Senior Living: Maintaining and enjoying sexual health in the second act of life

By Drs. Jocelyn Craig and Jennifer Liu,

Contributing writers

Continuing to want to be close to someone doesn’t change just because you are getting older. It is normal to still want to have an active, satisfying sex life as you age; you just may need to adapt sexual activity to accommodate physical, health and other changes.

These changes can vary for men and women, and, at times, it can impact both partners. It’s important to not be embarrassed to address any sexual change concerns with your partner and/or physician.

Women’s sexual health 

One in two women older than 50 are affected by sexual issues, according to the Sexual Advice Association. Many of these changes come from menopause. The further you are in your menopause journey, the more your estrogen levels deplete. That depletion may cause you to feel moody, tired and irritable, and experience hot flashes.

Menopause can also change a woman’s sex drive. While some report an increase in sex drive, it is more common for women not to get aroused as easily and become less sensitive to touch. This is often due to a loss of estrogen and testosterone on the body.

Menopause, and the subsequent decline in estrogen and testosterone levels, can cause other changes that can affect your sexual activity, including: 

• Dryness: Estrogen, along with collagen, help produce natural moisture in the vagina. If this is decreased during menopause, it can lead to vaginal dryness.
• Bladder leakage and urge: It may be harder for you to hold your pee and fight off the urge to make it to the restroom and you may feel you have to go more than normal. This is due to the weakening of muscles in your pelvic floor. 
• Bone density: Estrogen reduction can create bone density issues, which can lead to osteoporosis. This can impact your mobility and flexibility during sex. 

What women can do

• Several hormone therapies are FDA-approved for treatment of hot flashes and prevention of bone loss , though they are usually for more extreme cases.
• Over the counter medications, such as lubricants and estrogen creams, can help with vaginal dryness.
• Herbal therapies, acupuncture, certain low-dose antidepressants and other medications may be helpful in decreasing hot flashes.
• Take calcium for your bones.
• Maintaining healthy lifestyle changes such as weight loss, exercise, not smoking and avoiding alcohol also can help your body avoid severe symptoms naturally.

Men’s sexual health 

For men, it’s the reduction of testosterone that can affect their sexual health later in life and is a key component to a man’s sexual experience. These hormonal changes create a need for more sexual stimulation, as it can take more time for the penis to become erect, and erections become more difficult to maintain. 

Men can also go through mood swings, lose their hair, become fatigued and irritable, and have a low semen count because of testosterone decline.

Other issues that can affect men as they age include:

• Erectile Dysfunction: While hormone imbalances can be to blame for ED, many urologists point to conditions that block blood flow to the penis as the major culprit, such as diabetes or hardening of the arteries, or a faulty vein that lets blood drain too quickly. 
• Bladder leakage and urge: By age 60, more than half of men develop symptoms of an enlarged prostate and by age 86, that number grows to 90%. This makes men feel the urge to urinate more frequently, have weak urine flow and have difficulty starting to urinate.  

What men can do

• Testosterone replacement therapy is an option for men, with shots, and oral and ointment medication available.
• Over the counter medication can be prescribed for ED.
• Men can take alpha-blockers to help relax the prostate and bladder muscles.

Reducing sexually transmitted infections

Age does not protect you from sexually transmitted infections. Older people who are sexually active may be at risk for diseases such as syphilis, gonorrhea, chlamydial infection, genital herpes, hepatitis B, genital warts and trichomoniasis. Almost anyone who is sexually active is also at risk of being infected with HIV, the virus that causes AIDS. 

Lack of regular screening for sexual issues increases the risk of an infection or disease going unnoticed for years. 

Don’t be Ashamed to speak up

You may feel nervous or shy about discussing your sexual health issues, but opening up is the first step in getting help. This transparency can help you and your partner ensure sexual satisfaction on both sides. 

In addition, talk to your primary care physician; there may be an easy solution to help you enjoy sex again or reduce your risk for STIs. If you don’t have a primary care physician, visit  memorialcare.org/Providers.

Dr. Jocelyn Craig is the medical director of the Pelvic Health Program at MemorialCare Long Beach Medical Center. Dr. Jennifer Liu is the chief of urology at the hospital.

Source: Orange County Register