Our Bodies, Ourselves (120 page)

If you are told you have osteopenia, consider your options before taking prescription medicine. This relatively new term means only that your bone mineral density (BMD) is less than the average for young adult white women. In other words, your bone mineral density may be perfectly normal for you. Osteopenia is not a disease state, and not all women who have osteopenia will develop osteoporosis. For women with a “–1” or a “–2” BMD screening result, a bisphosphonate such as Fosamax shows no clear benefits, and longer-term use has been associated with decay of the jaw and unusual factures of the thighbone. For more information, see
“Medical Approaches
to Osteoporis Prevention and Treatment.”

When we've got wisdom, connection, logistics, time, intimacy, a sense of humor, ease of communication, resilience of body and spirit, and no kids barging in, who needs youth?

—
Joan Price, author of
Better Than I Ever Expected: Straight Talk About Sex After Sixty
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It is a myth that sexual desire and activity fade as a natural, irreversible part of aging. Our society's view of aging women as “dried up” and sexless is perpetuated by a hypersexualized, youth-oriented culture that doesn't know enough about the sex lives of older women and doesn't view older women as sexual. Sexuality, unlike fertility, can continue throughout our lives. Henry Wadsworth Longfellow understood and expressed the opportunities of aging very well when he wrote:

For age is opportunity no less Than youth itself, though in another dress, And as the evening twilight fades away, The sky is filled with stars, invisible by day
.

While we may have to accommodate changes that can make sexual enjoyment more challenging (such as arthritis or loss of energy), with good communication and a deeper understanding of our needs—as well as more creativity—we can continue to give and receive pleasure.

Appreciating our bodies and sexuality more fully can happen at any age. Many women enjoy sex more in middle and later life:

© DK Stock / David Deas

I'm no longer worried about pregnancy; the children are gone; my energy is released. I have a new surge of interest in sex. But at the same time, the culture is saying, “You are not attractive as a woman; act your age; be dignified,” which means, to me, be dead sexually
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A seventy-three-year-old woman says:

My sexual drive doesn't burst out, unasked for, anymore. But it's there. It just needs a particular environment in order to emerge: candles and wine at dinner, a long postdinner kiss, a rub against my husband's thigh, and then music. Not just any music, but certain songs and groups that over the decades have always turned me on. For me, it's UB40, Santana, and Manu Chao. A few minutes of dancing and slowly stripping, a bit of licking, and I am fully aroused
.

Sexual feelings often depend more on how we feel about our bodies and our relationships than our age. Some women discover their sexuality when they discover a new sexual identity or when they leave abusive or indifferent partners. Some make peace with parts of their bodies they didn't like. Sometimes health improves, either naturally or from making changes.

During partnered sex, we may have to overcome years of conditioning to initiate sex or consider alternatives to routine patterns. It is possible to change old habits and assumptions by talking and exploring together. Some of us have been with the same partner for years and are used to working things out:

My libido was down, as was Tom's. We were having less frequent sex, and I was waiting for him to take the initiative. Finally, I said to myself, “I can do something about this, I am a sexual being”—and I began to initiate sex and we had a great time
.

Inhibitions often lessen with age.
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We may give ourselves more freedom to experiment in relationships or to be more open about them. Some older women have relationships with younger men. Some have sexual relationships with women for the first time. Others who quietly have been lesbian or bisexual for many years may feel more comfortable coming out.

I am eighteen years into what I hope will be a lifelong relationship with a woman. Sex for us is a steady friend. During our busy workweek, we cuddle, and that's good. On weekends and on vacations, we make time for lovemaking and cherish how it reconnects and refreshes us
.

Others continue a lifelong enjoyment that has brought them much happiness and satisfaction:

The biggest reason my sexual life remains so vital is that I have multiple partners. My relationship with my husband has been nonmonogamous for all of our thirty-two years together. This is a very complex lifestyle and not for everyone; it has been a great challenge and brought much richness to my life. Sexual freedom has been incredibly liberating for me and has contributed to my staying younger in mind, body, and spirit. It has enriched my relationships with all my various partners, whether short or long term. I got the impression from my mother that at this age she was tolerating sex, but it was not a life-giving activity in her life. How sad for her!

Of course, not everyone wants to be sexual. A seventy-three-year-old woman writes:

I frankly don't need it, and I don't miss it at all. I had a very, very full sex life, and I was mad about my husband, which is a nice way to be. When he died, it was a real shock. I haven't discovered another person that I had that desire for in twenty-five years now. I'm used to my life the way it is now, and I don't think that my life is incomplete
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For some, sex is laden with abuse and pain that can never be overcome. Others are less interested in sex, even in a good relationship. And our partners may lose interest, too. Adjustments, disruptions, or feeling less sexual can also result from chronic or acute illness or surgery. It can take a while to adjust to new circumstances and resume a pleasurable sex life. But there are many ways to have sex and experience sexual pleasure, regardless of our relationship status or physical capacity.

A 2010 Harvard Medical School Special Health Report,
Sexuality in Midlife and Beyond
,
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identifies the following possible age-related sexual changes for women:

• Physical changes: decreased blood flow to genitals, lower levels of estrogen and testosterone, thinning of the vaginal lining, loss of vaginal elasticity and muscle tone

• Desire: decreased libido, fewer sexual thoughts and fantasies

• Arousal: slower arousal, reduced vaginal lubrication and less expansion of the vagina, less blood congestion in the clitoris and lower vagina, diminished clitoral sensitivity

• Orgasm: delayed or absent orgasm, less intense orgasms, fewer and sometimes painful uterine contractions

• Resolution: body returns more rapidly to a nonaroused state

For those of us with male partners, age-related effects on men's sexuality matter as well. Men over age fifty may have difficulty getting an erection sufficient for intercourse, and erections may require more direct stimulation. In addition, the need to ejaculate is less urgent, and the rest period between erections grows longer.

Such changes may affect our sexual relationships. It can be common, for example, to worry that vaginal dryness, less intense orgasms, or erection difficulties mean a partner is feeling less attracted to us or losing interest in sex. These perceptions can trigger feelings of rejection and resentment. (“Am I no longer sexually attractive?” “Is she or he having an affair?”) If you are
starting a new sexual relationship after divorce or the death of a spouse, it is also quite common to fear that you will not become aroused or will not be able to have an orgasm with a different partner. Or you may be self-conscious about baring your changing body in front of someone new. Sometimes we simply tire more easily, as this sixty-five-year-old woman writes:

I still need about the same amount of clitoral stimulation as in my earlier years, but I get tired so much more quickly. I joke with my partner that we will need to get a vibrator soon if he finds that his hands start getting too tired. Sometimes I start to fall asleep even as I am getting quite aroused. That would never have happened a few decades ago!

A 2007 study on sexuality and health among older adults found that the most prevalent sexual problems cited by older women were low desire, difficulty with vaginal lubrication, and inability to climax. Only 22 percent of women (and 38 percent of men) reported having discussed sex with a physician since turning fifty.
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Many women are reluctant to talk about sexual difficulties with their gynecologists or other health care providers; it's also probable that physicians are uncomfortable discussing sexuality with older patients—particularly women, since we are often perceived as sexless—and need more training about older women and sexuality. One woman notes that her doctor never brought up sex after a recent surgery:

I had a stent put in last summer, and I was concerned about resuming sexual activity with my husband. The doctor didn't mention sex in his long list of dos and don'ts. I had to bring it up
.

In a separate 2007 study on older women's sexual desire and agency, many of the women interviewed had internalized societal assumptions that led them to value their male partners' sexual needs over their own.
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We all deserve positive relationships with partners who love us for who we are and who care about our fulfillment.

Declining health or bodily changes can affect sexuality. Chronic illnesses such as diabetes can decrease blood flow to the genitals; arthritis, back pain, and limited mobility can restrict the range of comfortable sexual positions; and medications for chronic diseases such as hypertension and heart disease can affect energy levels and sexual functioning (See
“Sex with a Disability or Chronic Illness”
). It is also common to feel initial embarrassment over the loss of a breast, or over a colostomy bag or some other apparatus, especially with a new partner. In a 2004 AARP survey, respondents ranked better health for themselves or their partners at the top of a list of features that might improve their sexual satisfaction.
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At the same time, sexual activity has health benefits. If one moves and expends energy during sex, the heart and joints get a workout. Active sex can also burn calories and cause the brain to release endorphins, which help to reduce stress.
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Sexual activity may help people sleep better, owing to the release and sedative effects of oxytocin and endorphins. The clenching and unclenching of vaginal muscles during sex and orgasm condition the vaginal walls and work the muscles of the pelvic floor (known as the pubococcygeus, or PC, muscles). The movement also strengthens these muscles and may help delay or minimize incontinence. And research has shown that orgasms can decrease pain for hours.
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Having orgasms regularly can help to maintain vaginal lubrication, and regular vaginal penetration can help to maintain vaginal elasticity.

While I was married there was never an issue about “using it or losing it,” as we had sex at least two to three times a week, and that kept my vaginal tissues well lubricated. After my husband died, I didn't have a regular sexual partner for more than a decade, but I did enjoy having orgasms while by myself and also discovered along the way that taking cod liver oil daily had a major impact on keeping my vaginal tissues lubricated
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