Health & Sexuality




by Edith Ankersmit Kemp L.C.S.W. and Jerrold E. Kemp, Ed.D.

One of the most inspiring things I have learned from the couples I have interviewed is that physical intimacy is an important and satisfying part of their relationship. And, of course, health, especially in later years, is inextricably tied to sexuality.

A study of the sex life of older Americans, age 60 and older, that was conducted in 1998, revealed that many older people are active sexually. The study found that:

·       71% of men and 51% of women in their 60s were sexually active, while 57% of men and 30% of women in their 70s reported being sexually active. (These percentages might be low because, as well as recently coupled older people, the study included both single individuals and long-married couples.)

·       When asked about the emotional satisfaction they receive from their sex life, 74% of sexually active men and 70% of active women said they were as satisfied or even more satisfied than they were in their 40s. (We had quite a few couples who said the same!)

·       When older people are not sexually active, it is usually because they lack a partner or because they have a medical condition.


The dark side of this sexual activity is that older adults are becoming increasingly vulnerable to infection with HIV. A blood test for AIDS is a wise precaution before becoming involved sexually.

Physical changes occur gradually as both men and women age. After menopause, women can suffer from vaginal atrophy, which is a thinning of the vaginal wall that can result in pain during or after intercourse. Oral estrogen or estrogen cream applied to the vagina can often alleviate this problem. There is also a decrease in vaginal lubrication, especially if a woman is not taking a form of estrogen. An over-the-counter lubricant applied before intercourse is very helpful.

As men age, they gradually begin to have less firm and less frequent erections and more limited ejaculations. This will vary greatly with the man’s health. While impotence is often assumed to be part of the normal aging process, this is not necessarily so. It may reflect the effect of a chronic disease such as diabetes, or other conditions such as arteriosclerosis and hypertension that can affect the blood vessels and therefore the firmness of an erection. Necessary medications can also interfere with sexual function, especially those used to treat heart disease, high blood pressure, depression, and anxiety.

But even with the changes of aging, the impact of diseases, and the effects of drugs, older couples can, to some degree, continue to enjoy a satisfying sex life. Particularly inspiring were three women who had medical problems that one would think could end their chances of being sexually attractive to a partner. Karin lost one breast to a mastectomy, Barbara lost both breasts to a double mastectomy, and Naomi had an ileostomy after suffering from colon cancer. All of these women had these operations before they met their present partners, yet were still attractive to their mates and currently enjoy their sexual lives.

Of course, sex is not just a physical act. It is a supremely bonding force between a loving couple. Our sexuality is a strong component of our relationship and often takes the form of affection, teasing, and laughter. Jerry and I both had seriously ill spouses and long periods of abstinence, so our lovemaking makes up for all the years we lived without it. If continued aging or medical problems catch up with us, we will still be sexual to whatever degree we can, as the bond has been formed.

The couples we interviewed have taught us a great deal about sexuality in later life. For all of them, the return to a sexual life was an important part of their relationship. Here are their stories.

Ruth and Paul

Ruth and Paul, a married couple, first became sexually involved when she was 71 and he was 73. Their first experience together, after many years of abstinence, was not satisfactory. In fact, Ruth described it as “terrible.”

With time, trust, and more open communication, Ruth and Paul became more comfortable with each other, and their sex life gradually improved. Now they have sexual activity almost daily, usually after waking in the morning. (For many couples, morning is the prime time for sex, probably because they are rested.) Ruth’s initial vaginal dryness is successfully managed with estrogen and she now finds the experience “lovable.” They both believe that “sex contributes much to holding a marriage together. It increases the bond between the two of us. We express every day our love for each other.”

At age 80 Paul has no problems with erection or ejaculation! This is somewhat unusual, but Paul is active, in good health, and looks to me like a man of 60. He has a slightly enlarged prostate gland that is controlled with medication, but that does not interfere with his enjoyable sex life.

Nancy and Pat

Nancy, age 75, and Pat, 77, are a committed couple living separately. Let Pat tell us how their love life developed:

“The physical attraction to Nancy grew on me naturally. I just got to liking her better and better. I didn’t have any idea at first we’d ever do anything sexual. Then one night as we were cuddling up watching television, I just happened to mention, ‘I wonder if we could go to bed together.’ Laughingly, we ran into the bedroom . . . and so it started.”

It was after the beginning of their sex life that Nancy and Pat started to spend nights at each other’s homes and to see themselves as a committed couple. With most of those interviewed, their first sexual encounter also marked the beginning of their commitment to each other.

Currently Nancy and Pat have intercourse about twice a week, usually in the morning. At age 77, Pat still is able to hold an erection but doesn’t always ejaculate. “I can only charge up my battery twice a week,” he said with a smile. Pat feels he is able to enjoy sex more with Nancy than he had with his wife, primarily because during their marriage, as Catholics, they used the rhythm method for contraception. “It didn’t work very well—we had seven children. But maybe it did, since we didn’t have fourteen!”

Nancy had a hysterectomy at age 45 and takes estrogen. She lubricates naturally and is orgasmic. She suffers from incontinence, however, and has had surgery for this problem. She presently uses pads, but this in no ways turns off Pat sexually. Sex is better for her with Pat than it was with her husband, but at that time, between her husband’s work and the raising of three children, their distractions from sexual intimacy were many. For her as a Catholic, the rhythm method was an interference until after her hysterectomy. Also, her husband was more inhibited than Pat. “I’m a very different person now with Pat. We have a very open relationship sexually. He is a great lover. We can talk freely about our love life. I’m very responsive.”

Joanne and Andy

Joanne, 59, and Andy, 60, are a younger couple than most of those interviewed. After dating for 14 months, they have now been living together for eight months. They became sexually involved after keeping company for seven weeks. Joanne “held out” that long because Andy had told her that with his participation in singles groups, “The easiest thing in the world was to get laid.” She didn’t want to be “just another lay.” At first, they necked and petted. “It was like being in high school, in the back seat of a car, steaming up the windows,” Joanne recalled. “The first time we had intercourse, it wasn’t the best sex, but it’s been getting better ever since.”

Joanne has a stronger sex drive than does Andy. “I take hormones and would like sex almost every day,” she said. Andy had a previous bout with cancer, which has lowered his energy level somewhat. They have sex about once a week, and Joanne has learned to accept this. With a pleased look on her face, she exclaimed, “After living five years by myself, I thought I liked sleeping alone. Now I practically sleep on top of him, like a fly on a windshield.” Andy, with a glow on his face, added, “Just feeling our bodies close, it’s really nice. In the morning when we cuddle and hold each other, to me that’s heaven.”

Contrary to stereotypes, it is not at all uncommon for women to want intercourse more frequently than men. Closeness in bed, however, which Joanne and Andy so enjoy, is a pleasure that can be savored for many years, despite increasing age and deteriorating health.

Karin and John

Karin and John, like Pat and Nancy, are a committed couple, living separately. Their intimate relationship began about two years ago. Both are presently in good health, although Karin lost a breast to a mastectomy prior to meeting John. This did not stop John from finding her desirable, nor did it interfere with their sexual pleasure.

John, who is 69, tends to be a worrier. When discussing sexuality, he expressed concern about his sexual performance. (I dislike that word performance when men use it. It detracts from spontaneity and seems to put unnecessary pressure on the man to perform in a particular way.) Karin, who is 65, said she would like sex more frequently. John admitted that he is often tired from such activities as running and dancing, desiring sex less often. He often climaxes before Karin and then satisfies her manually. She expressed the wish that they could climax together during intercourse. When I discussed this with the two of them, they both realized that this goal was based on a myth: it is seldom that both partners climax at the same time.

John was concerned that he no longer could achieve an erection by just thinking about Karin, as he did when he was younger. Men can do this in their teens and early twenties, but certainly not at age 69! His erection now takes longer to attain, but this is no problem if he takes time, relaxes, and caresses Karin. Also, his erection doesn’t last as long as it did when he was younger. John needed reassurance that this is all normal as a man ages. As we discussed their sexuality together, John observed that, “If a man doesn’t know these facts, he can get scared and then may really not get it up.”

Karin on the other hand, has none of John’s worries. She described their sexual life as “wonderful, open, and satisfying.” Although it had been many years since she had been sexually involved, she has had no problems with urinary tract infections or vaginal dryness. She has multiple orgasms, which John really likes. Although Karin would sometimes like sex when John is not in the mood, she is accepting of his needs and hopes he doesn’t feel pressured, which he says he doesn’t. When asked about their sexual frequency, they agreed it was usually once or twice a week. They said that the more they are together, the more frequently they are sexual, if they are both rested and not too busy. With a twinkle in his eye, John said, “If my friends read this, tell them we have sex at least three times a week!”

Janice and Cliff

Janice is 55 and Cliff is 67. They are married and have been together as a couple for about eight years. For the first few years, their sexual intercourse was very satisfying, but recently their activity had become “much quieter.” Cliff was experiencing a diminished sex drive and was having difficulty maintaining an erection. Cliff expressed the fear that he was impotent and refrained from approaching her because of his performance anxiety. Janice believed that she had lost her attractiveness to him.

Janice said, “Sex has been an important part of our relationship, and I miss it. We both feel insecure about Cliff’s condition, knowing that otherwise he is in good health. As his desire decreases, his worry about his performance increases.”

During our discussion, Cliff was relieved to learn that problems with erection are common with aging. This knowledge has decreased his anxiety so that now he maintains a firm erection and their sex life is improving. If a man does not understand these natural changes and believes he is impotent, this thought alone is enough to inhibit his erections. Cliff’s doctor prescribed Viagra™, which he uses on occasion. Janice is pleased that sex is now more frequent and satisfying. “If I’m not getting enough sex, I’m somewhat edgy.” The two also touch, snuggle, kiss, and, at times, mutually masturbate.

Naomi and David

David, age 80, has similar concerns about impotence. He and Naomi, who is 78, a married couple, have been together for 14 years. Naomi told me that when they first became sexually involved, they had an active and enjoyable sex life.

Now approaching 81, David admits sadly that he is impotent. The most likely cause is his blood pressure medication. Recently his dosage was lowered, and Naomi is hopeful that the situation may improve.

His impotence is of great concern to David. He tried a suction pump, but it hurt, and now he wants to try Viagra™, but Naomi is afraid of possible harmful, long-term side effects.  Naomi emphasized that David brings her to orgasm by stimulating her manually, and I pointed out that for many women, clitoral stimulation is even more satisfying than intercourse.

Naomi was emphatic about David’s concern regarding his lack of erection: “It’s no problem for me. It is only a problem for him and it’s in his head. We have sex about once a month now, which is good enough for me. I’m not 21 years old. If sex only were what I wanted with David, would our relationship have lasted this long?”

Carol and Ron

Carol, age 64, and Ron, 72, have been together for 17 years. They are married and live separately. When they first became involved, at ages 47 and 65, they had many periods of intense sexual activity. Then, because of a back problem and vaginal pain during intercourse, Carol lost her sex drive and now has no desire for sexual relations. “It hurts too much,” she says. “I can’t stand it.” She attributes her pain and sexual problems to having been molested as a child. She recovered memories of this abuse as an adult, during individual and group therapy.

The theory behind “recovered memories” is that severe physical and sexual abuse is too painful for a child to hold in consciousness. These memories are therefore, dissociated (kept out of consciousness) and recovered in later years, usually during psychotherapy. There is much dispute in the psychotherapeutic community about the validity of this theory. Considering that Carol was left alone and unprotected a great deal as a child, I believe that her memories are likely to be true.

About five years ago, Ron was diagnosed with cancer of the prostate. He had an orchiectomy that removed the testosterone-forming glands from his testicles to retard the spread of the cancer. As a result, he lost his ability to have erections. Thus, Carol and Ron no longer have sexual intercourse, and Ron finds this frustrating. Their feelings for each other are expressed by sitting together, holding hands, and hugging, but no deep kissing, no touching, and no stroking of intimate parts. They sleep together at times, in a companionable way. Carol told me that Ron sees intercourse as the only way of making love, and he is not willing to do other things that she would find exciting and satisfying.

Some Suggestions

Older couples need to know that there are many other ways to achieve sexual arousal and even orgasm other than through intercourse, or in addition to intercourse. The following suggestions may be helpful if they fit with your moral and religious beliefs.

Touching the breast and stimulating the nipple with the hand or tongue can be very exciting. There is a spot right at the bottom of the spine that is erogenous. In fact, tenderly stroking and kissing all parts of the body can be a loving and exciting experience for both the receiver and the giver.

Mutual masturbation with the man gently rubbing the vulva and clitoris with a moist finger, and the woman stroking the penis can often lead to orgasm. The penis, limp or erect, can be rubbed within the exterior vulva and against the clitoris. Then there is oral sex, a very common practice today. In cunnilingus, the man stimulates the woman’s outer vagina and clitoris with his tongue. This can be extremely exciting and often the only, or the primary way, that many women achieve orgasm. Fellatio refers to the woman sucking a man’s penis. With this procedure, a woman can give her partner excitement and bring him to orgasm. She can withdraw her mouth before ejaculation, if desired. Two references treat this topic:

·       The New Male Sexuality, by Bernie Zilbergeld, 1992; Bantam Books (particularly pages 108–111 and 357–358)

·       The New Joy of Sex, edited by Alex Comfort, 1996; Crown Publishers (particularly pages 85–88 and 105–110)

Sexual Behaviors of Our Oldest Couples

Mary and Fred married when she was 63 and he was 57. Now she is 85 and he is 79. Previously they had an active sex life, but now they describe it as “nice.” They both agree that Fred’s erectile capacity is adversely affected because of his medication for heart problems and diabetes. Mary states emphatically that, “Sex is not everything in a marriage.” Fred follows with, “We get satisfaction from kissing and holding hands, and also closely embracing each other while in bed.”

Laura, age 80, and Ed, 90, have been together for twenty years and they related that for both of them, sex at first was “very healthy,” with intercourse three to four times a week. Their relationship began when Laura was 60 and Ed was 70. But over time, intercourse has waned with Ed’s inability to have an erection. At 90, Ed has had his share of medical problems, particularly with his heart and circulatory system. Now hugs and kisses are more important for expressing their affection.

Stuart is 26 years older than Donna. When they were first married, both of them felt their sexual activity was good at two to three times a week. Now, at age 90, Stuart can achieve only a limited erection, and they try for intercourse about once a month. Stuart is in very good health for his age. He has had no surgeries and takes no medication. However, it has become more difficult for Stuart to move into various body positions during intercourse.

Donna however, often feels excited and she misses the sexual activity she shared with Stuart. So she now initiates playfulness through sexual touching. Stuart says, “It’s up to her now if she gets the desire and it’s great that she is able to initiate some activity.”

All three of these oldest couples had frequent intercourse when they married at a fairly late age. Now, for various reasons, their sex life consists primarily of affection and physical closeness. They have had enough years together to enjoy sexual intimacy and become more deeply bonded. The suggestions I offer for sexual practices other than intercourse would not fit for these oldest couples because of their possible conservative orientation, and it might not be necessary because they are content with their love lives as they are.

Some Final Thoughts

All the couples had active and satisfying sexual lives during the early parts of their relationships. For those who married, only those with strong moral and religious convictions against pre-marital sex waited until after marriage to become sexually involved. Some, like Ruth and Paul, have continued with frequent and enjoyable intercourse until very late in life. Other couples, because of physical problems and medications, no longer have intercourse but still enjoy physical affection and cuddling in bed.

For many of the couples, the frequency of their sexual activity decreased as they aged. A sense of humor can really help when this occurs. One of the men I interviewed told me this story about two men conversing in a barber shop:

“Do you remember the first time you had sex?”

“I can hardly remember the last time I had sex.”

“That may be true for you, but I have sex almost every day . . . almost on Monday, almost on Tuesday, almost on Wednesday. . . .”

For older individuals, it is important to remember that certain changes in erectile functioning and ejaculation for the man, and thinning of the vaginal walls and a decrease in lubrication for the woman, are absolutely normal with the aging process. This can greatly relieve anxiety so that the couple may continue to enjoy satisfactory sexual experiences.

The authors may be contacted at and

Excerpted from Older Couples: New Romances—Finding & Keeping Love in Later Life by Edith Ankersmit Kemp, L.C.S.W. & Jerrold E. Kemp, Ed.D. Copyright © 2002 by Edith Ankersmit Kemp, L.C.S.W. & Jerrold E. Kemp, Ed.D.. Excerpted by arrangement Celestial Arts, Berkeley, CA. $14.95. Available in local bookstores or call at 800-841-2665 or click here.