Sex in your sixties… It’s a topic that is often overlooked and underrepresented but numerous studies have demonstrated just how beneficial a healthy sex life can be. Benefits for both physical and mental health have been described by researchers. And several large-scale surveys describe a significant desire for older adults to retain sexual expression. However, it is important to note that while desire is still present over half of the respondents in a 2009 survey of 57 to 85 year-olds reported that there was at least one bothersome sexual concern. Meaning that there are some very important considerations that need to be addressed to facilitate changing needs. This can be related to physical restrictions, mental health, other comorbidities, and polypharmacy considerations for the sexual wellbeing as we age.  

This 2014 study outlined the most prevalent concerns reported by physicians and patients regarding sexual health challenges facing men and women after the age of 50. For women themes around declining libido, diminished vaginal lubrication making penetrative sex painful, inability to orgasm were highlighted. Further for many women experiencing menopause there may be hormonal changes driving the vaginal dryness and changes in libido.

Some changes of female anatomy are completely normal as we age and may not significantly impact sexual functioning at all. For example, there is a natural loss in the fullness of labia, a narrowing of the introital opening, thinning, and greying of pubic hair, and the loss of collagen and elasticity therefore also loss of water retaining ability. Some other changes can be more upsetting such as the decreased sensitivity of the clitoris, decreased intensity of uterine contractions on orgasm. Chronic lower urinary tract infections in women over 60 may also contribute to sexual avoidance. Interestingly this can be caused by hormone mediated changes to the vaginal microflora. Specifically, the lowered estrogen results in shift in the Lactobacilli population a probiotic species that normally keep the vagina and vulva acidic. This shift combined with environmental factors (such as hygiene, diet, and antibiotic use) can lead some women to be more susceptible to overgrowth of yeast and other undesirable bacteria.

While for men most respondents focused on erectile difficulties. Erectile Dysfunction (ED) is the term assigned when something within the process of initiating or maintaining an erection is disrupted. Age related ED is usually secondary to several other conditions grouped as: psychological conditions; vascular (hardening of the arteries supplying the penis or damage or trauma to the penile arteries or veins) ; neurological; drugs and toxins; endocrine and metabolic disorders.

In fact, in both groups’ comorbidities were a larger predictor of sexual dysfunction. Some of these include diabetes, heart disease, Parkinson’s disease, urinary incontinence, and arthritis. Some of these concerns can directly impact sexual functioning, while others have a more indirect impact- altering mood or increasing pain. While it is important to address the specific unique needs related underlying conditions, a complete sexual health plan for anyone in their 60’s will also include the following:

1. Strategies to improve stress and mental health: Mental health considerations are important not to overlook as both loneliness and depression can induce or worsen sexual dysfunction. We can also consider botanical formulas for stress management to help with extreme cortisol fluctuations. This may include Maca root, yohimbe, ashwaghanda, licorice extracts. It is important to note that many of these botanical therapies require additional liver and kidney functions meaning you don’t want to use them if these organs are already stressed.
2. Supporting sexual organs and the hormones that regulate them. For women, post-menopausal changes may lead to increased sexual dysfunctions and can effectively be managed with hormone replacement therapies. However, the changes from menopause are alone do not cause these changes hence why not all women feel horrible after menopause (menopause is not the enemy!) Instead focus on promoting overall health. Sex hormone production requires dietary fats as well as sufficient vitamin D levels and a healthy gut, skin, and vaginal microbiome with fermented foods or probiotics.  In men with difficulty having and maintaining erections consider options that improve blood flow (similar to the mechanism of action of popular ED drugs like Viagra.) Nutrients that have been shown to improve peripheral blood flow include l-arginine which increases nitric oxide production and niacin or vitamin B3. Niacin is effective at inhibiting the release of low-density lipoproteins (or LDL [bad] cholesterol) and a study from 2011 found that men with moderate to severe erectile dysfunction found improvements by supplementing with 1500 mg/day of niacin.
3. The polypharmacy predicament: Several researchers have noted that the many drugs and supplements that many elderly adults take along with the reduced absorptive capacity as we age may cause or worsen sexual dysfunction. In fact, many of the drugs used to treat comorbidities listed above have that exact concern complicated by the fact that many treatments and medications for such disorders may induce or exacerbate sexual dysfunctions. Individuals may need to alter their diet to comply with their medication, they may also be able to supplement some of the nutrients that are depleted. Vitamins and minerals such as magnesium, zinc, and B vitamins may be depleted with long term use of several medications. It is important to speak with your prescribing doctor to understand your options and assess any risks. 

Select References:

Appa AA, Creasman J, Brown JS, et al: The impact of multimorbidity on sexual function in middle-aged and older women: beyond the single disease perspective. J Sex Med 2014; 11: pp. 2744-2755

Canadian Institute for Health Information. Chapter 3: Primary health care and prescription drugs – key components to keeping seniors healthy. In: Health Care in Canada, 2011: a focus on seniors and aging. Ottawa, ON: Canadian Institute for Health Information; December 2011

Fisher JS, Rezk A, Nwefo E, Masterson J, Ramasamy R. Sexual Health in the Elderly Population. Curr Sex Health Rep. 2020;12(4):381-388. doi:10.1007/s11930-020-00278-0

Lindau ST, Schumm LP, Laumann EO, et al: A study of sexuality and health among older adults in the United States. N Engl J Med 2007; 357: pp. 762-774

Malviya N, Malviya S, Jain S, Vyas S. A review of the potential of medicinal plants in the management and treatment of male sexual dysfunction. Andrologia. 2016 Oct;48(8):880-93. doi: 10.1111/and.12677. PMID: 27681645.

Rhim HC, Kim MS, Park YJ, Choi WS, Park HK, Kim HG, Kim A, Paick SH. The Potential Role of Arginine Supplements on Erectile Dysfunction: A Systemic Review and Meta-Analysis. J Sex Med. 2019 Feb;16(2):223-234. doi: 10.1016/j.jsxm.2018.12.002. Erratum in: J Sex Med. 2020 Mar;17(3):560. PMID: 30770070.

Taylor A., Gosney M.A.: Sexuality in older age: essential considerations for healthcare professionals. Age Ageing 2011; 40: pp. 538-543