By Victor S. Sierpina and Dr. Tristi Muir 

Despite the media and entertainment industries’ constant emphasis and exploitation of sexuality in the youth culture to sell products, services, films, and so forth, the mention of sexuality in aging persons remains a somewhat awkward and infrequently discussed topic.

There may be a number of reasons for this. Maybe good judgment, a more proper sense of decorum, and a natural modesty develop as we age — in some people at least. Maturity also brings with it a sense of perspective of deeper values in life that the raging hormones of youth do not have time for nor even fathom.

A recent research study of more than 1,700 seniors in the Netherlands, average age of 71, found that an active love life in older people was associated with improved cognitive function. Those who rated sexuality as “important” or “very important” had higher cognitive and memory scores than those who did not think sexuality was an important component of their lives. Perhaps the group more active sexually had better blood flow to their two most important sex organs- the brain and genitals. Cause and effect were not established by this study though it was an intriguing finding.

Physical capacity for sex changes as we age. Frequency of sexual relations diminishes with age for both men and women, though the desire for it may remain. Most doctors have a number of older patients who are alone due to the death, illness, or separation from an intimate partner but still wish for the intimacy, the touching, and the climactic events of sexuality if it were available to them.

Medications, hormonal changes, diabetes, heart disease, circulation problems, and even arthritis can make sex difficult and uncomfortable. Flagging desire or drooping erections can be a factor, as can psychological issues such as performance anxiety in both sexes. Realistic expectations and knowing sexual climax takes longer and may not occur with every attempt can take some of the stress out of intimate contact. Maybe this is the full circle, the chance to apply the patience learned in having and raising children.

And keep in mind that libido, the desire for sex, and the physical ability to have sex are two different aspects of the issue. The degree and rate of physiological changes is different for all of us, so talk to your doctor openly and frankly about your concerns.

For men, there are a number of options such as testosterone gels, patches or injections, and Viagra-like drugs to improve performance. Even the name of a botanical product, horny goat weed, seems to promise all kinds of sexual success. Evidence on its effectiveness and that of other over-the-counter supplements is limited.

For women, hot flashes are only the tip of the flaming changes that occur with menopause. The vaginal tissue changes becoming less lubricated and thinner - leading to pain and the potential for bleeding with sex. If sex is painful, it makes sense that desire will diminish and avoidance may rule the day and night. The good news is that vaginal estrogen can improve the health of the vaginal tissue. While a variety of botanical products exist, they have yet to be proven effective. Decreased desire is common. A steamy novel or film may rev the engine of desire.

Rather than turning to a medication or supplement with the promise of improving your sex life, we recommend that you turn to each other and open up your heart and talk about it. People who have spent decades together, living through the ups and downs of life, commonly do not talk to each other about sex. When you pull away because of a physical problem, the partner often interprets this as rejection.

Unmet sexual needs may cause other problems. A recent medical journal article described a hazard of sexuality in aging that is common to all ages, sexually transmitted diseases. The article reported on how one randy old rooster in a nursing home hen house of lonely women infected a dozen or so partners with gonorrhea, much to the surprise of their treating physicians. So like we tell younger folks, if you have multiple partners, use protection against STDs.

Sex life, intimacy, and touching have different meanings and values as we age. Sexuality shifts and, for some, changes entirely. Once a decades-long beloved partner is absent, sex life may seem unsatisfying or even undesirable. There are no substitutes, whether pharmacological or even imaginative. Intimacy takes new forms on psychological and spiritual levels. The touch of friends, family, members of your faith community, the Meals on Wheels volunteer all hold new and more significant meaning. Next week, we will explore the complex depth of multiple dimensions of intimacy and the amazing areas of life where human touch nurtures and sustains us, allowing us to accept and affirm love for others, and ourselves in a kaleidoscope of new ways.

Dr. Victor S. Sierpina is the WD and Laura Nell Nicholson Family Professor of Integrative Medicine and Professor of Family Medicine at UTMB. Dr. Tristi Muir is the director of the UTMB Pelvic Health and Continence Center at Victory Lakes. Visit www.utmbhealth.com/pelvichealth.