Dr (Col) V K Wadia is a renowned medical doctor with 35 yrs of practice. His expertise in treatment of Sex Problems, and effective result oriented counselling in Marriage & Relationship has won many accolades.

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Aging and Sex

Since time immemorial, ‘Aging and Sex’, has been a burning topic. It has acquired more significance in the present context as the average human life span has increased resulting in sizeable number of old age survivors. The advancement in medical sciences has further lent a hand in making people live not only longer, but healthier and active too. And the active lifestyle includes their sex life too. While earlier, sex in old age was considered with a derisive humor and was labeled as lecherous; the perception has widely changed now. The image of the ‘the dirty old man chasing young women’ has disappeared. Gone are the guilt feelings in the so called- oldies, about pursuing sex. And why not! We all are well aware that sex is meant not only for pleasure & propagation. It is well documented now that an active sexual life is important from health point of view too whether it is osteoporosis, memory loss, fertility, feeling of wellbeing, menopause, andropause, potbelly, heart problems and so on & so forth. But of all the reasons to have an active sex life till a person breathes his last, the most important probably is the ‘intimacy’. It is the intimacy that is at the root of ‘loving & be loved’- the two basic spoken & unspoken needs of all homosapiens, which give a meaning to life, if any.

Various studies have revealed that age does not significantly diminish the need and desire for sex; so long as the partner is available & a person’s health permits. In fact, there is a strong evidence to suggest that an active sex life contributes to the physical, mental and psychological well-being. Researches have conclusively proved that physical capacity for male erection, the female lubrication-swelling vaginal response, and orgasm both in male and female continue almost indefinitely. And that achieving orgasm is yearned, even if not always achieved. To achieve the same, the methodology or the sexual behavior may need certain modifications. It involves many aspects.  Not taking partner for granted, keep springing pleasant surprises, verbalizing sweet whispers, willingness to maintain innovate newness in sexual practices, reading or viewing erotica, fantasising, etc., go a long way. But the most important of all, is enhancement of communication which includes verbal and nonverbal, sexual and nonsexual, coital and noncoital communication. It is important to understand that a non-coital orgasm is as pleasurable as the coital. Orgasm is blind to its genesis. It has no way of knowing which way it has come thru’, or what roads have led to this. Orgasm is an orgasm and an end onto itself whatever the means. There is a pressing need to understand the importance to reach an end rather than worrying about the means. It is said that everything under the sun is normal in sex except when it is mutually not consented. The mind-set if needed, has to be changed from penetrative to participative indulgence and a good counselling is of utmost importance.

Contrary to the belief about the end of sexual life with age, many believe that; with the children settled, no career pressures, and availability of plenty of time; the partners in old age are better placed to explore and understand each other physically, mentally and sexually. Their awareness regarding the needs of each other enhances. Their intimacy increases. Thus in effect, the sexual satisfaction may increase as the age progresses. The cause of frustration in aged may be failure to find suitable partners rather than reduced libido, diminished arousal, or failure to achieve orgasm. The studies have unequivocally led to the realisation that, the urge and need for sex continues all through the life, though pattern may become different.

In males, due to decreasing Testosterone with age, the physiological response of the body changes, arousability and erection take longer, erection is less frequent and more difficult to sustain, the refractory period lengthens, the penile tumescence and firmness diminish, ejaculation is less forceful, the ejaculate turns yellow instead of white, the quantity becomes less and the liquefaction is quicker. All these changes however, may not significantly affect the joy of sex. If physically healthy, men are supposed to be virile and can participate in active sex, throughout their lives.

Another important fact which is very controversial in this age for males, is the Andropause- also called male menopause or ADAM (Androgen Deficiency in Aging Man) which is akin to female menopause. It is believed that, like female counterparts who suffer from menopause because of the reduced levels of estrogen, the males too suffer from Andropause that occurs as a result of reducing levels of androgens. Testosterone level decreases by about 50%  between the age of 25 and 75 years, as a result of decline in the Leydig cells (production site) in the testicles and by dysfunction of Pituitary control leading to Hypo-leutinaemia (LH & FSH control the release of Testosterone). But unlike menopause, the reduction of Androgens is very gradual in males and the body keeps getting acclimatized to the reducing hormonal levels. Thus, there are not many takers as yet for the Andropause theory and androgens are still not considered by many as a modality for treatment of reduced urge or erection disorder, especially in view of its likely carcinogenic effect on prostrate. Notwithstanding, the believers of Andropause feel that Andropause is a well established entity like menopause, and it is absolutely safe to give TRT (Testosterone Replacement Therapy) provided it is used judiciously under the strict supervision and a regular follow-up is there. A point to note here is that TRT is warranted only and only if there is a hypoganadism- it should not be instituted in persons with normal levels of androgen just to increase libido or erection.

In females however, menopause is an established entity though ERT (Estrogen Replacement Therapy) again may be a controversial issue. The reduced hormonal levels in the women lead to thinning of the vaginal lining, diminution of the vaginal lubrication and reduced swelling response, causing vaginal chaffing and discomfort during intercourse. Nevertheless like males, females too can enjoy their sex lives all through their life spans if their physical health permits though, the time taken for arousal to achieve orgasm increases in them too. Unlike men however, the fertility ends in women with menopause. In the past, menopause was assumed to mark an end in women's interest in sex which is not true. In fact, it is a well considered view now that women too may have an increased enjoyment of sex because of plenty of time available, less of commitments and, no worries about unwanted pregnancy.

So, the cause of frustration in old age is not the sexual health. It is the physical health which is a matter of concern. Diseases of the heart, circulatory system, liver, kidneys, endocrine system, nervous system, urogenital system; certain medications; some surgeries, drug addiction, alcoholism, smoking, depression etc are the culprits instead of the age. The unfortunate part of Sexual Dysfunction, as a result of these medical problems, is that even if the basic pathology is treated, the symptoms of dysfunction tend to become autonomous and stay till specifically addressed by Psycho-Sexologists. This happens because once people are not able to perform a few times because of the pathology, there develops a ‘fear to perform’. This leads to further anxiety called performance anxiety which in turn affects the performance again; and a vicious cycle sets in. So much so, people tend to pretend unawareness of the sexual advances made by the partner, complain of headache/tension/overwork/fatigue etc. in a bid to avoid participating in the sex.

While in the preceding, primarily the role of treatment of the basic pathology and psychosexual counselling has been discussed; it in no way undermines the role of drugs like androgens, estrogens, Sildenafil, Tadalafil, Verdanafil; nasal sprays; intracorporeal injections like Papaverine, Phentolamine etc.; vacuum devices; sex accesspries (the so called toys); surgeries like penile implantation, vascularisation, correction of venous leak etc., which may act as inescapable adjuncts.

To summarise, it is a hard reality that with advancing age; the sexuality, the sexual behavior and the pattern of sexual interaction; do undergo a perceptible change- both in males and females. Normal aging alters the physical and physiological sexual response to some measure.  But this per-se is not the real concern as it may be offset by modifying certain sexual practices & behaviors. The real culprit besides the ill health, is the apprehension over the declining performance. The fear of performance may be overwhelming and can lead to an irretrievable damage to the sexual relationship and in turn, nonsexual relationship; especially if the other partner is sexually active. An escapist attitude that the ‘one is too old for it anyway’, may further attribute to the deteriorating relationship. Elderly couples with sexual problems often benefit from sexual counselling as the ignorance, the escapism and the inhibited attitudes are amenable to good counselling.

To conclude, the Sexual Dysfunction in old age (like other age groups too) is required to be perceived in its entirety and the therapy needs to be holistic and integrated. We must consider it our sacred duty to help our senior citizens realise their dream of ‘dying young’. This would be a befitting tribute to the septuagenarians and octogenarians of the society.

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Other Articles Written By Dr Wadia

Sexual Counselling

Sexual Counselling is directed at providing the right perspective of 'sex & sexuality'. While 'sex' implies the sexual interaction, 'sexuality' encompasses a host of factors but can be summed up in simplest words as 'Sexual Personality'. Read more about Sexual Counselling to get answers to many questions that arise related to sex.

Sexual Variants & Paraphilias

It is important to understand the difference between sexual variations & Paraphilias. Sexual variations are sex acts which are variations or deviations of normal sex only and are therefore normal. Paraphilias on the other hand constitute abnormal or Pathological sexual behavior. Read about Sexual Variants & Paraphilias to learn more.

Importance of Sex

Next to survival, the most primitive & primal human instinct is sex. Inevitable or not, sex and sexuality are important for overall personality & happiness.

Humans have not been blessed with the bliss of sex for Procreation alone. It is for Pleasure, Physical & Mental health, Emotional health & most importantly Intimacy between 2 loving partners. Some people equate sexual orgasm with Spiritual orgasm too. Read further about the importance & benefits of having a healthy sex life.

Chemistry of Sex

It is naively thought that sex is natural & inborn. It is not. While the urge for sex is natural & lies between ears (mind), the act of sex is learnt & lies between thighs (body). Sex is a behavior one learns by experience & through an appropriate understanding of the Chemistry of sex. Read about the Chemistry of Sex to develop true perspective of sex & hone your sexual skills.

Sexual Myths

Sexual myths are the most rampant myths after religious myths. Let not myths thrive on quacks & quacks thrive on myths. Read this article on Counselling for Sexual Myths to learn more.

Sex Therapy

Sex therapy is the structured science of treating the sex problems with the help of both, counselling & drugs. Know what sex therapy entails & how it works. Read more on Sex Therapy to learn about the role of the mind and body in sex, the commonest sex problems in men and women and more.

Relationship Counselling

The meaning of life is a 'meaningful relationship'. The relationship can not be taken for granted but needs working up all the time. Read more on Relationship Counselling to know the mantras of a healthy relationship to develop a deep insight into the intricacies of human relationship & minimize proneness to relationship crises.

Aging and Sex

Since time immemorial, ‘Aging and Sex’, has been a burning topic. It has acquired more significance in the present context as the average human life span has increased resulting in sizeable number of old age survivors. The advancement in medical sciences has further lent a hand in making people live not only longer, but healthier and active too. And the active lifestyle includes their sex life too. Read more about Aging and Sex.

Sex and Relationship

If ever there is a meaning to life, it is a meaningful relationship. Find some mool-mantras that can help you nurture such a relationship. Read more on Sex and Relationship.

Premarital Counselling

Marriage is perhaps the most important mile-stone in a person’s life, and is many a times, referred in lighter vein as the biggest gamble. Whether man or woman, getting married often looks scary- and justifiably so because of the stakes involved. Read further about Premarital Counselling to understand the importance of the institution of marriage & prepare mentally for the marriage.

Marriage Counselling

A marriage older than a week, has reasons for divorce. A stitch in time saves NINE. This stitch is the ‘Marital Counselling’. Counselling, timely received & acted upon, helps prevent marriage conflicts/discords altogether; or handle them efficiently & successfully if they do occur. Read further on what entails in Marriage Counselling.

Adoloscent Counselling

Sudden spurt in hormones in adolescence/teenagers results in rapid physical, sexual & emotional changes. The changes are so sudden & so rapid that most teenagers are caught off guard & find it difficult to cope up with them unless specifically counseled. Read more about the importance of Adolescent Counselling.