The media rarely portrays sexual activity between anyone who is not young, healthy, and beautiful and it may be hard for a young doctor to even imagine his or her octogenarian patients having a sex life. However, sexual activity may continue into old age in many couples. As divorce becomes commoner and marriage less of a precursor for sexual activity, there are increasing numbers of people in later years of life who are not with their life-long partners. Most studies show a steady decline in the frequency of sexual activity in both sexes with age. One survey showed that the reported frequency of heterosexual sex rose to a peak between the ages of 20 – 29 for women and 25 – 34 for men with a median rate of five times per month for each sex. Between the ages of 55 – 59 the median frequency was two for men with more than 50% of women in this age group reporting no sex in the last month. Over the age of 50, women are more likely than men not to have a partner.
Reduction in sexual activity with age may not be a problem if it is due to lack of desire and is mutual between a couple. It may be caused by physical problems affecting one member of a partnership. Patients often want to know what is normal and whether they should or should not be having sex at their age. The answer is that there is a whole range of “normal activity” and it is what is right for them that is important.
Before treating one member of a partnership, find out the views of the other, especially when suggesting the physical and pharmacological treatments for physical erectile dysfunction that are now available. There is no point in enabling an elderly man to have an erection with a vacuum pump if his wife has severe atrophic vaginitis and osteoarthritis of the hip. There is no value in prescribing sildenafil if the female partner has no desire. Some women may have strong antipathy to what they might see as an artificially produced erection and for some men this is not the answer. On the other hand, some women may be delighted to become involved and will actually administer intracavernosal injections if their husbands have lost their dexterity. Even if both partners are not seen, their views must be discussed.
If there has been ill-health such as a heart attack or stroke, both members of the partnership may be frightened to initiate sex. The usual advice with heart disease is that intercourse should be safe if the patient can climb two flights of stairs without angina. If chest pain does occur during sexual activity then they should be advised to stop. The doctor is not always in a position to fix the problem and needs to acknowledge with the patient that a full sexual life is no longer possible.