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Sexual Drive in the Elderly

Introduction

Sex drive or libido in general is thought to decrease gradually with age in both men and women. Research has shown that while there is significant sexual desire, activity and function even after the age of 50 years; a decline by the age of 60 and above is seen especially in women. This can be attributed to many factors both medical and psychological and may be different for men and women. Sex drives also vary a lot between individuals, therefore highly sexually active 60 or 70 year olds may not be entirely uncommon. In fact some studies show that ageing can be liberating, freeing people from societal expectations so they can express themselves more freely sexually. On the other hand in more conservative countries, sex between the elderly may be looked down upon or considered a taboo. This may further affect an elderly person’s sexual drive.

Cause

Waning sexual drive in the elderly  can be due to a number of factors:

Women                                                                                                                                                                           Lack of estrogen: Menopause occurs because the ovaries gradually cease to ovulate and release estrogen and progesterone. The reduced availability of estrogen causes a number of menopausal symptoms which can affect sexual function and desire. When estrogen is not produced sufficiently, vaginal dryness may occur. In menopausal women, the vaginal mucosa also shows decreased vascularity and begins thinning. Additionally, chronic estrogen deprivation can cause the labia to lose firmness and to become less sensitive to tactile stimulation.

Many post menopausal women also experience atrophic vaginitis, a condition leading to thinning of the endometrium (uterine lining) and decreased vaginal lubrication. It is also accompanied by increased susceptibility to vaginal and urinary infections.                                                                                                      All these factors may result in abdominal discomfort with penile penetration and possibly painful sexual intercourse. Longer time may be needed for lubrication and for arousal; therefore it is not surprising that this leads to a loss in sex drive.

Loss of testosterone: Some studies show that lower sex drive has more to do with testosterone related changes than estrogen effects. Testosterone is thought to play a role in maintaining sexual health in women and its levels fall drastically during menopause. There is clear evidence to show that this loss of testosterone can lead to a loss of sexual desire and sexual pleasure, feelings of diminished physical well-being, and persistent fatigue.

Other problems may include common age related health issues such as breast atrophy and bladder and bowel problems, leaving elderly women less open to a sexual experience.

 

Men                                                                                                                                                                        Hormonal reasons: Testosterone levels also decline with age for men, however the fall is not as drastic compared to women. Therefore male libido may not decline as much as a woman’s. In some cases though, endocrinal disorders may affect testosterone release leading to a loss in sex drive.

Erectile dysfunction (ED): With age, most men show decreased penile responsiveness. This has to do with nerve function and blood flow. Erections then occur more slowly and require increased physical stimulation. In extreme cases, one can develop ED, which is the inability to have and maintain an erection for sexual intercourse. This too may contribute to decreased sexual drive.

Both elderly men and women experience various emotional and psychological issues such as depression, loneliness and embarrassment and anxiety due to body image issues and health problems. All these can further exacerbate a declining libido.

Risk Factors:

The presence of many medical conditions may impair sexual drive in the elderly: obesity, arthritis, sleep apnea, diabetes, heart disease, high cholesterol and high blood pressure. Medication required to treat these conditions is at times known to affect sexual performance as well as sexual desire. In addition, antidepressants and anti-anxiety drugs and opioid pain relievers are also found to be detrimental to one’s sex drive.

Diagnosis

A physician may be consulted if an elderly person is concerned about his or her decreasing sex drive. The doctor can determine possible causes by examining a person’s medical history, performing a physical exam and running lab tests.

Treatment

Once the underlying cause for decreased sex drive has been determined, the doctor can recommend appropriate treatment.

Hormone therapy: may be recommended for both men and women. Concurrent estrogen and testosterone therapy in women has been linked to increased sexual activity, satisfaction, pleasure, and  frequency of orgasm. Estrogen creams applied to the vagina have also been used to treat vaginal dryness.

Viagra and other drugs which treat erectile dysfunction may be prescribed to help sexual performance.

In some cases, where medication being used to treat other health conditions is interfering with sex drive, alternatives may be recommended.

Counseling is also an option when sexual desire is affected due to psychological problems such as depression and anxiety.

 

Prevention

A fulfilling sexual relationship is an important part of most people’s lives and most men and women want to continue experiencing physical intimacy throughout their lives even at an elderly age. Doctors can play an important role in helping the elderly understand the changes their bodies are going through. In addition elderly men and women can themselves adapt to the changes in their body and be more open to exploring new ways such as increased foreplay and stimulation to have a more satisfying sexual experience.