Aging and sex – what do we really want?

Recently over coffee, a friend complained that none of her friends seemed to want to talk about their sex lives any more.  Bear in mind, we are both hovering around 70.  You might be thinking: of course your peers don’t want to talk about their non-existent sex lives.

And you would be wrong.  Several of my aging women friends have healthy libidos and a strong sense of themselves as sexual people.  But they are sad that health issues get in the way.

Despite my friend’s regret that her friends did not want to open up, because I am a sexual health educator, other women have been very chatty with me.

“I miss it”, said one.  “It’s not like we aren’t loving with each other, but I miss sex, the way we used to enjoy it.

“I feel a sense of loss”, said another.  Because of my partner’s medication, his libido is completely gone.  He is happy to please me when I initiate, but it feels so one-sided”.

“We’ve worked something out,” said a woman whose husband is disabled due to a stroke.  In other words, they have figured out how to be sexual by getting around the impediments.

“My partner is like a teenager.  In his early ‘70s, he is ready – and able – at any time.”

“When my husband was in his early ‘80s, he found that he was unable to have an orgasm after his prostate surgery, so intercourse went on too long and too painfully.  We finally just gave it up.”

When I told one of my friends that I wanted to quote her in this article, she wrote:

“I would add that it isn’t just “health” issues per se that gets in the way, but our naturally aging bodies.  I don’t consider my thinning vaginal wall that makes sex painful a health issue as much as one of the unfortunate consequences of my body – at this age, biologically speaking – not needing so much estrogen anymore.”

Quite the range of responses.  And I haven’t even asked my lesbian friends.

What does the research say?

I have written before about sexuality and aging  as well as the “joys” of online dating and the sexual pleasures of aging.  I have given workshops on the issue and spoken at conferences, but I can’t seem to let this topic go.  And the personal stories are so compelling.

The studies tell their own stories.

“One such study noted that, “61% of all women in this cohort were satisfied with their overall sex life. Although older age has been described as a significant predictor of low sexual satisfaction, the percentage of…sexually satisfied women actually increased with age, with approximately half of the women over 80 years old reporting sexual satisfaction almost always or always.” This confirmed an earlier study by the National Council on Aging which concluded, “Seventy-four percent of the sexually active men and 70% of the sexually active women reported being as satisfied or even more satisfied with their sexual lives than they were in their 40s.”

And lest we forget, no matter how we define “sex”, intimacy generally trumps sensation.  Alex McKay of SIECCAN  said in a talk on mid-life sex and STIs, that there was, in his opinion, a “six-minute rule”.  Quoting a study on heterosexual use of condoms, he said 71% of women who had 6 – 10 minutes of post sex affectionate behaviour rated their last penis in vagina (PIV) intercourse as ‘very pleasurable’ as opposed to 44% of women who experienced 0 – 5 minutes.

Health Canada is encouraging us to carry on as is the Canadian Public Health Association.

“Along with better health and active aging comes sex! A nationally representative sample of 3,005 Americans between 57 and 85 years of age revealed that nearly three quarters of seniors aged 57 to 64 were sexually active; while more than half of seniors aged 65 to 74 and more than a quarter aged 75 to 85 reported being sexually active.”

However, medication can interfere with one’s sex life at any age.  For example, “currently available antidepressants may aggravate sexual dysfunction and make depression worse, a new survey of US adults with major depressive disorder (MDD) suggests.”

There are other meds that can get in the way of sexual functioning.

And people get scared to become “active” after an illness like a heart attack.

“Although most younger patients are sexually active 1 year after an acute MI [AMI], one in 15 women and one in 20 men never resume one of life’s greatest pleasures, a new report finds.”

Tell me what you want, what you really, really want

Another factor in maintaining sexual relationships into our ‘70s and ‘80s may be loss of interest, especially for those in long-term relationships.  Like lesbian bed death, for heterosexuals, the statistics are just a bit less “drastic”.

Then there are those older people having great sex, by which I mean at least connection and intimacy.  Others may be having more PIV sex because of erectile dysfunction medication, which may bring its own problems, like oppressive demands.  According to a study  back in 2003, “few studies have focused on the possible detrimental effects for women of Viagra use within a heterosexual relationship”.

“We argue that while previous medically-oriented research in this area has generally assumed an unproblematic link between Viagra use and the resumption of penetrative sex within heterosexual relationships, more attention needs to be paid to partners’ perspectives and desires, and to the specific dynamics of any given relationship.”

One wonders which people would choose: great sex without intimacy or intimacy without full sexual functioning.

I guess we want it all.  Love.  Intimacy.  Good sex, however we define “sex”.

Surely when there is open communication and a willingness to please, there is pleasure to be had.  If we see ourselves as desirable, some of that can translate into – if not desire and the mechanics that go with it – at least the desire to please.  And while some of us are wistful, others may be envious of others’ good fortune, however much of it “all” we have.

I look forward to hearing your stories.

Here are some disability resources that may be useful to people who are aging.

The case against hormonal contraception – January 22, 2014

I’m no big fan of hormonal contraception. That said, it has its place in the limited birth control options available to women. As I have written here before, the principle—as always—is informed choice and individual circumstance. “Informed” is the operative word and the provenance of the information is critical. Nevertheless, with the recent demonization of hormonal methods, I feel like weighing in once again and trying to seek some kind of balance.


For a related article, see also the Network book review of Sweetening the Pill

A friend posted an article on Facebook from The New American about Depo Provera and how the Gates Foundation was “killing African women.” I started to read the article on which the post was based and got as far as the statement that Depo causes STIs and cervical cancer.

The Rebecca Project For Human Rights’ Kwame Fosu quoted the reverend Dr. Randy Short,: “The used [sic] of Depo Provera contributes to and in several cases causes life threatening diseases and medical problems: cervical cancer, breast cancer, diabetes, osteoporosis, stroke, heart attack, sterility, miscarriages, HIV/AIDS, Chlamydia, and other STIs/STDs.”

In 1986, women’s health advocates (including me and Anne Rochon Ford representing the Toronto Women’s Health Network) made deputations to the Regional Meetings on Fertility Control. We were opposing the approval of Depo as a method of birth control primarily because not all the facts were in about its potential connection to breast cancer. At that time, we also argued that it had been used off-label to the detriment of women who did not give their informed consent—women with disabilities, poor and Indigenous women.

At that time, I was already working for a public health unit, a job that included counselling people in a sexual health clinic. When Depo was approved, although we did not consider it to be a “first-line” method, we counselled and prescribed its use. Counselling included giving women the facts as we knew them.

Aside from anecdotal information, there is no scientific evidence for most of the claims made by Reverend Short about Depo. Yes, it can cause what are considered to be reversible effects on bone mineral density; and, of course, if condoms are not used, people are likely to get STIs including HPV from infected partners. But Depo is not linked to the rest of Randy Short’s list. At the clinic, there were women who used it and liked it; there were women who used it and quit. Some women who quitcontinued to experience side-effects for many months after their last injection. All had been forewarned about the side-effects and risks, including Depo’s potential long-lasting effects.

We taught women at clinic who were about to start a combined contraceptive method about its potential side-effects and risks, including a lesson in the warning signs for a blood clot or stroke.

In the past few years, oral contraceptives have taken a public beating. Cavalier prescription of third and fourth generation hormones (e.g., Orthocept, Yasmin), which carry a higher risk to women than earlier formulations, have resulted in lawsuits, disability and death. Diane-35’s off-label use is simply a travesty. It would appear from a recent CBC program (The Current Oct. 28, 2013) that bad press as well as dissatisfaction have resulted in the increased use of withdrawal and fertility awareness as alternative methods.

In the program, the participants Ann Friedman, Holly Grigg-Spall and Kate Carraway, argued that women who were generally users of “natural products” were concerned about the side-effects and risks of hormonal contraception. For that reason, they were avoiding synthetic hormones in favour of withdrawal and/or the fertility awareness methods of birth control. They suggested that the women using withdrawal were in committed relationships and might accept an unplanned pregnancy.

It turns out that it was the younger women (25 to 26) interviewed by Friedman who were more concerned about pregnancy; older couples who were on the fence about having kids felt it would not be the end of the world if there were a pregnancy.

This is the crux of the problem. Ideally, we plan according to our personal lives and current needs. However, in real life, around 40% of pregnancies are unplanned.

The program raised the issue of STIs—and rightly so. They said women using withdrawal were making the choice to have unprotected sex with partners they trusted. They added that young people’s attitudes to STIs had changed and that condoms were seen as less important than they once were  during the worst of the AIDS epidemic. But younger women (15 to 24) are statistically at higher risk for STIs like Chlamydia which, if untreated, could lead (ironically) to infertility.

The point was made that, not surprisingly, withdrawal as a birth control method continues to have some stigma attached to it. It is very effective with perfect use (96%). But the current “pull-out generation” is indeed taking a risk if they are unaware of the factors that increase the effectiveness of the method including the ability to track their own fertility. Grigg-Spall, who favours Fertility Awareness Methods (FAM), has done women a favour by shining a light on this information. She sees FAM as the feminist way of dealing with birth control.

I acknowledge that withdrawal and FAM are both underrated methods. What irks me is what comes across as cheerleading for some methods, and the vilification of others.

Hormonal contraception is far from benign. There is ongoing research into its effects on the endocrine system, its risks and even its effectiveness. For example, there is ongoing controversy over the pill’s effectiveness for women who are obese. Shockingly, BMI was recently indicated as a significant factor in the reduction of the effectiveness of emergency contraceptive pills (ECP). [See also CWHN FAQ on ECP]. And there is, of course, the horrendous loss of life for women who are not well monitored on the pill (the Patch or NuvaRing); or whose symptoms are incorrectly diagnosed when they suffer a circulatory event like a clot or a stroke.

An individual or couple should have the all of the tools at their disposal to make a deliberate, informed decision when it comes to preventing pregnancy. Health advocates with their eyes wide open are understandably cynical about who sponsors the research and how the results are then transmitted to the public. Birth control is, after all, big business. So let’s make it our business to be as informed as we possibly can.