Older, wiser, and sexually healthier?

Many things improve with age. Fine wine, for instance, grows more complex, more enjoyable, and more valuable. So why not consider the possibility that one’s sexuality develops similarly as it matures?

Your experience of intimacy during midlife and beyond is not likely to be the same as it was in your younger years. Some age-related physical changes may be unavoidable. But these changes may not have to interfere with your being intimate. Your sex life is by no means destined to be dull or disappointing as you grow older. Quite the contrary.

Healthy individuals can remain sexually active and interested well into their 70s, 80s, and 90s, if they so choose. Research shows that about half of people over the age 70 are still having sex and about a quarter of people over the age of 80 do so, as well. In fact, when it comes to sex and aging, an active sex life may even help keep you feeling younger.

The fact is, there's no one right way to experience sex. The way you express your sexuality is shaped by your personality and circumstances. Whether you're single or in a relationship, disabled or able-bodied, younger or older, think of your sexuality as a unique part of who you are. By taking a more personal, less prescribed approach to sex and intimacy, you allow yourself the freedom to adapt your sex life according to your changing needs.

The first step to maintaining an active, fulfilling sex life is getting to know some of the normal physical changes you're likely to experience as you get older. The next step is being open to making a few simple adjustments to your standard sexual routine.

What to expect

There are several age-related changes that may affect your sex life. After a certain point, for example, it takes longer to become sexually aroused. But rather than worrying about your changing body and slower response time, talk to your partner about being intimate. They also may be experiencing something similar.

Changes with menopause

As women age, particularly around the age of 50, many may experience a drop in libido related to menopausal changes. But research suggests that some women may experience more frequent and more intense orgasms as they age. And because menopause dramatically reduces the risk of an unplanned pregnancy, sex during menopause may be more fully and freely enjoyable.

Nevertheless, changes related to menopause may make sexual activity uncomfortable or even painful. Many of these can be remedied, though, and sex can be just as comfortable as it was in your younger years.

Vaginal dryness

During and after menopause, lower levels of circulating estrogen may cause the lining of the vagina to become dry and fragile. It may feel itchy and sore. As a result, penetrative sex may be painful. If the lining of the vagina is very dry, intercourse can cause chafing and bleeding. Vaginal dryness might make a person want to avoid being intimate.

Pain can also occur because of age-related changes in the size and shape of your vaginal canal.

To cope with dryness, try a water-based vaginal lubricant, such as Replens or K-Y Jelly. These over-the-counter lubricants can help relieve dryness and irritation. Some are designed for application just before intercourse. Longer-lasting moisturizers are specifically for menopause-related dryness, and they help keep the vagina lubricated for up to 72 hours.

If these options don't work well for you, consider talking to a healthcare provider (HCP) about prescription creams. If intercourse is painful despite adequate lubrication, you may need to experiment with different sexual positions. If pain persists, tell an HCP.

Slower response time

As you get older, it may take longer for your body to respond to sexual stimulation. Even if you feel highly aroused, your natural lubrication or your erection may take time to kick in, and you may not become as wet or hard as you used to.

While this is not necessarily a sign of disinterest, some people, or their partners, may misinterpret it as such. To avoid misunderstandings, keep the lines of communication open. It may not be easy to talk about sex at first, but in the long run, it will benefit both of you.

To adjust to this change, slow down. Don't rush. Spend more time on what's traditionally been considered foreplay. Explore each other's body: kiss, caress, lick, or give each other erotic massages. And remember, your partner may be experiencing age-related changes and need more time and stimulation to become sexually aroused, too. For some men, having sex in the morning, when erections are more likely, helps improve their ability to maintain an erection longer.

Weakening pelvic muscles

Our muscles weaken as we age, and the pelvic muscles are no exception. Pelvic muscles play a key role in everyone's sexual function, so it's important to keep these muscles in shape.

Pelvic-floor muscles are partly responsible for drawing blood to the genitals during sexual activity, affecting vaginal lubrication and orgasm. As pelvic muscles weaken, people with female anatomy may experience shorter or less powerful orgasms and may be at increased risk for urinary incontinence and uterine prolapse.

To strengthen your pelvic muscles, do Kegel exercises every day. Those with male anatomy can benefit sexually from these exercises, too. Kegels are easy to do, but they're also easy to get wrong. Talk with your HCP about the correct approach.

Erectile dysfunction

When it comes to sex and aging, a person may have trouble getting an erection or find that their erections aren’t firm enough for sex. The technical term is erectile dysfunction (ED). The causes of erectile dysfunction are varied and complex, but ED is not an inevitable consequence of aging.

With age, however, certain physiological changes that are likely to affect sexual functioning do occur. An enlarged prostate can inhibit an erection. Levels of the hormone testosterone, believed to be linked to libido and sexual virility, gradually decrease, and blood flow to the genital area may not be as rapid as it was earlier in life. Erections may not be as hard, they may not last as long, and the experience of ejaculation may not feel as strong as it used to.

If you’re affected by ED, talk to an HCP. There are prescription options that can help manage the condition.

Longer periods between erections

It’s common for older men to experience a longer refractory period—the time until the body’s ready for another erection after ejaculation. In some cases, the cooling off period may be 12 hours, 24 hours, or more. After climax, if you’re both interested in continuing the moment, focus on alternative activities. You don’t need an erection for oral sex or manual stimulation, for example.

Be mindful of sexually transmitted infections

While sexually transmitted infections (STIs) are often discussed in reference to young people, these diseases can affect anyone of any age who is sexually active. In fact, between 2000 and 2022, rates of many STIs grew for people ages 55 and older in the United States, according to the Centers for Disease Control and Prevention (CDC).

For example, reported cases of gonorrhea rose from 3,229 in 2000 to 18,804 in 2022, an increase of nearly 500 percent. Similarly, reported cases of syphilis rose by more than 1,900 percent in the same period, while chlamydia cases increased by more than 800 percent.

It’s likely that HIV, the virus that causes AIDS, goes underreported in older adults. That’s because older people are less likely to get tested and some of the symptoms can seem like other diseases or common issues associated with normal aging.

Most STIs are treatable, including HIV, which is far from the dire diagnosis it once was. But to catch these infections early and lower the risk of infecting others, it’s important to get regularly tested if you’re sexually active. This is especially true if:

• You’re in a non-monogamous relationship
• You’re having unprotected sex
• You or your partner are sharing needles

For sexually active people, the best protection against STIs is to always use a barrier method. Use a condom during anal or vaginal sex, and a dental dam during oral sex, and talk with your HCP about getting tested regularly.

Other issues that can affect sexuality

Chronic medical conditions, such as arthritis, heart disease, diabetes, and cancer, can affect the ability or desire to be sexually active. It can be difficult to get in the mood when you’re in pain, feel sick or weak, or are recovering from surgery.

Certain medications can also affect sexual function. Antidepressants, antihistamines, chemotherapy, and drug treatments for high blood pressure may contribute to erectile dysfunction, reduce sexual desire, or increase vaginal dryness.

If these issues affect you, know you’re not alone. They play significant roles in the lives of millions of people. To help manage them, speak with an HCP. In many cases, they can suggest steps to improve both your sex life and your overall health. These may include making lifestyle changes, such as getting more activity or prioritizing sleep. In some situations, an HCP may be able to switch medications or change dosing for current medications.

Tips to nurture a healthy sex life

Try these simple tips to maintain and enhance your sexual well-being:

Think positively about yourself and your sexuality

Accept who you are at every stage in life. Remember that what you bring to the table is something you alone can offer—a unique expression of your desires, fantasies, fears, and experiences.

Talk with your partner about how you both may be changing

Many couples don't spend much time talking to each other about sex. Though it may be awkward at first, this type of intimate exchange, done with respect and care, may bring you much closer together. It’s also likely to have a positive effect on your sex life.

Remember there are many ways to enjoy being intimate

Penetration isn't all there is to good sex. Give yourself permission to experiment, alone or with your partner, to discover what feels right for you at this time in life. It might be a new sexual position, oral sex, cuddling, or choosing not to engage in sexual activity at all.

Use it or lose it

Remaining sexually active (with or without a partner) helps keep blood pumping to the genital area. This helps with natural vaginal lubrication as well as erection and ejaculation.

Take steps to protect your health

Eating a balanced diet, staying physically active, and maintaining a healthy weight are good for your overall and sexual health.

Talk to a professional

If you have concerns about your medications or if you have questions about your sexual health, reach out to an HCP. Not all HCPs are comfortable discussing sexual issues and may not be up to date on the latest research regarding sexual health. If that's the case, ask for a referral.

Remember that a healthy sex life is one that's healthy for you and your partner, if you have one. There's no such thing as a normal level of desire or an optimal frequency for sex. If you're not interested in being intimate at this time in your life and it's not affecting your relationship, then that's healthy for you, as well.