I wasn’t surprised to read in the Annals of Internal Medicine recently that elderly men are thinking about sex . The study in question, which was conducted in Australia, found that one-third of men over 75 were sexually active, and almost half remained interested in sex. The reason I’m not surprised? It’s not that, as a primary care physician, I dutifully ask my older patients about sex (though I should).
No, it’s the men who ask me, and the reason, quite simply, is drugs. When a male patient of a certain age starts to mumble and stare at the floor, I know that a request for Viagra is imminent. Discussion of other medications also may help break the ice. Take trazodone, a sleeping pill with a rare but serious potential side effect: priapism, an erection that lasts for hours. (Many wrinkled eyes widen with interest as I start to warn them about this, though priapism is a medical emergency, and can be painful.)
With my elderly women patients, it’s different. There’s no Viagra equivalent, priapism is a non-issue, and I’ll be honest: Like many doctors, I have a bad habit of assuming that they’re not having sex. This isn’t true. According to a 2007 study in the New England Journal of Medicine, 17 percent of women between 75 and 85 reported sexual activity in the preceding year, and of them, more than half had sex at least two or three times per month. In other words, although older women do it less often than older men, they still do it. But why don’t they do it even more-why do older men want (and have) sex more frequently than older women?
Depression plays a role. Elderly women are more likely to be depressed than elderly men, and lack of interest in sex is a common symptom. Yet another problem is that doctors aren’t exactly bursting forth with remedies for the older woman. It makes sense for elderly men to discuss erectile dysfunction with their doctors; we have treatments to offer them, from the notorious blue pill to vacuum devices to penile implants. There’s no equivalent quick fix for women. For problems such as vaginal dryness, lubricants may help a little, but the best treatment, estrogen, has risks. For other problems, such as lack of interest, inability to climax, and pain, we can refer older women to specialists, but progress tends to be slow and treatment can be costly. This paucity of options is another reason we don’t bring up sex enough with elderly women. (Our failure is particularly inexcusable given that some of the medications we prescribe, including beta blockers and antidepressants, can be part of the problem.)
Finally, there’s the gender ratio: Since women live longer, more elderly women than men lack partners. The man shortage may be worst in assisted living facilities , where gender ratios are notoriously skewed, and competition for eligible men can be fierce. Also, elderly women don’t tend to poach from other age brackets the way elderly men sometimes do, and this, too, limits their sexual opportunities. Where, after all, is the 84-year-old woman’s answer to Hugh Hefner ?