Posts Tagged ‘medical attitudes towards sex and aging’
New England Journal of Medicine: Seniors having sex despite “bothersome problems”
When the news splashed all over the media today that older adults are, indeed, having sex, my first reaction was to laugh and say, “Duhhh!” The idea that senior sex is alive seemed to me as much a news story as the revelation that most people find feet at the end of their legs!
But there was much more to the story. “A Study of Sexuality and Health among Older Adults in the United States,” published today in the New England Journal of Medicine, was a major study of 3005 U.S. adults (1550 women and 1455 men) 57 to 85 years of age which revealed some fascinating facts and a few surprises:
The majority of older adults are sexually active and regard sexuality as an important part of life. The prevalence of sexual activity declines with age, yet a substantial number of men and women engage in vaginal intercourse, oral sex, and masturbation even in the eighth and ninth decades of life.The frequency of sexual activity reported by sexually active older adults (age 57+) is similar to the frequency reported among adults 18 to 59 years of age.The study reported that 78% of men 75 to 85 years of age, as compared with 40% of women in this age group, had a spousal or intimate relationship. Since women live longer, and on average, older men marry younger women, this disparity can be accounted for by the lack of available men for the older single women. The sexually active people in the oldest age group interviewed — 75 to 85 years of age — reported having sex at least two to three times per month, and 23% reported having sex once a week or more.About half of the sexually active men and women reported at least one “bothersome sexual problem,” and almost one third reported having multiple problems. The women’s most prevalent sexual problems were low desire, difficulty with vaginal lubrication, inability to climax, finding sex not pleasurable , and pain, usually during entry. The most prevalent sexual problems for men were erectile difficulty (14% of all men interviewed reported using medication or supplements to improve sexual function), lack of interest in sex, climaxing too quickly, anxiety about performance, and inability to climax. About one quarter of sexually active older adults with a sexual problem reported avoiding sex as a consequence.
Most surprising, given the extent of these problems that prevented sex from being satisfying or pleasurable, was this fact:
Only 38% of men and 22% of women reported having discussed sex with a physician since the age of 50.
The study suggests that the reasons for poor communication include the unwillingness of both patients and physicians to talk about sex and the gender and age differences between patients and their physicians.
Negative societal attitudes about women’s sexuality and sexuality at older ages may also inhibit such discussions.
When I give workshops and talks, both women and men frequently bring up physical problems that affect their sexuality and want me to provide a solution. I always say, “Please get a diagnosis from your doctor.” I emphasize that the problem may be caused by retreating hormones, or by an underlying health condition that you don’t know you have, or a medication, or interactions of medications. You can’t treat a problem until you know what’s causing it.
As the NEJM article states,
Sexual problems may be a warning sign or consequence of a serious underlying illness such as diabetes, an infection, urogenital tract conditions, or cancer. Undiagnosed or untreated sexual problems, or both, can lead to or occur with depression or social withdrawal. Patients may discontinue needed medications because of side effects that affect their sex lives, and medications to treat sexual problems can also have negative health effects, yet physician–patient communication about sexuality is poor.
I invite your comments!
Don’t skip the sex part!
I was in the hospital following my cataract surgery, woozy from the sedative. Robert held my hand, attentive to the nurse who was reading us a checklist of postoperative instructions.
“Normal daily activity is fine, such as walking or light reading. Nothing strentous or jarring for one week, such as lifting heavy weights, bending all the way over, jogging…” she read in a crisp, clear voice.
Suddenly her voice lowered, becoming girlish and tentative. “Sex…” she paused, then whispered, “Do you want to know about sex?”
“Yes! Read the part about sex!” Robert and I almost yelled.
“You may resume sexual activities after one or two days,” she finished in a whisper, then raised her voice to the pre-sex level to read the rest of the instructions about bathing, protecting my operated eye, and treating discomfort.
“She almost skipped the sex part,” Robert said to me afterwards.
Why did the nurse feel the need to ask our permission and then whisper this one bit of information? I guess I should be used to this assumption that people of our age (63 and 70) are no longer interested in sex, and that approaching us with sexual information is embarrassing — but I wish this would change!
I keep saying that my mission is to change society one mind at a time. But darn, it’s taking a long time! Join me, please!
Does Your Doctor Talk to You about Older-Age Sexuality?
Have you ever consulted your doctor about your changing sexual responsiveness or about reclaiming your sexuality when you have a medical condition that makes sex more difficult?
What happened when you asked your doctor for advice about sex? How did he or she respond? Did you get the information you needed? And for the benefit of the medical professionals reading this — how would you have liked your doctor to respond to questions about sex? What advice would you give professionals about how and when to talk to their older patients about their sexuality?
I am planning to write a magazine article about this topic, so please feel free to comment here or email me and let me know if you’d be willing to be interviewed.
As background, I wrote the post that follows in March 2006, and I’d like to revive it now that I have many more readers. I invite your comments.
[post originally dated 3/29/06:]
I’ve been speaking to groups in the midwest and the San Francisco Bay Area, and corresponding with readers who send me emails. Over and over, this comment comes up: older-age sexuality is a huge gap in the education of medical professionals.
I keep meeting doctors, nurses, therapists, and alternative practitioners who are hungry for information for their patients and clients — and often for themselves. One woman’s eyes got teary when she said, “I’ve been so lonely wishing I could talk to someone about this.”
I’ve heard from women who have read my book and ask, “Why didn’t my doctor ever tell me that I have to ‘use it or lose it’?” These are usually older women who are not in relationships right now and didn’t realize the importance of internal massage, regular orgasms, and Kegels to keep their vaginas tuned up and healthy, or penetation in the future might be painful. (For more information about what to do, read Vaginal Rejuvenation & Health from A Woman’s Touch, a wonderful sexuality resource center which I had the pleasure of visiting in Madison and Milwaukee.)
I’m also talking to many women over sixty who didn’t know that lubricants and sex toys can enhance their sexual pleasure — solo or with a partner — by heightening arousal and speeding up orgasm. They thought that slow arousal and difficulty reaching orgasm were a part of aging that they had to accept. I’m distressed that many doctors tell women this — often without running tests to see whether hormone levels or other conditions which may be treated might be affecting sexual response.
I’m not dumping on doctors, just on their training. I’ve been thrilled by the response of medical professionals to my book. One Santa Rosa, CA gynecologist bought 14 copies of my book for her patients — and then, after she had given them all away, she bought 10 more!
Several readers have written in about their medical challenges since this post originally appeared. To read more on this topic, check on “medical attitudes towards sex and aging” or “cancer” in the “labels” column to the right, and you’ll see other related posts.
Reclaiming Sexuality after Cancer
Lynn, age 50+, phoned to order several of my books and she told me her story of trying to reclaim her sexuality after cancer. I encouraged Lynn to share her story with you here:
I was diagnosed with cancer in my mid 30’s and was given a grim prognosis of 3-5 years to live. Thanks to medical research trials and multiple treatments, I have survived over 3 times that long. Through the years I have met other cancer survivors who are struggling to deal with their questions about sexuality after cancer.
Part of my cancer treatment was a stem cell transplant that involved both chemotherapy and radiation which put me into premature menopause. I had a medical condition which made me susceptible to blood clots, so hormone replacement in any form was not an option.
The resulting sexual problems were sudden and unexpected and left me with feelings of grief and loss that were hard to put into words. At times I felt like “You should just be thankful to be alive,” but I wasn’t ready to give up my sexuality.
I began to search for information. One cancer newsletter’s “Ask the Doctor” column confirmed that many readers had asked the same questions about sexual problems following this particular treatment. The American Cancer Society has a publication titled, “Sexuality and Cancer.” Both of these resources mentioned that there are many women who cannot take hormone replacement therapy and suggested that people should discuss “options for facilitating sexuality” with their doctors.
When I asked my oncologist for help, he was too embarrassed to talk about sexual problems and practically ran out of the exam room. He could have at least referred me to another medical resource. Although we passed the turn of the century, some medical providers are still in the “dark ages” when it comes to addressing the sexual problems of cancer survivors.
I went to a cancer survivor’s conference at a large medical center in another city. One of the sessions was about cancer and sexuality. I sat next to a woman who had been through treatment identical to mine and also had the same blood clotting disorder which ruled out HRT. We were both blessed with partners that did not walk out the door when the cancer diagnosis arrived, but we missed the giving involved in making love to our partner and meeting their needs for intimacy as much as the pleasure we had derived from it ourselves.
Some people came to the group session accompanied by their partners – the standard response from the partner without cancer was “I’m just glad my partner is alive,” but the cancer survivors were not content with that. They went on to express their deep emotions and struggles. “First I was diagnosed, then I had treatment – I’m thankful I survived, but I am still working through the loss of my sexuality.”
The oncology professional who was the group facilitator listened, and could see that this was an important subject that needed to be given more attention in the future. I left feeling like at last we were heard, but I was still lacking practical information and resources.
I am now over 50 and my cancer is in a durable remission, but I was beginning to believe that I was probably “too old” to be hopeful about ever being sexually active again. I lacked the courage to ask another Dr. or medical professional for help to address sexual problems.
I’m so glad I found your blog – I read the post “a man asks about sex after prostate cancer” and was impressed by the personal interest you took in responding to his questions.
I went to your website to order your book and read, “Joy isn’t age-bound. Neither is sexuality or fitness.” Discovering that you have also faced challenges as a result of two car accidents and refused to give up was an encouragement to me. Your statement, “I had to get back to having a life”, really sums up where I am at currently. Your story inspired me with a “spark of hope” and I also found the resources that I need to begin working on regaining physical fitness and sexual function!
Lynn, thank you for sharing your experience and your thoughts. When you told me about your oncologist bolting out of the room when you asked about sexuality, I was shocked and outraged. Sexuality and intimacy are so much a part of what binds us to our partner and makes us fully human. How can doctors not understand this or help us reclaim that vital part of our being when we ask for help?
I know doctors get very little training in sexuality, and I’ve written about this here. Fortunately, there are some wonderful sex therapists and sex educators who are doing a great job in this arena, and I encourage you to find one of these in your area.
I am so happy that you survived cancer, and I wish you the best success reclaiming the joy of your sexuality. Please keep us posted about what you do and what you learn.
Best,
— Joan