As we age, the desire to have a good quality of life includes being sexually active. According to the National Council on Aging, it is normal for men and women to see a decline in their libido (sex drive) as they age. This can also be complicated by several things, including age related hormonal changes, chronic disease, depression, medication, lifestyle, loss of spouse, new relationships, and concerns regarding increased risk of sexually transmitted diseases (STDs). Your primary care doctor can be the first person to help you with these concerns.
In my almost 30 years of practicing medicine, I have seen and talked to many of my older patients about intimacy and sexuality. While no two people are exactly alike, below are the most common questions and the advice I have given to them.
Be honest.
Many people over 60 have a hard time getting past the embarrassment of talking about their sex life, even with a doctor, and especially if their doctor is of the opposite sex.
I always tell my patients it is important for them to know I am there to listen to their questions and concerns and give advice with no judgement or preconceived prejudices. I also remind them they’re not the first person asking these questions and certainly won’t be the last. I am here to help them stay healthy and continue enjoying a high quality of life. Therefore, it is vital for them to talk to me openly about any questions or concerns they have around sex.
Medical issues that impact intimacy and sexuality.
Here are some common medical issues patients can experience.
Men
○ Erectile dysfunction (ED)
○ This is when a man has trouble achieving or maintaining an erection. Since there are multiple things that may cause ED, it is important to discuss these with your doctor so you can discuss how to tailor the treatment to meet your specific needs. Treatments may include medication adjustment, Sildenafil (Viagra), Tadalafil (Cialis), implants, penile injections, pumps, and testosterone treatment.
○ Low libido
○ Treatment often consists of testosterone replacement therapy if testosterone levels are low. Patients need to be monitored by their primary care doctor or urologist to look for side effects.
Women
○ This is present when the tissues of the vagina become dry and un-lubricated. Initial treatment is for patients to use non-medicated, unscented over-the-counter lubricants every time they have sex and in between as needed.
○ If this doesn’t work, your doctor can prescribe a topical or oral hormonal therapy, for a short period of time. These treatments are also available in tablet forms.
○ Low libido
○ Treatment can consist of Dehydroepiandrosterone (DHEA) preparations and response is monitored through the patient’s primary care doctor or gynecologist.
I recommend to all my patients that they get a physical exam before starting any treatment plan.
Practice safe sex.
It is important you and your partner(s) be screened for any sexually transmitted diseases (STDs) before you start having sex.
What to know about STDs:
○ These are prevalent in the aging population.
○ Prevention is still key. Using barrier protection (condoms/dental dams) on your person and sex toys is strongly recommended.
○ Testing is done using blood and urine samples.
○ Treatment is recommended for patient and their partner(s) and can usually be started by your primary care doctor.
Older patients tend to tolerate symptoms for a longer period of time, including pain during sex, urination or defecation. As these symptoms are similar to a normal urinary tract infection, I recommend patients see their primary care doctor immediately upon onset of symptoms so they can begin appropriate treatment immediately.
The most important thing I want for all my patients, especially those over 60, is for them to realize their health and quality of life is worth overcoming any embarrassment that may come from talking about their sex life.
Nagma Lott, MD, is a family doctor and geriatrician.