Hormonal Update Volume 1 Number 11

Sexuality: At Mid-Life and Beyond

Sexuality is an integral and important part of the human experience. Were it not for our sexuality, none of us would be here. It is the way we reproduce as a species, but for most, sexuality represents much more. It can be a way of expressing love, bonding, sharing intimacy, or having fun, not to mention an exciting and pleasurable experience. Sexuality can be expressed in countless ways, such as with playful touching, comforting, hugging, snuggling, and massage. 

What excites, arouses, or satisfies a person is a very personal and individual experience. In fact, nowhere is individual-ity more evident than in a person’s sexuality. To some, sexuality and midlife represent freedom from the interruptions of children with more time and privacy to explore sexuality in new and exciting ways. To others, midlife sexuality represents a significant loss - of prowess, virility or response. However, this does not have to be the case. Midlife can be a time for replacing old images of performance, with new visions of intimacy and romance.

As We Age

Historically, women’s sexuality has existed with a menopausal line of demarcation that divides it into two parts — the time prior to menopause (when she is sexual) and the time after (when she is not). However, a recent survey showed that 89% of married women in the 60-64 age range are sexually active. Those numbers drop with advancing years, but even after the age of 80, 25% of women are sexually active. It is clear that sex is not just for the young.

If you have experienced or are experiencing a dwindling of your sexual energy, you may want to take your own personal and health inventory. The factors that can contribute to a loss of sexual desire and activity are both emotional and psychological in nature. A good place to begin your inventory is by opening the lines of communication with your primary healthcare practitioner. Let him or her know how important sexual activity is to you. Even though help is available, many women are afraid to ask for it. Consequently, their problems go unsolved and they miss out on a wonderful and exciting part of life. 

What Contributes to Lower Sexual Desire, Activity or Response? 

As we age some of us have physical limitations or illnesses that can create difficulties during sexual relations. For example, coronary artery disease can cause chest pain or the fear of having a heart attack during sexual activity.

Many treatable medical conditions such as diabetes, thyroid disease and depression can cause impotence or a loss of libido. Medications taken for some chronic diseases, especially hypertension and heart disease, may cause either a loss of libido or impaired performance. Some antidepressants and tranquilizers can put a damper on sexuality. Also, some antihistamines and high blood pressure medications may produce the same effect. If you suspect that one of your medications is affecting your sexuality, discuss it with your doctor. Frequently, other medications can be substituted that have less effect on sexual activity.

Other challenges to midlife sexuality are the age-related changes we experience in our body shape and function. Generally, as we get older, our body doesn’t look like it did when we were in our twenties; our skin may be drier and less taut. Perhaps we have gained weight. Men tend to lose muscle mass. We might feel self conscious or less attractive. Functionally, the clitoris may become less sensitive in some cases, or overly sensitive in others. Orgasms can be less powerful, slower to occur and shorter in duration. Your desire to be sexual may be diminished by a partner who cannot achieve a satisfying or effective response. For men, aging can bring a slower sexual response time with orgasms shorter and less forceful. The length of time between erections often increases with age. According to statistics, 30 million American men suffer from some form of sexual dysfunction. A low testosterone level can cause erectile dysfunction. 

Sexuality and Hormone Replacement Therapy

A wealth of scientific research describes the benefits of hormone replacement therapy (HRT), not just in matters of sexuality but in all areas of health. In addition to providing protection from some of the silent killers of aging such as heart disease, osteoporosis, diabetes, colon cancer, Alzheimer’s disease and lupus, hormones are intricately involved in your sexuality. If you, or your partner, would like to be more sexually active, your doctor can help determine whether or not you might benefit from HRT. Hormone replacement has been shown to improve sexual performance in men and to increase libido in women. 

Your mind and emotions each play an important role in your sexuality having as much to do with desire as biology. Even if a hormone does not affect libido directly, it can sometimes stimulate your level of sexual interest and activity indirectly, by increasing your sense of well being, relieving depression, enhancing sleep and alleviating mood swings, hot flashes and night sweats. HRT can also sharpen your senses, heighten your sensitivity, and increase your stamina and energy.

Current studies show that adding testosterone to an estrogen/progesterone replacement program can improve concentration, depression, and fatigue, as well as libido when compared to estrogen/progesterone alone. In addition, new research shows that estrogen depletion may lessen a woman’s sensitivity to touch. Restoring sensitivity can restore sensuality. Estrogen has also been shown to increase blood flow to the vulva, clitoris and breasts which heightens sexual response. 

Hormone Level Testing and Monitoring

Because sexuality and libido are affected by so many factors, it is important to have an accurate assessment of what is going on hormonally. If lowered hormone levels are causing changes in your sexuality, addressing the problem through communication or emotional adjustments may not solve the problem. 

Saliva hormone level testing is a very valuable tool in helping your practitioner determine which hormone and what dose you might need. Symptoms that might indicate a need for estrogen in one woman might actually be the result of a testosterone deficiency in another because each of us is a biochemically unique individual. 

Once you begin taking HRT, monitoring how you are doing with a follow-up saliva hormone test can help ensure the success of your program. Every individual responds to therapy in her or his own way. Taking the right amount of testosterone can benefit libido, while taking too much may cause anxiety, irritability or anger. In addition, high testosterone levels can cause physiological changes such as excessive facial hair and acne. 

The Choice is Yours

Sexuality is personal and individual, so finding what works for you is of key importance. Changing your sex-ual routine in a long-term relationship can re-ignite you physically and emotionally. Balancing hormones and restoring them to more youthful levels can rejuvenate your desire and give you the energy you need to be sexual. Again, the key to satisfaction and fulfillment with sexual experience in later life is individual choice. 

While no studies actually prove that sex prolongs life, one recent study showed that people who have few or no sexual encounters on a regular basis are at greater risk for catching a cold than people who have relatively frequent sex. The study found that individuals who were sexual once or twice a week had higher levels of the antibody immunoglobulin A than those who were not having sex or having it less than once a week. Another study reported that men who have more than two orgasms per week have lower mortality rates.