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 There is, however, a gradual slowing of response,
especially in men - a process currently considered part of "normal" aging, but
perhaps eventually treatable or even reversible. A pattern of regular sexual
activity (which may include masturbation) helps to preserve sexual ability. When
problems occur, they should not be viewed as inevitable, but rather as the
result of disease, disability, drug reactions, or emotional upset and as
requiring medical care.
Normal Physical Changes With Age
 Women generally experience little serious loss of sexual capacity due to age
alone. Those changes that do occur--mainly in the shape, flexibility, and
lubrication* of the vagina can usually be traced directly to lowered levels of
the hormone estrogen during and after menopause. Older men often notice more
distinct changes in sexual functioning, although these vary greatly from man to
man. It may take somewhat longer to attain an erection than when young (usually
a matter of a few minutes more after stimulation). The erection may not be quite
as firm or as large as in earlier years. There can be a shorter sensation that
an ejaculation is about to occur. Finally, the loss of erection following orgasm
may be more rapid, followed by a longer period of time before an erection is
again possible.
*One simple way to increase lubrication is to apply
water-soluble surgically (but not petroleum jelly) to the vaginal area.
Effects of Illness or Disability
 The incidence of illness and disability increases with age. Although they can
affect sexuality in later life, even the most serious diseases rarely warrant
stopping sexual activity. Heart disease, especially if a heart attack has
occurred, leads many older people to give up sex altogether for fear of causing
another attack. Yet the risk of death during sexual intercourse is very low.
Although a doctor's advice is needed, sex usually can and should be resumed an
average of 12 to 16 weeks after a heart attack, depending on physical
conditioning. An active sex life may in fact decrease the risk of a future heart
attack.
Diabetes' is one of the few diseases that can cause impotence (a loss of the
ability to achieve and maintain an erection hard enough for sexual intercourse).
Once diabetes is diagnosed and controlled, however, potency may be restored.
Impotence and other sexual problems have causes that can be treated or corrected
which various devices and procedures.
Stroke rarely damages physical aspects of sexual function, and it is unlikely
that sexual exertion will cause another stroke. Using assist body functions can
help make up for any weakness of paralysis that may have occurred
Arthritis Joint pain due to rheumatoid arthritis can limit sexual activity.
Surgery and drugs can relieve these problems, but in some cases the medicines
used can decrease sexual desire. Exercise, rest, warm baths, and changes in
position and timing of sexual activity (such as avoiding evening and early
morning hours of pain) can be helpful.
Hysterectomy is the removal of the womb. Performed correctly, a hysterectomy
does not harm sexual functioning. Those women who believe they have been damaged
by a hysterectomy--or men who consider their partners "less feminine" after this
surgery- should seek counseling. The same is true of mastectomy , the removal of
a breast. The loss of a breast can be quite upsetting because of the changes in
physical appearance. Programs like "Reach to Recovery" (sponsored by the
American Cancer society) are valuable in making an adjustment, as are a
carefully fitted artificial breast and, in some cases, reconstructive surgery.
Prostatectomy is the removal of excess prostate tissue; This procedure rarely
affects potency. Except for a lack of fluid, sexual capacity and enjoyment after
a prostatectomy should return to the presurgery level. In the past, impotence
was a side effect for nearly all men undergoing radical prostatectomy (removal
of prostate gland). However, new surgical techniques save the nerves going to
the penis so that the patient will be able to have an erection.
Alcohol Excessive drinking, which reduces potency in men and delays orgasm in
women, is probably the most widespread drug-related cause of sexual problems.
Medicines such as antidepressants, tranquilizers, certain high blood pressure
drugs can cause impotence. Other drugs can lead to failure to ejaculate in men
and reduced sexual desire in women. Such effects are reversed when the medicine
is stopped.- A doctor can often prescribe a drug with less sexual effect if he
or she realizes that this is important to the patient.
Emotional and Other Problems
 A common emotional problem in older men is fear of impotence. It is important to
remember that all men are impotent at times due to fatigue, tension, illness, or
alcohol. Usually, potency returns by itself, but if a man is too worried, he may
continue to be impotent due to his fears alone.
Older couples may have the same problems that affect people of any age. In
addition, reactions to physical changes with age, retirement and other shifts in
lifestyle and illness can cause sexual difficulties--and can usually be helped
by counseling.
Changing Attitudes
Public acceptance of sexuality in later life is gradually increasing. We can
expect the day when the special aspects of sexuality in old age will become
generally understood and when diagnosis and treatment of sexual problems will be
refined to a much greater degree.
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