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Mayo Foundation for Medical Education and Research

Sexual health is important at any age. And the desire for intimacy is timeless. While sex may not be the same as it was in your twenties, it can still be very fulfilling. Discover which aspects of sexual health are likely to change as you age—and how you and your partner can adapt.

Communication Is Key

To maintain a satisfying sex life, talk with your partner. Set aside time to be sensual and sexual together. When you are spending intimate time with your partner, share your thoughts about lovemaking. Help your part­ner understand what you want from him or her. Be honest about what you are experiencing physically and emo­tionally.

Sexual Health and Safe Sex

People of all ages should know how to practice safe sex. If you are having sex with a new or different partner, always use a condom. Also talk with your doctor about other ways to pro­tect yourself from sexually transmit­ted infections.

If you are in a long-term monoga­mous relationship and you have both tested negative for sexually transmit­ted infections, you probably don’t need to worry about protection. Un­til you know for sure, however, use a condom when you have sex.

Aging and Men’s Sexual Health

Testosterone plays a critical role in a man’s sexual experience. Testoster­one levels vary greatly among men. In general, however, older men tend to have lower testosterone levels than do younger men. Testosterone levels gradually decline throughout adult­hood—about 1 percent each year af­ter age 30 on average.

As a man ages, the penis may take longer to become erect, and erections may not be as firm. It may take longer to achieve full arousal and to have or­gasmic and ejaculatory experiences.

Erectile dysfunction also becomes more common. Several medications are available to help men achieve or sustain an adequate erection for sex­ual activity.

Aging and Women’s Sexual Health

As women approach menopause, their estrogen levels decrease, which may lead to vaginal dryness and slower sexual arousal. Emotional changes are somewhat more com­mon in women. While some women may enjoy sex more without worry­ing about pregnancy, naturally oc­curring changes in body shape and size may cause others to feel less sex­ually desirable.

Medical Conditions and Sexual Health

Any condition that affects one’s gen­eral health and well-being may also affect sexual health. Illnesses that involve the cardiovascular system, such as high blood pressure, diabe­tes, hormonal problems, depression, and anxiety—and the medications used to treat these conditions—can pose challenges to being sexually ac­tive. High blood pressure, for exam­ple, can affect the ability to become aroused, as can certain medications used to treat high blood pressure.

In addition, any surgical proce­dure that affects the pelvis and cen­tral nervous system may have a sig­nificant impact on sexual response. The body, however, is resilient. Given time to heal and some loving atten­tion, most people can often become sexually responsive again.

Medications and Sexual Health

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Certain medications can inhibit sex­ual response, including the desire for sex and the body’s ability to become aroused or have an orgasm. If you think you are experiencing sexual side effects from a medication, con­sult your doctor. It may be possible to switch to a different medication with fewer sexual side effects or to add an additional medication that reduces sexual side effects.

When One Partner Becomes Ill

If you are ill, your sexuality may temporarily take a back seat to other needs. Pain, discomfort, medi­cations, and worry can overshadow sexual desire. Talk with your partner about other ways to be close during this time.

If you are the caregiver, the demands of caring for your partner may take a toll on your sexual de­sire. Find a way to set aside the caregiver role from time to time and be a partner instead—so that you can relax and feel nurtured by your partner. In that way you can enjoy a mutually satisfying sexual en­counter.

Dealing With Differences in Desire

Differences in libidos are common among couples of all ages. Couples can become stuck in a pattern where one person initiates contact while the other avoids it. If you mainly avoid sex, consider taking charge of some engagement. If you usually initiate sex, try talking with your partner about what you need.

If you are worried about hurting your partner’s feelings, talk about your experience using “I state­ments,” such as “I think my body responds better when…” In turn, try to understand your partner’s needs and desires. Together you can find ways to accommodate both your needs.

Looking Forward, Not Back

Many couples want to know how to get back to the sexual arousal and activity levels they experi­enced in their twenties, thirties, and early forties. Instead find ways to optimize your body’s response for sexual experiences now. Ask yourselves what is satisfying and mutually acceptable.

Many books are available about how to main­tain a healthy sex life as you get older. In addition, many couples find consulting an expert helpful. Your doctor may be able to provide useful sugges­tions or refer you to a specialist.

Q&A With Stephanie S. Faubion, Md

Q: Are there physical symptoms that women might experience during or after sexual intercourse that would indicate serious med­ical conditions?

A: If a woman is experiencing pain or bleeding during or after inter­course, she should see her doctor. Vaginal dryness can result from es­trogen deficiency after menopause and is easily treated. Try a lubricant first. If that isn’t sufficient, see a doctor to discuss the possibility of us­ing vaginal estrogen. Some women experience urinary tract infections after intercourse, especially after menopause. This may also improve with vaginal estrogen treatment. If a woman experiences any vaginal bleeding after menopause (with or without intercourse), she should be evaluated by her doctor, as it may be a sign of a more serious problem.

Q: Some women might be embarrassed to discuss sexual con­cerns with their physician. Do you have any tips for addressing these questions with a clinician?

A: Your sexual health is important, and your doctor may not ask you about it. There is help available, and it may be up to you to tell your doc­tor. Some women find it easier to make a list of their health concerns and to hand the list to their doctor at the beginning of the visit. Some women prefer to tell the appointment scheduler their sexual health concern, which will ensure that the doctor knows what they would like help with. Also, telling your doctor about a sexual health concern is easier than you might think. Just as you might say, “I have concerns about back pain,” you can say, “I have concerns about my sexual func­tion” or “I’m having trouble with painful intercourse.” Know that you are not alone—many women (and men) have difficulty with sexual function as they age.

Q: Are there any age-related changes to birth control that women should consider at midlife, as they approach menopause?

A: In general, the benefits of most contraceptive methods outweigh the risks associated with pregnancy and postpartum state through the menopausal transition. The important point here is that about 30 percent of women ages 40 to 44 are not using any contraception, and conception is possible until a woman is in menopause and has not had a period for one year. The decade of the forties is the second most com­mon time of unwanted pregnancy behind the teen years!