Fantasies can help rev up your sex life. Myths, on the other hand, can stop desire dead in its tracks. Such myths aren’t the legends from classical history. They’re the stories we tell ourselves and each other to support the notion that older people shouldn’t, can’t, and wouldn’t want to have sex. This type of myth, however, bears as little relationship to reality as do the fanciful sagas of ancient gods and goddesses. Here are some examples of the most popular sexual myths and the myth-busting truths.

1. The myth: Only the young are sexually attractive.

The culture we live in exalts youth. Turn on the TV or open a magazine and you’ll be barraged with images of supple skin, firm flesh, and lustrous locks. But if your mirror is reflecting a different picture these days, you may feel like the party is going on without you.

The reality: Older can be quite sexy.

Sure, thinning hair, laugh lines, and a paunchy midriff are no picnic. But think back on what it was that made you attractive in your younger years. Was it your soulful brown eyes, your crooked smile, or maybe your infectious laugh? Chances are, those attributes are still as appealing as ever. In fact, a 1999 survey conducted by the AARP and Modern Maturity magazine revealed that the percentage of people age 45 and older who consider their partners physically attractive increases with age.

2. The myth: Sexuality in later life is undignified.

Whether it’s the white-haired grandmother fussing with her knitting or the loveable old codger puffing on a pipe, society is inclined to desexualize older adults. When older adults do express their sexuality, it’s often viewed with derision — for example, the stereotype of the “dirty old man.”

The reality: It’s healthy for older adults to express their sexuality.

People are living longer and remaining healthier. And they are more vigorous than ever before. Former president George H.W. Bush went skydiving to celebrate his 75th birthday, John Glenn returned to space at age 77, and Carol Sing forged a new world record at 57 by becoming the oldest woman to swim the English Channel. With this trend toward later-life vitality, why shouldn’t seniors be allowed to cast off outdated and ill-fitting stereotypes in order to express their normal, healthy sexual appetites?

3. The myth: Men and women lose their ability to perform sexually after a certain age.

Vaginal dryness and erectile difficulties loom large as you hurtle past 50. You may be feeling that you should just listen to what your body is trying to tell you: Sex is a thing of the past.

The reality: You can still have a satisfying sex life.

While a certain degree of physical change is unavoidable, this fact of life doesn’t necessarily translate into insurmountable sexual problems. For men, the Viagra revolution means most erection problems can be corrected with little medical intervention. For women, high-tech vaginal lubricants and hormone creams and rings are viable substitutes for what nature no longer supplies. What’s important for both sexes to remember, though, is that a softer erection, reduced natural lubrication, or a less intense orgasm doesn’t mean you’re no longer interested in your partner or in sex itself. For many couples, these kinds of changes provide an impetus for developing a new, rich, and satisfying style of lovemaking — one that’s based more on extended foreplay and less on intercourse and orgasm.

4. The myth: Sex is boring when you get older.

Drooping libido, slower rates of arousal, and the predictability of having the same partner for 20 or more years all add up to a ho-hum sex life.

The reality: Sex is as good as you make it.

While it’s true that a 19-year-old will have a faster, harder erection and a more forceful ejaculation than his 55-year-old counterpart, it doesn’t mean the quality of the experience is necessarily better. On the contrary, the older man has better control of his ejaculations. Less penile sensitivity means he may be able to enjoy a wider range of erotic sensations and maintain his erection longer. And his experience may pay off in improved sexual technique and a better understanding of what will please his partner.

Many women begin to find sexual confidence in their 30s, and this blossoms with maturity. As a woman moves through her 40s, her orgasms actually become more intense, and she can still have multiple orgasms. After menopause, when she’s free of any worry about pregnancy, she can give herself over to the pure enjoyment of sex.

Although longtime partners do have to contend with issues of familiarity in their relationship, these problems can be offset by greater emotional intimacy and trust. Because inhibitions often lessen with age, sex at 50 or 60 may include a level of experimentation and playfulness you wouldn’t have dreamed of in your younger years.

By the numbers: Statistics on sexuality and sexual satisfaction In 1999, Modern Maturity magazine and the AARP foundation polled 1,384 adults age 45 and older about the role sex played in their lives. The findings paint a detailed picture of sexuality at midlife and later. The importance of sex Over all, the majority of men (66.8%) and women (56.7%) responding felt that a satisfying sex life was important to their quality of life. But an even higher percentage (91.9% of men and 87.1% of women) thought that a good relationship with their spouse or partner played a key role in their happiness. Frequency of sexual activity Of individuals with partners, just over 60% in the youngest age bracket surveyed (45–59) had intercourse at least once a week. At age 75, the proportion dropped to one in four. Still, nearly three-quarters of respondents of all ages had intercourse once a month or more, provided they had partners. However, when the group was examined as a whole, one out of five men and two out of five women had not participated in any form of sexual touching or caressing over the last six months. Men tended to think about sex and feel sexual desire more frequently than women. While rates of intercourse were similar for both sexes, more men than women reported engaging in sexual touching. Self-s timulation on a regular basis was also about eight times higher among men. Factors affecting sexual satisfaction Not surprisingly, one of the major factors associated with respondents’ satisfaction was the availability of a partner. In the 45–59 age group, roughly four out of five individuals had partners; by comparison, only one in five women over 75 had partners. Declining health also appeared to have an effect on sexual activity and satisfaction. On a list of features that might improve their sexual satisfaction, the men ranked better health for themselves or their partners at the top. Although impotence emerged as a significant issue for nearly a quarter of the men, less than half of those men had ever sought medical treatment for the problem.
Table 3. Survey facts and figures
What participants said, in a nutshell	Men	Women
A good relationship with a spouse or partner is important to quality of life	91.9%	87.1%
My partner is physically attractive	59%	52.9%
A satisfying sexual relationship is important to my overall quality of life	66.8%	56.7%
Sexual activity is a pleasurable but not a necessary part of a good relationship	50.4%	52.9%
Had sexual intercourse at least once a week during the last six months	43%	35%
Engaged in kissing or hugging at least once a week during the last six months	74%	48%
Am satisfied with my sex life	54.9%	54%
Better health for myself would improve my sex life	30.3%	15.9%
Better health for my partner would improve my sex life	22.1%	19.4%
Have taken medication to improve sexual functioning	10%	7%
Sex becomes less important to people as they age	38.7%	36.5%

Emotional and social issues

“The brain is the body’s most important sex organ.” This oft-repeated phrase bears more than a little truth. While the initial prerequisites for sexual activity are physiological — functional sex organs, adequate hormone levels, and freedom from healt h conditions that interfere with the body’s ability to respond to erotic cues — these elements don’t guarantee sexual satisfaction. Stress, anxiety, self-esteem issues, negative past experiences, lifestyle demands, loss of loved ones, and relationship conflicts can weigh heavily. During midlife and beyond, these factors, combined with naturally occurring physical changes, can make you vulnerable to sexual problems.

Lack of a partner

It may seem obvious that not having a partner is an impediment to an active sex life, but it’s an especially important issue for older people. By age 65, many people find themselves alone, through either divorce or widowhood. This affects sexuality in a variety of ways.

According to the AARP/Modern Maturity Sexuality Survey, 64% of men with partners and 68% of women with partners are primarily satisfied with their sex lives. This is in sharp contrast to the small proportion of those without partners (18% of men and 28% of women) who are pleased with their sex lives.

The partner gap is a particular problem for American women because their average life span (79 years) is more than five years longer than that of men. Because American women marry men who are on average three years older, that can mean even more time alone. Should a woman want to remarry, her chance of finding a new mate in her age bracket dwindles yearly; there is an average of only 7 men for every 10 women age 65 and above. All this boils down to the fact that, compared with men, women are likely to live a greater portion of their lives without a mate.

Finally, starting a new sexual relationship after divorce or the death of a spouse can present its own dilemmas. People often fear that they will not become aroused or be able to have an orgasm with a different partner. They also may be self-conscious about baring their body in front of someone new. Because a new relationship may come along months or years after their last sexual relationship, some individuals feel anxious that they have “forgotten how to have sex” or that “the equipment doesn’t work anymore.” For those who have lost a much-loved spouse, feelings of guilt or disloyalty at starting a new relationship can be overwhelming.

Relationship issues

Tension in a relationship can be deadly to a couple’s sex life. In many cases, conflict is at the root of a sexual problem. Other times, a sexual issue strains a couple’s ability to get along. The following issues are often connected to sexual problems.

Anger and frustration. Accumulated anger, hurt, disappointment, and resentment can fester, destroying closeness between partners. These pent-up feelings often extinguish the flames of desire. For men, anger and frustration can interfere with arousal and getting an erection. Likewise, the breakdown of trust can be devastating to a woman’s ability to reach orgasm. Both partners can suffer loss of libido in a conflict-ridden environment. This type of disappointment turns toxic when one or both partners resort to criticism and defensiveness — two of the major harbingers of divorce. In addition, one member of the couple may unconsciously withhold sex as a way of expressing anger or to maintain the upper hand in a situation where he or she feels otherwise powerless.

Poor communication. Communication is essential for partners to build the trust needed for a successful sexual relationship. By talking frankly about your feelings, you can foster acceptance and understanding in your relationship. This makes it easier for you and your partner to collaborate on finding solutions to issues, and it can prevent resentments from piling up. When conversation breaks down, anger and resentment are likely to build.

Dialogue is especially vital as physical changes take place. Vaginal dryness or erection difficulties can be wrongly perceived as waning interest in sex, which can trigger feelings of rejection and resentment. By articulating feelings, couples can sort out the physiological factors from the emotional and relationship issues, and address each appropriately.

Boredom. Once the honeymoon is over, almost every couple has to contend with boredom sooner or later. The person who was once so electrifyingly mysterious to you may become as comfortable — and as alluring — as an old shoe. While the deep trust and intimacy created from years of shared experiences are the building blocks of a truly loving relationship, such familiarity can take the edge off desire. Sex may not even seem worth the trouble when you’re facing the same old lovemaking routines.

When sexual activity wanes, other types of physical affection often fade, too. This lack of physical connection can extend the emotional distance between you and your partner. As a result, it’s all the more difficult to resume sexual intimacy later on. But it’s possible to do so.

One frequent motivator for a person to have an affair is a quest for newness. This yearning may arise from a need to banish midlife drudgery, a desire to find out what sex is like with someone else, or an urge to recapture the heart-pounding sexual highs of youth. Other times, an individual searches out a new partner to meet unfulfilled emotional or intellectual needs. An affair sometimes occurs because of sexual dysfunction in the marriage. For example, men who have erection difficulties or women who can’t reach orgasm may seek out new lovers to prove that the sexual problem is their spouse’s doing, not their own. Likewise, the partners of those with sexual difficulties may try to seek reassurance that they’re still sexually appealing in the arms of someone else.

Affairs. While researchers can’t seem to agree on how many people seek sex outside their marriage — the estimates range from 20% to 60% — one thing is clear: An affair is often an indication of an unmet need in the relationship.

The reverberations of an affair can extend throughout a couple’s relationship like ripples on a pond. Sometimes the straying partner isn’t able to respond sexually to his or her spouse because of guilt over the affair, fatigue from juggling two sexual relationships, or a negative comparison of the spouse with the new lover. If the spouse discovers the affair, he or she may withdraw emotionally.

An affair can be a serious, sometimes fatal, blow to a relationship. However, it’s possible for a marriage not only to survive infidelity, but also to grow from this painful expe rience. To do this, though, both partners must face the personal and relationship issues that led to the affair in the first place. Couples therapy is a good place to turn for help in doing this. Sex therapy can also be useful if the affair has caused or resulted from sexual problems.

The Viagra revolution

In the years since the famous “little blue pill” entered the market in March 1999, millions of couples have seen firsthand what this drug can and can’t do. In many cases, Viagra (sildenafil citrate) is the answer to a prayer for men who have been unable to have an erection. But the drug offers no help in untangling the emotional and relationship pressures that frequently accompany erectile dysfunction.

For one thing, Viagra only works if there is desire to have sex. If emotional issues are impinging on libido, the pill won’t help. It’s important that the partner of a man who has begun taking Viagra understands this. During a long bout with erectile dysfunction, many women blame themselves for their partner’s inability to perform. When Viagra comes onto the scene, the woman may find it hard to let go of past feelings of rejection. She may mistakenly assume that her husband’s newfound erections are merely a chemical phenomenon, not an outgrowth of sexual attraction to her.

When intercourse is suddenly a possibility again, relationship issues can sprout up or resurface. For example, dramatic differences in libido sometimes emerge. Also, a woman can develop problems related to vaginal atrophy if she hasn’t had sex in a long time. She may need to undergo a few weeks of therapy using medication or dilators before she can comfortably resume intercourse.

The bottom line is that couples should try to regard Viagra as an opportunity to become erotic again, while realizing that it is neither a mandate to have intercourse nor a panacea for every problem in the bedroom.

Performance anxiety

Defined as an overwhelming concern about sexual performance that obscures pleasure and leads to sexual dysfunction, performance anxiety is a particularly insidious issue affecting aging couples. Performance anxiety becomes a particular problem for men as they move into their 50s. It’s the most common psychological contributor to erectile dysfunction.

Here’s how the problem often develops. The natural effects of aging dictate that a man needs more time and direct penile stimulation for an erection. Medications and cardiovascular disease may also contribute to erection difficulties. If a man continues to expect the instantaneous rock-hard erections of his 20s, he may equate this change in his physical response with the end of his virility. Once he makes this erroneous leap, the problem snowballs. After a few incidences of erection failure, embarrassment and feelings of defeat leave him unwilling to try again. He may withdraw from all forms of intimacy to avoid having to perform. In turn, his partner feels rejected and fears that she’s no longer attractive enough to sexually excite him. She may also suspect him of having an affair.

If this happens, the woman may shy away from touching her partner sexually out of fear that another failure will occur. Paradoxically, her reticence denies the man just the type of direct stimulation that he needs at this stage of life to achieve an erection. The result is that an addressable physical issue becomes a morass of anger, resentment, and frustration.

Women, too, can experience performance anxiety. Frank discussion of sexuality has become commonplace in women’s magazines and on daytime television. This openness has had the unintended consequence of making some women worry that they do not respond quickly or intensely enough to be considered a “good lover.”

At one point or another, you may have come to the realization that gravity is not kind to your body as you age. Nor is childbirth, a fatty diet, lack of exercise, or the hormone declines that lead to muscle loss, loose skin, and thinning hair. But what does this have to do with your sex life? It can have everything to do with it if you let it. Worry about having your partner see your sagging breasts or potbelly can discourage you from even thinking about having sex. If you do decide to be intimate, you may demand that sex take place only under the covers, with the lights out, while you’re wearing a T-shirt. Needless to say, these conditions don’t leave much room for inspired lovemaking. You may also find that your preoccupation with your appearance while making love prevents you from fully enjoying sex.

Body image and self-esteem

Relationship conflicts can ensue. When one partner needs constant reassurance about his or her attractiveness and becomes overly sensitive to perceived criticism, it can foster mutual resentment. The paradox in this dynamic is that the majority of middle-aged and older adults responding to the AARP/Modern Maturity Sexuality Survey said they still found their partners physically or romantically attractive. What’s more, the percentage increased with age.

By shifting your focus away from your perceived flaws to your attributes — for example, your eyes or your hair — you can boost your self-esteem and establish your own standards for attractiveness. Also, try directing your attention to the experience of giving and receiving pleasure during sex. This can help you find the confidence to give yourself over to the experience. Great sex is often the outgrowth of a deep emotional connection — something that’s not guaranteed by having a perfect body.

A negative self-image isn’t always rooted in your appearance. Career setbacks or other disappointments can lead to feelings of failure and depression, both of which sap desire. For men, episodes of impotence can undercut confidence in their manhood. No matter what its cause, a poor self-image can take a toll on your sex life. When performance anxiety develops as a result, it can spark a downward spiral of repeated sexual failure and diminishing self-esteem. Correcting this problem demands serious attention to its origin. Because feelings of low self-worth are a symptom of depression, you should talk to a doctor if the problem persists.

Your sexuality is a natural drive that’s with you from birth, but your family and cultural background shape your attitudes toward sex. As you become an adult, your own experiences further influence your sexuality. The result for many is a healthy enjoyment of sex, but others may have more mixed feelings. The changes that take place in midlife and beyond often exacerbate issues about sex. Deeply entrenched negative associations can also emerge during this time.

Expectations and past experiences

For example, women (and men) — particularly those who came of age before the so-called sexual revolution in the ’60s — may cling to the notion that it is improper for “nice girls” to enjoy sex. This belief can be damaging for both partners. A woman who has merely acquiesced to sex as a duty to her husband or as a necessary step in childbearing may feel uncomfortable seeking sexual pleasure. Her partner may interpret this lack of enthusiasm as a reflection of her feelings about him.

Inexperience and embarrassment over discussing sexual matters may hamper people from fully expressing themselves sexually. For example, intercourse alone does not give many women the kind of stimulation they need for fulfilling sex, and uneasiness about discussing the problem prevents some couples from developing techniques that could offer the woman greater pleasure. Compounding the problem, childhood taboos against masturbation may prevent a woman from ever discovering the means to her sexual pleasure, so she’s unable to direct her partner in this regard. It may be more comfortable for a woman to forgo her own pleasure than to confront these matters. She may ultimately resort to faking orgasms rather than risk asking for a different approach to lovemaking. When this pattern exists for years, revealing the truth would mean admitting to a longstanding deception, which could shake the trust in the relationship and injure her partner’s self-esteem.

Alternately, a man may feel his self-worth depends on his ability to please his partner. His focus during sex, therefore, is on performing rather than succumbing to pleasure. If his partner doesn’t immediately respond to his efforts, feelings of inadequacy can pervade the relationship, eroding the couple’s bond. This dynamic can ultimately lead to performance anxiety and related sexual problems.

During the early years of a couple’s relationship, such missed connections are often masked by priorities outside the bedroom, such as building a marriage, raising a family, and launching a career. However, midlife may prove to be a turning point. Upon reaching menopause, the long-unsatisfied woman might greet the physical changes in her body as a sign that her sexual duties are fulfilled. If her husband is still interested in sex, a conflict is likely to erupt.

A much more hopeful scenario is also possible. Midlife and later may be a time when a woman’s sexuality blossoms. Menopause means that women no longer have to worry about pregnancy. Often, children are grown and family responsibilities have eased, allowing a couple to engage in more relaxed and spontaneous lovemaking. In addition, the changes a man is experiencing during these years, such as slower erections and longer time before ejaculation, lend themselves to the kind of pleasurable play that a woman may have been missing out on before.

For a couple wishing to embark on the more positive course, the key is to begin to unravel negative patterns. To do this, you must open up a dialogue. It’s also important to resist succumbing to unproductive beliefs about aging and sex.

Stress and lifestyle issues

Stress and fatigue are major libido sappers. During midlife, stress can hit from any direction and take any form. Challenging teenagers, financial worries, aging parents, and career woes are common. Concern over your own health or that of a loved one, or general anxiety about aging can also weigh heavily. With so many demands on your time and attention, you and your partner may neglect to nurture your relationship. This inattention can cause your sexual connection to fray as well.

Sheer lack of time is often a major factor. The physical changes in sexual response that occur in both men and women as they age mean that it will take you and your partner more time to become aroused and reach orgasm than it did in your younger years. You may find it hard to squeeze an extended lovemaking session into an already packed day. If a couple typically waits until bedtime to have sex, exhaustion also can become an obstacle.

Stress has a particularly deleterious effect on libido, especially in women. Whereas men can sometimes use sex to relax, women more often need to be relaxed in order to enjoy sex. This mismatch can create conflict for a couple.

Sexual issues brought on solely by stress and fatigue often can be remedied simply by taking a vacation. If you and your partner are able to resume pleasurable lovemaking in a pressure-free environment, you’ll be reassured that the underpinnings of your sexual relationship are sound.

Midlife and after is also a time when profound lifestyle changes take place. Events such as retirement and children leaving home can upset decades-long patterns in a couple’s life. For example, many couples go through a period of adjustment when they retire. If a woman is used to having the house to herself, her feeling of control over her domain can be threatened by her husband’s constant presence. If both partners worked outside the home, they must each adapt to having more time together at home.

One bonus is that retirement may allow you and your partner the opportunity to engage in leisurely lovemaking — something you may have lacked for many years. One danger, however, is that couples who begin spending a lot of time together may stop making an effort to include romance in their relationship.

Chronic illness also affects many couples’ sexual relationships during this stage of life. People who are ill may find that a condition or its treatment causes sexual difficulties, while healthy partners may worry that sexual activity will make their loved one’s condition worse. The fatigue and stress of the caretaker role may also dampen desire. In addition, sexual interest may wane for both partners if their caretaker−patient relationship begins to feel too much like that of a parent and child. During this time, many people also experience the loss of someone close — parents, friends, or siblings. Grieving may make it difficult to enjoy anything pleasurable, including sex.

For 20 years, the Harvard Health Professionals Follow-up Study has gathered important information about men’s health. In 2000, it added questions about sexuality to its semiannual surveys. According to the Harvard Men’s Health Watch, the new data offer insight on how men can maintain a satisfying sex life as they age.

Chronic illness and the medications used to treat them account for many of the sexual problems of older men. Sexual dysfunction was most prevalent in men with illnesses such as diabetes, hypertension, heart disease, stroke, and even depression. The Harvard Men’s Health Watch points out that one of the striking results of the study was that men with prostate cancer are 10–15 times more likely to experience sexual dysfunction than men without the disease—however, these sexual difficulties typically stem from the treatment rather than the cancer itself.

Even in healthy men, each aspect of sexual function showed progressive problems with age. Although libido decreased with age, sexual desire was preserved substantially better than erectile function. Although testosterone levels fall just as many men begin to experience sexual dysfunction, the Harvard Men’s Health Watch reports that most men have plenty of testosterone to spare—levels remain in the normal range in at least 75% of senior citizens.

“All in all, men who remain well are less likely to develop sexual dysfunction with age than men who fall ill,” says Harvey B. Simon, M.D., editor of the Harvard Men’s Health Watch. “And men who take good care of themselves enjoy substantial protection from both illness and sexual decline. The secret to preserving sexuality is to stay healthy and to build healthy relationships—and both require a series of wise choices throughout life.”

Americans are living longer than ever. As the population ages, many senior citizens are burdened with chronic illnesses, but many others remain healthy and active. When scientists investigate aging, they have to distinguish between changes caused by disease and those caused by aging itself. It’s important research: among other things, it has taught us that men who take care of themselves can prevent many of the illnesses that make less prudent gents old before their time.

Until recently, research on aging has focused mainly on crucial things that go wrong — on heart disease, mental decline, arthritis, prostate woes, and the like. But while big-ticket items are still getting the priority they deserve, researchers are also expanding their horizons to include less critical issues. Sexuality is an important example. Several reports shed light on aging and sexuality, and one of them suggests that sex itself may help prevent sexual dysfunction in older men.

The male sexual response

At any age, sexual activity is an instinctive, automatic part of human behavior. But the biology behind that behavior is quite complex.

Although the sex act is a continuous process, researchers have divided it into six stages. The first necessity is sexual desire or libido. The normal sex drive is a prime example of the unity of mind and body. It requires both an appropriate mindset and sufficient amounts of the male hormone testosterone. Sexual desires surface in puberty, when testosterone levels rise; although ardor tends to wane with age, most men produce enough testosterone to maintain libido throughout life. At any stage of life, however, worry, stress, or depression can thwart sexual interest, even if a man’s physical apparatus remains intact.

Sexual activity itself begins with a state of arousal that results from various combinations of erotic thoughts and sensory stimulation that may involve the senses of touch, sight, scent, taste, or hearing. An area of the brain called the hypothalamus co-ordinates erotic images and sensations and transmits the impulses of desire through the spinal cord to the pelvis, where they link up with the nerves of the autonomic nervous system; sensory nerves from the skin of the penis and other erogenous zones connect directly to the autonomic nerves without involving the brain.

When properly stimulated, the autonomic nerves in the pelvis spring into action. They start the second stage of the male sexual response by transmitting chemical signals to the arteries of the penis, causing them to widen and admit more blood. Blood rushes into the two corpora cavernosa, shafts of spongy tissue that contain many vascular channels. The corpora cavernosa swell, producing an erection. The engorged corpora also put pressure on venules, compressing and narrowing them to prevent the extra blood from leaving, so the erection can be maintained.

For years, doctors have known that an erection is a hydraulic event that depends on a sixfold increase in the amount of blood in the penis. But research has revealed that an erection is also a chemical event. A tiny chemical called nitric oxide allows nerves to communicate with each other and with the arteries of the penis. Nitric oxide acts on the arteries through an intermediary called cyclic guanosine monophosphate (cGMP). It’s been an exciting discovery for scientists, and it led to important progress for men with erectile dysfunction (ED) since the ED pills (Cialis, Levitra, and Viagra) act by boosting cGMP levels in the penis.

The third stage of sexual activity is called the plateau, which usually lasts from 30 seconds to two minutes. The heart rate and blood pressure rise as sexual activities continue, pumping more blood to the body’s tissues. The penis is not the only recipient of increased blood flow; most men also experience facial flushing, and the testicles themselves swell by about 50%. During the plateau phase, the prostate and seminal vesicles begin to discharge fluid in preparation for ejaculation.

Sexual excitement climaxes with the fourth stage, ejaculation. The autonomic nervous system is in charge here, too. It tells the muscles in the epididymis, vas deferens, seminal vesicles, and prostate to contract, propelling semen forward. At the same time, nerve impulses tighten muscles in the neck of the bladder so that semen is forced out through the urethra instead of flowing back into the bladder. Ejaculation is usually accompanied by the pleasurable sensation of orgasm; in nearly all men, the heart rate reaches its peak during ejaculation.

All good things come to an end. The fifth stage of sexual activity is detumescence, when the penis returns to its flaccid state. Detumescence usually follows ejaculation, but it can occur prematurely if the sex act is interrupted by an intrusive thought or event. In either case, detumescence occurs when the penile arteries narrow and the veins widen, draining blood away from the organ.

The final stage in the sex act is the quietest. It’s the refractory period, a span of 30 minutes (in younger men) to three hours (in older men) during which the penis cannot respond to sexual stimulation.

Slowing down

For many men, sexuality is one of the things that change over time. It’s usually a gradual, almost imperceptible process that begins in middle age. Whereas most older men retain an interest in sex, it’s generally a far cry from the preoccupation with sex that’s so common in youth. Although interest is retained, desire tends to wane; many older men think about sex, but don’t have the drive to put theory into practice. And even when the spirit is willing, the flesh may be weak; male sexual performance typically declines more rapidly than either interest or desire.

Most men experience decreased sexual responsiveness with increasing age. Erections occur more slowly, and they become more dependent on physical stimulation than on erotic thoughts. Even when erections develop, most men in their 60s report that their penile rigidity is diminished and harder to sustain. The ejaculatory phase also changes with age; the muscular contractions of orgasm are less intense, ejaculation is slower and less urgent, and semen volume declines. Sperm counts also decline; although healthy men can father children well into their senior years, their reproductive efficiency can’t match younger men’s.

Sexual intercourse requires a partner. But male sexuality demonstrates age-related changes that are not dependent on interpersonal factors. Nighttime erections, which are normal events that occur during deep sleep, diminish with age; men between age 45 and 54 average 3.3 erections per night; between age 65 and 75, men average 2.3. Nocturnal erections also tend to become briefer and less rigid as men age.

Changes due to age

Sexuality is complex, and scientists don’t understand all the factors that contribute to sexual function in young men, let alone what is responsible for the changes that occur with healthy aging. Still, it’s clear that the hormones, nerves, and blood vessels responsible for male sexuality all change over time. In the average man, levels of testosterone fall by about 1% per year beyond age 40 — but most older men still have enough testosterone to function sexually. To produce arousal, testosterone acts on part of the brain called the locus ceruleus, and these nerve cells become less hormone-responsive with age. Levels of estradiol, a predominantly female hormone, tend to decline with age; levels of another female hormone, prolactin, tend to rise. As for nerve function, penile responsiveness to sensory stimulation also slows with age. In addition, penile blood flow may decrease as men grow older, even if they stay healthy.

Changes due to illness

In men who stay well, all these changes add up to a gradual, partial decline in sexual activity. But in some men, the shift is more abrupt and complete. ED is closely linked to age. Only 5% of men under 40 years of age experience ED, but the prevalence rises steadily with age. About 44% of men in their 60s have ED, and the problem may affect up to 70% of American men over 70.

Because ED is so common in older men, many assume that it’s part of the normal aging process. It’s not. Instead, ED reflects the impact of chronic diseases that become increasingly prevalent with age. The most important are atherosclerosis and hypertension, which affect blood vessels, and diabetes, which strikes both blood vessels and nerves. In addition, stress, depression, and anxiety about adequate sexual performance can reduce sexual activity and satisfaction at any age. So too can marital strife, poor communication, poor sexual technique, and boredom; many of these problems become more common with age. Still, both partners in a relationship can expect to experience intimacy and sexual activity in maturity; if these expectations are not met, both people should explore the problems that may be responsible and the remedies that may be available. Important, too, are the medications that many older men require; numerous drugs can interfere with sexual function, including many used to treat high blood pressure, heart disease, anxiety, and depression.

Sexual surveys

Although you’d never guess it from late-night talk shows, TV ads for ED pills, or Mae West (“A hard man is good to find”), erectile dysfunction is not the only measure of successful male sexuality. Two surveys of sexuality in older men paint a more nuanced picture.

An American survey evaluated 1,455 men 57 to 85 years of age. Nearly 84% of men under 65 reported sexual activity with a partner during the year prior to the survey, but the figure fell to 67% in men between 65 and 74 and to 39% between 75 and 85 years of age. But among sexually active men, most reported at least two to three encounters per month throughout the three age ranges. There was little decline in sexual interest between ages 57 and 85, with over 70% of men maintaining interest. Confirming Shakespeare’s insight (“Is it not strange that desire should so many years outlive performance?”), however, ED became more common over the years. In all, 14% of the men reported taking medication or supplements for sexual dysfunction.

A Swedish survey evaluated 225 70-year-old men. Among the men who were living with a partner, 66% reported sexual intercourse within the previous year; of these, 31% reported intercourse one or more times per week. More than half of all the 70-year- old men reported that sexuality contributed to happy relationships.

Troubleshooting

In the age of Viagra, many men, young and old, respond to sexual dysfunction by downing a little blue pill or one of Viagra’s newer rivals. Indeed, the ED pills have been a tremendous boon to male sexuality, psychological health, and relationships. But men with sexual dysfunction should always work with their doctors to identify underlying causes of the problem — and when the issue is ED, it’s particularly important to identify and treat or correct cardiovascular risk factors, including abnormal cholesterol levels, high blood pressure, diabetes, tobacco abuse, obesity, and lack of exercise. In fact, ED is a powerful predictor of future heart disease, even in men who have no cardiac symptoms.

Keeping it up

Although treatment can help remedy sexual dysfunction, prevention is surely the best medicine. A 2003 Harvard study of 31,742 men between 53 and 90 emphasizes the preventive power of avoiding tobacco, getting regular exercise, staying lean, and avoiding excessive alcohol. And without contradicting these key instructions, a study suggests that sexual activity itself may help preserve erectile function in older men.

Sex “therapy”?

To find out if sexual intercourse protects against developing ED, scientists in Finland evaluated 989 men between 55 and 75. None of the men had ED when they volunteered for the study, and over 80% were married or living with a partner. Over the next five years, men who reported having intercourse less than once a week at the start of the study were more than twice as likely to develop ED as men who had intercourse weekly; they were also over four times more likely to develop ED than the men who reported having intercourse three times a week at the start of the study.

The study shows that men who are sexually active are less likely to develop ED than men who are less sexually active. But which is the horse and which the cart? Did increased sexual activity actually protect men from ED, or were men with good erectile function simply more active because they had better sexual function to begin with? The Finnish researchers tried to answer the question by evaluating the volunteers for problems that are linked to ED, including smoking, obesity, heart disease, high blood pressure, diabetes, depression, and cerebrovascular disease. Because they found little difference in ED risk factors among the groups, they argue that the crucial difference that protected against ED was sexual activity itself. Unfortunately, the study did not evaluate the possible impact of exercise, which lowers the risk of ED, or alcohol abuse, which raises risk.

The scientists offered a biological explanation for the apparent protective effect of sexual activity: erections bring oxygen-rich blood to the penis, perhaps preserving the health of tissues. It’s the theory behind the still unproven practice of using ED pills for “penile rehabilitation” in men with ED following prostate surgery. It’s an interesting theory, but more research is needed to see if it’s right. Since healthy men have two to three erections each night, it’s not clear that one to three acts of sexual intercourse per week would provide important extra benefit. The Finnish study did not evaluate nighttime erections, but it did report that the sexually active and less sexually active men had similar numbers of early morning erections.

Sex and age

Sexuality is an important aspect of life, but its role changes over time. Sex is necessary for procreation, which preserves the life of the species. And a healthy lifestyle is the best way to preserve sexuality in seniority. Most men remain interested in sex as they age, but many experience a diminished urge for sex and altered sexual function. Despite these changes, healthy men should expect to retain the capacity for sexual activity and satisfaction throughout life. The Finnish study suggests that regular sexual activity may help preserve erectile function as men age. Many men will welcome that finding, but more research is needed. At present, the best way to preserve sexuality is to preserve health; a good diet, regular exercise, and good health habits are the most effective ways to reduce the risk of developing the chronic diseases and requiring the medications that so often impair sexuality

Even the most optimistic men know that the clock ticks for all of us. With each passing year, our bodies change, as does our behavior.

It’s certainly no surprise that male sexuality changes over time. Some 400 years ago Shakespeare asked, “Is it not strange that desire should so many years outlive performance?” Still, a major Harvard study of male sexual function in maturity does contain some surprises. It reports that sexual dysfunction is common and increases rapidly as men age. But it also says that simple lifestyle choices can slow the tick of the clock for many of us.

The Harvard study

Until Viagra burst onto the scene in 1998, few men were willing to discuss sexual problems. But the little blue pill and Senator Bob Dole changed all that, and researchers took advantage of the new openness to conduct a study of age and male sexuality.

The subjects were 31,742 men between the ages of 53 and 90. As members of the Health Professionals Follow-up Study, all were dentists, optometrists, osteopaths, podiatrists, pharmacists, or veterinarians. That makes them knowledgeable observers and reliable reporters of their health, but they do not reflect the broader U.S. population in terms of education, income, and race.

Since it began in 1986, the study has been gathering an enormous amount of information, and in 2000, it added sexuality to its semiannual surveys. Each man answered questions about his sexual desire, his ability to sustain an erection satisfactorily for intercourse, his ability to reach orgasm, and his overall sexual function. Because the database also contains details about each man’s general health, medications, and health habits, the scientists were able to evaluate sexuality in terms of health and lifestyle as well as age.

The toll of time

One of the striking results of the study was that men with prostate cancer are 10–15 times more likely to experience sexual dysfunction than men without the disease. In nearly all cases, the sexual difficulties stem from the treatment rather than the cancer itself. But since the incidence of prostate cancer increases steadily with age, it could skew the results of the analysis. To avoid confusion, the study excluded men with prostate cancer from the final tabulation, though it did include all other medical conditions.

Even in men without prostate cancer, the prevalence of sexual problems was very high: 29% reported moderate or severe difficulties. But not all age groups were equally affected; major problems rose from 10% in men younger than 59 years to 23% in 60- to 69-year-olds, 47% in 70- to 79-year-olds, and 64% in men 80 and over.

Each aspect of sexual function showed progressive problems with age. Fully a third of the men reported moderate to severe erectile dysfunction; but only 2% remembered that their difficulty began before the age of 40 and only 4% reported that it developed between 40 and 49. After 50, the number of men with the problem rose steeply from 26% between 50 and 59 all the way to 61% after 70. And as usual, Shakespeare got it right; although libido also decreased with age, sexual desire was preserved substantially better than erectile function.

Testosterone and male sexuality The male hormone testosterone is necessary for the development of male genital structures during fetal life. It triggers the dramatic events of puberty, and it is necessary for libido, sexual function, and fertility throughout maturity. Testosterone levels peak at about age 17, then remain high for the next few decades. But after the age of 40, testosterone levels fall by about 1% a year. That doesn’t sound like much, but by the age of 70 or so, it adds up to a 30% decline. Testosterone levels fall just as many men begin to experience sexual dysfunction. But that doesn’t make testosterone responsible for the problem. In fact, most men have plenty of testosterone to spare, so levels remain in the normal range in at least 75% of senior citizens. Testosterone patches and gels are increasingly popular among older men; doctors write more than a million such prescriptions a year, and the number is increasing rapidly. In addition, many men take weaker male hormones such as dehydroepiandrosterone (DHEA) and androstenedione (Andro) that are sold with-out a prescription as “dietary supplements.” It’s not a good idea. There is no evidence that male hormones will improve sexual performance in healthy men, and by stimulating the prostate, they may do more harm than good. Men who are truly testosterone deficient (hypogonadism) have diminished sexual interest and desire as well as erectile dysfunction. They can benefit from testosterone replacement therapy, but only after careful medical tests establish a diagnosis of testicular insufficiency.

The toll of illness

Sexuality is not the only thing that changes with age. Chronic illnesses also become more common, and in each age group, sexual dysfunction was most prevalent in men with illnesses such as diabetes, hypertension, heart disease, cancer (other than prostate cancer), and stroke.

All in all, men who remain well are less likely to develop sexual dysfunction with age than men who fall ill. And men who take good care of themselves enjoy substantial protection from both illness and sexual decline.

The benefits of healthful choices

No man chooses to get sick, but many choose behaviors that boost their odds of becoming ill. Although the health professionals who participated in the study should have known better, some didn’t — and they paid the price in terms of impaired sexual function as well as illness. The risk of sexual problems was linked to smoking, obesity, heavy drinking, and the time spent watching television. In contrast, regular physical exercise and moderate alcohol consumption help preserve good sexual function. In this respect, the study agrees with earlier research showing that erectile dysfunction can be prevented.

Age and sexuality

The Harvard study of male sexuality and age is the largest of its kind and provides important confirmation of earlier research as well as additional interesting information. Chronic illness and the medications used to treat them account for many of the sexual problems of older men; depression can also take a toll. But even in healthy men, a slow change in sexuality begins in middle age and continues throughout life. Whereas most older men retain an interest in sex, it is generally a far cry from the preoccupation with sex that is so common in youth. Although interest is retained, desire tends to wane; many older men think about sex but do not have the drive to put theory into practice. And even when the spirit is willing, the flesh may be weak; male sexual performance typically declines more rapidly than either interest or desire. Most men experience decreased sexual responsiveness with increasing age. Erections occur more slowly, and they depend more on physical stimulation than erotic thoughts. Even when erections develop, most men in their sixties report that their penile rigidity is diminished and harder to sustain. The ejaculatory phase also changes with age. The muscular contractions of orgasm are less intense, ejaculation is slower and less urgent, and there is a longer refractory period following intercourse, when men cannot respond to sexual stimulation. Semen volume and sperm counts decline, as does fertility.

The study evaluated sexuality but not relationships. Sexual intercourse requires a partner, but male sexuality demonstrates age-related changes that do not depend on interpersonal factors. Nocturnal erections diminish with age; men between 45 and 54 average 3.3 erections per night; between 65 and 75, they average 2.3 erections. Nocturnal erections also tend to become briefer and less rigid with age.

Life may not begin at 80, but sex life doesn’t automatically end with advancing age. Many surveys report that the frequency of sexual activity declines, but they disagree about how often older couples have intercourse. In round numbers, 50%–80% of healthy couples over 70 report sexual activity on a regular basis, including weekly intercourse in about half of them.

The secret to preserving sexuality is to stay healthy and to build healthy relationships — and both require a series of wise choices throughout life.

Sex isn’t just for the young. Research is showing that older Americans are sexually active.

The sexuality that’s such a big part of our teens and young adulthood has more staying power than younger people usually recognize and can continue to spice things up well into old age. Results from a University of Chicago survey published in 2007 suggested that over half of Americans continue to engage in sexual activities well into their 70s. Now another batch of findings from a survey conducted by researchers at Indiana University suggests that 20% to 30% of long-lived Americans are sexually active into their 80s.

Both of these surveys are cross-sectional — snapshots of behavior in a given period — so making pronouncements about trends would be getting ahead of the evidence. Still, there’s reason to believe that sexuality is assuming a larger role in American old age. Millions of men are now taking erectile dysfunction drugs like sildenafil (Viagra) or tadalafil (Cialis). Growing numbers of Americans are enjoying relatively good health in their 60s, 70s, and 80s, and, not surprisingly, the University of Chicago study found a close association between good health and sexual activity among older people.

Consider also who is getting old these days — the baby boomers, a generation that came of age in the 1960s and ’70s when sexual mores were changing, and a demographic group that hangs on to its youthful ways.

But the “frisky seniors” story line can be overdone. Sexual activity does subside with age. Biological factors tug in that direction, as do social arrangements: older people, especially women, often end up single when a spouse or partner dies. The Indiana University researchers found that sexual activity with a partner is common among those in their 20s, 30s, and 40s, dips significantly for both men and women in their 50s and 60s, and then drops further once people enter their 70s.

Now suitable for study

It wasn’t long ago that older people weren’t included in studies of sexual behavior because they were seen as largely irrelevant to the topic: 59 was the upper age limit of a landmark study of American sexuality conducted in the early 1990s. The University of Chicago survey (the formal name is the National Social Life, Health, and Aging Project) went a long way toward rectifying the situation. It focused exclusively on older adults, including just over 3,000 Americans ages 57 to 85. The results, published in The New England Journal of Medicine in 2007, received a fair amount of attention and lent some legitimacy to the subject of sexuality of older people.

The Indiana University survey was conducted by the university’s Center for Sexual Health Promotion, which grew out of the research efforts of Dr. Alfred Kinsey in the 1940s and 1950s. Kinsey, who died in 1956, is credited with being one of the pioneers of research into human sexuality, although revelations about his research methods and personal life have since tarnished his reputation.

Kinsey and his colleagues conducted their research with in-depth interviews; this generation of Indiana sex researchers used electronic questionnaires and the Internet. A total of 5,865 Americans, ranging in age from 14 to 94, were included in the survey. A parent or legal guardian had to give permission for a teen to participate. Computers and Internet access were provided to the participants who didn’t have them.

Sophisticated sampling techniques are used in this kind of survey research to make sure the study volunteers accurately reflect the population’s age, income, geographic distribution, and other attributes. But sex researchers can’t overcome the problem of self-selection: the sort of people who agree to fill out such a questionnaire may not reflect the population as a whole, particularly when it comes to sexual behavior. There’s also no way of telling whether respondents are telling the truth about their behaviors, although the Indiana researchers point out that the anonymity of their Internet-based research may tend to make people more, not less, truthful about taboo subjects. The University of Chicago survey depended on in-home interviews.

Church & Dwight Co., the company that makes Trojan condoms, funded the Indiana University survey, and condom use featured prominently in the initial batch of survey-based articles published in a supplement to The Journal of Sexual Medicine in October 2010. One of them focused on the 1,973 respondents ages 50 and older, a third of the total.

A statistical picture of the sexuality of older Americans begins to emerge from that article and the University of Chicago survey results. Here are some of the main points:

Sexual activity tapers off with age. Both surveys show a decline in sexual activity with age, although the drop-off isn’t as steep as one might expect, and a significant minority (especially men) defies the trend. In the Indiana study, 35% of the men age 80 and older reported that they had intercourse with a woman a few times or more in the past year. In the University of Chicago study, 38.5% of the men ages 75 to 85 reported having sexual activity with a partner in the previous year.

Older women are less sexually active than older men. Both studies show that older women — even the “young old,” in their 60s — are less sexually active than men of the same age. The gender gap widens as people get older. The University of Chicago researchers noted that the women in their study were less likely than the men to be in a marital or intimate relationship, and even more so with age, presumably because men tend to die at a younger age than women. Differences in the amount of sexual activity that occurs outside of a relationship contribute to the overall gender disparity. In the University of Chicago study, about one in 20 women who were not in a relationship reported being sexually active in the previous year, compared with about one in five men who were not in a relationship.

Partnered sex gets high marks. In the Indiana study, over three-quarters (78%) of the men ages 50 and over rated their most recent sexual experience with a partner as either extremely or “quite a bit” pleasurable. About two-thirds (68.2%) of the women in that age group rated their most recent experience with a partner that highly.

Masturbation is common. Most men (63%) and almost half of women (47%) in the 50 and over age group reported masturbating in the past year, according to the Indiana survey. As with other sexual activities, the percentage declined with age, although a significant number of those 80 and older indicated that they masturbated.

The University of Chicago survey found masturbation to be almost equally common among those in a relationship and those not in one.

Good health matters. The University of Chicago researchers found a strong association between good health and sexual activity, particularly among men. Diabetes seems to have a greater negative effect than either arthritis or high blood pressure on both genders, but especially on women. In the Indiana survey, a woman’s evaluation of her last sexual experience did not vary with her self-reported health status.

Sexual problems are common. Half of those who participated in the University of Chicago study reported having at least one bothersome sexual problem. Among men, the problems included difficulty achieving and maintaining an erection (37%), lack of interest in sex (28%), anxiety about performance (27%), and inability to climax (20%). Among women, the common problems were lack of interest in sex (43%), difficulty with lubrication (39%), inability to climax (34%), lack of pleasure from sex (23%), and pain during sex (17%). In the Indiana survey, 30% of the women ages 50 and over said they experienced some level of pain during their most recent sexual experience with a partner.

The University of Chicago researchers also asked people whether they were bothered by their sexual problems. Men tended to be bothered by them more than women, although when it came to lack of interest in sex, the percentages were about the same: of those who had this problem, 65% of the men said they were bothered by it, compared with 61% of the women.

Sexual activity outside of a relationship is common. A sizable minority of the men (43%) and women (36%) in the Indiana study reported that their most recent partnered sexual activity was with someone other than a spouse or long-time partner. This “nonrelationship” partner category included casual or new acquaintances, friends, and “transactional” partners — people who engaged in sex in exchange for something, often but not always money. Women whose last sexual partner was with a nonrelationship partner reported higher arousal, less lubrication difficulty, and a higher rate of orgasm than women whose last partnered sexual activity was with a spouse or a long-time partner.

Many men take something to improve sexual function. In the Indiana survey, 17% of men ages 50 and older took an erectile dysfunction drug in connection with their most recent sexual experience with a partner. In the University of Chicago study, 14% of the men and 1% of the women reported taking medications or supplements to improve sexual function during the past year.

Age cuts both ways

So it’s pretty clear: old age doesn’t preclude sexual activity, although it also doesn’t make it any easier. Men experience declines in testosterone, which adversely affects sexual arousal and desire. There are age-related changes to blood vessels and smooth-muscle tissues that can make achieving an erection more difficult. Chronic conditions such as diabetes and high blood pressure become more common in old age, and in many men, they adversely affect erections more than any of the strictly age-related changes. Women are also affected by chronic illnesses, in addition to changes related to menopause, which include reduced vaginal lubrication associated with lower estrogen levels.

But age and experience may also hold some advantages. For example, some research suggests that women become more comfortable asserting themselves sexually as they get older. Some men gain greater control over ejaculation. It’s also easier now to overcome some of the physiological hurdles that occur with age. Men have the erectile dysfunction drugs. Women can use any number of vaginal creams and gels. In fact, the number of older people who are sexually active has doctors and public health officials concerned about unprotected sex and sexually transmitted diseases in the elderly. With sex comes responsibility, even if you’re old enough to collect Social Security.