Ageing and Sex RH2008

Population studies
Film Clip
Practical issues
“Sex… is the deep delicious undercurrent
that runs beneath all our lives and
Rosie Scott
Language of sex
Two Languages
Quotations from
“You Are My Darling Zita”
by Glen Bush
Publisher Godwit 1991
Muriel Morrison
As we have become older the sexual act itself
has become very much less important …
Certainly there is a real need for kissing, hugging
and all kinds of gentleness. What we have now
is not less intimate, it’s just different.
We were funny creatures…
bursting our boilers to get there…
ejaculation… orgasm!
At our age any sort of pressure to perform is
long gone. What feels good now is to be
relaxed, quiet and just enjoy the moment
with John…
John Morrison
… the purely erotic side of my life has
practically gone, that I can now enjoy the
subtleties of affection and delight in
another's presence, that I am able to touch or
cuddle without the kind of sexual stimulus
that was inherent in that at a younger age that is a tremendous relief.
Now, you see, that may be hard for a young
person to understand
“Sex isn’t as powerful a need as when you are
young but the whole feeling is there; it’s nice
as it ever was. He puts his arms around you,
kisses you, and it comes to you – satisfaction
and orgasm - just like it always did ... Don’t let
anybody tell you different. Maybe it only
happens once every two weeks, but as you
get older, it’s such a release from tensions.
I’m an old dog who’s even tried a few new
tricks. Like oral sex, for instance …
We weren’t too crazy about it though …
We take baths together, and he washes my
body, and I wash his. I know I’m getting old
and my skin could use an ironing but we
love each other - sex is beautiful.”
Masters and Johnson (1966)
 700 subjects
 Only 31 over age 60!
 Physiological studies and photos during
intercourse and masturbation
 Established ‘phases’ of sex response
 Clitoral vs vaginal orgasm
 ? Activity forestalled age change in genitalia
The Older Male
 Testosterone ↓ - but variable
 Fertility ↓
 Penile atrophy
 Erection slower, softer, less sustained
 Orgasm awareness reduced
 Ejaculation – less fluid, force and duration
 Rapid detumescence, longer refractory period
 Libido peaks in 20’s, falls throughout life
 Erection is slower, softer, may need manual
 Needs time
The Older Female
 Oestrogen ↓
 Fertility lost
 Vaginal atrophy and loss of elasticity
 Breast atrophy
 Vaginal lubrication slower and reduced
 Orgasm shorter but NOT lost
 Libido peaks @ 30-40’s,maintained into 60’s+
The Older Female
 Vaginal lubrication is slower and decreased
 Needs time
 1940’s
 Landmark of sex research
 10,000+, 2 hr interviews
 300+ questions on sexual behaviour
 15 years to complete
Only 48 men and 31 women over 65yrs
That ! ! !
Duke Longitudinal Study
Verwoedt et al, 1970
254 people, age 60 - 94 yrs
Followed 3 yearly x 2
50% of 80 yr olds still moderate libido
20% of 80 yr old men still sexually active
15% all subjects increased libido / sex
(women 6%, men 25%)
- Why?
Duke Longitudinal Study
 Late marriages!
 30% married couples over 75 years sexually
 But overall decline in libido / sex
Determinants of Sexual
 Regression model on 502, 46 to 71yrs
 Past activity and enjoyment
 Being married
 In men being physically well
 Use it or lose it
Pfeiffer, Davis 1972
 Tendency for level of activity to be stable if
George, Stephen, Weiler 1981
Swedish X-Sectional Study
 1506 (F = 946, M = 560), 70 year olds
 1971, 1976, 1992, 2000
 As part of broader study of ageing
 Increasing proportions in later cohorts report:
 Sexual activity (M>F)
 Sexuality as a positive factor in their lives
Swedish X-Sectional Study
 Reporting sexual intercourse
 Married male:
 Married female:
 Single male:
 Single female:
52% to 68%
38% to 56%
30% to 54%
1% to 12%
Swedish X-Sectional Study
 Of those sexually active, later cohorts:
 Females
 Higher proportion report satisfaction and orgasms
 Males
 Higher proportion report high & low satisfaction
 Lower proportion report dysfunction
 Men not active due to personal reasons
 Women not active due to partner related
factors or no partner
Why Do
Sex ?
“In my experience older people stop having sex
for the same reason as they stop riding a bicycle
• general infirmity
• think it looks ridiculous
• no bicycle.”
Director Paul Cox
Sexuality – Practical Issues
 Ask your older patients about their sex
 They won’t faint !
Practical Problems
 Women
 Dryness
 Reduced interest
 Orgasm more difficult
 Men
 Early ejaculation
 Erectile difficulties
Important Issues
 Medications
 Diseases  impotence
 Surgery:
 prostate, uterus
Catheters, pessaries
Altered body image
 No partner
 No privacy
 Social conditioning