Low Sexual Desire

This article reproduced from the Mayo Clinic Newsletter

Finding a new rhythm

In your younger years, the thought of older adults having a satisfying sex life may never have crossed your mind.

Of course, you know better today. Sexuality and intimacy are important aspects in life no matter what your age. But with age, sexuality also can be challenging. Health issues may interfere with a variety of things you never gave a second thought to in your 30s and 40s. For adults in the second half of life, one such issue may be a drop in sexual drive (libido). However, reinvigorating or cultivating sexual desire — a longing for intimacy — is often possible once the contributing factors are understood and addressed.

Steps in the dance of intimacy
Libido results from a combination of biology, emotion, thoughts, meaning and motivation. Libido strongly correlates with satisfaction in a couples’ emotional as well as physical relationship. It also includes an understanding of you and your partner’s wants and needs. Sexual drive is the normal urge to be sexual.

A study published in the British medical journal BMJ looked at sexuality and health among a large group of adults ranging in age from 65 to 85. Overall, the study found that many older adults are sexually active and consider sexuality an important part of their lives.

However, the need or desire for sexual intimacy can be quite variable over a lifetime due to priorities related to family, career or social commitments. Being sexually available to your partner can be especially challenging during times of illness or after developing a serious medical condition. The physical and emotional changes that come along with aging also may contribute to how you feel about sex.

For instance, if you’re with someone new in your life, you may feel as anxious and uncertain about sex as you did during your first sexual experiences. Alternatively, attraction to a new partner may result in an increased libido.

Ladies in this corner
Throughout a woman’s life, bodily changes including those related to the ups and downs of estrogen and progesterone and the gradual decline of testosterone, which women produce in small amounts, can play a significant role in libido.

Changes leading up to menopause and after — both physical and emotional — can make a difference in how you experience your sexuality, including various sexual activities. These changes may include:

Naturally occurring changes in body shape and size — These factors may affect how desirable you feel. Changes with age also may mean a loss of support in your pelvic floor muscles, which normally hold your uterus, bladder, rectum and vagina in place (see our June 2009 article “Pelvic floor weakness”).
Decreased estrogen production — This typically results in thinning of vaginal tissues and less natural vaginal lubrication. These changes may lead to lower levels of desire due to pain or discomfort during sexual stimulation.
Urinary or genital tract changes — Problems such as urinary incontinence, overactive bladder, or vaginal itching or dryness may hinder your participation and enjoyment in relaxed foreplay and intercourse.
Changes in sexual arousal — With age, orgasms typically become more muted.

Men over here
For men, aging means a natural change in testosterone levels. Unlike the rapid drop-off in estrogen that women experience with menopause, testosterone levels peak in a man’s late teens and then gradually decline throughout life.

Normally, as men get older, that gradual decline in testosterone may show up as a normal change in sexual response, specifically:

Erections may take longer to achieve and may not be as firm.
Penile sensitivity may be decreased.
Full arousal may take longer and ejaculation may be less intense.

The problem of erectile dysfunction (impotence) becomes more common as men age. Erectile dysfunction may be due to treatment or surgery related to prostate cancer and conditions affecting the cardiovascular system or the nervous system.

Among aging men, the desire to be sexual is often based less on hormonal drive and more on emotional attachment to their partner. Desire for emotional intimacy defies age, so the focus on a physical relationship can shift increasingly to an emotional one. This change tends to bring older adults together for satisfying sexual intimacy even if arousal and orgasm aren’t the same as they once were.

Issues beyond gender
For both men and women, medical conditions that affect general health and well-being can interfere with their sexual life. If medical concerns or illness impairs your partner’s sexual function, you’re also likely to encounter a dampening effect on your own sexual enjoyment.

Multiple chronic conditions of aging can lead to impaired arousal and reduced sexual enjoyment or comfort. Some of these may include:

Diseases affecting the cardiovascular system — Adequate blood circulation figures strongly in arousal for women and men during sexual activity. Conditions such as diabetes, high blood pressure and high cholesterol can contribute to problems of impaired or diminished blood flow. Cardiovascular damage is also related to smoking.
Joint health — Conditions affecting joints, such as osteoarthritis and rheumatoid arthritis, may impair movement or cause pain. Special considerations and adapting new positions during sexual intercourse may be necessary after joint replacement surgery.
Nervous system damage — Many conditions, such as diabetes and stroke, may impact normal nerve function that contributes to the process of sexual response. Nerve sensation is required for sexual arousal and is as important for women as it is for men.
Psychological issues — Depression or anxiety can distort and flatten normal enjoyments in life, including libido. Relationship issues — such as performance anxiety or the guilt some experience when moving into a new relationship after the death of a partner — can impair sexual desire or enjoyment.

In addition, older adults tend to take more medications, which can inhibit sexuality — including desire for sex, ability to become aroused and orgasmic function. Among prescription drugs that may affect sexual function are antidepressants, opiate-type drugs for pain relief and high blood pressure medications. Excess alcohol consumption can have a similar effect.

Hormone therapy related to cancer treatment also can have an impact on sexual relationships. Some women who have had breast cancer are prescribed medications that reduce or block estrogen action. These drugs can have a powerfully negative impact on sexual enjoyment, comfort and desire.

Hormone therapy may be used in treating prostate cancer to lower a man’s testosterone level. Commonly, this causes a loss of libido, but not always. Some men maintain their sexual desire, but have difficulty getting an erection or are unable to reach orgasm.

What can be done
Communication is key to addressing sexual-function changes, including loss of libido. Talk openly with your partner about any physical difficulties you may be encountering and changes you’re experiencing in your sexual function or sexual enjoyment. Try to explore different ways to enhance your enjoyment of intimacy as a couple. Sharing in this manner can enhance your relationship.

Vaginal dryness related to menopause may be helped by using a nonprescription, water-based product such as a moisturizer (Replens), or non-glycerin lubricants, such as Slippery Stuff.

Another consideration may be to talk with your doctor about using a vaginal estrogen. If you suspect or wonder if the problem is medical in nature, see your doctor. Underlying medical conditions can be troubling obstacles to sexual enjoyment for men and women of all ages.

If you’re taking medications, ask your doctor whether any might be limiting factors for sexual activity. In that case, a different medication or another form of treatment may be an option for you.

But remember, drugs such as sildenafil (Viagra), tadalafil (Cial-is) and vardenafil (Levitra), used to treat erectile dysfunction, don’t alter libido, only function.
Regular exercise can help improve your energy levels as well as help you feel more attractive. Exercise also helps stimulate genital blood flow.

Many individuals and couples benefit from brief counseling by a trained therapist who can provide education, specific suggestions and tailored interventions for sexual concerns. Often, counseling is done as well as medical evaluations and related treatments for the specific sexual concerns.

The one thing you can’t do is go back in time. So, rather than wishing for things to be as they were in your youth, consider instead who you are now and how you and your partner might enjoy or respond to sexual experiences now.