Aging and Sexual Function

With normal aging, persons require more time to become sexually aroused. Although some persons perceive this gradual slowing as a decline in function, others do not consider it an impairment because it merely results in men and women taking more time to achieve orgasm.

Changes in men: In addition to slowing of arousal, elderly men may notice less preejaculatory fluid and less forcefulness at ejaculation. The erection is less firm and shorter-lasting. After orgasm, elderly men take longer than younger men to achieve another erection. Unlike women, who undergo a physiologic climacteric, men often remain fertile throughout life.

Erectile dysfunction is a common concern for many men. Although the incidence of erectile dysfunction increases with age, aging per se is not the cause. Drug treatment helps some men with erectile dysfunction.

Changes in women: Women usually can maintain sexual functioning throughout life unless a medical disorder intervenes. Women tend to be less concerned than men about sexual performance but are more worried about loss of youthful appearance or sexual attractiveness. The frequency of sexual activity for women often relates to the age, health, and sexual functioning of their partner (or the availability of a partner) rather than to their own sexual capacity or desire.

For women, most sexual changes occur during menopause, when estrogen production slows. These changes may include atrophic vaginitis, with dryness of the vaginal mucosa leading to irritation or pain during intercourse. The ability to engage in pleasurable intercourse may be further compromised by age-related shortening and narrowing of the vagina. Less acidic vaginal secretions increase the likelihood of vaginal infections. Cystitis is more common in elderly women than in younger women because of the changes from atrophic urethritis. Decreased estrogen levels can lead to a reduction in clitoral size, stress incontinence, and an increase in facial hair. However, estrogen replacement therapy prevents or reduces many of these problems, and some women enjoy sexual activity more after menopause because pregnancy is not an issue.

Many women are skeptical about the benefits of estrogen, are concerned about its risks, and may experience "estrogen anxiety." The decision whether to use estrogen should be made by a woman and her physician through careful weighing of the risks and benefits. Nonestrogen measures (eg, water-based vaginal lubricants such as K-Y Jelly) can help prevent or control vaginal dryness and irritation during intercourse.