Sex, intimacy and aging focus of public health keynote address

Just the nature of her talk silenced the crowd – aging, sex and intimacy.

Keynote speaker April Winningham told attendees at a recent public health series hosted by the Medical University of South Carolina’s Department of Public Health Sciences that it’s time to break the silence, especially for health professionals who should be encouraging discussion on that topic.

The need is growing as baby boomers age, she says. In 1900, 1 in 25 Americans were age 65 or older. That ratio is expected to reach 1 in 4 by 2050. “Why is it that we are talking about sexuality while we are talking about aging? Because when we turn 50, they don’t they take away our sex card,” she says, smiling as nervous laughter ripples through the audience. “They really don’t.”

Winningham, DrPH, of the University of South Carolina’s Arnold School of Public Health, throws out a trivia question: How many baby boomers are turning 60 every hour? The answer: 330. And though young people may have difficulty imagining aging and sexuality, it is a natural process of life and people need to understand the physiological changes that are happening, she says.

“The need for intimacy is absolutely ageless. The TV may tell us that sex is only for the young and advertisements may say that sex is only for the young. It just isn’t true. Intimacy is, in fact, ageless. We never outgrow the need for affection, for emotional closeness or for intimate love. We want that throughout all of our lives.”

Contrary to the prevailing stereotype, older adults want to and are able to have an active, satisfying sex life. A National Institutes of Health Study from the 1980s, surveying about 4,000 people ages 50 to 93, found at least half of them, men and women, were sexually active. The breakdown for men sexually active on a weekly basis was about 90 percent of men in their 50s, 73 percent in their 60s and 58 percent in their 70s.

Another study done in the ’90s surveyed national behaviors and found only 18 percent of adults over 50 wanted to be celibate. “That means that 82 percent wanted to have sex, and potentially were having sex. We know that it can happen, and that we can have sexual health throughout our whole life.”

A Modern Maturity Sex Survey by AARP in 1999 found that almost 30 percent of women and 62 percent of men reported that to have a good quality of life, sex is very important. Winningham says she thinks the percentages between men and women would be closer except that women tend to live longer than men so there are fewer options for them as they age. Another important note is this study came out one year after the release of Viagra, which may have affected how men responded, she says.

Physiologically, there are changes that happen with aging and patients should be able to share health concerns relating to sex and intimacy with their providers, she says. Even better, those conversations should be broached by their doctors. “I talk with medical students across the country, and medical students are not inclined to talk to their older patients about taking their sexual history or talking to them about sex. Why do you think that might be?” she asks, and nods when someone answers, ‘All you see is grandma.’

“It is a real problem. I have even gone to the NIA, the National Institute on Aging, to talk about some of this research and the folks that I actually talk to, these are honed researchers in sexuality and aging, say the same thing to me. ‘I just can’t really go there. I just picture my parents having sex.’ That’s a problem. We need more research.”

Times are changing, though. It’s getting easier to have discussions about sexuality and aging as the media offers new role models. Winningham shows the group a clip from the popular television show “Grace and Frankie” where a good number of the main characters are senior adults who are sexually active.

“We know that older adults are more active. This is a more active, more wealthy, more aggressive generation than we ever have had before. As such they are not only interested in running and jogging, but they are also interested in more sexual health as well,” she says. “As somebody who’s interested in older adults and sexuality, this has been an incredible move forward. The actors on this set, none of them is younger than 78 years old.”

There are physical changes that happen with aging. Testosterone is key for both men and women, dictating sex drive. “The good news is that we have enough testosterone, and our bodies continue to produce enough to be sexually active all of our lives and to have a drive towards sex. For women estrogen levels decline as a result of menopause, and it takes longer for the vagina to naturally lubricate itself and it also loses some of its elasticity.

This can cause problems with sex. Not only can it be difficult and challenging for sex, but it can also be painful.”

Erectile dysfunction (ED) can be challenging for men as they age and compounded by high blood pressure. “We know it may take men longer to achieve an erection as they age. Their erection may not be as hard or may not last as long.”

While men have Viagra and other medications as an option to help with ED issues, there really hasn’t been a satisfactory pharmacological option for women, she says.

Medications and surgeries also can lead to physical changes. Medications, including some for blood pressure, allergies and acid reflux, can impact a person’s ability to become sexually aroused. In addition, there are psychological changes. “The ability to have sex resides in our mind. I don’t remember who said it, but it’s true that our most important sex organ is between our ears. Changes in appearance may affect our emotional ability to connect with people. How we feel makes a difference on how we make connection with others.”

Top five tips to embrace sexual health during aging

1. Expand your definition of sex.

For heterosexual couples, sex doesn’t always have to be about intercourse. “As we age, the definition of sex, how we define sex, how we think about sex can change. For anybody, for men and women, we want to communicate with our partner. If you’re really adventurous, there are some really fun, fabulous sex toys out there.”

2. Get comfortable talking about sex with your partner.

“It’s really important to have conversations with our partners about things that are working and things that aren’t working. Not only is it good for us in terms of our sexual health, but it also builds a stronger bond with our partner. So it’s very, very valuable.”

3. Make changes to your routine.

There’s a first time for everything. It’s a great way to enhance sexual health, she suggests. “You might want to make changes in the time of day you engage in sexual activity. What time of day are you most refreshed, most energetic? Remember, both men and women, as we age, may take a little bit more time to become aroused. Maybe this is where we can add a little romance. Maybe we can have romantic dinner, go out dancing, build up to it. Also, we might try a new sexual position. It’s very important to try all those things and see what works for us.”

4. Manage expectations a bit.

“If you didn’t have lots of sex when you were younger, you’re not going to become a sex rock star when you’re 80 years old. So managing your expectations is really important.”

Understand the impacts of aging and seek help when you experience pain or discomfort, she says. Understanding the mental aspects also is critical. Personal appearance and self-esteem affect desire as do stress levels. “Stress is the enemy. Stress is bad. Stress can trigger impotence in men and stress can trigger lack of sexual arousal in women. We want to avoid stress at all costs.”

5. Take good care of yourself.

“The more physically healthy we are, all those other aspects of health, the likelier we are to have better sex and longer sex and longevity in terms of having sex all of our lives. Also as an HIV researcher, I do have to make one little plug. Sex is not just for the young and neither are STI’s,” she says, referring to sexually transmitted infections. She encourages the use of condoms, even for those past the age of being concerned about pregnancy. “We don’t offer a lot of education to older adults. Why in the world would they be using condoms in the first place? It makes perfect sense that this is one of the fastest growing groups.”

The Centers for Disease Control and Prevention estimates that nearly 20 million new sexually transmitted infections occur every year in this country, half among young people aged 15–24, accounting for almost $16 billion in health care costs. Consistent condom use provides substantial protection against many STIs, including significantly reducing the risk of HIV, chlamydia, gonorrhea, herpes and syphilis.

It’s another reason health professionals and patients need to be willing to address sexual health, she says. Asking the group to write down how sexually active they are now and how active they want to be 20 years from now, Winningham says that’s an important exercise to embrace their sexual health. “My hope to you is that those five strategies might be helpful to you, and to borrow from Robert Browning, come and grow old along with me because the best is yet to be. We have lots of good things ahead of us.”