Sexual health


Updated July 2006 A satisfying sexual relationship throughout life is an important part of that life, but it is not always easy to achieve. People who have been sexually active on a frequent basis throughout their life will show a lower rate of decline in activity with advancing years than will those who have been less sexually active.[see reference 1] With age and experience, most people become better able to establish and fully enjoy sexual relationships. Regular sex seems to improve cardiovascular fitness and may prolong life and helps to maintain healthy relationships.

Potential problems
It is normal to experience fluctuations in sex drive or occasional temporary loss of sexual desire, lack of sexual responses, or inability to perform sexually. If sexual problems persist, they may be distressing and cause anxiety, which may further inhibit the enjoyment of sexual activity.

Sexual problems may have a number of causes including physical or psychological disorders, emotional difficulties, external stress such as work or financial worries, or a lack of sleep. Problems may also result from the complications of certain long-term physical conditions such as diabetes mellitus, disabilities that cause pain and restrict movement, convalescence from surgery or illness, or the use of alcohol, recreational drugs and certain medications. The most common sexual problem that affects both sexes is decreased sex drive and this is often a natural response to changing hormone levels over time. A sexual problem may begin with an underlying physical cause, but anxiety about sexual performance can often develop and compound the original problem.

An example of a common sexual problem faced by women is vaginal dryness related to low oestrogen levels. The use of appropriate creams such as oestrogen cream (if the woman is not already taking hormone replacement therapy), KY Jelly or Senselle, or an aromatic oil may enable a woman, and her partner, to enjoy sexual activity much more fully.

A variety of treatments are currently available, and there are many doctors and therapists who specialise in treating sexual problems. Sources of specialised help include urologists, gynaecologists, sex therapists and counsellors. For some problems, assistance from a psychiatrist or psychologist may be helpful.

A healthy relationship
What constitutes a healthy sexual relationship varies widely from person to person. Sexual fulfilment depends on a blend of physical and psychological factors, and what is right for one couple may not suit another. An important factor that must not be forgotten when contemplating a healthy sex life, is the risk of infection. These range from uncomfortable but minor problems such as pubic lice, to life-threatening disorders such as HIV infection. Certain disorders, such as genital herpes, genital warts, and gonorrhoea are almost always transmitted only by sexual contact and are known as sexually transmitted infections (STIs). Others such as hepatitis B and C and HIV infection, may be transmitted by other means as well as through sexual contact. Anyone in a sexual relationship, regardless of his or her age, should be aware of the risks posed by STIs and know how to minimise the risk of exposure to them.

While it is healthy for individuals to enjoy active sex lives, it is important to realise that there are over 25 sexually transmitted infections some of which, if left untreated, may cause serious and permanent damage. STIs are among the most common causes of illness. With the increased interest in these infections and improved methods for diagnosis has come awareness of the far-reaching health, social and economic consequences of STIs. For further in-depth information as this specific subject, please see the BMA's publication ‘Sexually transmitted infections’ and subsequent 2005 update.

If there is any doubt about the likelihood of being exposed to an infection, or of what the risks might be, it is best to use a condom, or avoid sex altogether.

Erectile dysfunction
Erectile dysfunction, sometimes called ‘impotence,’ is the repeated inability to get or keep an erection firm enough for sexual intercourse. The word ‘impotence’ may also be used to describe other problems that interfere with sexual intercourse and reproduction, such as lack of sexual desire and problems with ejaculation or orgasm. Using the term erectile dysfunction (ED) makes it clear that those other problems are not involved.

In older men, ED usually has a physical cause, such as disease, injury, or side effects of drugs. Any disorder that causes injury to the nerves or impairs blood flow in the penis has the potential to cause ED. Incidence increases with age: about five per cent of 40 year-old men and between 15 and 25 per cent of 65-year-old men experience ED [see reference 2], but it is not an inevitable part of ageing.

ED is treatable at any age, and awareness of this fact has been growing. More men have been seeking help and returning to normal sexual activity because of improved, successful treatments for ED.

Since its introduction in the late 1990s Viagra has helped millions of couples all over the world enjoy a full and active sex life together. A man achieves an erection when the muscles of the penis relax, allowing blood to flow and pool in the corpora cavernosa of the penis. Viagra works by relaxing the smooth muscles of the penis allowing the corpora cavernosa to fill with blood. The usual dose is taken one hour before sex, preferably on an empty stomach or after a light meal. The effect of the pill may last up to four hours. This means an erection may occur up to four hours after taking the pill. It does not mean that the erection will last for four hours.

For Viagra to work, sexual stimulation is necessary. Viagra alone is not an aphrodisiac. It will not cause an erection if there is no sexual stimulation (of either a physical or mental nature), it does not increase the libido (sex drive) and does not affect the orgasm. A GP should be contacted for further information.

Older people and diverse sexuality
Traditionally, the needs of lesbian, gay, bisexual and transgender (LGBT) people have not been high on the agendas of agencies associated with service provision for the elderly. As LGBT seniors grow older and more dependent on services for care and assistance, they may come into contact with these institutions. Awareness of this issue amongst such institutions is beginning to be raised both around the world and within the UK. The British charity Age Concern launched a ground-breaking training pack which aims to place the subject firmly on the agenda. ‘Opening Doors’ is in part a beginner's guide, which seeks to challenge stereotyping as well as providing guidelines for best practice.

References:
[1] Read J (1999) Sexual problems associated with infertility, pregnancy, and ageing. British Medical Journal 318(7183): 587-589.
[2] National Kidney and Urological Diseases Information Clearinghouse

Further information:

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