TAKE CHARGE OF YOUR HEALTH
by Harriet Hodgson
"The publisher wants me to tell personal stories," I told my husband at
dinnertime. "Im trying to include at least two stories in each chapter."
"What chapter are you working on now?" he asked.
"Sexuality and intimacy."
My husband almost dropped his fork. "Youre not
"No, Im not going to tell stories about our sex
life," I assured him. "But I am going to tell some things about our
"Thats ok" he said, and we immediately got
into a conversation about our marriage. Friends often comment on what a loving couple we
are and this makes us feel good. We think we know why our marriage works, but we
arent sure, and have decided not to overanalyze it.
I think we have a good marriage because we knew each other
well before we married. We listen to each other and this has led to mutual respect.
Forty-one years together havent eliminated the element of surprise from our
marriage. We make each other laugh. Best of all, we know we can always count on one
another. My husband is my champion and I am his.
Sexuality is part of our lives. Younger people may not
believe this, however, because they dont know much about sexuality in the aging. Our
society seems to think young people are the only ones with sexual feelings. And sexuality
is, by itself, a complex topic.
Fran Kaiser, MD, author of "Sexuality in the
Elderly," thinks the topic covers attitudes, behavior, practices, and activity. Many
people believe that loss of sexuality comes with age and this belief is false. Sexuality
is part of the human condition and continues throughout life. It is natures way of
ensuring the survival of the species.
Sexuality Is Cumulative
There is no age at which thoughts about sexuality and sexual activity end, according
to Kaiser. Experts say our past experience influences future sexual behavior. If you have
a passionate relationship in your younger years, chances are you will have a similar
sexual relationship in your later years. As Kaiser writes, "Another
predictor [of sexuality] appears to be sexual interest, enjoyment, and
activity in younger years."
The mind is the bodys main sexual organ. When I look
at my husband I see a man approaching retirement age. I also see a man who was a James
Dean look-alike in his youth, a man who bought me gifts on his birthday, the Air Force
officer who received the Bronze Star for valor in Vietnam, a loving father to our
daughters, a dedicated health professional, and a sweet grandfather who plays games with
the twins. I see the experiences that made the man.
My husband has a similar reaction when he looks at me. He
sees the 17-year-old woman he met two weeks after starting college, a person who loves to
learn, a competent cook, a community volunteer, an amateur decorator, an adoring
grandmother, and a nonfiction writer.
We see each other through the colorful, changing
kaleidoscope of life experience. Time has increased the sexual excitement we feel for one
another. Being with my husband makes me feel 17 again. Despite our respective health
scares, we are in pretty good health, thanks to modern medicine. We have been blessed. But
health is a barrier to sexuality for many aging people.
Barriers to Sexuality
Diana Wiley and Walter Bortz II studied sexuality and report their findings in
"Sexuality and AgingUsual and Successful." They began their study with a
three-part series on sexuality at the Palo Alto, California, Senior Center. An average of
58 people attended the series.
Wiley and Bortz surveyed the attendees to get some personal
information on sexuality. Six months later they sent a follow-up questionnaire to the
attendees. The questionnaire topics included the importance of kissing, oral sex, manual
genital stimulation, sexual intercourse, orgasm, loving and caring, and satisfying your
Current findings were compared to past findings. Wiley and
Bortz say their current findings about sexual enjoyment are more complex than the ones
gathered 10 years ago.
Roughly 32 percent said the frequency of sexual activity had not changed in
60 percent reported a decrease in sexual activity
8 percent reported an increase in sexual activity
More males (71 percent) wanted increased sexual activity
52 percent of females said they wanted an increase
About 50 percent of both males and females said they thought less about sex
now as compared to a decade ago
"Whereas our follow-up questionnaire showed no real
change in sexual behaviors, there was a substantial expression of increased knowledge,
confidence, and sensitivity," the researchers write.
Illness, relationship problems, and erection difficulties
were some of the causes of decreased sexual activity. The death of a spouse may close the
door on the known sexuality of the past and open the door to sexual exploration. Older
women who dont have a male partner or the prospect of one may express their
sexuality with other women.
In her book, Be An Outrageous Older Woman, Ruth
Harriet Jacobs, Ph.D., says this expression of sexuality may be overt or sublimated. She
lists some of the ways older women may express sexuality: intercourse with a husband,
vacationing with male friends, self-pleasure, reading sexual novels, seeing sexual movies,
joining singles groups, focusing attention on children and grandchildren, choosing
celibacy, and marrying again.
Lesbians may look for another lesbian partner after a
partner dies. Jacobs says lifelong lesbians face the same kind of sexual deprivations as
heterosexual women. "Maybe I have shocked you with my frank chapter," she
writes. "But I could back it up by references in the scientific literature."
Medication, environment, and chronic illness are also
barriers to sexuality in the aging. For some, living in a nursing home is a sexual
barrier. Further complicating the issue is the fact that many nursing home employees have
little or no sexuality training.
Chronic illness, financial problems, and the vulnerability
of age force some parents to move in with their adult children. This arrangement tests the
old and the young. Living with children can put a damper on the parents sexuality
and their childrens as well.
Increasingly, grown children are moving back home to
regroup. The timing is poor. Just when parents have gotten used to their honeymoon nest,
they have adult children underfoot, and the hassles that come with it. "Hes up
watching TV half the night," a father complained. "We cant sleep, let
alone have sex."
Life-threatening illness is another barrier to sexuality.
Lets say one partner has a heart defect that requires surgery. The surgery is
successful and the patient is restored to good health. Long after surgery, however, the
fear of relapse is still present. This mental barrier may alter sexual behavior.
The Sexuality/Health Equation
Stephen Holzapfel, MD, CCFP, of the Department of Family and Community Medicine at
the University of Toronto Medical School, studies sexuality in the aging population. He
views sexual expression in the aging as a predictor of general health. In other words,
people who have good health continue to be sexual. "The greatest barrier to being
sexual in old age is lack of a healthy sexual partner," he writes in his study
"Aging and Sexuality."
Menopause affects sexuality in older females. Women spend
about a third of their lives in menopause, according to Holzapfel, and that is a large
chunk of time. Medication may also alter our sexual performance. People who are 65 years
old and above take roughly three times as many prescription drugs as younger people.
Holzapfel notes that medical treatmentmedicine, surgery, rehabilitationis the
most common cause of sexual dysfunction.
Many doctors are reluctant to bring up the topic of
sexuality with their patients because it is embarrassing. Whether we are embarrassed or
not, aging people are sexual people, and that is a fact. The sexuality equation has many
components and they may, or may not, balance. Societys view of sexuality is one of
"Im Sexually Invisible."
When I told a friend of mine that I was going to write a book about aging, she
immediately asked, "Whats in it?" I listed some of the topics, including
sexuality, and she interrupted me. "Thats good, because Im sexually
invisible," she said. "Nobody thinks I am a sexual person anymore. Its
Once you are sexually invisible you may also become
generally invisible. Sexual invisibility is like a leaking faucet; it begins with one
drip, or one experience. More experiences come, faster and faster, until there is a
constant stream of sexual invisibility. You may be ignored while standing in line, for
example, or patronized by younger co-workers.
A recent trip to the drive-in bank made me feel totally
invisible. I wrote a check for 75 dollars, put it in the tube, and sent the tube to the
teller. The tube came back empty, so I pressed the service button. Nothing happened. I
pressed the service button again and, still, nothing happened. Although I could see the
teller, somehow she couldnt see me.
In desperation, I started waving at the teller. The intercom
came on with a crackling sound. "May I help you?" she asked in an annoyed voice.
"Yes, you can give me my money," I said. "I
wrote a check for 75 dollars and the tube came back empty."
The teller was startled. "Just a minute," she
answered. A few minutes later the tube came back with 75 dollars in it. "Sorry about
that," she said. "I didnt think anyone was there."
Didnt think anyone was there? I was sitting in a red
car, pressing the service button repeatedly, waving at the teller, and she didnt
think anyone was there? Her apology was vexing. Age discrimination is the real issue here,
societys way of saying we arent worth noticing.
Unlike the Oriental cultures, which respect age, our society
views the aging as dried up, useless, sexless people.
At home I am a cherished wife. My husband and I show
affection in front of the twins so they know their grandparents love each other. The twins
are getting the idea. We were playing a self-esteem game with them and my husbands
game piece landed on a square that read, "Say something nice about the person next to
He gave me a hug, and said, "You are beautiful."
Our granddaughter beamed. A few minutes later, her game
piece landed on a square that asked her to list something that made her happy. Her reply:
"When people say Im beautiful."
"And you are beautiful," I added.
Some day, and it will probably come sooner than I expect,
the twins will figure out that we are sexual people. Until that time comes, they know love
is the cornerstone of our family, our love for each other, our love for our children, and
our love for them.
Sexual Dysfunction in Men
Two major problems, erectile dysfunction and Widowers Syndrome, prevent many
men from expressing their sexuality. The causes of erectile dysfunction include vascular
disorders, medication (such as diuretics and hypertensives), tobacco, marijuana, alcohol,
neurologic disorders, and psychological problems.
Widowers Syndrome "may result from unresolved
guilt and grief toward the deceased partner, and subconscious repression of sexual
feelings," according to Fran Kaiser, MD. Painful memories may also contribute to
Widowers Syndrome. Grief is a process that takes time. Sadly, time may not heal this
Sexual Dysfunction in Women
Women who have difficult or painful intercourse may become sexually dysfunctional.
Sex becomes something to fear, rather than a joyous celebration of life. Lack of vaginal
lubrication may also make intercourse painful. Incontinence may also inhibit sexual
desire, according to Kaiser.
Hysterectomy, which has been performed on one-third of the
women in our country over age 60, is not associated with sexual dysfunction. However,
Kaiser says the women who associate a hysterectomy with loss of femininity may experience
Vaginismus (painful spasms of the vaginal muscles) may also
contribute to sexual dysfunction. Yeast infections, which are fairly common in aging
women, also play a part in sexual displeasure. As you might expect, menopause has a
profound effect on female sexuality.
The treatment for menopause continues to improve. Gloria Bachmann, MD, describes
treatment in her study, "Influence of Menopause on Sexuality." Hormone
replacement therapy (HRT) is one focus of her study. As she writes, "The importance
of hormone replacement therapy in four areas of menopausal health is quite clear:
cardiovascular health, prevention of osteoporosis, control of vasomotor symptoms, and
maintenance of urogenital health."
Bachmann discusses the effects of decreased estrogen levels
on sexual function and they are considerable:
Decreased support of pelvis (which affects sexual satisfaction)
Loss of lubrication (which may make intercourse painful)
Changes in body configuration
Skin changes (touch may be less pleasurable)
Muscular and skeletal loss
Many people assume males are always "sexually
ready" and this isnt true. Bachmann says the male partner may have less sexual
interest and this leads to a decline in sexual activity. In contrast, women who have
completed menopause may feel sexually freer because they no longer worry about getting
Hormone replacement therapy has been part of my life for
more than 15 years. Migraine headaches are a side-effect of this therapy. Although I
dont have full-blown migraines, I have colorful auras displays of zig-zag
lines and flashing lights. The auras can hit at the worst times.
I was on the way to a conference in St. Paul when an aura
developed. It got progressively worse and by the time I reached the city my field of
vision had been reduced to a circle. Traffic was heavy and I couldnt find a place to
pull over. Since I was two blocks from my destination, I slowed down, continued on to the
hotel, and arrived safely.
But my circle of vision got even smaller, and I was having
trouble thinking. I went to the ladies room before the meeting started. As I was washing
my hands I realized the ladies room had shadowy, rectangular depressions on the wall.
Artwork in the ladies room? Upon closer examination, I realized the depressions were
urinals, and I was in the mens room.
I raced out the door, past a man standing at a phone kiosk
beside the mens room entrance. He stopped talking and gave me a disgusted look.
"OK, I made a mistake," I declared. "These things happen."
The experience came to mind after I read Dr. Fran
Kaisers study, "Sexuality in the Elderly." "Until recently, sexual
activity in older adults has been considered to be inappropriate, immoral, deviant, or at
best, bizarre," she explains. Apparently the man in the phone kiosk thought I was a
sexual deviant, voyeur, or pervert.
The truth of the matter is that I am a grandmother on
hormone replacement therapy who had a migraine aura that prevented me from reading the
sign on the door. Surely I am not the first woman to make this mistake and I probably
wont be the last. At least I can laugh about it.
Of course men dont experience physical menopause, but they do experience some
of the psychological symptoms. Doctors are becoming more aware of male menopause and its
effects on sexuality. Douglas Schow and his colleagues explain the condition in their
study, "Male Menopause: How to Define It, How to Treat It."
The symptoms of male menopause sound a lot like the symptoms
of female menopause: hot flashes, depression, sleep problems, lower sex drive, general
weakness and lethargy, weight gain, and loss of bone mass. You can imagine the problems
that develop when both partners have these symptoms.
Schow and his colleagues think "male menopause will
become an increasingly important issue for primary care physicians because the number of
men in the United States between the ages of 4570 years is expected to grow from 46
million in 1990 to 81 million by 2020." They also think more research is needed into
the psychological effects of male menopause.
New Definition of Impotence
A new definition of impotence was proposed in a National Institutes of Health
Consensus Conference article. The NIH conferences have dual purposes: one, to evaluate
existing scientific information, and two, to advance public understanding. Since impotence
had become a term with "pejorative implications" the NIH recommended the term
This is a more accurate term, according to the NIH. Millions
of men in our country suffer from erectile dysfunction and the Consensus Conference says:
Erectile dysfunction increases with age but it isnt inevitable
Embarrassment keeps patients and health professionals from discussing the
Many cases can be managed with medical therapy
The diagnosis and treatment of erectile dysfunction must be specific
Erectile dysfunction has a ripple effect, altering partner,
family, and work relationships. Raul Schiavi, MD, and Jamil Rehman, MD, detail the causes
of erectile dysfunction in their study, "Sexuality and Aging." They say physical
health, fear of failure, and relationship with a sexual partner all affect erectile
dysfunction. "Marital conflict, problems of commitment and intimacy, power struggles
and lack of trust" also contribute to the problem, according to researchers. They
point out that men and women tend to blame the man for the cessation of intercourse.
Fortunately, many treatments for sexual dysfunction are available.
Treating Male Dysfunction
Before he or she recommends any treatment, a doctor will do a complete physical exam
and assess the drugs the patient is taking. Stephen Holzapfel, MD, CCFP, author of
"Aging and Sexuality," says drugs can cause sexual dysfunction in men. He
includes cardiac, gastrointestinal, neurological, endocrine, oncological, psychiatric, and
recreational drugs in his observation.
For example, beta blockers, which are taken to lower blood
pressure, may interfere with male erections. Schiavi and Rehman also point out that the
erections of aging men may not be as stiff as they used to be. Certainly, sexual
dysfunction strikes at the heart of masculinity.
Researchers continue to search for solutions to male
dysfunction. Associated Press writer Lauran Neergaard reports on a new medication in her
article, "Impotence Pill Gains Approval." In March of 1998 the Food and Drug
Administration (FDA) approved Viagra, produced by Pfizer, Inc., to treat impotence.
Neergaard notes that Viagra is the first nonsurgical treatment for male impotence that
doesnt involve injections or inserting something into the penis. Since Viagra was
approved the cost of the pills has risen steadily. The medication is supposed to be used
once a day, about an hour before sexual intercourse. Medical experts think Viagra may spur
more males into getting help. "Only 5 percent of the estimated 10 million to 20
million impotent Americans get treatment," explains Neergaard, "but the pill
could increase that number to 20 percent very quickly."
The public seems to be ignoring the fact that Viagra is not
an aphrodisiac and helps dysfunctional men only. An ABC World News Tonight report said
demand for the drug has been "enormous." According to ABC, 20,000 prescriptions
for Viagra are being filled per day in the United States, and the drug has nearly tripled
in price. Viagra has serious side-effects, said ABC, especially when taken with nitrates.
Men who have a low sperm count may benefit from testosterone
therapy. This therapy may be oral, intramuscular, or transdermal. As with any therapy,
testosterone therapy has some risks, things like weight gain, sleep apnea, and
Douglas Schow and his colleagues cite these and other risks
in their study, "Male Menopause: How to Define It, How to Treat It." According
to the researchers, aging men usually have decreased serum testosterone levels. However,
the researchers think this "plays an insignificant role in the decline of sexual
The question is, should aging men have testosterone
replacement therapy? "Testosterones role in restoring the lost vigor and body
composition of youth is questionable," the researchers note. Routine androgen therapy
needs to be studied more, say the researchers, and the risks need to be weighed with the
Impact of Stress on Sexuality
Whether it is unpaid bills, kids on drugs, or added job responsibilities, stress has
an impact on sexuality. Phil was a research scientist at a major corporation. His research
was so complex that few people understood it, not even his colleagues. Phils wife
had a vague idea of his research, at best. Brilliant, preoccupied, and in his own world,
Phil paid scant attention to his appearance, and often had no recollection of driving to
the laboratory. Often he worked late into the night. Sexuality became a low priority in
"He is so absorbed in his research that sex
doesnt interest him," his wife commented.
When Phil was interested in sex, he was emotionally absent.
Although the couple had children, Phil wasnt very involved in their care, or in
caring for the couples sexual relationship. The couple drifted apart until they had
Stress may affect sexuality in unusual ways, ways that
require professional help. Contact your doctor if you think stress is affecting your
sexuality. Your doctor may refer you to a stress-management program. Get your stress under
control as quickly as possible because it can lead to high blood pressure.
Stress management is just one way to improve your sexuality. An essay in the Mayo
Clinic Health Letter called "Sexuality and Aging" contains some other
suggestions. First, older people may have to do some planning before they have
intercourse. Long-term estrogen replacement has helped many women. Men have a range of
medical options: testosterone medication, vascular surgery, self-injection therapy
(injecting medicine into the penis) and new medications. Professional counseling is also
an option for both partners. Many couples have improved their sexual relationship by
getting away from the daily grind.
Years ago, one of my husbands colleagues told him to
attend all of the conferences he could. "My wife and I did that," he said.
"Every trip was a honeymoon." Shortly after he made this comment his wife died.
We have followed this advice, traveling when we can, going
away for the weekend, or staying home and puttering about the house. Sometimes we just sit
on the couch and read. These times are indescribably beautiful. Over the years we have
learned to revitalize our sexual relationship in a variety of ways:
Saying "I love you" every day
Going out for a romantic dinner
Enjoying a romantic dinner at home
Laughing together (my husband cuts out cartoons from the newspaper and gives
them to me)
Surprising each other with small gifts (a hobby magazine, a flowering plant,
Leaving love notes around the house
Giving each other massages
Education seems to be the key to all solutions. You
cant benefit from new medical treatments unless you know about them. You cant
be helped by an intuitive counselor unless you know what counseling is available. The
increasing life span will make sexuality education more important in the years to come.
The National Institutes of Health Consensus Development Panel on Impotence has
discussed the importance of public education on sexuality. The NIH panel thinks sexual
information needs to be distributed via:
Accurate newspaper and magazine articles
Radio and television programs
Special programs at senior citizens centers
Accurate diagnosis and treatment
Television programs are showing older people in a sexual
context, but the portrayals are limited, and some border on ridicule. The print media
seems to be doing a better job in the sexuality education department. My hometown
newspaper, the Rochester Post-Bulletin, published an article, "Courting the
Golden Years" by Dawn Schuett.
She cites some U.S. Administration Aging statistics in her
article. Life expectancy is 79 years for women and 72 for men. This means "seven out
of 10 women born during the baby boom will outlive their husbands,"
In a companion article, "Seniors Put a New Spin on
Dating," Schuett says dating is a whole new world for women and men 60 years old and
older. These people are young at heart. You would think this would be cause for
celebration, but some adult children dont like to see their parents dating. Fixed
incomes may put a crimp on dating and women often pay their own way. I think dating in
later years shows trust in life. After all, life is for living.
Smart Aging Tips
Learn more about sexuality in the aging.
Think of sexuality as a cumulative experience.
Become aware of the barriers to sexuality, such as health problems, lack of
partners, effects of medicine, and Widowers Syndrome.
Be aware that sexuality is a predictor of general health.
Stand up for yourself and dont let yourself become sexually invisible.
Learn about the causes and treatment for sexual dysfunction.
Discuss the symptoms of menopause and male menopause with your doctor.
Get professional counseling if stress is interfering with your sexuality.
Find ways to revitalize your sexual relationship.
Stay attuned to the medical advances regarding sexuality.
Give the gift of touch.
Remember that love is sexual, intimate, and ageless.
From Smart Aging, Taking Charge of Your Physical and Emotional Health,
by Harriet Hodgson. Copyright © 1999 by Harriet Hodgson. Excerpted by arrangement with
John Wiley & Sons, Inc. $14.95. Available in local bookstores or call 800-225-5945 or click here.