In the last issue of MHR, Sarah Goodfellow discussed sex and the elderly. The contributors to this InkLinks continue this conversation from a medical perspective.
InkLinks is a regular column in which readers reflect on issues related to the previous article. It is meant to tap the rich intellectual resources that this network provides. We welcome your contribution at leahtamar@comcast.net.
Fun, Sex Toys, and the Elderly
Aron Sousa, M.D.
College of Human Medicine
No one expects their elderly patient to ask how to buy a dildo. But about three months ago that was the question I got from T. Because of certain plumbing issues, he and I had discussed sex a couple of times, and by his report, he and his wife were into it. By which I mean that the conversation was not about how sex “was important” or “meaningful,” but rather how sex was fun and they wanted to have sex for that reason.
In her piece “Gendered Neutral? Medical Representation of Senescent Sexuality,” Sarah Goodfellow asks a concluding question, “What would constitute age-appropriate sexual behavior for the elderly?” And I guess my question in return is “Why focus on age?”
***
I started innocently enough. “So T, given that the meds haven’t worked, what do you want to do?”
“Well,” he answered a bit sheepishly, “what about those…. [awkward hand gesture] those things….”
“You mean a sex toy?!”
“Yeah, I know it would not help me, but my wife would enjoy it and I think she’d be interested.”
“Sounds like a good idea.”
“But, Aron, I am a crippled up 85 year-old guy. I can’t take a walker into some….some sex shop [he chuckles]”
“Oh, but T,” I said, “that is why the government invented the internet.”
“I am not sure how I’d go about that.”
“I’ll bet if you Google dildo or vibrator, you’ll find plenty of options.”
***
From a clinician’s point of view, I think that sex of the elderly, by the elderly, and for the elderly will not perish from the earth even as elderly do perish. Reading Erasmus Darwin or Ben Franklin makes it pretty clear that the urges of the old are old indeed. Not that doctors have wanted to deal with it. Some of this is surely the hang-ups about age that Goodfellow rightly address – that somehow the elderly are childlike or diminished. But appropriate sexual behavior is not about age; people of all ages make good and bad decisions, get infections, get frustrated, get bored, get laid. What I’ve learned from my patients is that disability is a larger issue for sexuality than age. Disease and disability completely changes a person’s sexual life. And most of us are so afraid of disability, or loathed to deal with the intimate ramifications of disability, that any hint of sexuality or sexual attraction is immediately suppressed.
I vividly remember my own reaction to a home visit to young woman whose car accident had left her disfigured and slightly mentally diminished. This was a long time ago, but I can still see the pictures of her before the accident. In them she was beautiful and the man she was with was handsome. When our discussion turned to her friends, she said that her former-boyfriend (not ex-) had visited. I murmured something about how nice that must have been, and she said, “it made me horny.” I awkwardly moved on, but I should not have.
Goodfellow claims that “the elderly continue to inhabit an ambiguous sexual space.” I am not sure where that space is but I doubt it is between their legs. More likely the ambiguous space is between our ears and is generalizable beyond the elderly to everyone who goes outside of society’s approved erogenous zones.
Euro-American society past and present has focused on containing sex. No sex with other races or with the same sex or outside of marriage or between cousins or below your class or with anyone transgressive. For some, even sex just for fun is or has been hedonistic and transgressive. At some point sexy old people must have become transgressive, dirty old women and dirty old men. That’s a shame, because they just want to have fun.
Quality of Life and Sex in the Elderly
Mark Ensberg, M.D.
College of Human Medicine
Sex is not just for the young. Surveys by the AARP suggest the elderly remain interested in sex and that most elderly want more sexual activity than they have. Satisfaction with personal relationships may increase with age, and sexual activity often remains an important part of these relationships. In general, elderly remain more interested in touching, embracing, and kissing; less interested in masturbation and intercourse.
Unfortunately, myths regarding sexuality in the elderly have been perpetuated because of inadequate study about their sexual behavior. Early studies often examined sexuality in persons “older than 50”--an age considered youthful by geriatricians who define the “young old” as those aged 65 to 74. Most recent studies have been done in healthier, married, mostly white, affluent populations.
Geriatricians do not like to blame age for the consequences of lifestyle or disease. Despite age-related changes in human body, sexual activity can continue to be an important contributor to quality of life in the elderly. The old adage ‘if you don’t use it, you loose it’ applies as much to sexual activity as it does to the preservation of mental function or physical strength. Alcohol may increase desire but dull performance. Studies point to illness, medications, and psychological issues as important reasons for discontinuation of sexual activity.
The most important barrier to sexual activity is the lack of a partner. Two thirds of persons in the United States aged 65 to 74 are married and live with their spouse. Because older women live longer than men, older men are more likely to be married and living with their spouse. More than 50% of women between the ages of 75 to 84, and 80% of women older than 85, are widows. A new friendship, or the reestablishment of an old relationship, by a widow or widower can be very disconcerting to children.
Although the majority of the elderly live in their own homes, older and disabled elderly couples are more likely to live in environments with less privacy, approximately 15% of those older than 85 live with children and 20% live in nursing homes. Assisted living facilities are the fastest growing trend in residential settings for the elderly. Nursing homes are establishing policies and procedures addressing intimacy among their residents, many of whom are cognitively impaired.
Attitudes and behaviors related to sexuality are likely to change rapidly as the baby boomers turn 65. Later-life divorces are increasing. Older lesbians and gay men are more open. Dating services for the elderly are available on-line. Older people are more likely to be involved in intimate relationships. Sexually transmitted diseases in the elderly, including HIV, are being seen much more frequently. Viagra, Levitra, and Cialis are being heavily marketed. This is a generation with very high expectations.
References
American Geriatrics Society. Geriatrics Review Syllabus: A Core Curriculum in Geriatric Medicine. 2006; pages 415-422.
Gott M. Sexual health and the new ageing. Age and Ageing. 2006; 35: 106-107.
Ginsberg TB, Pomerantz SC, and Kramer-Feeley V. Sexuality in older adults: behaviors and preferences. Age and Ageing. 2005; 34: 475-480.
Kuhn D. Intimacy, sexuality, and residents with dementia. Alzheimer’s Care Quarterly. 2002; 3(2): 165-176.
Robinson JG and Molzahn. Sexuality and quality of life. Journal of Gerontological Nursing. 2007; 3: 19-27.
Nusbaum MRH, Lenahan P, Sadovsky R. Sexual health in aging men and women: addressing the physiologic and psychological sexual changes hat occur with age. Geriatrics. 2005; 60 (90): 18-23.