Sex at 50 and Beyond

Sex is for young people. Who needs sex at our age? No one needs to see my cellulite.

If these statements sound familiar to you, the AARP Virginia webinar “Sex at 50 and Beyond: Sexual Health and Wellness” is for you.

The webinar aired live in October, and the recording is available to view on demand on the AARP Virginia website currently. The presenter, Dr. Marissa Galicia-Castillo, is the John Franklin Distinguished Chair of Geriatrics at Eastern Virginia Medical School, and a very engaging voice on sex in the senior years. As a gerontologist, Galicia-Castillo has had firsthand experience with patients navigating sex at 50 and older. Her objectives for the webinar were: to describe perceptions and the prevalence of sexuality in older adults; to address the importance of safe sex; and to review strategies for success.

Older adults were addressed as young-old (65-75 years old), middle-old (76-85 years old), and old-old (85 years and over). Astonishingly, Galicia-Castillo noted that by 2060, the old-old will have up to a 200% increase in numbers and that almost one-fourth of the population will be over 65. Despite the myths and misperceptions that older adults are asexual, that sexual expression in older adults is a problem behavior, that it is impolite to discuss sexuality, and that sexual interest disappears as dementia occurs, many in these age groups will be seeking sexual intimacy.

How much sex are the 50-plus enjoying? Galicia-Castillo noted that according to 38.5% of the men and 16.7% of the women in the 75-85 age group, 54% had sex two or three times per week, 23% had sex once a week, and 30% had oral sex. The prevalence of sexual activity increased as the ages decreased: 83.7% of men and 61.6% of women ages 57-64 were sexually active, decreasing to 67% of men and 39.5% of women for ages 65-74.

Why are older people having less sex? The reasons are not surprising: medical conditions, side effects of medications, poor body image, discomfort, and lack of opportunity. When addressing lack of opportunity, Galicia-Castillo focused upon barriers in health care facilities. The barriers included lack of privacy, frequent interruptions, and attitudes of staff and family members (60% did not feel it was necessary for residents to maintain sexuality, while 80% did not believe that residents had sexual needs). Surprisingly, according to Galicia-Castillo, although nursing homes are the second highest regulated entities after nuclear facilities, there are not many regulations regarding conjugal visits in nursing homes. Although cognitively impaired patients may be among the nursing home population, since sexual interest and activity do not decrease with the onset of dementia, Galicia-Castillo addressed the importance of promoting privacy for those who have the capacity to consent to sexual activity.

Age is not a condom. Although older adults may think that they are at low risk of acquiring sexually transmitted diseases and thus are less likely to use condoms, HIV/AIDS statistics reveal the harmfulness of this behavior. According to Galicia-Castillo, persons 50 and older account for 15% of new HIV/AIDS diagnoses, 24% of persons living with HIV/AIDS, and 35% of all deaths of persons with AIDS. Unfortunately, the HIV/AIDS diagnosis is made later due to underreporting of symptoms and the presence of other chronic diseases, the disease course is faster, and the prognosis is poorer. Galicia-Castillo emphasized the CDC recommendations for HIV screening, including routine screening for patients 13 to 64 years old regardless of risk, and testing of persons 65 or older based on a risk assessment and clinical judgment.

How do you improve your sex life at 50 and beyond? Galicia-Castillo suggested the following strategies: timing; focusing on “outercourse” (hand-holding, kissing, massage, oral sex, and fantasy sharing); expanding your repertoire (think outside of the bedroom and try different positions); getting help (medications and devices for erectile dysfunction); limiting alcohol and tobacco; and increasing your physical activity. Above all, communicate with your partner. Communication is a big part of improving sexual function.

Remember, as Galicia-Castillo concluded, lifelong sexual function is an important component of successful aging.