You're Never Too Old (Sex for Seniors)

Beverly Whipple, PhD, RN, FAAN
Rutgers University

Special from Bottom Line's Daily Health News.

A lthough many seniors still believe that sex is mainly the province of the young, a recent American Association of Retired Persons (AARP) survey indicates that for older adults, sexual health is considered an essential part of a good quality of life. Here's why...

SURVEY FINDINGS

In 2004, AARP surveyed almost 1,700 adults age 45 and up about the factors affecting their health, sexuality and general quality of life. Then, they compared the results with a similar study they ran in 1999. Now, it turns out, older folks are more open and involved in their sexuality than ever before...

• 60% now believe that sex is a critical part of a good relationship, compared with 55% who thought so in the 1999 survey.
• More than twice the number of men (22%, up from 10% in 1999) reported using drugs or other treatments to improve sexual performance.
• More people are willing to consult health professionals about their sexual health (37%, up from 26% in 1999).

There is much scientific evidence to back up respondent's attitudes about the importance of sex to quality of life. Positive health benefits of regular, satisfying sex for both body and mind include...

• Immune system enhancement: A 1999 study found that college students who had sex once or twice a week had stronger immune systems than their celibate peers.
• Natural pain relief: A 2001 study found that orgasms can ease migraine pain faster than any medicine.
• Tension release: Orgasms relieve stress and also can help combat insomnia.
• Preventing depression and boosting self-esteem: Studies have shown that people with active sex lives report a higher quality of life and less depression. A study of women showed that those who masturbate have higher self-esteem than those who don't.
• Longer life: Research indicates that an active sex life is one of the predictors of long life for both men and women.
• Aerobic benefits: Sex is a great workout, burning about 150 calories an hour.

An impressive list of potential benefits!

MEDICATION MALAISE

Sadly, nearly one-third of the AARP respondents ranked their sex life somewhere between the survey categories of "yawn" and "bloody awful." One reason may be that many middle-aged and older adults are taking medications whose side effects negatively impact sexual performance or enjoyment.

I asked Beverly Whipple, PhD, sex researcher, professor and current secretary general of the World Association for Sexual Health, which medications are known to affect sexual health. "Selective serotonon reuptake inhibitors (SSRIs) taken for depression/anxiety certainly can affect both men's and women's abilities to experience orgasm," Dr. Whipple said. Some widely used brands of SSRIs are Prozac, Zoloft and Paxil.

In addition, she said, it's long been well known that high blood pressure and cardiac medications can affect men's ability to achieve or maintain erections. Dr. Whipple advises middle-aged and older persons to report to their physicians any changes in their sexual responses, especially if medications have changed. Also, make sure to bring a complete list of current prescribed medications as well as any over-the-counter remedies when you discuss your situation with your doctor.

How to overcome the challenges? Read on below...

Stoking the Fires of Intimacy

Given the results from the AARP survey, what can older adults do to improve their sex lives? It all depends on what's causing the sexual problem.

If you take medications...

As mentioned above, certain medications (most notably, blood pressure drugs and antidepressants) can negatively affect libido and sexual response. But not all medications affect everyone the same way. Dr. Whipple suggests trying different ones, under your physician's direction, of course. Simply changing your "brand" of high blood pressure medication, for example, may help preserve your sex life.

Daily Health News contributing editor, Andrew L. Rubman, ND, tells me also that for certain conditions there may be natural treatment options that can replace medication -- which would in turn ease the libido problems. Talk to your doctor or a naturopathic physician about whether medication is required or simply the convenient fix to your symptoms.

A note for women who take SSRI antidepressants: Zestra for Women, a massage oil that has been found to aid sexual interest and satisfaction (described below), has been proven effective in women taking SSRI antidepressants.

If you have a medical condition...

Medical conditions that inhibit movement, such as arthritis, may make certain sexual positions and practices awkward or downright painful. Discover through trial and error which positions are most comfortable for you.

To deal with the fatigue that accompanies many illnesses, try to determine when your energy or your partner's energy waxes and wanes during the day. Perhaps there's a time other than bedtime that fits your energy cycles.

If you lack desire, arousal and/or satisfaction...

Dr. Whipple recommends three over-the-counter products for sexual desire and response problems -- ArginMax for Men, ArginMax for Women and Zestra for Women. Each product is all natural, and double-blind placebo-controlled studies show promising results. Although there are no significant side effects for any of the products, if you're on medication, it's always best to check with your doctor first.

ArginMax for Men: This nutritional supplement consists of a standardized combination of ginkgo biloba, Korean ginseng, American ginseng, vitamins A, C, E, B-6, B-12, folate, thiamin, riboflavin, niacin, biotin, pantothenic acid, zinc, selenium and L-arginine, a naturally occurring amino acid.

Is ArginMax for Men an alternative to Viagra? Dr. Whipple thinks so. It certainly should be considered by men for whom Viagra is contraindicated, for example, those who are taking nitroglycerin for heart conditions, she said. And because ArginMax for Men is a natural supplement, and not a drug like Viagra, it is more gradual in its effects, gentler to the body and, most importantly, has no significant side effects.

ArginMax for Women: This nutritional supplement contains a combination of L-arginine, korean ginseng, ginkgo biloba, the herb damiana, and vitamins A, C, E, B-6, B-12 as well as folate, thiamin, riboflavin, niacin, biotin, pantothenic acid, zinc, calcium and iron. Again, no significant side effects were reported in this study, but it is wise to check with your health-care provider about possible medication interactions. If you are already supplementing with some of the ingredients in ArginMax, check to make sure that you are not overdosing on these.

Zestra for Women: Zestra Feminine Arousal Fluid is a topical massage oil that is applied manually to the genitalia prior to intimacy to increase arousal and sensation. Zestra works by increasing genital sensory nerve conduction and genital blood flow, which in turn increases sensitivity. The effects generally begin three to five minutes after application and typically last about 45 minutes for most women. Zestra is a blend of pure botanical oils including borage seed oil, evening primrose oil, angelica extract, coleus extract, vitamins C and E and natural fragrances.

In this study, reported in the Journal of Sex and Marital Therapy in 2003, three out of 20 subjects did report mild genital burning sensations lasting five to 30 minutes after application.

Dr. Whipple adds one caveat: Because Zestra is an oil-based product, it is not recomended for use with condoms or dental dams.

I asked Dr. Rubman to also review these three products. Both ArginMax and Zestra contain active ingredients at very low doses, which may impact their effectiveness for some. A naturopathic physician may be able to prescribe different or stronger natural products based on your needs. Of course, starting out with the lowest strength of any product -- whether natural or pharmaceutical -- is always a safe strategy.

What if you're just in a rut?

Dr. Whipple acknowledges that even in the absence of medical conditions or medications that inhibit sexual interest or performance, many couples in long-term relationships have unsatisfactory sex lives simply because they are bored. How to get out of that sexual rut?

Communicate! It is vitally important to communicate your sexual preferences to your partner, says Dr. Whipple. Communicating specific sexual and sensual likes and fantasies often is difficult for people in long-term relationships who may never have talked about sex, Dr. Whipple concedes.

"An interesting communication problem we're finding now in middle-aged and older couples is that men, unbeknownst to their wives, are getting prescriptions for Viagra and then expecting their partners (some of whom have been vaginally inactive for years) to respond all of a sudden," Dr. Whipple said. "It doesn't work that way. I encourage older couples to go together to their health-care provider and select a treatment, if one is necessary, that will be comfortable for both of them."

Do try this at home!

Dr. Whipple recommends that her patients "play" with each other. Intimacy isn't just about a single sex act, it's about being relaxed and free to enjoy. Watch erotic movies together... read to each other (erotic or non-erotic literature)... light aromatic candles or incense... play sexy music... give massages to each other... try a new perfume... feed your partner grapes. The key, says Dr. Whipple, is to engage all your senses in foreplay -- sight, sound, smell, touch and taste. Be creative!

Realize it's more than okay to have sex at any age!

In her practice as an AASECT-certified sexuality counselor and educator, Dr. Whipple found that older couples become inhibited about having sex "at my age" or guilty about even having sexual desires as they get older. Here's where health-care providers can help -- by inquiring about their patients' sexual health, practitioners can, in effect, give those older people who need it "permission" to be sexually active. That encouragement may be all that's needed for a better sex life, Dr. Whipple says.