Sexuality Changes throughout the Life Span
In addition to gender influencing the definitions of normal, healthy sexuality, changes across a person's lifespan also effect what is considered normal and healthy. Aging, and related physical concerns, may have an effect on sexuality. Different concerns face men and women at different ages as well. While aging may have an effect on sexuality, there are also many stereotypes and myths about older adults and sexuality.
When determining what is "normal" or "healthy" it is important to keep in mind that sexuality changes throughout the life span. One "becomes" an older adult at the age of 65. The U.S. Census Bureau (He, Sengupta, Velkoff, DeBarros, 2005) indicates that 35 million men and women (12 % of the current population) are age ages 65 and older. Additionally, of those 35 million approximately 18 million are between the age of 65-74, 13 million between the ages of 75-84, and 4 million are over 80. Despite negative stereotypes of older adults not being interested in sexuality, research has demonstrated that older adults remain quite interested in sex well beyond the age of 70. In fact, a recent national study indicated that sexual interest remains in the moderate to high range for the majority of women and men in their 70s. In terms of engaging in sexual behaviors, 54% of men and 21% of women ages 70-80 report having sex within the past year and approximately 25% reported having sexual intercourse more than once a week (Hillman, 2008). If we consider that overall the average American couple has sex once per week (Stritof & Stritof, 2004), it seems that age does not necessarily impact frequency of sex. On the other hand, partner availability seems to greatly impact the type and frequency of sexual activity particularly for older, non-married women who significantly outnumber their male counterparts (Hillman, 2000).
Certainly, several health conditions associated with the natural aging process can impact sexuality. For women, menopause represents a normal, long-term biological change that can affect sexuality in various ways. With the onset of menopause, the amount of estrogen present in the body declines and the muscles in the vagina receive less blood flow and become less elastic and begin to atrophy. Women may also experience vaginal dryness as the amount of natural secretions in the vagina decreases. This may cause intercourse to be painful. An additional physical change that accompanies menopause is the loss of reproductive ability. Women can no longer bear children. Without the fear of becoming pregnant, some women may find themselves enjoying sex even more. For other women, their entire perception of themselves may change, and they may have a hard time viewing themselves as a woman because they can no longer bear children. This may result in feeling undesirable. While men do not experience menopause, the level of testosterone in body decreases with age prompting some health professionals to use the terms "andropause." Because testosterone plays a large role in sexual desire and arousal, its natural decline during aging process is thought to impact sexual desire and arousal in both men and women.
In addition to the life-span changes discussed above, chronic and acute illness can impact sexuality both in terms of interest, and participation in sexual activity; regardless of interest or desire. The risk for chronic and acute illness increases as we age. Some examples of these illnesses include arthritis, diabetes, heart disease, and cancer. Arthritis can cause sexual activity to be uncomfortable, or even painful. Conditions such as heart disease and stroke may create fear about engaging in sexual activity. Diabetes impacts blood flow and can even cause nerve damage, which can lead to vaginal dryness in women, and erectile difficulties in men. Finally, cancer (and its treatment) can certainly impact sexual function (Forrester-Anderson, 2005). In fact, the harsh side-effects of cancer treatment can actually impact the hormone-producing organs (testes and ovaries), which in turn, affects the amount of sex hormones available in the body. Thus, physical health can change across a life-span and influences what is considered normal or healthy.
While the above discussion includes how diminished health in older adulthood can negatively impact sexuality, older adulthood may also bring increased comfort for many adults. For most adults, the aging process includes a new freedom associated with decreased parenting responsibilities. This change due to an "empty nest," coupled with the onset of retirement, can provide a long-awaited time to spend together. Retirement may provide new opportunities for shared experiences, which may in turn, enhance intimacy and improve sexual functioning. Thus, changes throughout the lifespan may affect sexuality in both positive and negative ways.
So far, we have tried to define "healthy" sexuality and identify some things that influence that definition (i.e., age, gender, illness). In the following section we will review the history of sexual science emphasizing what has led us to our present conceptualization of sexuality.