Our Bodies, Ourselves (121 page)

If the sensitivity of your nipples, clitoris, or vagina changes, you may want to adjust the intensity of stimulation and possibly experiment with the use of a vibrator. Shifting positions—and bed cushions—can protect joints and tissues and lead to more comfortable sex, especially if you have problems with mobility, flexibility, or painful joints. More time and stimulation may be needed for arousal and reaching orgasm, but that's okay. Set aside a time that works best for you. Some people use late afternoons for sexual activity, for example, because medications have kicked in and fatigue hasn't.

Most women experience fluctuations in levels of desire throughout their lives. There are many reasons for experiencing less sexual desire: overwork and anxiety; the loss of newness in a long-term relationship; a past history of abuse; gradual changes and accommodations reached in a long-term marriage; or the fact that somebody we're dating for companionship just doesn't attract us in that way. Sometimes, though, lack of sexual desire or responsiveness can be caused by medications, lower hormone levels, or other medical problems, such as low thyroid function or cardiovascular disease.

If you want to be sexual but are experiencing difficulty, or if you're experiencing pain or anxiety about sexual activity, talk to a health care provider or counselor and let that person know that sexual activity is important to you. Depending on the cause, there may be steps you can take to improve your sexual experiences, including modifying your medications.

If you think your relationship is causing the problem and communication with your partner is difficult, consider getting help together—or alone, if your partner is unwilling to go for counseling. A licensed sex therapist or counselor specializing in relationships and sexuality may provide useful advice or recommend workshops or support groups on older women's sexuality. If no workshop or support group is available, consider organizing one.

Couples can learn to handle changes in desire. A woman writes of having “no libido” at sixty-three:

I did the creams (which worked wonderfully) but now want to be as drug-free as possible. On the fingers of my wonderfully patient and determined husband, or on my very occasional own, any oil-based cream works wonders on the clitoris. Combined with plenty of skin-to-skin coziness as we sleep, this is plenty of satisfaction for me
.

The author Joan Price writes about the importance of planning for sex:

We've discovered that sex works best when we schedule it, make time for it, clear away our busy calendars for it. We turn off our computers and phone ringers. We make dates, anticipate our times together, plan for them, fantasize about them, and tantalize each other by phone by murmuring about what we'd like to do. What we give up in spontaneity, we make up for with constant mental foreplay
.
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Sex is whatever gives you erotic, sensual pleasure, either with an intimate partner or by yourself
.

—
Carol Rinkleib Ellison, the author of
Women's Sexualities: Generations of Women Share Intimate Secrets of Sexual Self-Acceptance
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As in our younger years, we can explore sexuality without a partner, satisfying ourselves and discovering what turns us on by enjoying fantasies and/or self-stimulation. Sex toys and erotica are available online. See
Chapter 7
, “Sexual Pleasure and Enthusiastic Consent,” for good sources.

With a partner, do whatever pleases you both. If your partner is a man of middle age or older, it may be difficult for him to get or keep an erection. Impotence in men is often an unspoken secret.

Studies have shown that that only 30 percent of women regularly climax from vaginal intercourse alone. In a 2009 study
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of women age sixty to seventy-five, many women reported that there are a wide range of sexual activities that could be equally pleasurable. Touching, kissing and caressing all over, mutual masturbation, and oral sex can give both women and men pleasure and satisfaction.

I still miss being with my late husband, even close to twenty years after he died. But now that I am again in a steady, loving relationship with someone who understands my body so well, I experience deep and satisfying sexual pleasure once again. Sometimes I think he knows more about my clitoris than I do!

If you love intercourse and your partner's age-related sexual changes are affecting the experience, you and/or your partner might talk with a health care provider about Viagra and other erectile-function medications. If he's doing fine but intercourse is uncomfortable for you, see
Chapter 8
, “Sexual Challenges.”

At any age, we may have to consider the medical tests we are willing to have, which of several possible treatment options is best for us (and which ones we can live without), and how much intervention we want—or don't want—if our condition is not likely to improve. These issues are even more important now with high-tech medical advances. Overtreatment is sometimes considered as big a problem as undertreatment in the U.S. health care system.

Many of us will enjoy better health and longevity than previous generations, but the rates of gain are inconsistent across income levels and racial and ethnic groups, and there are disparities compared with other industrialized countries.

According to the U.S. government report
Older Americans 2010: Key Indicators of Well-Being
,
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in the 1980s, a sixty-five-year-old woman living in the United States had one of the highest average life expectancies in the world, but twenty years later the life expectancies of older women in many countries surpassed that of women in the United States.

Older people face physical, emotional, and social changes and challenges that require special attention. We may need a multidisciplinary team to help us manage medical conditions so we can be as vital, active, and independent as possible. Unfortunately, there is a great shortage of doctors, nurses, psychologists, psychiatrists, dentists, and other health care professionals trained in caring for older adults.

In 2010, there were about 7,100 geriatricians in the United States, a 22 percent decline from 2000. According to a 2008 study by the Institute of Medicine (IOM), a larger shortage is looming. By 2030, when more than 71 million people in the United States will be age sixty-five or older, there will be only an estimated 8,000 geriatricians.
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The Association of Directors of Geriatric Academic Programs predicts that the nation will need 28,000 more geriatricians—for a total of 36,000—to meet the demand.

If the IOM predictions hold true, there will be only one geriatrician for every 4,254 older adults, compared with one for every 2,546 older adults in 2007, and one geriatric psychiatrist for every 20,195 older adults, compared with one for every 11,372 older adults in 2007.

Providers without adequate training may interpret emotional or mental confusion as normal aging when it may actually indicate poor nutrition, chronic dehydration, lack of stimulation (interesting daily activities), treatable physical problems, grief, or a reaction to medicine.

Health care providers may judge older women's concerns about pain and health problems to be neurotic, imaginary, or the inevitable result of aging, far more than they judge men's this way. Sometimes providers do not fully treat chronic conditions, misdiagnose and/or fail to manage reversible conditions, and overprescribe drugs. Time after time, older women receive antidepressants and pain relievers instead of a full exam to determine what's really wrong.

Conversely, simpler things such as diet, exercise, and therapy (including physical, occupational,
and psychological therapies) get less attention, even when we need them most. Complicating things further, health care insurance plans may limit access to certain tests, treatments, and health care practitioners.

People over age sixty-five take 34 percent of the medicines prescribed annually in the United States, though they currently make up only 13 percent of the U.S. population.
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Health care providers sometimes neglect to find out what drugs we are taking, including over-the-counter products, before prescribing others. Older adults are more likely to be taking multiple prescriptions, have fewer physical reserves to combat adverse drug responses due to incorrect dosage or drug interaction, and are more likely to be hospitalized owing to an adverse response.

Aging may cause increased sensitivity to drugs, since the kidneys and liver break down and excrete drugs more slowly. You may need lower doses adjusted to your size, age, activity level, and nutrition needs. Women at any age may require lower doses than men because of physical differences. Some drugs can cause depression (for which you may be offered more drugs) or mental confusion, though the symptoms often stop when you stop taking the medicine.

A friend of mine who lives in a nursing home was recently diagnosed as having various ailments that require anywhere from three to ten pills a day. She was never told what the pills were or what they were for. When the nurse came to her room to give her the pills, my friend looked her squarely in the eye and said, “The doctor only knows my body and how it works for a short time. I have known it for ninety-four years, and nothing is going in it until I know what it is!”

When you visit a health care provider, it's good to bring a list of physical changes and the medications you are taking, as well as a list of questions and concerns. Or send the information to the provider's office in advance of the appointment. Some doctors now have interactive websites that enable patients to ask questions ahead of time. A sixty-nine-year-old woman says:

I told my new doctor about what I eat, all the vitamins I take, why I dislike going to a gym, and what I do for physical activity. I also explained why I don't want to have all the invasive tests everyone my age seems to be having. Even though she's under 40, she seemed to get it and didn't push me. Most important, she took the time to listen to me
.

We sometimes feel intimidated by health care providers and are afraid to ask questions, inquire about alternative approaches, or request a second opinion. Remember, you have the right to do all those things. If your practitioner is not well informed about managing the diseases and chronic conditions of aging, or is not caring toward you and not responsive to your concerns, try to find someone else who can be more helpful.

I had lower back problems. My neurologist sent me to an orthopedic surgeon, who told me to have an operation which, he informed me, had some risks. I didn't feel comfortable with his assessment and sought a second opinion. It was hard to find a doctor to do this. The opinion of the second doctor was that I didn't need an operation. I agreed, as did my husband and children. I started physical therapy and feel much better
.

If you're not comfortable raising questions, ask an advocate to accompany you. Having a significant other, family member, or friend with you can be helpful, particularly if you are going to have a surgical procedure. This person needs to know what to ask and watch for and should be persistent with each provider, especially if multiple health care providers are involved. Paid advocates are becoming increasingly necessary to navigate health care settings.

For more information on the topics discussed above, see
Chapter 23
, “Navigating the Health Care System.”

Planning ahead involves integrating all aspects of our lives: work/retirement, health/health care, long-term care, finances, housing, meaningful relationships, activities, and community. It's best to be proactive and to talk about living arrangements and health care before a crisis arises so you can age in line with your values.

Sharing your desires with family and friends can help you clarify plans and goals and learn what roles you might need others to play. Sometimes talking about your future with a social worker, life planning coach, mental health professional, or clergyperson can be helpful. If you have financial resources to pay for counseling, an organization such as the Life Planning Network (lifeplanningnetwork.org) can help you identify a coach or consultant.