US Edition
As we get older, any number of things – from illness to medication, body confidence, relationship worries and family dynamics – can impact our sex lives. Here, doctors and therapists explain the ups and downs you might encounter in every decade. This guide covers:
- Can you have great sex at any age?
- What happens to your sex life as you age?
- Sex in your 40s
- Sex in your 50s
- Sex in your 60s
- Sex in your 70s
- Sex in your 80s
Can you have great sex at any age?
“Yes, but we have to define what great sex actually means,” says Ammanda Major, a sex therapist and the head of clinical practice at Relate. “If you look at movies or social media, it’s generally people having multiple orgasms. But for many people, simply being together intimately can be rewarding.”
Sex can mean different things to different people, and it changes as we go through life. “We have to recognise how our bodies change over time and how the ageing process impacts us sexually. There’s something to be said for accepting that and working with what’s possible, rather than comparing yourself with everybody else.”
What happens to your sex life as you age?
Things may change as we get older, but that’s not necessarily bad news, says Cynthia Graham, a senior scientist at the Kinsey Institute, the editor-in-chief of the Journal of Sex Research and a co-author of the Healthy Sexual Ageing project, which analysed successful sex in people aged over 60 across Europe.
“There’s a negative stereotype that it all goes downhill – and it’s true that frequency tends to drop, but that’s not necessarily linked to lower sexual satisfaction,” she says. “A lot of changes with ageing and sexuality are gradual, so people are able to adapt. It’s not all doom and gloom.”
Sex in your 40s
Significant changes to our sex lives can begin now, as men and women experience hormonal shifts that alter desire and arousal. It is “a hell of a decade”, says Dr Angela Wright, a GP, clinical sexologist and the co-founder of Spiced Pear Health.
In women, perimenopause can cause fluctuating hormones. “You won’t feel arousal in the same way because the amount of blood flow that goes to the area when you’re excited isn’t the same. You don’t lubricate as well, so sex can become less pleasurable and even painful. You can get UTIs more easily because your pH levels become less acidic and you’re less able to fight off infection,” she says. “You may also still be on hormonal contraception – the combined pill can drop the libido because it mops up the testosterone that’s circulating around your system.”
One option to replace hormones is HRT, but Wright acknowledges that some women can’t have or don’t want it. “But many can use vaginal HRT, or oestrogen creams and pessaries that work solely on the genitals, which can make a big difference to comfort and pleasure,” she says.
Men may see the beginnings of erectile dysfunction and lower libido, with 40 per cent of those over 45 experiencing low testosterone levels – or hypogonadism – according to research published in the journal Frontiers in Endocrinology.
Dr David Goldmeier, the clinical lead for the internationally renowned Jane Wadsworth sexual function clinic at Imperial College London, says this is commonly linked to the health issues that take their toll on our bodies in midlife: “high cholesterol, high blood pressure, being overweight and having diabetes”.
Stopping smoking, exercising more and eating healthily may help as a first port of call, then you could ask your GP to prescribe a PDE5 inhibitor, such as Viagra or Cialis, which can be taken daily at a low dose. This will “reverse some of the changes that are happening in the blood vessels. That and testosterone replacement can make a really big difference to sexual function and desire,” says Wright.
But if you see any change in erectile function, go to the GP. Goldmeier says it’s “a window into the cardiovascular system”, as both rely on healthy blood vessels and could be an indicator of an underlying condition, such as atherosclerosis or a narrowing of the blood vessels that might mean you’re at risk of heart disease.
Stress can also have a huge impact on your sex life, says Major, especially given the common demands of work, children and caring responsibilities in this decade. “When we’re anxious, it can understandably be difficult to relax and get into that space where you feel that you can initiate or receive intimacy,” she says. This can create a cycle of rejection where either you or your partner feels continually unwanted.
Aoife Drury, a psychosexual and relationship therapist, advises taking a mental “temperature reading”. “Have a scale in your head of zero to 10 – 10 being ‘I’m definitely up for it’ and zero being ‘not at all’. Think to yourself, ‘I’m at a four and maybe there’s an opportunity to get to a five.’ But perhaps decide that below a four is just an impasse. Knowing where you sit is really helpful.”
Sex in your 50s
The average age for a woman in the UK to go through the menopause, when they have not menstruated for a year, is 51. Historically, the narrative has been that women are “dried up” from this point, but the experts disagree. Indeed, a US study from 2019 concluded that “sexual health and function are essential components in the care of menopausal women” and can improve quality of life.
One of the main biological issues is the big drop in the production of oestrogen by the ovaries, which diminishes the blood supply that reaches the vagina, reducing sensitivity, lubrication and desire, and potentially causing weight gain that can make women feel alienated from their own bodies.
“The impact of the menopause can have a real hit on a woman’s body,” says Drury. “Sex can go down the pecking order because we might not be feeling ourselves.”
“You’re ageing and that can impact your sexual confidence,” says Wright. “Your body shape can change, your skin becomes less firm, you can get hot flushes, you’re not sleeping, which makes you feel rubbish. It can be hard to muster the energy for it.”
Women might start experiencing bladder leaks, Wright adds, with pelvic floor issues becoming more common along with changes to the skin on the outside of the genitals. She recommends seeing a GP, who can prescribe local oestrogen or steroid creams. Pelvic-floor therapy can be helpful: exercises designed to strengthen the muscles around the bladder, bottom, vagina or penis, which are as helpful for healthy sexual function in men as they are in women. Vaginal moisturisers can help make sex more comfortable and boost blood flow. Not every woman experiences menopause negatively, however. For some, says Drury, it means the end of painful periods and can feel liberating.
Wright says that it can be helpful to talk about “good enough” sex, with couples reminding themselves that intimacy doesn’t have to mean full intercourse. “Deliberately making time to nurture that aspect of your relationship is really important,” she says.
Life changes such as children becoming more independent or the loss of your parents can act as a catalyst for recalibrating your sex life as a couple, she adds. “It can be a chance to pay attention to one another, but it can also shine a light on what you’ve not been doing. Take stock of the relationship and work out what you miss and how you can reestablish that. Life is limited and you’ve got to crack on.”
Sex in your 60s
The 60s can be a turning point in the wake of empty nests, bereavement and retirement. Office for National Statistics data shows that divorce rates in the over-60s doubled between 1993 and 2019, with many people finding themselves single again.
The good news, says Graham, is that “sex and intimacy are still really important and the quality doesn’t have to be impacted negatively”.
“Going into a new relationship has benefits because you have lots of novelty, so arousal and libido are often higher and better. But it can be more difficult to work around problems,” says Wright. “If men haven’t had sex for a long time, due to divorce or losing their wife to illness, they can find that their sexual function is altered and it’s harder to get and maintain an erection.”
This could also be related to health issues, such as diabetes or an enlarged prostate, as well as medication (antidepressants are known to lower libido in both men and women), so it’s worth going through what you’re taking and making changes if needed.
The 60s are also when men might start to experience a longer “refractory period” – the time between having an orgasm and being able to become aroused again. “With older men it can last hours, even days,” says Wright. “It might be time to adapt your sexual activities and focus more on caressing, so it’s not so centred on having an erection.”
The third National Survey of Sexual Attitudes and Lifestyles in Britain found that embarrassment is a potential barrier to seeking medical help for sexual problems as we age. But, Wright says: “it’s key not to feel embarrassed and avoid the issue – it’s a natural age-related decrease in sensitivity that can happen for both men and women.”
Medications like Viagra can make a difference, she adds, as can losing weight, which improves your general health and self-esteem, as well as lessening the chances of conditions that can increase the risk of erectile dysfunction, such as diabetes and high cholesterol. In one study, Canadian researchers found that 30 per cent of men experiencing erectile dysfunction who then lost weight regained their normal sexual function. “As you get older, sex changes, and the people who do well at maintaining their sex lives are the ones that adapt and stay healthy,” adds Wright.
If you’re making a fresh start when it comes to dating and relationships, it’s worth bearing in mind that STIs are on the rise in people over 65. Data from UKHSA found the number of STIs recorded in this age group increased by 20 per cent between 2017 and 2019, with the biggest rises in gonorrhoea and chlamydia.
“Newly single people are getting out there and being more adventurous,” says Major. “The sexual experience, far from going off the boil, can be reignited as you go through life. But the sexual landscape has changed fundamentally, so it’s about knowing how to set boundaries and keep yourself safe.”
The experts recommend asking about any other sexual bedfellows a new partner may have, for any relevant history and, for ultimate peace of mind, that both parties are tested for possible infections before embarking on a sexual relationship. Visit your GP with any concerns, such as lumps, bleeding or unusual discharge. And use a condom. “Postmenopausal vulvas and vaginas are more fragile, so skin breaks and that can more easily lead to transmission or infection,” says Wright.
As for couples, retirement can have a major impact on sex, says Major. “It’s often a time that people have to face problems they’ve managed to avoid talking about because they were too busy with work. But retirement can be a rich opportunity to recalibrate the relationship sexually.”
She recommends making the space to talk and ensure you both feel listened to, using a third party if needed. “Life tends to take over and we make a lot of assumptions along the way that everything is OK. Now it’s about reaching a place where you both want the same thing.”
Sex in your 70s
Your 70s, say the experts, are a decade for broadening the definition of intimacy. A study into the sex lives of people aged 50 to 90, published by Cambridge University Press, concluded that “being able to adapt to a more sensory sexuality, with less focus on penetrative sex, can make an important contribution to continued sexual activities into later life”.
Any number of health worries might impact your ability to engage in full intercourse – cardiovascular issues, major surgery such as a mastectomy, or prostate treatment that blocks testosterone production. You may have pain along scars or simply feel tired from having been manhandled and examined.
“What is important now are things like cuddling, kissing, touching each other, oral but not necessarily penetrative sex,” says Graham, “although some people of this age say they’re having the best sex of their lives.”
Body shame can be an issue, says Major, who regularly hears from women in her clinic who are reluctant to fully undress in the bedroom.
“It’s about coming to love your body because of the experiences it’s already been able to give you and the experiences it can still offer you,” she says. “Yes, there might be a droopy bit there, but you’re still you. Men struggle too – the waning erection and saggy bits. It’s about thinking ‘My body isn’t how it was when I was in my 20s, but it’s still OK and still valuable’.”
Patricia*, 74, recently met a new partner after being widowed. “Breast cancer had made me terrified at the prospect of showing my body, and osteoarthritis in my knee and hip had impeded my flexibility – but then men have those insecurities and doubts too,” she says. “My partner went to the GP for Viagra and I went to a gynaecologist for Idracare, a vaginal moisturiser. Sex in your 70s takes preparation, but it’s worth it for the joy of sharing my bed and my body with a gentle man of the same age. I’d missed the fun, mutual delight and the exercise.”
Devices can help where joints, arthritis or mobility issues present obstacles – pillows or inflatable and foam wedges to maintain sexual positions, or the Ohnut to control the depth of penetration. Where men are struggling with erectile dysfunction and PDE5 medications haven’t helped, Goldmeier suggests speaking to a GP about injectables, vacuum pumps and high-tech implants.
Communication is vital, says Wright, particularly if a couple sleeps in separate beds. “Set some clear expectations – that it’s OK to have a cuddle but it doesn’t necessarily mean that it’s a green light for anything more. It’s about redefining what intimacy looks like within your relationship, regardless of the adaptations you’ve had to make around your changing bodies.”
Sex in your 80s
A study published in 2017 reported that at least one in four men and one in 10 women aged over 85 said that they were still sexually active. What’s more, it suggested that people over 80 experienced more emotional closeness during sex than younger age groups.
Wright says we need to de-stigmatise sex in this age group. “There’s a feeling of sex being for young, beautiful bodies, whereas actually this is the Woodstock generation. They were sexually free, so for many of them it’s still a very important part of their identity,” she says. Indeed, research by Linda J Waite of the University of Chicago in 2010 concluded that people who were young in the 1960s are likely to have more liberal attitudes to sex.
“Sexuality and sensuality are still important,” agrees Wright. “We make assumptions about intimacy not being important in settings like nursing homes, but it often still is. That’s still a valid and important need, regardless of age.” A 2017 Dutch study of dementia-free people living in retirement communities found that more than half of those with partners engaged in sexual activity and two thirds in physical touch. The greatest barrier to being sexually active at that age was the lack of a partner.
“I think this is a really good time to get into toys like vibrators or rings,” says Drury, pointing out that these can work between couples where mobility is limited but also solo, given that people may have lost partners and be on their own.
“It might be something that you haven’t engaged with before and could feel a bit alien. But they can be stimulating tools to maintain that sexual arousal and bring a bit of novelty to something that might have become a bit stale over time. It’s about practicality and what hits the spot. You might just have to think outside the box.”
*Name has been changed