We are all sexual beings. Sexuality is a natural, normal part of life and looks differently throughout our lives. Some people do not want to think of children or older people as sexual, but they are.
When we reach middle and older adulthood, the body undergoes changes that can affect our sex lives. Being aware of impending changes can make us better able to understand them, and to remember that the changes do not prevent us from having meaningful and satisfying sex with our partners.
Sex in Middle Adulthood
Adults in their midlife often have many responsibilities: children, working long hours, and/or caring for parents — and these can all impact sex and desire. People may be too tired, stressed, or preoccupied to have sex.
Bodies change and so does desire. Sexual activity may change and the ways we express and participate in sex may look different.
People may be single for the first time in a long time and will be navigating dating after years of being in a couple.
Even with irregular periods in mid-life, a person with ovaries still may be able to achieve pregnancy. To avoid unplanned pregnancy, a person should continue to take contraception and/or use condoms.
Note that rates of sexually-transmitted infections (STIs) are rising in older adults. This is due to several reasons: drugs for erectile dysfunction enable people with penises to have sex in their later years; there has been a rise in mid-life divorces; there is more dating online; older adults don’t perceive themselves to be at risk; lack of sexuality education; and low condom use. Many STIs do not have symptoms, so many people don't realize they are infected. Make sure to use condoms and get tested.
The menstrual cycle is a natural, normal part of life that comes full circle.
Menopause happens because the ovaries stop producing the hormones estrogen and progesterone. Once you have gone through menopause, you can't get pregnant anymore.
Some people call the years leading up to a woman's last period menopause, but that time actually is the menopausal transition, or perimenopause.
Menopause is defined by 12 consecutive months after the last menstrual period and marks the end of menstruation. Menopause can happen when a person is in their 40s or 50s; the average age is 51.
Menopause is a natural biological process. Although it ends fertility, a person can stay healthy, vital, and sexual. Some feel relieved because they no longer need to worry about pregnancy.
Changes During Menopause
There are many bodily changes during menopause:
- Irregular periods: Periods can come late or sooner, be heavier or shorter.
- Hot Flashes: These are a sudden feeling of heat in the upper part or all over the body. The face and neck may become red, and red blotches may appear on the chest, back, and arms. Heavy sweating and cold shivering can follow.
- Sleeping: A person may find it hard to sleep through the night. They may have night sweats — which are hot flashes that make you perspire while you sleep. They may also feel extra tired during the day.
- Vaginal/Urinary: The walls of the vagina may get drier and thinner because of lower levels of estrogen. Estrogen also helps protect the health of a woman’s bladder and urethra, the tube that empties your urine. With less estrogen, sex may become less comfortable. A person also could have more vaginal infections or urinary tract infections.
- Mood Changes: Mood swings are related to the fluctuating levels of ovarian hormones during the transition to menopause. If a person is not sleeping well due to night sweats, their mood would no doubt be affected. People who had severe premenstrual syndrome (PMS) in their younger years may have more severe mood swings during perimenopause. Also, people with a history of clinical depression seem to be particularly vulnerable to recurrent clinical depression during menopause.
- Sex: Some people feel less aroused, while others feel more comfortable with their sexuality after menopause. Some may be less interested in sex if it is less physically comfortable.
Writing down menopause-related symptoms can give a person a better sense of how many symptoms they have, severity of symptoms, and how bothersome they are. Exercise can help a person’s bones, heart, mood, and more.
People with ovaries will still need certain tests like a pelvic exam after menopause. Most people with a cervix need a Pap test every three years. Depending on their health history, they may need a Pap test more often, so they should check with their doctor. Mammograms are also important for a person’s health.
There are many types of hormone therapy to treat menopause symptoms. These include pills, patches, implants, rings, and vaginal creams. These treatments work by replacing the hormones (estrogen and progesterone) that the body stops making during perimenopause and menopause. Some people take both hormones for therapy — hormone therapy (HT). Others take estrogen only — estrogen therapy (ET).
Sex in Late Adulthood
Later adulthood brings some additional physical changes that can affect sexual activity.
As aging happens, the vagina shortens and narrows. The walls become thinner and also a little stiffer, with less vaginal lubrication, affecting sexual pleasure. Additional lubrication has been reported to help a person with a vagina enjoy sexual activity. Hormone therapy in the form of estrogen gels or pills may help, but it is important to talk to your doctor about risks associated with hormones and cancer first.
For people with penises, erectile dysfunction becomes more common, which is the loss of ability to have and keep an erection hard enough for sexual intercourse. A person may find it takes longer to get an erection, and it may not be as firm or as large as it used to be. There are medications available to help achieve and sustain an erection for sexual activity.
Illness, disability, or drugs that are taken to treat a health problem can affect your ability to have and enjoy sex. But even the most serious health problems don't have to stop people from having satisfying sex lives.