For women, aging complicates the already delicate chemistry of desire. Researchers study the role of hormones, drugs and romance.
By SUSAN ASCHOFF
Published June 29, 2004
[The Arts Center]
Wilson Hasty, Ghost of Geisha, acrylic on canvas, 2004
At the heart of good sex
For women, aging complicates the already delicate chemistry of desire. Researchers study the role of hormones, drugs and romance.
There's no age limit on safe sex or good sex
Seniors having sex - it's not a punch line to a joke. Yet one of the popular misconceptions about seniors is that after a certain age, sex is of little interest to them.
Free information about menopause
Menopause is a natural step in a women's life. As you age, your body produces fewer hormones so that eventually, your periods stop. For a lucky few this change is the only symptom they experience. Some women will suffer from hot flashes, night sweats and a loss of bone mass as a result of lower hormone levels.
A woman who wants a rollicking sex life as she ages needs not only an enthusiastic partner but patience with her own performance.
Physical changes in her body and emotional ones in her relationships all rewrite the recipe for good sex. And as in so many health issues for women, sexual well-being is understudied and complicated by sentiment and science.
"So much has to do with what's going on in women's brains," says certified sex therapist Nancy Pegg of Vero Beach.
"The more we work in this field, the more we think men and women are not different," counters Dr. Irwin Goldstein, director of the Institute for Sexual Medicine at Boston University School of Medicine, who studies and treats physiological problems.
The media imply that everyone of every age is having lots of sex.
If you're not, you can be fixed, advertisers promise.
Drug manufacturers have sold billions of pills for erectile dysfunction. Now they are pitching creams, capsules and herbals for the vagina, from old standby K-Y Jelly to new elixirs with names like Senselle and Replens.
In laboratories, the hunt is on for a "pink Viagra" - a pill to boost women's lust and orgasms.
Meanwhile, doctors confronted with patients' complaints of lagging libido are prescribing antidepressants and even testosterone.
Others dismiss complaints as "all in your head."
At a time when a woman should be having a pretty good time - she's older, wiser and more skilled at relationships and sexual pleasure than when she was young - she instead may wonder why she feels like a neophyte.
No magic pill, so far
So little research has been done on the efficacy of libido enhancement for females that no one agrees what works. There are no medications approved by the Food and Drug Administration for treatment.
For older women whose bodies are undergoing dramatic hormonal changes and whose social lives may be upended due to the death of a spouse, the goal of a pleasurable sex life is often daunting.
"There's a woman-driven market to maintain that sexuality. The question is how much of (the demand) is coming from being marketed" to by so many drugs, says Jennifer Bass, spokeswoman of the Kinsey Institute for Research in Sex, Gender and Reproduction, at Indiana University.
"I don't know if it's reflecting reality," Jessica McIlvane says of the advertising blitz that began with the male impotence drug Viagra. McIlvane, who teaches a class on aging and sexuality at the University of South Florida School of Aging Studies in Tampa, says statistics show that about 7 percent of older women and 10 percent of older men use drugs to enhance sex drive.
The truth to be gleaned from all the talk of hotter sex lives, McIlvane says, is that older people still have them.
"It's one of the big myths of aging that older people don't have sex," she says. "Almost half (of those) 60 or older report that they're sexually active (some form of sexual activity at least once a month) - 61 percent of men, and 31 percent of women." The lower numbers for women may reflect fewer available partners, as women statistically outlive men.
Pinpointing the causes
For those with lagging drive, there is ongoing debate over whether it results from aging or is a byproduct of the diseases that can accompany seniority. For men, the problems are typically physiological. Are the mechanics working? For women, lust is, as it always has been, linked to emotional investment.
"The dynamics in a relationship are so significant for women," says Pegg.
A report by the Kinsey Institute in 2000 found that emotional health and relationship factors were more important for women's sexual satisfaction than orgasm.
Pegg says women may be physically more interested in sex - and better at it - as they age. An uninhibited 20-year-old has nothing on an uninhibited 40-year-old who's "more sexual, more comfortable with her body, and in what she's willing to do."
Interest in the topic was sparked by a 1999 study on women's sexuality published in the Journal of the American Medical Association. Researchers reported 43 percent of American women experience sexual dysfunction. An estimated one-third of those said they had no or low sexual desire, called hypoactive sex drive, or HSD. A woman with HSD lacks sexual fantasies, suddenly finds sex uninteresting and rarely masturbates.
"The women who walk into our office are like the color beige. They blend into the background," Goldstein says.
The Boston center is studying male-impotency drugs' application for women. He says they've been besieged by would-be study participants for six years. More than 90 percent of patients prove to have some kind of hormonal imbalance.
After treatment, Goldstein says, "They become the color red."
He says he is weary of medicine's tendency to blame women - their poor relationships, their fatigue, their headaches - for bad sex lives. A woman without a sexual appetite or ability to climax is "raising a red flag and saying that something is wrong with her body."
The chemistry of desire
Women are buffeted by hormonal fluctuations throughout their lives. Childbirth, breastfeeding, menstruation and menopause all change, sometimes drastically, their body chemistry.
In aging women, a drop in estrogen dries the vagina and thins the vaginal wall, making intercourse uncomfortable or painful.
While less estrogen has not been linked to loss of sexual desire, menopause causes other changes, including a decline in the male, androgen hormones such as testosterone. The primary result of androgen deficiency is a loss of sexual desire.
Older women may also be taking libido-blocking medications. Blood pressure drugs - diuretics, beta-blockers and alpha-agonists - have been shown to be major culprits in loss of desire and performance in men. Antidepressants and tranquilizers (particularly Prozac and Paxil) affect sexual performance and interest. Removal of the uterus or ovaries affects a woman's body image and endocrinology.
Much of the search for answers focuses on testosterone.
Since the 1930s, experts have studied testosterone's effects on a woman's libido and well-being. A testosterone patch is under evaluation, and women in the trials report a higher interest in sexual activity, according to the University of Michigan School of Nursing, one of the study sites. Testosterone can also be administered through skin gels, lotions, pills or lozenges taken in daily dosages or before sexual activity.
Risks include skin problems, extra hair on the face and body and voice changes. Testosterone also has the potential to change cholesterol levels, which need to be monitored.
"People don't know this, but testosterone is required to make women feminine," Goldstein says.
Another drug under investigation as a substitute for hormone replacement therapy also appears to help libido. Called tibolone, it is marketed in Europe as Livial, a mix of progesterone, estrogen and androgen.
Some doctors prescribe Estratest, an oral medication that combines estrogen and testosterone, for estrogen-resistant hot flashes and, in an off-brand use, low libido. Others recommend the antidepressant Wellbutrin, found in some studies to increase arousal and orgasm. Avlimil, a heavily advertised herbal supplement, promises to increase desire and balance a woman's system. A month's worth of daily capsules costs about $45.
Is her heart in it?
There is another key component to a healthy sex life. It's the part psychologists say is between the ears. Modern Maturity surveyed 1,384 adults of both genders who were ages 45 years and older and found relationships to be more important than sex to their quality of life.
In ongoing studies at the Kinsey Institute, researchers are looking at what cues lead to arousal or inhibition in women. Women suffer far more problems sexually than men if they are stressed, depressed or detached emotionally from their partner. Concern about reputation is still a factor for women.
A sex shutdown in a woman often stems from power struggles, resentment over unequal distribution of household chores, feelings of inattention or anger over past injustices, therapists say.
If a woman's emotional house is in order, then the biggest change to her sex life may be in its style. Older women and men both need more kissing and caressing before becoming fully aroused, Bass says. The good news is that older women are less "partner dependent" for their arousal than younger women.
Bass says studies show younger women get their arousal cues from the man - a muscular abdomen or graceful walk, for example. Older women, including those in longtime marriages, use more fantasizing.
The medical message to women about their sexual lives as they age is evolving. The good doctors explore treatments for physical and mental sexual problems. The best ones never discount the importance of a fulfilling sex life or define it for their patient. Options are confusing, but leaps ahead of what society and science once knew, the experts say.
Still, it sometimes seems it all comes back to an old-fashioned Harlequin romance.
The most important predictor of good sex for a woman, researchers find over and over again, is how she feels about her partner.
