Part 1 of 3: What actually happens to sexuality as we age?
The body changes as we age, but our capacity for intimacy does not simply vanish.
Many changes come with aging.
We discuss our joints, our memory, our metabolism, and our sleep; we also talk about blood pressure, cholesterol, medications, and whether we are getting enough exercise.
There's another aspect of growing older which we don't discuss quite as easily: sexuality.
It is commonly believed that as people get older, their sexual interest and intimacy disappear. Older adults themselves may hold this belief, and so may their partners.
Unfortunately, healthcare professionals can do the same.
Sexuality never reaches a point where it becomes obsolete.
Our bodies do change as we age, and these changes may affect sexual response. If we understand what is actually taking place, we can tell the difference between normal physiological aging and a problem that warrants further attention.
This first article in the three-part GeriAcademy series on sexuality and aging looks at the body: what actually happens to it as we age?
Aging Changes Sexual Response, Not the Capacity for Sexuality
It is one of the most important points to grasp that sexual response can tend to slow down as a result of aging.
It doesn't necessarily imply that there's a problem.
Consider how many different things change as we age. It probably takes us longer to warm up before exercise, and we might need more recovery time afterward. The body still functions; it doesn't always react the way it did when we were 25.
The sexual response can be similar.
Arousal may take longer. A person may need more direct stimulation. Orgasms may take longer to achieve or feel different. And the amount of time needed for recovery before becoming sexually responsive again might increase.
Those are physiological changes, not proof that a person is 'too old' for sex.
Individual differences are huge. For example, two healthy men who are 75 can have
very different sexual experiences, just as two men who are 35 can.
What Changes for Women?
A major transition impacting the sexual health of women is menopause.
When estrogen levels drop, the tissues of the vulva, vagina, bladder, and urinary tract may change significantly. These changes are known medically as genitourinary syndrome of menopause, or GSM. In everyday language, GSM refers to a group of symptoms caused by the lack of estrogen after menopause that can affect a woman's genital and urinary organs. Common symptoms of GSM include vaginal dryness, burning, itching, irritation, discomfort during intercourse, and increased urinary urgency or frequency. Recognizing these symptoms is important, as they are treatable and not just an unavoidable part of aging.
Vaginal tissue can become thinner, drier, less elastic, and more susceptible to irritation. The body's natural lubrication may take longer to appear or may decrease.
In some cases, the changes are not easily noticed, while in others they may cause burning, irritation, urinary symptoms, difficulty with penetration, or pain during intercourse.
And this is where I want to make an important distinction:
It is not acceptable to regard pain during sex as a normal part of getting older.
GSM is common, but that does not mean it cannot be treated.
For some women, using lubricants and vaginal moisturizers can be an immediate, helpful way to address dryness or discomfort during sex. Choosing a water-based or silicone-based lubricant, whichever feels most comfortable, is a simple first step.
Regular use of vaginal moisturizers (not just during intercourse) can also help maintain tissue comfort. If these measures are not enough, some women may find relief from treatments such as low-dose vaginal estrogen or other therapies that a healthcare professional can prescribe. Watch for persistent pain, burning, or irritation. Also consider pelvic-floor dysfunction, skin conditions, infection, musculoskeletal problems, and other causes of pain. If discomfort continues despite self-care, or if pain is severe, make an appointment with a healthcare professional to explore effective, appropriate treatments.
If sex is now causing pain, it should lead to a discussion with a healthcare professional, not just the remark that "Well, I'm getting older."
What Changes for Men?
Men also change in their sexual response as they age.
Erections can take longer to occur and might need more direct stimulation; they may also be less firm than they used to be. There could be a change in ejaculation, and the refractory period—the length of time before another erection or orgasm is possible—will usually become longer.
Testosterone levels also decline gradually with age, although the amount of this decline varies greatly from person to person.
There is also an important distinction here.
Erectile dysfunction indeed becomes more common as people get older, but one should not automatically regard it as merely a result of aging.
Erectile dysfunction that persists can be linked to vascular disease, diabetes, the effects of medication, neurological disorders, hormonal disorders, and other health issues.
Because erections rely on healthy blood vessels and good blood flow, a sudden change in erectile function can sometimes indicate a person's overall cardiovascular health.
Even though some alteration in erectile function is to be expected, we should not disregard the complete loss of erectile function just because a person is 70 or 80 years old.
Orgasms Can Change, Too
People might also notice changes in this regard: orgasm.
Orgasm might be reached more slowly. The sensation could be less strong, or simply different. Some people may need more direct or extended stimulation than they did earlier in life.
That doesn't necessarily mean pleasure vanishes.
It could indicate that the route to pleasure has changed.
For some couples who have been together for many decades, this could be a significant adjustment. The approach that worked in their thirties may not work the same way in their seventies.
That involves a matter which isn't always easy to discuss: adaptation.
It sometimes happens that if you want to have a satisfactory sexual relationship in later life, then you have to get to know your own body once more and also have to get to know your partner's body once more. Open communication plays an important role in this process. Gently talking with your partner about changes, new needs, or what feels comfortable can help both people feel more confident and connected. Taking time to listen to each other's experiences and preferences, asking questions with kindness, or simply acknowledging that both bodies and desires can change with age can deepen trust and intimacy.
Our Bodies Change in Other Ways, Too
Sexuality is not something that exists apart from the rest of the body.
Our joints tend to become stiffer, and mobility may be affected; we may develop arthritis, back pain, or reduced flexibility. The skin also changes, as does our weight and body makeup. Our breasts change as well, and there are changes in the appearance of the genitalia. Scars from surgery may show up.
Our feelings regarding our bodies can also change.
A person who has for a long time been at ease with their body can suddenly become self-conscious following surgery, menopause, changes in weight, or an illness. On the other hand, another person might grow more at ease with their body as they age and come to care less about the expectations they used to have of themselves.
There is no single universal experience of an "aging body".
That is important since sexuality is not merely a matter of anatomy; it also relates to how we feel about being seen, touched, desired, and vulnerable.
Don’t Assume Everything Is “Just Aging”
This is perhaps the most important message in the first section of the series.
Changes in sexual function become more frequent with advancing age, but that
something becoming more common as we get older doesn't mean it is an inevitable result of aging.
That is not the same thing.
Arousal taking longer? Common.
Is it common to need more direct stimulation?
Is a longer refractory period common?
Is the orgasm different or does it take longer? That's common.
Sex should be examined more closely if there is severe pain during it, if there is a sudden or total loss of sexual desire, if there is new erectile dysfunction, or if there are other major changes in sexual function. If you notice these concerns, consider reaching out to a healthcare provider. It can feel uncomfortable or even embarrassing to bring up sexual health, but these topics are a routine part of healthcare, and physicians are trained to help. You might start by describing your symptoms simply and clearly, and letting the provider know how they affect your well-being. Remember, you are not alone, and seeking help is a positive step toward improving your quality of life.
At times the cause is hormonal, at other times it is vascular, on other occasions it is due to a medication, and at times it is sleep, depression, chronic pain, a neurological disorder, stress, or some other health condition.
In some cases the change isn't mainly physical at all.
This leads us to yet another aspect of sexuality which becomes especially interesting as we get older: desire.
What if the body is the issue?
One of the questions I hear is some version of:
What is it that makes me not want sex as I used to?
And there is another version of that question:
Why do I still desire sex but my partner does not?
The questions are different from those concerning whether the body is physically capable of sexual activity.
Hormones affect desire, but it is also influenced by sleep, stress, relationships, caregiving, medications, body image, culture, our life experiences, and even the things we were told about sex many decades ago. These factors can change over time, and it is completely normal for desire levels to shift or fluctuate as life circumstances change. Everyone's experience of desire is unique, and there is no single 'right' pattern. Understanding this can help reduce shame or worry about changes in sexual interest, and remind us that a wide range of experiences is part of being human.
Importantly, desire doesn't always function the way we suppose it does.
There is a situation in which desire precedes sexual activity.
It can occur after intimacy has already started.
This difference can completely change how a person interprets what they thought was a "low libido."
Next, we'll go there.
Coming Next: Part 2 of 3
Where Has My Desire Gone? Understanding How Sexual Desire Changes as We Age
We will discuss the difference between spontaneous and responsive desire, explain why partners do not age sexually at the same rate, and look at what occurs when one partner wants sex and the other does not, as well as examine how our relationships, experiences, and beliefs regarding sexuality stay with us throughout our lives.
Aging changes our bodies.
It does not eliminate our capacity for affection, pleasure, connection, or intimacy.
This blog post is for educational purposes only. Please discuss sexual concerns or treatment options with your doctor or medical professional.
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