SEXUALITY IN OLD AGE

“Ageing is not a mere physiological process: it is a form of art and only by cultivating it we will make a powerful and memorable “aesthetic structure” out of our old age. What happens in our body is imprisoned in the idea that the mind has of the body itself”. (J Hillman) 

Changes and transformations are typical of life itself, both on a physical and emotional level. In his book “Vital Involvement in Old Age” Erik Erikson (psychologist and psychoanalyst) explains that the cycle of life goes through eight phases of social development. Therefore, also the elderly live a normal process of growth, not of decline. A stadium which requires making healthy power prevail over and resist against pathogen spurs. Many men believe that the loss of sexual energy is a natural consequence of the passing of time. Instead, far more often, the problem is caused by heart complications, diabetes, insulin resistance and scarce metabolic health deriving from wrong lifestyles in youth and adulthood, whose effects affect  old age.

In man the androgenic organs depending on hormonal production gradually lose their functionality in time, but the decrease is so slow that it does not exclude sexual activity. The natural decrease in testosterone rate relatively influences the male vigour; however, degenerative pathologies caused by a wrong diet and the use of medicine in control of such pathologies, together with psychological problems or changes in the central nervous system, have a fundamental influence.

Testosterone decreases with age and this may lead to a loss of muscle mass, increase in abdominal fat, cardiovascular problems, depression, erection difficulties. In patients presenting these symptomatologies and with testosterone levels below average, the use of testosterone – for example  a gel to be applied on cutaneous level – can improve their quality of life. Drugs such as Viagra control the problem by increasing nitric oxide, an important factor released in blood which increases the blood afflux.

Studies carried out by a university in Chicago on middle-aged and elderly men have found that health is the most important factor in sexual activity and for the quality of sexual life. Middle-aged men in good or excellent health had better sexual performances in a percentage of 100%, and the healthy elderly had a percentage of 400% compared to unhealthy ones. Therefore, “stay healthy and in good shape and you will continue to have good sex over the age of 85”. (British Medical Journal, 2010; 340:c810,2010 published on line).

In menopausal women estrogens disappear and the androgens decrease up to 50%, causing a series of body and mental changes as well as sexual ones. A number between 40 and 60% of menopausal women is affected by changes in the sexual function: drop in desire, lack of orgasm, general dissatisfaction. In particular, two disorders restrain sexuality: vaginal dryness and pain during intercourse.

Desire depends on the right balance between estrogens and progesterone and androgens. The lack of  estrogens modifies the secondary sexual characteristics and therefore the biological perception of femininity. Also the lack of androgens leads to a drop in sexual desire with persistent asthenia.

In order to improve sexuality there are some pharmacological treatments, even if psychosexual and relational possibilities must also be kept in mind. The hormone replacement therapy can treat many problems connected to menopause (burst of heat, sweating, insomnia) and it can prevent risks such as osteoporosis.

The drug which is most widely chosen by women with significant drop in libido is Tibolone, a molecule which – besides its estrogenic and progestin action and thanks to its mild androgenic effect – increases the sexual desire on cerebral level, rising the “good mood” molecules (opioid peptides) and improving vasocongestion.

The use of drugs to increase sexual activity has boosted so much that it may lead us to think we have removed a limit to old age. In an interview dating back to 2006 Alberto Spagnoli (psychiatrist specialised in old age therapy) states that, more accurately, drugs have removed a limit to our vision of the issue. The elderly have an important erotic activity that we adults, being their children, collectively tend to repress. Our society lacks new ideas, a fresher outlook, a context where the elderly can have a future”.

Erikson states that at no age it is normal or acceptable to give up the contact with the other sex, at no age it is logical to give up emotions, or eroticism.

The extension and improvement of the quality of life in economically developed countries has led to a greater attention to sexuality. The health of the individual is today considered in a more global way than some time ago and healthy sexuality is regarded as an important element in the life of an individual throughout all the phases of existence. The health of an individual is not only considered in terms of laboratory analyses but it also depends on the perception of well being and satisfaction of one’s life in a more general way.