Emotional and social issues
| January 1, 2007
In-Depth Report
Emotional and social issues
The brain is the body's most important sex organ." This oft-repeated phrase bears more than a little truth. While the initial prerequisites for sexual activity are physiological — functional sex organs, adequate hormone levels, and freedom from health conditions that interfere with the body's ability to respond to erotic cues — these elements don't guarantee sexual satisfaction. A number of other factors, combined with naturally occurring physical changes, can make you more vulnerable to sexual problems.
Lack of a partner
It may seem obvious that not having a partner is an impediment to an active sex life, but it's an important issue for older people. By age 65, many people find themselves alone, through either divorce or widowhood.
According to the AARP sexuality survey, 64% of men with partners and 62% of women with partners are primarily satisfied with their sex lives. This is in sharp contrast to the small proportion of those without partners (19% of men and 28% of women) who are pleased with their sex lives.
The partner gap is a particular problem for American women because their average life span (80 years) is about five years longer than that of men. Because American women marry men who are on average three years older, that can mean even more time alone. Should a woman want to remarry, her chance of finding a new mate in her age bracket dwindles yearly; there is an average of only 7 men for every 10 women ages 65 and above.
Finally, starting a new sexual relationship after divorce or the death of a spouse can present its own dilemmas. People often fear that they will not become aroused or be able to have an orgasm with a different partner. They also may be self-conscious about baring their body in front of someone new. Because a new relationship may come along months or years after their last sexual relationship, some individuals feel anxious that they have "forgotten how to have sex" or that "the equipment doesn't work anymore." For those who have lost a much-loved spouse, feelings of guilt or disloyalty at starting a new relationship can be overwhelming.
Relationship issues
Tension and emotional distance in a relationship can be deadly to a couple's sex life. In many cases, conflict is at the root of a sexual problem. Other times, a sexual issue strains a couple's ability to get along. The following issues are often connected to sexual problems.
Anger and frustration
Accumulated anger, hurt, disappointment, and resentment can fester, destroying closeness between partners. These pent-up feelings often extinguish the flames of desire. For men, anger and frustration can interfere with arousal and getting an erection. Likewise, the breakdown of trust can be devastating to a woman's ability to reach orgasm. Both partners can suffer loss of libido in a conflict-ridden environment. This type of disappointment turns toxic when one or both partners resort to scornful criticism and defensiveness — two of the major harbingers of divorce. In addition, one member of the couple may subconsciously withhold sex as a way of expressing anger or to maintain the upper hand in a situation where he or she feels otherwise powerless.
Poor communication
Communication is essential for partners to build the trust needed for a successful sexual relationship. By talking frankly about your feelings, you and your partner can collaborate on finding solutions to issues, and it can prevent resentments from piling up. When conversation breaks down, anger and resentment are likely to build.
Dialogue is especially vital as physical changes take place. Vaginal dryness or erection difficulties can be wrongly perceived as waning interest in sex, which can trigger feelings of rejection and resentment. By articulating feelings, couples can sort out the physiological factors from the emotional and relationship issues, and address each appropriately (see "Talking to your partner").
Boredom
Once the honeymoon is over, almost every couple has to contend with some sexual boredom sooner or later. The person who was once so electrifyingly mysterious to you may become as comfortable — and as alluring — as an old shoe. Sex may not even seem worth the trouble when you're facing the same old lovemaking routines.
When sexual activity wanes, other types of physical affection often fade, too. This lack of physical connection can extend the emotional distance between you and your partner. As a result, it's all the more difficult to resume sexual intimacy later on. But it's possible to do so (see "Putting the fun back into sex"). And you may take your intimate relationship to new heights. Because inhibitions often lessen with age, sex at 50 or 60 can include a level of creativity and playfulness you wouldn't have dreamed of in your younger years.
Affairs
One frequent motivator for a person to have an affair is a quest for newness. This yearning may arise from a need to banish midlife drudgery, a desire to find out what sex is like with someone else, or an urge to recapture the heart-pounding sexual highs of youth. Other times, an individual seeks out a new partner to meet unfulfilled emotional or intellectual needs. Sometimes sexual dysfunction in the marriage contributes to affairs. For example, men who have erection difficulties or women who can't reach orgasm may seek out new lovers to prove that the sexual problem is their spouse's doing, not their own. Likewise, the partners of those with sexual difficulties may try to seek reassurance that they're still sexually appealing in the arms of someone else.
The reverberations of an affair can extend throughout a couple's relationship like ripples on a pond. Sometimes the straying partner isn't able to respond sexually to his or her spouse because of guilt over the affair, fatigue from juggling two sexual relationships, or a negative comparison of the spouse with the new lover. If the spouse discovers the affair, he or she is likely to withdraw emotionally.
An affair can be a serious, sometimes fatal, blow to a relationship. However, it's possible for a marriage not only to survive infidelity, but also to grow from this painful experience. To do this, though, both partners must face the personal and relationship issues that may have contributed to the affair. Couples therapy is a good place to turn for help in doing this. Sex therapy can also be useful if the affair has caused or resulted in part from sexual problems (see "The role of sex therapy").
The Viagra revolution
In 1998, sildenafil (Viagra) burst onto the scene. Within days, male sexuality was making headlines, and within weeks, sales of the "little blue pill" were making history. The success of Viagra spawned the development of two similar drugs: vardenafil (Levitra) and tadalafil (Cialis). Now, millions of couples have seen firsthand what these drugs can and can't do.
In many cases, these medications are the answer to a prayer for men who have been unable to have an erection. But these pills offer no help in untangling the emotional and relationship pressures that frequently accompany erectile dysfunction.
For one thing, they work only if the man is feeling sexual desire for his partner. If emotional issues are impinging on libido, the pills won't help. For example, a man may feel so embarrassed by being unable to get an erection that he is no longer willing to attempt sexual activity, and his partner may mistakenly believe that he is no longer attracted to her. When Viagra, Levitra, or Cialis enters the picture, the woman may find it hard to let go of past feelings of rejection. She may mistakenly assume that her husband's newfound erections are merely a chemical phenomenon, not an outgrowth of sexual attraction to her. In these cases, sex therapy is helpful.
When intercourse is suddenly a possibility again, relationship issues can sprout up or resurface. For example, dramatic differences in libido sometimes emerge. Also, a woman can develop problems related to vaginal dryness and atrophy (see "Vaginal pain") if she hasn't had sex in a long time. She may need to undergo a few weeks of therapy using medication or dilators before she can comfortably resume intercourse.
The bottom line is that couples should try to regard pills for erectile dysfunction as an opportunity to become erotic again, while realizing that they are neither a mandate to have intercourse nor a panacea for every problem in the bedroom.
Performance anxiety
Defined as an overwhelming concern about sexual performance that obscures pleasure and leads to sexual dysfunction, performance anxiety is a particularly insidious issue affecting aging couples. Performance anxiety becomes a problem for both men and women as they move into their 50s.
In men, it's the most common psychological contributor to erectile dysfunction. Here's how the problem often develops. The natural effects of aging dictate that a man needs more time and direct penile stimulation for an erection. Medications and cardiovascular disease may also contribute to erection difficulties. If a man continues to expect the instantaneous rock-hard erections of his 20s, he may equate this change in his physical response with the end of his virility. Once he makes this erroneous leap, the problem snowballs. After a few incidences of erection failure, embarrassment and feelings of defeat leave him unwilling to try again. He may withdraw from all forms of physical intimacy to avoid having to perform. In turn, his partner feels rejected and fears that she's no longer attractive enough to sexually excite him. She may also suspect him of having an affair.
If this happens, the woman may shy away from touching her partner sexually out of fear that another failure will occur. Paradoxically, her reticence denies the man just the type of direct stimulation that he needs to achieve an erection. The result is that an addressable physical issue becomes a morass of anger, resentment, and frustration.
Women experience performance anxiety in different ways. Performance anxiety is common in women who have experienced pain during sex (dyspareunia) in the past. They may be worried that sex will be uncomfortable again, and this anxiety can decrease lubrication. In turn, this makes sex painful, which heightens their anxiety and further interferes with lubrication. Ultimately, some women decide to avoid sex entirely.
The frank discussion of sexuality that has become commonplace in women's magazines and on daytime television can also contribute to performance anxiety. This openness has had the unintended consequence of making some women worry that they do not respond quickly or intensely enough to be considered a "good lover."
Body image and self-esteem
Gravity is not kind to your body as you age. Nor is childbirth, a fatty diet, lack of exercise, or the hormone declines that lead to muscle loss, loose skin, and thinning hair. What does this have to do with your sex life? It can have everything to do with it if you let it. Worry about having your partner see your sagging breasts or potbelly can discourage you from having sex, or you may demand that sex take place only under the covers, with the lights out, while you're wearing a T-shirt. Needless to say, these conditions don't leave much room for inspired lovemaking. Often, a preoccupation with your appearance while making love will prevent you from fully enjoying sex.
Relationship conflicts can ensue. When one partner needs constant reassurance about his or her attractiveness and becomes overly sensitive to perceived criticism, it can foster mutual resentment.
By shifting your focus away from your perceived flaws to your attributes, you can boost your self-esteem and establish your own standards for attractiveness. Think back on what it was that made you attractive in your younger years. Was it your soulful brown eyes, your crooked smile, or maybe your infectious laugh? Chances are, those qualities are still as appealing as ever.
Also, try directing your attention to the experience of giving and receiving pleasure during sex. This can help you find the confidence to give yourself over to the experience. Great sex is often the outgrowth of a deep emotional connection — something that's not guaranteed by having a perfect body.
A negative self-image isn't always rooted in your appearance. Career setbacks or other disappointments can lead to feelings of failure and depression, both of which sap desire. For men, episodes of impotence can undercut confidence in their manhood. No matter what its cause, a poor self-image can take a toll on your sex life. When performance anxiety develops as a result, it can spark a downward spiral of repeated sexual failure and diminishing self-esteem. Correcting this problem demands serious attention to its origin.
Expectations and past experiences
Your sexuality is a natural drive that's with you from birth, but your family, your culture, and your religious background shape your attitudes toward sex. As you become an adult, your own experiences further influence your sexuality. The result for many is a healthy enjoyment of sex, but others may have more mixed feelings.
For example, women — particularly those who came of age before the so-called sexual revolution in the '60s — may cling to the notion that it is improper for "nice girls" to initiate and enjoy sex too enthusiastically. This belief can be damaging for both partners. The woman may feel uncomfortable seeking pleasure, and her partner may interpret this lack of enthusiasm as a reflection of her feelings about him.
Inexperience and embarrassment over discussing sexual matters may hamper people from fully expressing themselves sexually. For example, intercourse alone does not give many women the kind of stimulation they need for fulfilling sex, and uneasiness about discussing the problem prevents some couples from developing techniques that could offer greater pleasure. Compounding the problem, childhood taboos against masturbation may prevent a woman from discovering the means to her sexual pleasure, so she's unable to direct her partner in this regard. A woman may find it easier to forgo her own pleasure than to confront these matters. She may ultimately resort to faking orgasms rather than risk asking for a different approach to lovemaking. When this pattern exists for years, revealing the truth would mean admitting to a longstanding deception, which could shake the relationship.
Alternately, a man may feel his self-worth depends on his ability to please his partner. His focus during sex, therefore, is on performing rather than succumbing to pleasure. If his partner doesn't immediately respond to his efforts, feelings of inadequacy can pervade the relationship, eroding the couple's bond and leading to performance anxiety.
During the early years of a couple's relationship, such missed connections are often masked by priorities outside the bedroom, such as building a marriage, raising a family, and launching a career. However, midlife may be a turning point. Upon reaching menopause, the long-unsatisfied woman might greet the physical changes in her body as a sign that her sexual "duties" are fulfilled. If her husband is still interested in sex, a conflict is likely to erupt.
A much more hopeful scenario is also possible. Midlife and later may be a time when a woman's sexuality blossoms. Women often gain confidence as they mature, and they may be more willing to ask for what they want sexually. Menopause means that women no longer have to worry about pregnancy (or birth control). Often, children are grown and family responsibilities have eased, allowing a couple to engage in more relaxed and spontaneous lovemaking. In addition, the changes a man is experiencing during these years, such as slower erections and longer time before ejaculation, lend themselves to the kind of pleasurable play that a woman may have been missing out on before. For a couple wishing to embark on the more positive course, the key is to begin to unravel negative patterns. To do this, you must open up a dialogue.
Stress and lifestyle issues
Stress and fatigue are major libido sappers. During midlife, stress can hit from any direction. Challenging teenagers, financial worries, aging parents, concern about your health or that of a loved one, and career woes are common. With so many demands on your time and attention, you and your partner may neglect to nurture your relationship, which can cause your sexual connection to fray.
Sheer lack of time is often a major factor. The physical changes in sexual response that occur in both men and women as they age mean that it will take you and your partner more time to become aroused and reach orgasm than it did in your younger years. You may find it hard to squeeze an extended lovemaking session into an already packed day. If a couple typically waits until bedtime to have sex, exhaustion also can become an obstacle.
Stress has a particularly deleterious effect on libido, especially in women. Whereas men can sometimes use sex to relax, women more often need to be relaxed in order to enjoy sex. This mismatch can create conflict for a couple.
Sexual issues brought on solely by stress and fatigue often can be remedied simply by taking a short vacation. If you and your partner are able to resume pleasurable lovemaking in a pressure-free environment, you'll be reassured that the underpinnings of your sexual relationship are sound.
Midlife and after is also a time when profound lifestyle changes take place. Events such as retirement and children leaving home can upset decades-long patterns in a couple's life. Many couples go through a period of adjustment when they retire. For example, if one person is used to being in the house alone much of the time, his or her feeling of control over the domain can be threatened by the partner's constant presence.
One bonus is that retirement or changes in working habits may allow you and your partner the opportunity to engage in leisurely lovemaking — something you may have lacked for many years. One danger, however, is that couples who begin spending a lot of time together may stop making an effort to include romance in their relationship.
Chronic illness is a major cause of sexual difficulties. People who are ill may find that a condition or its treatment causes sexual difficulties, while healthy partners may worry that sexual activity will make their loved one's condition worse. The fatigue and stress of the caretaker role may also dampen desire. In addition, sexual interest may wane for both partners if their caretaker-patient relationship begins to feel too much like that of a parent and child. During this time, many people also experience the loss of someone close. Grieving may make it difficult to enjoy anything pleasurable, including sex.
Review Date: 2007-01-01
Harvard Medical School does not endorse products or services.
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