The Ultimate Guide to Sex after Fifty

Disease and treatment, more than age, affect one’s ability to enjoy sex. People with arthritis and other movement disorders, for example, may have chronic pain or lose their ability to move well. People with diabetes, which can affect the circulatory system, may have reduced blood flow to sex organs, causing men to have difficulty achieving an erection or women an orgasm. Heart disease can be associated with fatigue and reduced physical strength. Dementia can have a number of effects, including loss of emotional connection with one’s partner and the inability of the partner with dementia to consent to sex.

—“Can we talk about Sex? Seven Things Physicians Need to Know
About Sex and the Older Adult” in Minnesota Medicine.⁵⁷

How do we stay sexual when medical conditions alter us? What does staying sexual even mean now? Our new sexuality might mean more comfortable positions for partner sex, or maybe just sharing caresses, with or without orgasm. Whatever is happening in our body and mind, or our partner’s, will need adjustment, but we never lose our need for touch. Life is hard enough without giving up that.

Whatever medical challenge you’re facing, be open to expanding your definition of what sex is. Instead of insisting that “real” sex is over because it can’t be the way it used to be, focus on what’s possible now—and making that the best it can be, one step at a time. If you are partnered, explore ways to touch, kiss, please each other, and express physical and emotional intimacy without focusing on just one goal. If you are unpartnered, find the kinds of touching and sex toys that arouse and satisfy you.

GREAT SEX DESPITE CHRONIC ILLNESS⁵⁸

By Michael Castleman

Your doctor announces that you have diabetes, lupus, heart disease, rheumatoid arthritis or some other condition. To enjoy the best sex possible despite your chronic condition, follow these six steps:

1. Define Sex Differently. Sex isn’t just vaginal intercourse. If your definition of sex is more flexible, then bidding farewell to intercourse is passing up one dish at a huge buffet. There are many other ways to enjoy physical intimacy, fulfilling lovemaking, and orgasm. Focus not on your disabilities, but on your abilities. Where there’s a will, there’s a way.

2. Find Information and Support. Ask your doctor about the sexual implications of your condition and the sexual effects of your medications. Then ask your pharmacist. Next, search the Internet. Join the organization devoted to your condition. Find it by searching the Internet, or visit the American Self-Help Group Clearinghouse (www.mentalhelp.net/selfhelp). Ask the organization for information on coping sexually, and possibly for a referral to an expert. Join a support group related to your condition and ask members how they cope sexually.

3. Stay as Healthy as Possible. “How can I be healthy?” you ask, “I have this damn disease.” Yes, you do. But you’ll feel better, manage your condition more easily, and retain more sexual interest and ability if your lifestyle is as healthy as possible:

• If you smoke, quit.

• Don’t drink more than two alcoholic drinks per day.

• Eat at least five servings of fruits and vegetables a day.

• Within your abilities, strive for regular moderate exercise, ideally, at least thirty minutes a day.

• Get at least seven hours of sleep a night.

4. Look for New Opportunities. Having a chronic condition means grieving the loss of things you can no longer do, among them, how you had sex. But if you stop there, you wind up depressed. Look for new opportunities for fun and personal growth—including new approaches to making love.

5. Use Lubricants and Toys. Diabetes and other conditions may decrease genital sensitivity. Lubricants and vibrators often help. (See chapter 4, Sex with Yourself and Toys.)

6. Consider Sex Therapy. Sex therapists are psychotherapists with advanced training in sex problems. They discuss your situation, suggest ways you can enjoy sex, and assign erotic “homework.” Studies show that two-thirds of people who consult sex therapists report significant benefit. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists (www.aasect.org).

—Journalist Michael Castleman
has covered sexuality since 1975.
He publishes www.GreatSexAfter40.com.

Arthritis causes joint pain, stiffness, and flexibility problems. When it’s difficult to find a comfortable position for arthritic hips, spine, or knees, it’s even more difficult to abandon yourself to sexual feelings. Arthritic wrists and fingers make it difficult to please a partner or yourself manually. Oral sex can become—quite literally—a pain in the neck. These tips may help:

• Experiment with timing—when are you most comfortable during the day? Make that your sex time.

• Try taking a painkiller and a warm bath or shower an hour before sex.

• Do some gentle exercise before sex to loosen stiff joints. Move through the joint’s full range of motion. Stretch and reach to make yourself as limber as possible.

• Experiment with different positions. Often people with arthritis in the hips, knees, or spine find lying on their sides most comfortable. Try the sex cushions described in the Sex Furniture section of chapter 2, What’s Happening to My Body?

I have pretty bad osteoarthritis in one knee, so some positions are difficult. We do a side-lying position that works well to accommodate that. Some positions even help at times. If I am bent over a chair and my hamstrings are being stretched, it actually feels good!

I’m a younger man, and I assumed that your advice for staying sexual while getting older would be useful for me someday in the future. I didn’t anticipate having a partner who already had these issues. I was recently with a man in his midfifties who had arthritis in his knees and his fingers. This meant no kneeling for him on the floor while we played, so we did everything in bed. Not terribly unusual, except that I rarely have sex in a bed!

Then, as I moved his hands to my nipples to pinch them, we discovered another issue: the arthritis in his fingers makes it painful and actually impossible for him to squeeze at the strength or for the duration I like. He mentioned this and I made a mental note: next time, bring the wooden clothespins! They’d be perfect to use on me and would relieve him of that concern—and pain.

Once we figure out how to be comfortable, we may find that sex actually improves our arthritis, as sex therapist Marty Klein, PhD, explains:

Most people find that joint replacement surgery helps everything about their enjoyment of life, including sex. In one study of people with severe osteoarthritis, 90 percent reported improved overall sexual function after hip or knee replacement surgery.⁶⁰

If your doctor doesn’t bring up sex, bring it up yourself. Ask about safe sexual positions if he or she does not volunteer the information. Check out www.recoversex.com, which offers large, clear diagrams of recommended sexual positions after hip replacement and knee replacement. Although, unfortunately, they only illustrate male-female couples, most of the positions are translatable to other gender combinations.

Knee replacement: You can resume sex once you feel healed and comfortable, usually four to six weeks after surgery. At first, stick to positions where you are the passive receiver, and use pillows to support your knees. Avoid kneeling positions until you fully heal.⁶¹ Face-to-face positions with you on the bottom or side-lying positions that allow you to drape your leg over your partner are recommended.⁶²

Hip replacement: Your doctor will probably tell you to abstain from sex for six to eight weeks after surgery. ⁶³ After that, avoid bending your new hip more than ninety degrees, crossing your leg past the center of your body, opening your hips widely, or turning your toes in.⁶⁴ Recommended positions include face-to-face, letting your partner be on top (without putting all of his or her weight on your new hip), or lying in spoon position. ⁶⁵ Once you heal, you’ll most likely find that hip replacement improves your sex life, because your hip pain is gone.

When your arteries have been narrowed by fatty deposits (called atherosclerosis), your genitals as well as your heart do not receive enough blood. The penis cannot engorge, neither can the clitoris or the vagina.⁶⁶ Erectile dysfunction and difficulty with arousal and orgasms in women can be signs of heart disease, and you need to get medical attention pronto.

After a heart attack, it’s natural that you or your partner may be afraid that sex will cause another attack. Often people are so anxious about the risks that they don’t dare resume sexual activity following a heart attack or heart surgery.

In 2013, the American Heart Association released guidelines advising healthcare professionals to counsel heart patients about sex, including assessment of when they’re healthy enough to resume sex, recommendations for best positions and activities, and individualized counseling.⁶⁷ Your doctor may order an exercise stress test to determine if your heart is strong enough for sexual activity, or recommend a regimen of brisk walking to work up to it. Once you’re cleared, sexual activity carries very little risk.

If your doctor doesn’t offer all this information to you as a matter of course, please ask for it. Again, it’s up to us to let our healthcare providers know that our sexuality matters.

If your doctor assumes that your goal is vanilla heterosexual intercourse and that’s not what floats your boat, speak out. Your right to accurate and helpful medical information trumps any embarrassment that your doctor may feel because he or she is not prepared for your question.

In 1991 at the age of forty-seven, I had a moderate heart attack. I was put on Cardizem, which did wonders cleaning out my arteries, but it prohibited me from getting fully aroused and maintaining an erection. After a year, my cardiologist took me off the drug, and I bounced back. We changed our diet to a lower fat regimen and I began a regular exercise routine which included walking and lifting weights.

At fifty-four, my wife and I decided that our sex lives, which had been somewhat neglected since my heart attack, needed to be revitalized. We feared that if we didn’t enliven that part of our lives soon we might indeed “lose it.”

We invested in toys and sexy clothes and we began watching adult videos, both porn and instructional videos. We continued to eat heart-healthy and exercise routinely. And we were having sex once or twice a week.

Even after doing so many things right, at the age of sixty-two, I underwent a triple bypass for badly clogged arteries. Given my age and this life threatening event, we both thought that this might be the end of our sex lives. But we were both determined not to let that happen unless absolutely necessary.

Fortunately I did not have to take medicines that compromised desire or function. Within six weeks of surgery I had the go ahead from the doc to become active sexually again. The major warning was not to put any pressure on my chest and risk doing damage to his handiwork.

HEART DISEASE MEDICATIONS

These medications used to treat heart disease can have sexual side effects. ⁶⁹

• ACE inhibitors, such as captopril (Capoten), enalapril (Vasotec), and ramipril (Altace), can cause low libido and erectile dysfunction.

• Nitrates for chest pain, such as isosorbide dinitrate (Isordil) and isosorbide mononitrate (Imdur, Ismo), can cause erectile dysfunction. Do not take Viagra, Levitra, or Cialis with nitrates because the interaction can cause a dangerous, potentially life-threatening drop in blood pressure which can cause kidney failure or stroke. ⁷⁰

• Beta blockers, such as penbutolol (Levatol), propranolol (Inderal), and timolol (Blocadren), can cause low libido, erectile dysfunction, female arousal problems, and difficulties reaching orgasm.

• Calcium-channel blockers, such as diltiazem (Cardizem), nifedipine (Procardia), and verapamil (Verelan), can cause erectile dysfunction.

Hypertension can contribute to sexual problems, and so can the drugs that control it. High blood pressure can cause lack of desire; erectile dysfunction and difficulty ejaculating in male bodies; and uncomfortable or painful penetration and difficulty having an orgasm in female bodies.⁷¹

These recommendations from the American Heart Association⁷² will benefit your sex life as well as lower your blood pressure:

Since high blood pressure is a leading cause of stroke and can lead to heart disease, it is essential to take any medications that were prescribed, even if they have sexual side effects. Tell your doctor about these side effects and ask whether another medication might work as well to control your hypertension, with fewer side effects.

A stroke, sometimes called a brain attack, happens when blood flow to a part of the brain stops.⁷³ Stroke survivors often report decreased desire and increased sexual problems due to the stroke, pain, medications, and, often, depression. Women may experience less vaginal lubrication and decreased ability to have an orgasm. Men may experience weak erections or no erections. The part of the brain where the stroke occurred affects the stroke survivor’s sexual response, attitude, and behavior.⁷⁴

The National Stroke Association recognizes the need for intimacy and sexuality and recommends honest communication with your partner and your doctor. Sometimes a change in medication can decrease the sexual problems, so tell your doctor what you’re experiencing.

Experiment with positioning, pillows, and props so that the weaker side is protected. The partner with greatest ease of movement should be the top if intercourse is possible. You may find manual and oral sex to be easier physically, less stressful emotionally, and more satisfying.

You may fear having another stroke during sex, but this is very unlikely.⁷⁵ The increase in breathing and heart rate during sex is normal and not a cause for worry, and you use about as much energy as walking up a flight or two of stairs.⁷⁶ But don’t try to tough it out if you’re scared—anxiety is a libido killer. Admit your worries to your partner and also to your doctor. You may want to get counseling to deal with your feelings and fears and to help you and your partner work through the changes.

PREPARING TO LOVE SOMEONE WITH DEMENTIA: 10 WAYS

By Peggy Brick, Med

1. Become an advocate for dementia research, education, care services, and progressive public policies. If you’re lucky enough to live to be eighty-five, there’s a 50 percent chance you will experience dementia.

2. Do your best to prevent or delay dementia by promoting brain health through regular exercise, a heart-healthy diet, social connections, and brain-stimulating activities.

3. Get an early diagnosis by a primary physician and then a psychoneurologist if you’re concerned about a loved one’s memory, so you can plan, make choices, and get support.

4. Understand the experience of dementia by reading books such as Richard Taylor’s From the Inside Out and viewing films, such as those from Terra Nova Films, www.terranova ondemand.org.

5. Learn how to connect with a person with dementia by listening, touching, hugging, respecting, and loving the person who remains.

6. Recognize that dementia profoundly affects partner relationships. You may experience decreased attraction after assuming care-taking duties. As the disease progresses, your partner may no longer recognize you.

7. Understand that sexual expression is important in a nursing home, and physical contact may be a beneficial and calming means of communication.

8. Ask whether a home you are considering has a sexuality policy that documents residents’ sexual rights, adequate staff training, and abuse prevention strategies.

9. Be prepared to experience difficult and exhausting loss and grief as you interact with someone who is both there and not there.

10. Take care of yourself, which is challenging—but essential—when you love and care for someone with dementia.

—Peggy Brick, MEd, teaches “Alzheimer’s: New
Perspectives” at Osher Lifelong Learning Institute,
University of Delaware, and is the founder of the
Sexuality and Aging Consortium at Widener University.

(Read about the sexual rights of people with dementia in a long-term care facility in chapter 17, Sexy Aging Going Forward.)

The change from spouse or lover to caregiver is life-altering. If at all possible, hire someone to provide some of the daily care. If that’s not financially feasible, find out if the local chapter of the advocacy group for your partner’s disease can help you get low-cost or no-cost help.

Friends, family, and members of your faith community are often eager to help out, but they don’t know what to offer. Help them know! If you can’t imagine asking people for help, ask one friend to coordinate this for you. The more people help you out with caregiving, the more physical and emotional energy you’ll have to interact with your loved one in a way that’s nurturing to both of you—with smiles, hugs, and laughter.

It’s essential that you make it a priority to take care of yourself, too. You need both time alone and time with friends. Keep yourself healthy, including physical and social activity. Get involved in a support group for other caregivers.

And since this is a book about sex, you know I’ll also tell you to give yourself sexual pleasure! Keeping your sexuality alive is in your own hands, double entendre intended. Please reread chapter 4, Sex with Yourself and Toys.

Every medical condition you might face as you age deserves its own section here, but that would make this book impossibly long. Use this book as a jumping-off place to take questions to your doctor and explore the Internet for books, articles, and support forums about your medical challenge. See Recommended Resources.

Whatever is going on for you, please consult your doctor and let him or her know how important your sexuality is to you. I can’t stress that enough. It’s the only way we can communicate to our medical professionals that health isn’t defined by absence of disease—it’s having a vibrant quality of life.

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