Staying well means taking care of your sexual health, too

Most of us agree that healthy sexuality is an important part of adult wellness. But sex is often difficult to discuss — whether with our intimate partners or our health care providers.

When we do have the courage to have sex-positive conversations about our wellness, we reaffirm for ourselves and others that respectfully discussing adult sexuality and sexual health are appropriate, acceptable and responsible.

A few years ago, a 64-year-old grandmother came to see me for a checkup. After she finished relating her medical issues to me, I innocently asked her the perfunctory question, “Is there anything else you want to tell me?” Following a long pause, she suddenly blurted out, “How did you know?” And then, sheepishly, she began to talk about her sexuality.

There is a common misconception that mature adults are asexual, but adults in long-term, stable relationships usually become more intimate, resulting in greater sexual gratification.

A large European study from the World Journal of Urology published in 2006 questioned 10,000 men and women between the ages of 40 and 80 about their sexual practice. Some 83 percent of men and 66 percent of women reported sexual intercourse during the year preceding the interview.

However, 23 percent of men and 32 percent of women reported some type of sexual dysfunction, yet only 26 percent said they discussed this with a physician. So although sexual activity is maintained in most middle-aged and older adults, many adults experience some type of sexual dysfunction but do not seek medical help.

There are normal sexual health changes in men and women that occur with aging. Sexual desire, or libido, decreases in both men and women, more so in women. Estrogen levels drop after menopause, resulting in less sex drive and less vaginal lubrication. The latter can be helped by using water-based lubricants or by prescription forms of vaginal estrogen.

In men, testosterone levels decrease. This can result in a longer time to achieve an erection, having a less-firm erection or taking longer to ejaculate. Erectile dysfunction is not inevitable, however. When ED happens occasionally, it’s not necessarily a problem. If it happens a lot, then it’s wise to seek medical evaluation. If appropriate, drugs such as Viagra, Cialis or Levitra can be prescribed.

Often overlooked, there are numerous medications and other substances that can impair sexual performance. For example, too much alcohol in men can cause impotence, and too much alcohol in women can delay orgasm. Medications that can cause sexual problems include most blood pressure medicines, antihistamines, antidepressants, tranquilizers and others.

There are several medical conditions that can result in decreased sexual performance. I have uncovered cases of diabetes and underlying heart disease in patients whose only symptom was poor sexual performance. Although some types of surgery can cause sexuality problems, such as mastectomy or prostatectomy (removal of some or the entire prostate), I have been surprised to see that women who have had a hysterectomy usually seem to enjoy a better sex life.

One is never too old to worry about safe sex. Some sexually active older adults are oblivious to the fact that they are at risk for sexually transmitted diseases from unprotected sex, just as they were earlier in life. And seniors must be aware that the use of a condom will not guarantee protection from getting genital herpes, because skin-to-skin contact alone can result in herpes transmission.

If there is a problem with sexual intimacy or performance, don’t be afraid to discuss your situation with your doctor.  Sex is an important part of most adults’ well-being, regardless of age. â–

Jerry Saliman, M.D. is a contributing medical writer for the Peninsula Jewish Community Center ( in Foster City. He retired from Kaiser South San Francisco after a 30-year career and is now a volunteer internist at Samaritan House Medical Clinic in San Mateo.

Dr. Jerry Saliman

Jerry Saliman, MD, retired from Kaiser South San Francisco after a 30-year career and is now a volunteer internist at Samaritan House Medical Clinic in San Mateo.