Aging & Sexuality

Reprinted from PN February 2001

When you need information, do you consult books? Visit your physician? Or just ignore the whole issue?

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In this age of Viagra, much has been written about the prevalence of sexual dysfunction in our society. A few short years ago, it would have been almost unthinkable to consider how relaxed and open we have become about sexual conversations and practices. More than ever, sex has come out of the closet and become an acceptable topic of discussion among families and friends.

Recently, the Association for Advancement of Retired Persons (AARP) obtained some interesting information regarding sexuality and aging. Although AARP's survey did not deal specifically with SCI, it does provide fascinating insights into our attitudes and behaviors regarding sexuality.

This article includes some of the findings of the AARP study, other surveys, and some of my own experiences as a sex therapist.

Obtaining Treatment

Since Viagra was introduced in spring 1998, nearly twice as many men seek treatment for erectile dysfunction (ED) per month as did before the drug was available. In addition, men tend to seek treatment sooner than ever before. In spite of this increase, however, men still find it difficult to discuss the topic.

Conversations about sexual dysfunction are often avoided for long periods of time. Some men prefer to seek treatment from a doctor before ever discussing such issues at home. More commonly, however, the sexual partner ultimately forces the issue and pushes the man to speak to his doctor. Although few men with SCI received adequate information about sexuality during their rehabilitation, most were too embarrassed to ask specific questions about sex before they left the rehab hospital.

Older individuals have the most difficult time seeking help about sexual concerns. Men over 50 use books rather than medical professionals as the number-one source of information. Women are more comfortable seeking advice from a physician, especially if the doctor is also female. Younger people use the Internet as their first source of information.

In general, men are less fearful about seeking help on sexual matters if they know their problems are from physical conditions rather than psychological ones. They will downplay any emotional pain or distress caused by the condition. Men are always relieved to learn that the sexual difficulty is physical and not emotional.

The Importance of Sex

Men and women over age 45 tend to downplay the importance of sexuality in their lives. This group reports that close ties with friends and family are very important to the quality of their lives—more than a satisfying sexual relationship. Women, even today, have a difficult time acknowledging that they enjoy sex or find it important in their relationship. They say emotional closeness is equally or more important than the physical satisfaction obtained from sexual activity.

For people between ages 45 and 59, "less stress and more time" are the top things that would improve their sexual lives. Individuals over 60 say better health for themselves or their partner leads the list. After age 70, women report that finding a partner is the most important factor toward a better sexual life.

If a couple is not sexually active, it is not uncommon for one member of the couple to feel guilty. This person feels that sex is more important to the other individual and tends to blame him- or herself for the lack of activity. Women often interpret a lack of sex as signifying a loss of attractiveness. Talking about the lack of sex in a marriage or relationship is probably the only way to reduce the feelings of guilt that occur as the importance of sex changes in a relationship.

Sexual Desire

Arthritis, pain, medications, and other such medical conditions are primary factors in reducing sexual desire after age 50 for people with and without SCI. In this age group, these medical conditions can restrict sexual positions, limit movement, and ultimately reduce sexual pleasure. In addition, fears of failure and lack of sexual confidence can make sex seem like work rather than pleasure.

When sex is perceived as a task to be accomplished, the frequency of the activity drops dramatically. About 50% of people between ages 45 and 49 have sex at least once a week. After age 60, only about 30% of couples have sex on a weekly basis. If an individual has a partner, at least 70% of couples have intercourse at least once a month regardless of age.

SCI Patterns

Sudies indicate that all age groups of people with SCI have less sex than do people without disabilities in that particular age group. Most people with SCI do have sexual activity, alone or with a partner, at least once per month. Intercourse is typically not a part of each sexual encounter.

In almost all couples, sexual activity after SCI takes longer, and most people report it is satisfying. Level and completeness of injury as well as presence of a supportive partner are the major factors in whether someone with SCI will find sex satisfying. Openness to new techniques significantly correlates with sexual satisfaction after SCI.

Difficulty in achieving ejaculation and orgasm are the biggest sexual frustrations experienced after injury; poor-quality erections are the second. Less than 50% of men with SCI have tried Viagra. About 85% of men with SCI report it is ineffective in improving their erections.

Men who still use penile injections to improve erections tend to be older individuals who are in long-term, stable relationships. They often prefer injections because they find them more consistent and predictable.

Concerns about the partner's degree of pleasure during sex is universal for men as well as women with SCI. Younger people with SCI discuss such issues more often than do older couples. Nevertheless, most people with SCI, regardless of age, report that communication about sex is more important than it was prior to injury. Some men with SCI say they are better lovers since the onset of injury.

Stanley Ducharme, Ph.D., is a clinical psychologist in the departments of Rehabilitation Medicine and Urology at Boston University Medical Center. Dr. Ducharme writes a quarterly column for PN, entitled Sexuality & SCI.


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