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Sexuality Changes throughout the Life Span

Lorraine Benuto, Ph.D., edited by C. E. Zupanick, Psy.D.

Changes across a person's lifespan also affect what is considered normal and healthy. Aging, and related physical concerns, may have an effect on sexuality. Different concerns face men and women at different ages as well. There are also many stereotypes and myths about older adults and sexuality.

When determining what is "normal" or "healthy" it is important to keep in mind that sexuality changes throughout the life span. One "becomes" an older adult at the age of 65. In 2010, according to United Nations Population Division estimates, there were 523 million people over the age of 65. The World Health Organization reports that the number of people today aged 60 and over has doubled since 1980, and the number of people that are 80 years old will almost quadruple to 395 million between now and 2050. Despite negative stereotypes of older adults not being interested in sexuality, research has demonstrated that older adults do remain quite interested in sex well beyond the age of 70. A recent national study indicated that sexual interest remains in the moderate to high range for the majority of women and men in their 70s. In terms of engaging in sexual behaviors, 54% of men and 21% of women ages 70-80 report having sex within the past year and approximately 25% reported having sexual intercourse more than once a week (Hillman, 2008). If we consider that overall the average American couple has sex once per week (Stritof & Stritof, 2004), it seems that age does not necessarily impact frequency of sex. On the other hand, partner availability seems to greatly impact the type and frequency of sexual activity particularly for older, non-married women who significantly outnumber their male counterparts (Hillman, 2000).

Certainly, several health conditions associated with the natural aging process can impact sexuality. For women, menopause represents a normal, long-term biological change that can affect sexuality in various ways. With the start of menopause, the amount of estrogen present in the body declines. The muscles in the vagina receive less blood flow and become less elastic and begin to deteriorate. Women may also experience vaginal dryness as the amount of natural secretions in the vagina decreases. This may cause intercourse to be painful.

An additional physical change that comes with menopause is the loss of reproductive ability. Women can no longer become pregnant. Without the fear of becoming pregnant, some women may find themselves enjoying sex even more. For other women, their entire perception of themselves may change. They may have a hard time viewing themselves as a woman because they can no longer bear children. This may result in feeling undesirable.

While men do not experience menopause, the level of testosterone in body decreases with age. This prompts some health professionals to use the terms "andropause." Because testosterone plays a large role in sexual desire and arousal, its natural decline during the aging process is thought to impact sexual desire and arousal in both men and women.

Chronic and serious illness can impact sexuality. This can happen both in terms of interest, and participation in sexual activity and can happen regardless of the person's interest or desire. The risk for chronic and serious illness increases as we age. Some examples of these illnesses include arthritis, diabetes, heart disease, and cancer. Arthritis can cause sexual activity to be uncomfortable, or even painful. Conditions such as heart disease and stroke may create fear about engaging in sexual activity. Diabetes impacts blood flow and can even cause nerve damage, which can lead to vaginal dryness in women, and erectile difficulties in men. Finally, cancer (and its treatment) can certainly impact sexual function (Forrester-Anderson, 2005). In fact, the harsh side-effects of cancer treatment can impact the hormone-producing organs (testes and ovaries), which in turn, affects the amount of sex hormones available in the body. Physical health can change across a lifespan and influences what is considered normal or healthy.

The above discussion includes how diminished health in older adulthood can negatively impact sexuality. However, older adulthood may also bring increased comfort for many adults. For most adults, the aging process includes a new freedom associated with decreased parenting responsibilities. This change due to an "empty nest," combined with the start of retirement, can provide a long-awaited time to spend together. Retirement may provide new opportunities for shared experiences, may enhance intimacy and improve sexual functioning. Changes throughout the lifespan may affect sexuality in both positive and negative ways.

So far, we have tried to define "healthy" sexuality and identify some things that influence that definition, such as age, gender, and illness. Now we will review the history of sexual science, focusing on what has led us to our present view of sexuality.