Older women have sex.
I’ll say it louder, just because it feels good.
OLDER WOMEN ARE HAVING ALL KINDS OF SEX.
Just wanted to get that out of the way for anyone who did not realize it or who just loves to see it recognized on the internet.
Too often in our society, older women are portrayed as asexual or uninterested in sex. Research funded by the National Institutes of Health—and the experiences of our friends and patients—tell us that this is just not true. The National Social Life, Health, and Aging Project (NSHAP) began in 2003 and gave researchers more data than ever before on how older Americans have sex. Among many other things, the study found that about 85% of older women aged 57 to 64 were in some kind of romantic or intimate relationship and that almost all of these relationships involved some type of sexual activity. Of course, as these numbers suggest, not every older woman is having sex and we are not suggesting that they should be having sex if they are uninterested. But for older women who are sexually active or would like to be, it is easy to feel erased from popular view.
Thankfully, representations or older women and their sexuality are slowly changing in the media, but pervasive myths abound that sex is generally better for younger people. Our own research shows that, on the contrary, aging can result in many benefits for a person’s sex life, including knowing one’s partner better, knowing your body better, and having decreased sexual inhibition. Our understanding from this research and our experience helping women improve their sexual function in our clinic tells us that great sex is possible for all women at any age.
At every age, however, there are steps we must take to overcome challenges that can impede having the sex we want. If you’re a young adult, this might be avoiding unwanted pregnancy or learning about your sexual preferences for the first time. Solutions? Contraception, and maybe checking out your first edition of the Joy of Sex. If you are older, while some of the worries of yesterday might be gone, there are likely new challenges to having the sex life that you want that are related to changes to the body due to the normal aging process. Thankfully, these too are often addressable. Here are some things we know…
Reducing Dryness can help to prevent Pain
By virtue of their structure, vaginal tissues are typically moist. The layer of the vagina that we can feel when sticking a finger into the vagina is a “mucosa.” This means it is a skin-like layer of tissue that is moistened by mucous, much like the inner lining of our mouths and cheeks.
For many older women, menopause can mean vaginal dryness. This is because one hallmark of menopause is decreased estrogen in the body. The hormone estrogen is part of what helps keep the vagina elastic and moisturized—key functions for comfortable vaginal intercourse. Vaginal dryness due to low estrogen can result in dryness or sandpapery or even painful sensations with vaginal penetration. Vaginal intercourse without sufficient lubrication or wetness can cause injury to the vagina. Other problems can cause vaginal dryness during sex. Lack of sufficient arousal or foreplay is a common problem. Too much washing with soap, wipes and other irritating products can also cause vaginal and vulvar irritation and dryness.
Estrogen is the most effective way to treat vaginal dryness due to low vaginal estrogen levels and there are several estrogen products that have been approved for use in women with painful sex due to menopause. Other prescription products to treat vaginal dryness include ospemifene, a pill taken by mouth, and DHEA suppositories inserted into the vagina. Some women can’t or don’t want to use estrogen or estrogen-like products.
Over-the-counter products are sold widely to help alleviate vaginal dryness and painful intercourse. There is very little evidence to suggest one kind is better than another. Moisturizer products are intended for regular use, like every couple of days. Lubricants are intended to reduce friction during vaginal penetration and come in water-based, oil-based, and silicone-based varieties (check out our blog on lubricants here for more information).
While there is little science to say which lubricant or moisturizer is better, reducing friction during sex is welcome relief for many women and their partners.
older adults still must manage the risk of Sexually Transmitted Infections
Often when we think of safe sex, we think of pregnancy prevention. While pregnancy is not the concern of a menopausal woman (menopausal women are no longer fertile), safe sex also means protection against sexually transmitted infections. While rates for common STIs are typically much lower in older populations than in younger populations, the rates for older adults are increasing.
- In 2016, the Centers for Disease Control and Prevention (CDC) reported that, for people over the age of 45, the total reported cases of Syphilis, Chlamydia and Gonorrhea increased by more than 50% from 2012 to 2016.
- In 2015, almost 7,000 of newly diagnosed cases of HIV were among adults over the age of 50 years.
The bottom line is: risks for older adults having sex, especially with a new of non-monogamous partner, really do exist. Here is a double whammy: vaginal dryness may increase a woman’s susceptibility to sexually transmitted infections in later life. So what can you do? In addition to treating vaginal dryness, an older woman with a new sex partner or a non-monogamous partner should use condoms. Both partners should be tested for sexually transmitted infections, including HIV.
Condom use might take a bit of extra work (but that can be part of the fun)
Using a condom with a male partner in old age can pose its own set of challenges. The most common condom type is the male condom that fits over the penis. To apply a condom properly, the penis should be fully erect. Changes in male sexual function with aging may make achieving a full erection difficult. Without a full erection, the condom may not stay on and it can feel uncomfortable, especially when a woman has vaginal dryness. There are some ways to combat this problem.
One option is to masturbate or give oral sex to your partner before attempting intercourse. This does not have to feel like a detour from the action, but can be incorporated into foreplay. The extra stimulation to the penis and additional time before intercourse can help your partner to become fully erect before attempting to put on a condom. Lubrication can also be used during this time for pleasure and to lubricate the penis before intercourse.
Another option is to use a “female condom,” also called an internal condom. Fewer people know about this variety of condom. Internal condoms are inserted into the vagina for protection, which means they may be a good alternative for the couple who would like to use condoms for safety, but have trouble getting the penis erect enough for a condom before intercourse begins.
Masturbation can play an important role in a satisfying sex life
Solo masturbation is a normal human behavior – 25% of women in the NSHAP study reported regular masturbation (likely a conservative estimate). In the NSHAP study, sexually active women were more likely than men to report having partnered sex without pleasure and difficulty with orgasm. In our clinical practice, many women who struggle with satisfying partnered sex are able to experience orgasm and pleasure with masturbation.
Unless otherwise indicated, the data and information in this blog were derived from Chapters 41 and 42 of Hazzard’s Geriatric Medicine and Gerontology. Seventh Edition. McGraw-Hill Education. 2017.
*Note: Names of specific products or places to buy products should not be considered as endorsement. We provide examples to help make this information easier to understand.
Edited by Chenab Navalkha