Sexuality in Older Adults' Relationships

By Zeiss, Antonette M.; Kasl-Godley, Julia | Generations, Summer 2001 | Go to article overview

Sexuality in Older Adults' Relationships


Zeiss, Antonette M., Kasl-Godley, Julia, Generations


Sexuality is a major aspect of intimacy and includes components such as sexual desire, activity, attitudes, body image, and gender-role identity. Sexuality is integral to most marital or romantic relationships and is central to one's self-concept, self-esteem, and mental and physical health. The centrality and complexity of sexuality continue throughout the lifespan. This review examines the following issues of sexuality in older adults: normal physical changes associated with aging and strategies to compensate for those changes, patterns of change in sexual behavior psychosocial and cultural aspects of sexuality, sexual dysfunction, and some of the unique concerns in working with cognitively impaired and physically disabled older adults. Assessment of sexual function and treatment of dysfunction are beyond the scope of this review. For a review of these issues, see Zeiss, Zeiss, and Davies (1999) and McConaghy (1996).

Throughout this article, we attempt to frame information in ways that are relevant to heterosexual and gay, lesbian, and bisexual individuals. While it can be easy to slip into assumptions that all older adults are heterosexual and in coupies, this clearly is not the reality. It is important to recognize the needs and interests of older gay, lesbian, and bisexual adults, as well as those of heterosexual individuals. Unfortunately, little research on sexuality and aging has been conducted on self-identified gay, lesbian, and bisexual adults.

PHYSICAL CHANGES WITH AGING

A reasonable place to start examining the effects of aging on sexuality is to consider the physical response to sexual stimulation in older adults as compared to younger adults. The organized pattern of response to sexual stimulation is called the "sexual response cycle." Characteristic physiological changes during the sexual response cycle do occur with aging (Masters and Johnson, 1966; see Meston, 1997, for a recent review), but there also are great individual differences in the extent and timing of these changes. Some of the individual differences are accounted for by general health factors, but in addition, continued sexual activity lessens changes; that is, the more sexually active the older person, the fewer physical changes the person is likely to experience in her or his pattern of sexual response.

Among postmenopausal women, age is associated with a reduction in estrogen, progesterone, and androgen levels. Loss of estrogen results in a thinning of the vaginal walls and decreased or delayed vaginal lubrication in response to sexual stimulation. Both of these changes can result in pain during intercourse or any vaginal penetration. Vaginal penetration also may be more difficult, given that the labia no longer fully elevate during sexual arousal to create the funnel-like entrance toward the vagina. Additionally, the vaginal barrel shortens and narrows, and the cervix may descend into the vagina, increasing the chance of cervical bumping during intercourse, which can be painful. Orgasmic (and multiorgasmic) response remains, but vaginal contractions are fewer and weaker, and general body involvement is reduced. Once a sexual interaction is completed, older women also return to the pre-aroused state more rapidly than when they were younger.

Among older men, age is associated with decreased testosterone levels. However, loss of testosterone seems to have limited impact on sexual functioning, as only a minimal level of testosterone is necessary for adequate sexual functioning (Meston, 1997). Older men require more direct stimulation of the penis, and for a longer duration, to experience erection. The maximum level of erection may be less than too percent (e.g., 80-go percent). Orgasmic response remains but, as with women, orgasm consists of fewer and weaker contractions and reduced general body response. Both the force and amount of ejaculation may be reduced. The refractory period, or the time during which a man cannot be restimulated to erection, can lengthen, to hours or days, from a few minutes in younger men. …

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