, older adults walk out of the doctor’s office uneducated about the natural physical changes occurring as part of the process of aging, the potential sexual side effects of their prescribed medications, or with any understanding of how their diagnoses may impact their sexuality.

A 2009 study found that most medical students do not have formal opportunities to learn how to talk with their patients about sexual issues (Barrett & Rand, 2009). As health providers, we are relatively comfortable answering our patients questions related to sex, but how comfortable are we inquiring about our patient’s sexual health? How often do we openly discuss the potential impact on an older patient’s sexual functioning when rendering a diagnosis or discussing treatment options? Are physicians missing important indicators of comorbidities and opportunities to support a patient’s overall health by not asking about their current sexual functioning?

As part of my practice as a sex therapist, I review each patient’s general health history and request a list of their current prescribed medications. Frequently I have encountered older males who may be experiencing symptoms of erectile dysfunction and who are currently taking a prescribed anti-hypertensive. All too often they appear completely unaware of the potential for erectile difficulties as a result of these types of essential medications.

How can physicians help older patients feel comfortable talking about their sexual health?

Don’t be afraid or embarrassed to ask about a patient’s current sexual functioning
Ask direct questions
Use clinical terms for body parts and processes
Provide education about normal physical changes, as a result of aging, and how they may impact a patient’s sexual health
Review potential sexual side effects of any prescribed medication with the patient
Provide appropriate referrals to certified sex therapist
Be warm, open minded, accepting, and concerned

There is much we can do together to help patients compensate for the normal changes that come along with aging, complicating sexual relations. Through open dialogue and intentional conversations with aging patients about their sexual functioning, we can improve the accuracy of diagnosis and expand collaborative treatment options for this growing population.

Valerie Areaux, MS, LMFT. Bluegrass Family Therapy, LLC has offices in Lexington and Danville KY. Contact her at (859) 492 9955.