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Active Living
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A Healthy Balance
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Active Kids, Healthy Kids
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Childbirth
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Advice from the Maternity Clinic
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Introduction
Managing Your Pain
Movement Matters
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When Pain Doesn't End
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Smiling through the Senior Years
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Tobacco Risks to Oral Health
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DIABETES
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10,000 Steps
A1C Test
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Alchohol and Diabetes
A Diabetes Success Story
ABCs of Diabetes Management
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Benefits of Insulin
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Canada Food Guide Revisited
Carbohydrate Counting
Catastrophic Drug Plan
CDA Guidelines for Diabetes
Celiac Disease and Diabetes
Celebrating Health
Childhood Diagnosis of Diabetes
Children and Type 2 Diabetes
Cholesterol-lowering Medications
Colds and Diabetes
Constipation
Continuous Blood Glucose Monitoring
Cutting Edge
Dangers of Uncontrolled High Blood Pressure
Debunking Diabetes Myths
Driving and Diabetes
Diabetes and Menopause
Diabetes and OTC Medications
Diabetes Care Team
Diabetes and Celiac
Diabetes and Depression
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Diabetes Distress
Diabetes Eating on a Shoestring Budget
Diabetes Etiquette
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Diabetes in Cats
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Diabetes Management ABCs
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Diabetes Myths
Diabetic Ketoacidosis
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Diet Tips for South Asians
Dining Out
Drinking and Diabetes
The Discovery of Insulin
Eating Disorders
Easing the Strain of Stress
Eating to Protect Your Kidneys
Eating Well During Shift Work
Eggs in a Diabetic Diet
Emotional Eating
Emotions of Diabetes Diagnosis
Erectile Dysfunction
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Why Fad Diets Fail
Fats
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Fill Your Day with Energy
Financial Support for Diabetes
Food Temptation
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Gestational Diabetes
Get Active
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Gift Ideas
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Going Green in the Kitchen
Grocery Shopping Tips
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Holiday Party Survival Guide
Health Information on the 'Net
Healthy Happy Holidays
Healthy Beverage Choices
Health Benefits of Soy
Healthy Restaurant Meals
High Blood Pressure and Diabetes
High Blood Pressure
HbA1c Test
Healthy Eating for Active People
High Blood Lipids
Home from the Hospital
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Immunization & Diabetes
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Injecting Insulin
Insulin Discovery-The Story
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Immunization and Diabetes
Internet Health Sites
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Kidney Disease - Reducing the Risk
Living with Diagnosis of Diabetes
Living Powerfully with Diabetes
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Your Medication Expert
Medication Research Studies
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Microalbuminuria
New Diabetes Technologies
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No Need for Insulin?
Not Snoozing
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Diabetes and OTC Medications
Pedicure Precautions
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Pet Diabetes
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Safe and Successful Travel
Schizophrenia and Diabetes
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Setting Health Goals
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Sharps Disposal
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Sleep - a Missing Link
Smart Snacking
Smart Summer Nutrition
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Solving the Insurance Puzzle
Stress and Diabetes
Success in School
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Supporting Spouse with Diabetes
Sweeteners
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Think Positive with Diabetes
Tiny Bites Equal Big Calories
Travelling with Diabetes
Tips for a Better You
Tobacco Use and Diabetes
Top 10 Reasons to Exercise
Treating Low Blood Glucose
Treating Hypoglycemia - Role of Glucagon
Tune up Your Diet
Type 1.5 Diabetes
Type 2 Diabetes
Understanding Diabetes
Understanding Diabetes Medications
Understanding Ketones
Used Sharps
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Vacationing with Diabetes
Vegetarian Eating for Diabetes
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Walking
Wise Choices About Natural Medicines
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World Diabetes Day
Your Medicine Cupboard
Zimbabwe Hand Jive
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ADHD in Children
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Aspirin Every Day?
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Canada's New Blood System
Caring for a Loved One Dying at Home
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Planning for End of LIfe
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Schizophrenia
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Diet Reality Check
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Healthy Diet, Healthy Smile
Healthy Eating for Boomers and Zoomers
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Feeding Your Kids
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Food Chemistry 101
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Healthy Eating for Teens
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New Ingredients for Your Shopping Cart
Iron
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Nutrition Questions Top 5
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Power of Fruits & Veggies
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Pharmacy Care
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After a Heart Attack
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Changing Role of the Pharmacist
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15 Great Reasons to Breastfeed
Anemia
Approaching Menopause
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Breast Cancer Screening Guidelines Changes
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xx
Sexually Transmitted Infections
Urinary Incontinence
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Viagra for Women
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Your Pelvic Floor
Family Health Online / Pharmacy at Safeway
Family Health Magazine - growing older

Sexual Expression at Any Age
Older people enjoy sex too!

The idea that sexuality belongs only to the young is a myth. In fact, older adults can, and do, continue to express sexuality into and even beyond their 80s and 90s. Some changes in sexual expression tend to occur with age. However, many problems in sexual function that we tend to link with aging are not actually a result of getting older. More commonly, they are due to specific illnesses or drug side effects.

The entertainment industry tells us, with some exceptions, that we must be as young and beautiful as a movie star to be sexual. Older adults are rarely seen as sexual beings. Exceptions, including the television show The Golden Girls, and the film Something's Gotta Give, are few and far between. Aging is seen as something to be avoided at any costs. Just take a look at the recent reality shows involving plastic surgery!

We tend to think that once people are seniors, they no longer have sexual desires, needs, or abilities. If a senior expresses the same sexual interest as his younger counterpart, he may be thought of as a dirty old man. Older women who express their sexuality as they did when they were younger may be seen as oversexed or loose. As negative stereotypes are repeated time after time, we start to believe them.

Interestingly, it is largely western culture that has the idea that older adults are not, or should not be, sexual. One study done about 25 years ago looked at 106 different cultures.It found that sexuality among older adults is common and accepted throughout most of the world.

Sadly, we have been trained to think that with aging comes the end of sex. Believing a myth can make it a reality. Many of us think of our own aging negatively. We believe that our sexual interest and ability will decline. We assume that the game is over with the first change in function related to age. Sadly, we may stop pursuing relationships with others or feel ashamed of sexual feelings, thinking they are abnormal.

Sometimes friends and relatives give the message that we should no longer have sexual feelings. As one 82-year-old man put it, 'My friends keep telling me I'm too old to have these feelings and should forget about it. But I do feel this way and I don't feel I should have to forget about it or not do anything about it just because I'm 82. It is a big part of my life.'

In the senior years, most of us are experiencing significant losses in other areas of life. We may be retiring from work, our physical health may decline, and partners and friends may die. Continuing intimacy can bring many benefits, but sadly it seems forbidden.This is especially true for older adults living in institutional settings or with adult children. In these situations, intimacy tends to be discouraged other than in the most platonic (non-sexual) forms.

Sexuality is a lifelong need. As we age, our expression of sexuality may change. It may go from an emphasis on genital contact or intercourse, to broader expressions of intimacy including caressing, cuddling and other more sensual experiences. Some older adults say that this shift in focus makes sex much richer. Those who are open to trying new ways of expressing intimacy may find this particularly true. Sexual function in older adults can be affected as a natural part of the aging process, because of illness or injury or for psychological, social or environmental reasons.If losses in function mean that the tried and true no longer brings satisfaction, experimentation is worthwhile.

Useful Resources

There are also some good reading materials regarding sexuality and aging that are now widely available through bookstores and some libraries.

Books

One good example is The New Love and Sex After 60 by Robert Butler and Myrna Lewis (Ballantine Books 2002).

Websites

There are also many interesting sites that provide information regarding sexuality and aging, although it is important that information is gathered from reputable sites as misinformation is common.

Government of Canada

US National Institutes of Health

Calgary Health Region

Society of Obstetricians and
Gynecologists of Canada

Health Link Alberta

50 Plus

American Association of Retired Persons

Women

Most natural aging changes in women are related to the hormonal shift of menopause. Decreased lubrication and reduced elasticity, thinning of the vaginal wall, and decreased length and width of the vagina can all be part of this process.These changes can make sex painful. Lubrication, either over-the-counter or prescription, is often necessary.

It has been suggested that continuing to have sex can slow physical changes, such as the decreased length and width of the vagina. Certain exercises may help to stretch the vagina if it does become smaller. With time, the genital area may become less sensitive to touch. It may take more time to become physically aroused to sexual stimulation. For some women, hormone changes are accompanied by a decrease in sexual desire. Pain during intercourse, depression, or side effects of medications can also contribute to loss of libido. Others report an increase in sexual desire following menopause, which, for some, is due to no longer having to worry about getting pregnant. On a positive note, the ability to orgasm (sexually climax) typically does not change with age, although vaginal contractions may be weaker.

Men

Senior men, as well as women, may find that physical arousal takes more time. In other words, erections (hardness of the penis) can take longer to achieve. More direct touch for a longer period of time may be required to achieve and maintain erections. The sight of an attractive person may no longer be enough to bring on a full erection, in spite of strong feelings of desire. Erections may not be as firm or large as in younger years and they may be lost more quickly after orgasm.

Ejaculation can also be delayed. This can be a good thing as pleasurable feelings can continue to build for a longer period of time. Both partners may enjoy sex more when they understand that this is normal and the delay is not significant. The length of recovery time needed between erections (called the refractory period) may increase with age. In some cases, this changes from minutes to hours, or even days. As with women, the ability to experience satisfying orgasms typically does not lessen with natural aging.

For both men and women, the bottom line is that sexual interactions can continue to be a pleasurable part of older adult's lives. Be patient with yourself and your partner, as the process can take longer. Understand the changes that are occurring, and try not to interpret slower reactions as lack of interest. Partners are sometimes accused of being unfaithful when arousal takes longer due to aging or illness.

Physiological signs of sexual interest, such as erection or lubrication, do not necessarily indicate the degree of desire. These may be changed by many factors, including natural aging. Sometimes people notice these changes and feel that their sex life is over. The resulting grief and depression can also disrupt sexual functioning.

Chronic health conditions

As we age, our chances of developing a chronic health condition increase. One study has estimated that 75 per cent of older people have one or more chronic medical conditions. As medical conditions emerge, it can become more difficult to function both in general and sexually. Common illnesses that can affect sexual functioning include heart disease, diabetes, stroke and rheumatoid arthritis. Effects vary depending on the condition.

Changes in physiological arousal, difficulty moving part of the body, and difficulty coping emotionally with changes caused by the illness can all be related. Both the person with the condition and their partner may fear that having sex will do more damage. This is particularly true in the case of heart disease and stroke. With a few changes, most people can continue to interact sexually after illness or injury. Talk to your doctor about any restrictions or changes that may be needed for safety reasons.

Bowel or bladder incontinence may be a concern for some people. Many people with these difficulties are hesitant to have sexual activity for fear of an 'accident.' There are many ways to treat or manage incontinence. Your doctor or sexual health professional can help you with these concerns. Some physiotherapists also specialize in the treatment of some types of incontinence.

Substance use

Nicotine, chronic heavy alcohol use, and some illegal drugs can permanently change sexual functioning. The nerves controlling sexual function and blood flow to the genital area are most often affected.

Medications

Many common medications can affect sexual desire and sexual functioning. These include some antidepressants, birth control pills, blood pressure, diabetes and heart disease medication. Side effects may include decreased desire, difficulty or inability to achieve an erection, and difficulty reaching orgasm. Do not immediately stop taking medication if you think it may be affecting your sexual function. This may cause harm. Instead, talk to your doctor, as a change in dose or medication may solve the problem.

Psychological, social, and environmental factors

Many other factors can affect the sexuality of older adults. Imagine how losing a partner, feeling guilty about being with a new partner, or feelings about your own aging might affect how you express sexuality. The attitudes of others towards sexuality and aging can have an effect. Those who are more sensitive to the attitudes of others may be particularly affected. Depression and anxiety can both play a role in sexual desire and expression. We may worry about the effects of aging on sexual performance, or about dating if we have not done so for decades.

Emotions about sexuality can affect not only desire but also the ability to become physically aroused. For example, if someone has experienced changes in his erections due to illness and is worried that he will not be able to have an erection during his next sexual encounter, he may become anxious before that event. Anxiety alone can prevent an erection. Usually those who have been sexually healthy throughout life and were more sexually active in their younger adult years are more likely to remain sexually active. Some lose interest in sex as they age. This is not really a problem unless it is creating relationship difficulties or the person is worried about it.

Many older adults report that the lack of a partner is their biggest barrier to sexual expression. Self-stimulation (masturbation) is a way to continue to experience the positive emotions and physical benefits of sexuality.
Where we live is often key to how we are able to express our sexuality. In most care facilities, there is little privacy and intimate sexual expression is discouraged. This is also generally the case for seniors living with their children. Some adult children are uncomfortable with their parents' sexuality, especially when a new partner is involved. While our culture seems to be more accepting of sexuality among elders, the change happens slowly and there are still many stereotypes.

Communication

Communication between partners is key. Many couples rarely talk about their likes and dislikes in the bedroom. We often assume that our partner knows what we want, or we do not want to hurt feelings by saying we dislike something.

Couples can learn to communicate with each other in a caring, non-judgmental way. Natural changes in function related to aging make this particularly important. For instance, a woman may find that hormonal changes have made her vagina dry. If intercourse is painful, she may be less interested in this aspect of sex. If her partner is unaware of this, he may assume she doesn't want or is angry with him. This can lead to hurt feelings and negative interactions in other aspects of the relationship. Talking about her discomfort can help solve many problems. The couple can explore alternatives that allow positive sexual interaction. They might include more foreplay and lubrication to help her become physiologically aroused. Talking about sexual problems protects the relationship on many levels.

Similarly, if a man is experiencing changes with his erections, his partner may feel there is a lack of attraction. In reality, there may be a physiological cause and many possible solutions to the problem. Simply increasing the length of time of manual stimulation of the penis may help. Without communication, relationship problems could develop. Couples who find this difficult may benefit from a few counselling sessions with a sexual health professional to help them communicate their sexual needs.

Other considerations

Many treatment options are now available for those whose chronic health difficulties interfere with sexual function or desire. Getting more information can help in adjusting to changes so that satisfying sexual interaction is still possible. Your family doctor may be able to help. For instance, medication can be used to treat difficulty with erections or changes in lubrication.

Depression and anxiety can lead to changes in sexual function, and treatment is available. Counselling by a regulated mental health professional with a focus in the area of sexual health may be of great help. Some health districts offer free programs that focus specifically on sexuality and illness or disability. Even those who have been severely ill or injured can have satisfying sexual and sensual interactions if some adaptations are made.

Sexuality does not stop on one's sixty-fifth birthday. Some changes in sexual function come as part of aging. However, if we are patient and willing to experiment a little, these natural changes of aging do not need to result in the end of sex. Indeed, those who understand the natural changes and have adapted often report that sexual intimacy is actually better in comparison to when they were young. We become less focused on the end result and more interested in the journey. Communication between partners and a willingness to try new methods of sexual stimulation help in developing a healthy sex life in older age.

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FAMILY HEALTH is written with the assistance of
College of Family Physicans of Canada
Alberta College of Family Physicians
FAMILY HEALTH is written
with the assistance of
The College of Family Physicans of Canada
Alberta College of Family Physicians
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2015, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 2S6    [GO_FHc11]
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