Senior Sex: Top Tips for People Older Than 65

Social stigma surrounds older people and sex.

Kecia Gaither, M.D., is board-certified in OB-GYN and maternal-fetal medicine, and the director of perinatal services/maternal-fetal medicine at NYC Health + Hospitals/Lincoln in the Bronx, New York. She explained that as people age, they tend to have sex less frequently.

"However, according to the National Poll on Healthy Aging, approximately 40 percent of individuals between the ages of 65 to 80 are sexually active," she said.

For these people, safe and satisfying sex may call for a change in approach.

What changes when you reach 65?

Hana Patel, M.B.B.S., a fellow of the Royal College of General Practitioners and a mental health coach in London, noted she often gets older patients asking for guidance on managing sex and sexual health. The most common catalysts for these questions include:

• Starting a new relationship with a partner, particularly after bereavement or divorce
• Rekindling intimacy with a long-term partner
• Dealing with physical issues such as vaginal dryness, low libido or erectile problems
• Planning ahead for dealing with long-term conditions such as arthritis

Working with older people to navigate a new sex life is also not unusual for Sarah Tilley, an integration specialist and a clinical therapist in London who specializes in psychedelic therapy, modern relationships and sexual wellness.

"Many older couples learned sex in their 20s, and often, alcohol was involved," Tilley said. "Then here they are, years down the line, looking to regenerate their sex life. This is a time to navigate new ideas and explore questions."

The questions Tilley poses are:

• Where does touch start?
• What does pleasure look like if you're not having penetrative sex?
• How do you navigate long-term conditions or sexual dysfunction?
• What does coming together look like if you are low in body confidence?

The answers to these questions often point to a different approach to sex.

"Older adults place a greater emphasis on affection, bonding and intimacy in comparison to the actual sexual act itself," Gaither explained.

Then there's the question of how to restart your sex life if you haven't been sexually active in a long time, or how to carve out privacy if you still have family members in the home. There are always ways to overcome these challenges and to enjoy a great sex life.

Dealing with medical issues can improve sex 

Physical and medical problems that affect sex are often the easiest to manage. Gaither emphasized that most issues can be dealt with by a medical provider, including:

• Hormone replacement therapy (HRT) as an option to manage low libido.
• Treating erectile dysfunction (ED) with penile pumps and rings, implants and medications such as sildenafil (brand name: Viagra) and tadalafil (Cialis).
• Another type of ED treatment that should be considered is a wearable device such as Eddie by Giddy™, an FDA-registered Class II medical device designed to treat erectile dysfunction and improve male sexual performance.
• Treating vaginal dryness/dyspareunia with topical estrogen creams, suppositories, vaginal rings and lubricants. A relatively new drug called ospemifene (Osphena) may be utilized, said Gaither, adding, "Its mechanism of action is to thicken vaginal tissue."

For problems with ailments such as chronic pain or arthritis, Patel explained that adequate relief and the timing of intimacy can help make sex more comfortable.

"Remember that it's natural to feel different as we grow older and we may feel different in our bodies as we age, but the key is to recognize and communicate these changes," Patel said.

Approaching sex differently may help too 

Sex doesn't have to involve penetration. Take the time to think about what you enjoy and ask your partner about their desires. Though it might seem embarrassing at first, open and honest communication can lead to an explorative and exciting new version of sex.

Tilley recommended thinking about what you enjoy and what sex looks like to you at this stage in your life.

"It isn't just sexual activity," Tilley explained. "It's thinking about the other person during the day, sending them little messages and reminding them they are desired."

She added that sex is a whole language—both verbal and nonverbal—so start with communication.

You may also want to try breathwork to get back in tune with your body and each other.

"The majority of people have forgotten how to breathe," Tilley noted.

Breathing techniques can reduce stress, improve mindfulness and increase blood flow, all of which lead to better arousal. Deep breathing can also positively affect mental and cardiovascular health.

Top 10 tips for sex over 65

Our experts' top tips for keeping your sex life vibrant and fun at 65 and older include:

1. Stay healthy. Eat a balanced diet, exercise regularly and maintain a healthy weight.
2. Be open and honest with your partners. Three words: communicate, communicate, communicate. Actively listen to each other and show you are listening. Reassure your partner if they're feeling anxious or uncomfortable with intimacy.
3. Don't forget to use a condom to protect yourself from sexually transmitted infections and diseases if you're in a new relationship. STIs and STDs do not discriminate against older people.
4. Carve out time for yourselves. Create a scheduled space in your calendar to be together.
5. Drop all the shame and societal stigmas you learned while growing up.
6. Speak honestly to your doctor about physical health problems you suspect are affecting your sex life because there may be simple treatment options.
7. Explore nonpenetrative sex. Learn what else you find pleasurable.
8. Don't forget the small gestures: a message here, a note there, letting your partner know you're thinking of them when you're apart.
9. Try some breathing techniques to reconnect to your body. Consider practicing breathing together.
10. Rethink how you look at sex and relearn what you want sex to be like.

Sex after age 65 is different from sex in your 20s and that's OK. According to Tilley, the key is to remember that anything is possible with effort and communication.