How many times have you shuddered the moment someone mentions your parents or your grandparents having sex?

As a doctor specializing in sexual health, I’ve seen that inevitable gasp time and time again.  The mere mention of our parents, or worse, our grandparents, “rolling around in the hay” leads to grimaces followed by an expression of “really!?” “yuck” or “gross”. This reaction is natural in our often times sex-phobic, even puritanical culture, but these attitudes set too many people up for failure. A fear of aging and an inability to associate sex with aging undermines the many health benefits gained simply by continuing sexual activity through our 70s and beyond. These health benefits are often overlooked by healthcare practitioners as well. A recent NYT Magazine article, “The Joys (and Challenges) of Sex After 70” attempts to normalize sex in older adults.

Here are 5 important points we wanted to highlight for you:

1. People frequently have sex up until the end of their life.
2. Everything about sex after 70 usually takes longer, is slower, but generally still works.
3. Sex is so much more than penetration. Too often we are taught that sex is only penis-in-vagina (PIV), but that’s incredibly limited. If PIV is your definition of sex, that may need to change as you age.
4.  Communication is one of the most critical components when it comes to good sex, especially since pleasure and desire change as we age.
5. There are effective medications and non-medical treatments for sexual problems related to aging, regardless of your sex or gender.

As men age there are plenty of medications approved to increase their sexual health—we’re sure you’ve heard of Viagra or Cialis? And there are many other brands designed to do the same thing, plus no fewer than 25 different testosterone formulations for men.

For women, on the other hand, there are just two FDA-approved options: Addyi (Flibanserin), and Vyleesi (Bremelanotide). And while they both work for women well beyond menopause, as of right now,  neither of the two have been approved by the FDA for postmenopausal women, simply because FDA requirements have not been satisfied. And while pharmacologic treatments are not for everyone, both Addyi and Vyleesi should work for women of any age. Data on Addyi’s benefits in menopausal women was published almost 8 years ago, and is approved by Health Canada for use in women up to age 60. Many of our patients at IntimMedicine Specialists find it to be beneficial regardless of their age.

It is extremely frustrating that there are currently no testosterone products approved for women’s sexual health in the US. This past year, off label use of male testosterone products and compounded testosterone treatments for women had become so prevalent that the International Society for the Study of Women’s Sexual Health (ISSWSH) developed a manifesto for healthcare practitioners.  This “how to” is a classic citation of safe and effective use of “male” testosterone products in women.

As emphasized in the NYT Magazine article,  people often face many physical challenges in the bedroom as we age. It is normal for bodies to change, and for the ways we access pleasure to shift. For example:

• Vaginal dryness is a normal shift in the body.
• Erections are often not as naturally hard, as reliable,  or as long-lasting.
• Physical movements and positions may become more limited, but that doesn’t mean that adaptive positions can’t be just as pleasurable.

While pharmacologic options can be really helpful, they aren’t for everyone, and there are other resources that can help normalize and troubleshoot sexuality through the aging process. You should check out the following:

• A study of sexuality and health among older adults in the US
• What we don’t talk about when we don’t talk about sex
• Sex For Grownups: Dr. Doree Reveals the Truth, Lies, and Must-Tries for Great Sex After 50

Next time you shudder at the mention of your parents or grandparents still enjoying sex, consider the age you want to stop having sex – our guess is that you don’t ever want that. So, if you (or that parent or grandparent) need a little help, let us help identify the problem and offer some solutions for your body (or theirs). We can help, just reach out.