Sex after 50: How to hold on to the passion

Aging affects your whole body, so it's bound to have an impact on sex. A Mayo Clinic specialist offers tips for a satisfying sex life as you grow older.

Though movies and television might tell you that sex is only for the young and beautiful, don't believe it. The need for intimacy is ageless. Sex may not be the same as it was in your 20s, but it can still be as fulfilling and enjoyable as ever.

What aspects of sex are likely to change as you and your partner get older? How can you both adapt to those changes? Janice Swanson, doctor of psychology, a licensed psychologist and a specialist in human sexuality at Mayo Clinic in Rochester, Minn., has some answers.

Why is sexual health and aging such an important topic?

The changes your body goes through as you age impact your whole sexual experience — not just your sexual function. Sex education in the U.S. focuses largely on coming into adulthood and not on what happens to your body during the aging process. When confronted with the normal changes of aging, you may feel as ill-prepared and awkward about sex as you did during your first sexual experiences as an adolescent.

Not much has been written about this complex transition, but that's changing. People are living longer than they ever have before, and many have the expectation of being sexually active for the majority of their years.

Specifically, what can you do to maintain a satisfying sex life as you get older?

Most important, communicate with your partner. It sounds simple, but it can't happen unless you actually set aside time to be sensual and sexual together.

When you're spending intimate time with your partner, verbalize your thoughts about lovemaking. Tell your partner what you want from him or her. Be honest about what you're experiencing physically and emotionally as your body undergoes the inevitable changes of aging.

More generally, it never hurts to do some reading. Learn about sex during the second half of life. Often, books include helpful exercises and suggestions — such as sensual massage, different types of foreplay and sexual variety — that can help you.

How do the changes in men's bodies as they age affect sexual health?

For men, testosterone plays a critical role in the sexual experience. Men's testosterone levels are highest in their late teens. After that, they gradually fall throughout the lifespan. By the time men reach age 60 to 65, most will notice a difference in their sexual response. The penis may take longer to become erect, and erections may not be as firm. It may also take longer to achieve full arousal and to have orgasmic and ejaculatory experiences.

Another significant change is in the actual chemistry of an erection. A chemical the body produces to help sustain engorgement of the penis has a shorter duration of activity as men get older. Drugs such as sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) have been introduced to help with the general functioning of that biochemistry.

What physical changes in women as they age impact their sexual health?

As women approach menopause, they experience a hormonal transition very similar to the one they reached in adolescence — except that now, instead of starting up, their cycles are shutting down. The amount of estrogen their bodies produce declines. As a result, many women feel noticeably less receptive to their partners' sexual overtures. They also may miss that midcycle spark of interest that reproductive biology gave them. And because estrogen affects the brain, women may experience emotional changes as well.

What kinds of medical conditions can cause problems with sexual health?

Any condition that affects general health and well-being is also going to affect sexual function. Illnesses that involve the cardiovascular system, high blood pressure, diabetes, hormonal problems, depression or anxiety — and the medications used to treat these conditions — could pose a potential problem for your sexual health.

Your blood pressure, for instance, could affect your ability to become aroused, as could the medication you take to treat high blood pressure. For a man, this might mean difficulty in getting an erection. For a woman, it might affect how her clitoris engorges.

What people often don't think about is the emotional effects of having an ailment. After a heart attack, for instance, you could become depressed because the experience drove home the fact of your mortality. One of the symptoms of depression is the loss of pleasure or sexual interest. So even though the heart attack itself may have no direct effect on your sexual functioning, your emotions may disrupt it.

What can you do if you suspect your medications are having a negative effect on your sexual health?

Certain medications can inhibit each part of your sexual response, including your desire for sex, your ability to become aroused and your orgasmic function. If you think you may be experiencing sexual side effects from a medication, talk with your doctor. It may be possible to switch to a different medication with fewer known sexual side effects.

Don't let embarrassment keep you from asking for your doctor's help. But don't stop taking prescribed medication before discussing it with your doctor, either, even if that medication seems to be messing up your sex life. The results of quitting therapy can be much worse than the side effects.

The situation gets more complicated if you have to take not just one but several medications — each of which can have a different effect on your sexual function. In this case, sexual flexibility, including the type of sexual activity you engage in and how you approach it, can be helpful. Your sexual relationship can evolve to meet your changing medical circumstances.

How can surgical procedures have an impact on your sexual health?

Any surgical procedure that affects your pelvis and your central nervous system is going to have a temporary — but often significant — impact on how you respond sexually. Over the long term, though, the body is amazingly resilient. Given time for healing and some loving attention to stimulation, you can become sexually responsive again.

Is there any age at which you can stop being concerned about having safe sex?

No. People of all ages should remain vigilant about practicing safe sex. If you're having sex with new or different partners, talk with your doctor about your risk of sexually transmitted diseases.

If you're in a monogamous relationship, and you've both been tested twice, then you probably don't need to worry about protection. But you need to go through the process of finding out that you and your partner are disease-free. Until you know for sure, use condoms or some other form of protection.

What sexual health concerns are most common in long-term relationships, say 30 years or longer?

The most common concerns between couples are discrepancies of libido and maintaining passion for each other. Sexual concerns like these are normal. They're not a sign that the relationship is over. Instead, they're an opportunity for growth. If you don't know what's needed for you to grow or where to turn for help, you may avoid your partner's advances, rather than engage them. It's engagement that leads to growth and a much more fulfilling sexual experience for both of you.

What do you tell a couple when one wants to engage and one wants to avoid?

Couples can become polarized — one person initiates contact while the other avoids it. What's most helpful is to recognize that's what's happening. If you're the one who's mainly avoiding, you need to take charge of some engagement. And if you're the one who's already engaged, continue to tell your partner what you need, but try not to carry the sole responsibility for initiating every sexual experience.

Also helpful is to get an understanding — if you're in a heterosexual relationship — of how your opposite-sex partner's body really works. That way, you can appreciate the context of your partner's needs. It's often said that men have sex in order to feel close, and women need to feel close to have sex. You can find a middle ground, though. If men focus on being romantic and women put less effort into experiencing sex the same way men do, you can usually find the sexual flexibility that accommodates both your needs.

How can a couple adjust sexually when one partner becomes a caregiver to the other because of illness?

If you're the one who's ill, your sexuality may take a backseat to survival or treating your illness. Pain, discomfort, medications or worry can overshadow your sexual desire. If you're the caregiver, your sexual desire might be compromised by the stress of dealing with the situation or the demands of caring for your partner.

You both need to be able to grieve what's happening in your relationship. As a caregiver, be aware of your changing role. 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. That way, you can enjoy a mutually satisfying sexual encounter.

Where can a couple having problems find resources to help them out?

Start at a good bookstore with a well-stocked human sexuality section. You'll find helpful resources geared specifically toward sexuality during the second half of life. Beginning at a bookstore, rather than a video store, usually provides better references and resources for a couple seeking help.

Talk with your doctor if you and your partner have worked on a particular concern for six months and what you've tried just isn't working for you. Your doctor may be able to provide useful suggestions, or he or she can refer you to a sexual medicine specialist.

What are the main questions couples ask and how do you counsel them?

Often, couples ask, "What is normal?" There's a wide range of what's considered normal, and it varies depending on each individual and each relationship. More importantly, ask yourselves what is satisfying and mutually acceptable to the two of you. One partner may be ready for certain sexual experiences, but the other person isn't ready for that. You, as a couple, need to practice some sexual flexibility, understand where your bodies are in terms of age-related physical changes, and communicate your needs effectively.

Another question that comes up for couples in the second half of life is, "How do we handle these changes in our bodies?" Often, couples want to know how to get back sexual arousal and sexual activity that they experienced in their 20s, 30s and early 40s. Instead, think about how things are changing for you, and learn how you can optimize your body's response for sexual experiences in the here and now. This takes a combination of education, sexual flexibility, communication with your partner and understanding of each other's bodies.

Finally, couples often ask, "How do I tell my partner what I really need or what I really want?" You may be so worried about hurting your partner's feelings that you can't be candid about your needs. Deal with this concern by speaking about your own experience. Use "I" statements — such as "I think my body responds better when ... " or "I find that as I get older I need more touch all over my body ... " — to break down barriers in communication with your partner.