Verified by 
Key points
- A study published in the NEJM shows that 28 percent of people between ages 75 and 85 are still sexually active.
- Pain during intercourse and vaginal dryness are preventable if addressed early and treatable if addressed late.
- Knowing your body's normal physiology and being aware of the timing of hormonal secretions are keys for a happy, long, romantic relationship.
As we move from middle age into old age, we tend to have sex less often, if at all. But that doesn't have to be true for you.
A study conducted by Stacey Lindau, M.D., and colleagues, published in the New England Journal of Medicine, shows that out of 3,005 US participants (men and women), 73 percent were still sexually active between 57 and 64 years of age, but only 53 percent were still sexually active among those 65 to 74 years of age, with the rate falling to only 26 percent among those 75 to 85 years old.
Women were significantly less likely than men at all ages to report being sexually active, but few talked about this to their therapist or their physician.
Yet sexual intimacy with a partner could be important for a satisfying emotional relationship and a satisfying emotional relationship could be important for happiness, as well as good health. So, how can we keep having a satisfying sexual intimacy with our partner as we get older?
Try these four tips for great sex after 50:
1: Know the female physiology of aging and act as soon as you can.
When women go through menopause, their body starts secreting less estrogen, which can trigger hot flashes. Those hot flashes tend to decrease as years go by. What doesn’t decrease is vaginal dryness.
In fact, as years go by, vaginal dryness will tend to increase slowly, year after year. Itchiness might start, as well as decreased tissue elasticity. And then intercourse might ultimately become painful.
Women will usually not consult their physician and will just stop having sex altogether, which could make their partner unhappy and sexually frustrated, straining the relationship.
Women will consult their physician when, in addition to vaginal dryness, they start having urinary symptoms, like urinary incontinence, which starts while coughing, sneezing, or during physical exercise. Both urinary and vaginal symptoms might get worse year after year, but both are preventable.
How can painful sex after menopause, vaginal dryness, and stress urinary incontinence be prevented without incurring other health risks?
Studies by Ginger Constantine and colleagues, published in the journal Menopause in 2019, show that low-dose vaginal estrogens can be used without increasing the risk of cancer.
Physicians usually prescribe 1 gram of estradiol vaginal cream (or the equivalent in the form of vaginal inserts, capsules, or tablets) to be used with an applicator one to three times a week.
But one gram of cream is a lot.
In fact, vaginal dryness and stress urinary incontinence can be prevented by using a very small, lentil bean-sized dose of vaginal estrogen cream at night one to three times a week, applied with a finger at the entrance of the vagina.
Usually, after a few months of using the vaginal cream, urinary incontinence will improve, sex will often stop being painful and will become pleasurable again, and the romantic relationship will blossom.
If vaginal secretions increase too much during the day, I recommend using the vaginal cream only once a week, once every two weeks, or even once a month. Alternatively, use a pea-sized dose (instead of lentil-size) of vaginal estrogen cream two to three times a week. If vaginal estrogens are contra-indicated, use an over-the-counter vaginal moisturizer containing hyaluronic acid.
In addition, make sure you use an over-the-counter vaginal lubricant as needed during intercourse.
2: Use men’s biological clocks.
Because men have their biological testosterone secretion peak in the early hours of the day, sex in the morning after a good night's sleep and a light breakfast are the best bet for successful intercourse as men get older.
3: Know about diseases and medications.
Know that certain antidepressants will decrease libido. Certain heart and blood pressure medications will affect men’s potency. Talk to your doctor if you suffer from depression, heart disease, or high blood pressure, and try staying away from the medications that affect libido.
Ask your doctor about medications that will be equally effective for your condition without affecting your sex life.
Also know that diabetes, heart disease, low testosterone levels, and low thyroid hormone levels can affect your sex life. Make sure you have your blood tested to detect abnormalities that can be easily remedied by the appropriate diet and/or medications.
4: Use your imagination.
For sex to be even more enjoyable, physician Mary Jane Minkin, a clinical professor of obstetrics, gynecology, and reproductive sciences at Yale Medical School, recommends using your imagination and fantasize during sex. Minkin also strongly recommends using vaginal estrogens.
Conclusion
Sexual pleasure during intercourse can continue long after menopause. Yes, pain during intercourse, vaginal dryness, and urinary incontinence after age 50 can happen, but those are treatable even if addressed late, and preventable if addressed early.
Don’t hesitate to talk to your doctor about those issues. They are worth addressing to keep a romantic pleasurable relationship with your partner as years go by, one of the secrets for a long, happy, and healthy life.
Disclaimer: This post does not create a physician-patient relationship between the reader and Dr. Gilbert. What is written in this post does not apply to everybody. You should consult your physician before relying on or using any of the content of this post.
References
