Sex And Little Worries

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Sexuality and Intimacy in Older Adults

Sexuality and Intimacy in Older Adults

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Sexuality is the way we experience and express ourselves sexually. It involves feelings, desires, actions, and identity, and can include many different types of physical touch or stimulation. Intimacy is a feeling of closeness and connectedness in a relationship that can occur with or without a physical component.
Aging brings life transitions that can create opportunities for older adults to redefine what sexuality and intimacy mean to them. Some older adults strive for both a sexual and intimate relationship, some are content with one without the other, and still others may choose to avoid these types of connections.
The following information is for older adults who want sexuality and intimacy in their lives. Included are common aging-related challenges and opportunities, and approaches to consider making the most of individual situations in these areas.
Sexuality is often affected by one’s emotional and physical state. How you physically feel may affect what you are able to do and how you emotionally feel may affect what you want to do.
Many older couples find greater satisfaction in their sex lives than they did when they were younger. They may have fewer distractions, more time and privacy, and no worries about getting pregnant. They also may be better able to express what they want and need, which can offer an opportunity for greater intimacy and connection.
Normal aging also brings physical changes that can sometimes interfere with the ability to have and enjoy sex. As we age, our bodies change, including our weight, skin, and muscle tone. Some older adults don’t feel comfortable in their aging bodies. They may worry that their partner will no longer find them attractive. Health conditions can cause physical problems, along with stress and worry, that can get in the way of intimacy or enjoying a fulfilling sex life.
Two common changes that older adults experience are related to the sex organs. The vagina can shorten and narrow, and the vaginal walls can become thinner and stiffer. For most, there will be less vaginal lubrication, and it may take more time for the vagina to naturally lubricate itself. These changes could make certain types of sexual activity, such as vaginal penetration, painful or less desirable.
With age, impotence (also called erectile dysfunction, or ED) also becomes more common. ED is the loss of ability to have and keep an erection, and the erection may not be as firm or as large as it used to be. ED is not a problem if it happens every now and then, but if it occurs often, talk with your doctor.
Menopause is another change that may affect sexuality and intimacy in older adults. During a woman’s menopausal transition , which can last for a number of years and ends when she has not had a period in 12 months, there may be a variety of symptoms. These can include hot flashes, trouble falling and staying asleep, and mood changes. The desire to have sex may increase or decrease. Women using hormone therapy to treat hot flashes or other menopausal symptoms may experience a considerable boost in sexual interest and drive.

Some illnesses, disabilities, medicines, and surgeries can affect your ability to have and enjoy sex.
Alcohol. Too much alcohol can cause erection problems in men and delay orgasm in women.
Arthritis. Joint pain due to arthritis can make sexual contact uncomfortable. Exercise , drugs, and possibly joint replacement surgery may help relieve this pain. Rest, warm baths, and changing the position or timing of sexual activity can be helpful.
Chronic pain. Pain can interfere with intimacy. It can also cause tiredness and exhaustion, leaving little energy or interest in sex. Chronic pain does not have to be part of growing older and can often be treated. But, some pain medicines have effects on sexual function. Always talk with your health care provider if you have side effects from any medication .
Dementia. People with some forms of dementia may show an increased interest in sex and physical closeness , but they may not be able to judge what is appropriate sexual behavior. People with severe dementia may not recognize their spouse or partner but may still desire sexual contact. They may sometimes even seek this with someone else. It can be confusing and difficult to know how to handle this situation. Talking with a doctor, nurse, or social worker with training in dementia care may be helpful.
Depression. Lack of interest in activities you used to enjoy, such as intimacy and sexual activity, can be a symptom of depression . If you think you’re depressed, talk with your health care provider about possible treatments that will not further interfere with desire.
Diabetes. This is one of the illnesses that can cause ED. In most cases, medical treatment can help. When not well controlled, diabetes can lead to yeast infections, which can cause itching and irritation and make sex uncomfortable or undesirable.
Heart disease. Narrowing and hardening of the arteries can change blood vessels so that blood does not flow freely. For some, it may take longer to become aroused, and it may be difficult to have or maintain an erection. As a result, this can make it difficult to achieve an orgasm. People who have had a heart attack, or their partners, may be afraid that having sex will cause another cardiovascular incident. Even though sexual activity is generally safe, always follow your doctor’s advice.
Incontinence. Loss of bladder control or leaking of urine is more common as people grow older. Extra pressure on the belly during sex can cause urine to leak. This can be helped by changing positions or by emptying the bladder before and after sex. The good news is that incontinence may be treated with medical treatments, bladder control training, and behavioral and lifestyle changes.
Medications. Some drugs can cause side effects that interfere with sex, such as ED, difficulty ejaculating, difficulty with arousal and orgasm, reduced sexual desire, and vaginal dryness. Drugs that can cause these problems include some blood pressure medicines, antihistamines, antidepressants and drugs for other mental health conditions, sedatives, medications for Parkinson’s disease or cancer, appetite suppressants, and anti-ulcer drugs. If you experience any of these side effects, check with your health care provider to see if there is a different drug you could take.
Obesity. Adults with overweight or obesity have an increased risk of erection problems.
Peyronie’s disease. This is a disorder in which scar tissue forms under the skin of the penis and pulls on the surrounding tissues, causing the penis to curve or bend, usually during an erection. Curves in the penis can make erections painful and may make sexual intercourse painful, difficult, or impossible. If you are affected by Peyronie’s disease , discuss treatment options with a doctor.
Stroke. The ability to have sex is sometimes affected by a stroke . A change in positions or medical devices may help people with ongoing weakness or paralysis to have sex. Some people with paralysis from the waist down are still able to experience orgasm and pleasure.
Surgery. Any kind of surgery can cause worry, and this can be even more troubling when the breasts or genital areas are involved, such as with the surgeries listed below. Most people are able to return to the kind of sex life they enjoyed before surgery. For some, these types of surgeries may even help them to increase their sex life options.
For some people, talking with their health care provider about sexual problems may feel uncomfortable. It’s important to remember that these are topics your doctor needs to hear about to treat you most effectively. You may also consider speaking with other physical and mental health professionals, such as a nurse or therapist. Many health care providers now use online patient portals through which people may feel more comfortable opening a discussion with their health care team.
Age does not protect you from sexually transmitted diseases (STDs). Older people who are sexually active may be at risk for diseases including syphilis, gonorrhea, chlamydial infection, genital herpes, hepatitis B, genital warts, and trichomoniasis.
People who are sexually active, no matter their age, may also be at risk of being infected with HIV, the virus that causes AIDS. In fact, the number of older people with HIV/AIDS is growing. You are at risk for HIV/AIDS if you or your partner has more than one sexual partner, if you are having unprotected sex, or if either you or your partner is sharing needles.
To protect yourself, always use a condom during vaginal or anal sex and use a dental dam or other barrier method during oral sex. Learn more about using condoms , dental dams , and other ways you can prevent STDs .
Talk with your health care provider about ways to protect yourself from STDs and infections during your regular check-ups and if you have any concerns between visits. Remember, you are never too old to be at risk.
People who identify as part of a sexual and gender minority (SGM) group, such as lesbian, gay, bisexual, transgender, or queer, may experience additional difficulties with sexuality in later life. For example, studies have found that:
Researchers are partnering with people in SGM communities to learn more about the health disparities and other factors affecting these groups. For example, the Aging with Pride: National Health, Aging, Sexuality and Gender Study (link is external) , funded in part by NIA, is a long-term effort involving more than 2,000 older adults to better understand the aging, health, and well-being of SGM populations and their families.
Years of hiding their identity and other factors can cause stress and fear that may make it difficult for SGM older adults to talk openly with doctors or other health care providers. If you’re not comfortable talking with your doctor, it may be helpful to talk with another medical professional like a nurse or medical assistant. Learn about talking with your doctor about sensitive topics .
Many organizations maintain provider directories that can help connect people to local health care providers with appropriate experience and expertise, such as the CDC’s LGBT Health Services and World Professional Association for Transgender Health (link is external) . The organizations listed below may also have helpful information for SGM older adults.
There are approaches you can take for an active and enjoyable sex life. If you have a partner, talk openly with them about the changes you are experiencing, and try not to blame yourself or your partner. Take time to enjoy each other and to understand the changes you both may be facing. This time in your life can be an opportunity to form more intimate bonds and explore your sexual relationship in a new way.
You may also find it helpful to talk with a therapist, either alone or with your partner. Some therapists have special training in helping people with sexual problems. If you sense changes in your partner’s attitude toward sex, don’t assume they are no longer interested in you or in having an active sex life with you. Many of the things that cause sexual problems in older adults can be rectified.
For example, if you are experiencing pain due to vaginal dryness, your health care professional or a pharmacist can suggest over-the-counter lubricants or moisturizers to use. Water-based lubricants can be used to make sex more comfortable, whereas moisturizers can be used regularly over time to replenish moisture and reduce dryness. Your provider also might suggest prescription hormones, such as a vaginal estrogen , or nonhormone medications that are also approved by the U.S. Food and Drug Administration to treat painful sex.
If ED is the problem, it can often be managed with medications or other treatments . A health care professional may suggest lifestyle changes, such as limiting alcohol or increasing physical activity, to help reduce ED. A health care professional may also prescribe testosterone for people with low levels of this hormone. Although taking testosterone may help with ED, it may also lead to serious side effects and can affect how other medicines work. Make sure to talk with your health care provider about testosterone therapy and testing your testosterone levels. Be wary of any dietary or herbal supplements promising to treat ED. These products may have dangerous side effects or interact with prescription medicines. Always talk to a health care provider before taking any herb or supplement. Another important reason to see your health care provider for ED is that it may be a sign of an underlying health problem that should be treated, such as clogged blood vessels or nerve damage from diabetes.
Physical problems can change your sex life as you get older. If you are single, dating may be easier later in life when you’re more confident and sure of what you want. If you’re in a relationship, you and your partner may discover new ways to be together as you grow older. Talk to your partner or partners about your needs.
American College of Obstetricians and Gynecologists
800-673-8444
resources@acog.org (link sends email)
www.acog.org (link is external)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
800-860-8747
866-569-1162 (TTY)
healthinfo@niddk.nih.gov (link sends email)
www.niddk.nih.gov
MedlinePlus
National Library of Medicine
www.medlineplus.gov
Services & Advocacy for Gay, Lesbian, Bisexual & Transgender Elders (SAGE)
212-741-2247
info@sageusa.org (link sends email)
www.sageusa.org (link is external)
The World Professional Association for Transgender Health (WPATH)
www.wpath.org (link is external)
This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.

Content reviewed:
April 18, 2022

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Elizabeth Scott, PhD is an author, workshop leader, educator, and award-winning blogger on stress management, positive psychology, relationships, and emotional wellbeing.
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From worrying about money to deadlines at work, everyday stress can affect your sex drive. And low libido can exacerbate stress by causing relationship issues or lowered self-confidence. So, improving the way you manage stress is important, because it may improve your sex life as well.

When you encounter stress, your body goes through a series of changes in order to prepare you to run away or stay and fight. This is known as the fight or flight response . As part of the fight or flight response, you may experience an increase in heart rate, blood pressure, and breathing rate while non-essential functions, like sex drive, are acutely diminished. 2

This response also triggers the release of hormones, such as cortisol and epinephrine , which in high levels can cause decreased sex drive. When stress is chronic, the body uses sex hormones to meet the increased demands for higher cortisol production, decreasing interest in sex. 3

In addition to the physiological effects of stress, there is also a psychological aspect. Stress can cause you to have a busy, frazzled mind, and distract you from wanting sex or being present during sex. It can also impact your mood, leading to anxiety and depression, both of which can diminish libido. 4

Uncontrolled stress can lead to unhealthy habits such as smoking, drinking, and overeating and poor lifestyle choices like lack of self-care and exercise. These shifts can influence how you feel about yourself and interfere with a healthy sex life.

If your stress response isn’t reversed, it can contribute to a condition known as chronic stress , impacting your physical health in many
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