I was 19, the first time, and a soldier on leave in France. I paid $5 -- my whole week's salary -- and she was worth every penny.
It's not uncommon to hear stories like this when you're talking about sex. I'll never forget being in front of a particularly quiet group of seniors, when this 90-year-old man started telling this story of his first time. He looked back on this experience fondly, and he greased the wheels for an open conversation by the group about their sex lives.
As in all of my groups about sex over 60, we talked about redefining sex as we age, and of course about HIV and staying safe. One couple in the group had just gotten married. Some had been divorced or were widowed. Others had been married for almost 50 years. I always joke that they were having sex long before I was born, and they appreciate that I accept they have more experience with this topic than I do. They also appreciate that there is someone out there who acknowledges they are sexually active.
LiveOn NY (formerly Council of Senior Centers and Services) is a not-for-profit organization that champions the rights of older adults. Together with ACRIA, we have worked for the last eight years in New York City to provide education to service providers and seniors on HIV, aging, and related health topics. Most of my sessions have been with providers who actively serve seniors or people with HIV. The providers serving the aging may not know the most current information about HIV, and the HIV service providers don't always have a good grasp on what happens as we get older and how best to work with older adults. We work to bridge the gap between the two groups so they can better serve older adults living with and at risk for HIV.
It's critical to educate providers about aging, sexuality, and HIV. They are on the front lines with seniors and people with HIV and are key to busting stigma and stereotypes. While many of them are excellent at what they do, even they may not be free of society's negative beliefs about sex and aging. By promoting a sexpositive atmosphere in both senior and HIV services, and by avoiding the stereotype of nonsexual old folks, we promote happy and healthy sex lives for all ages. And that's important! When we can talk more openly about sexuality, we're able to have more empowering conversations about safer sex. But more on that later.
The Realities of Sex and Aging
All too frequently we relegate older adults into a nonsexual role. Some seniors may even agree with that, saying things like, "I'm too old for that nonsense", or "My husband is gone and I've closed that chapter in my life", or even, "I've had a hip replacement and I'm afraid I won't be physically able to have sex." At one center, a staff member said, "Oh, there's only one married couple here, so no one else is having sex." I could go on.
While I won't deny that celibacy is an option for older adults, we know that only a minority of them make that choice. We also know that sex is about intimacy and partnership -- not necessarily about the sex act itself. I've had seniors say, "I just like the feeling of someone in my bed" or "It's his touch that I miss the most." They are talking about the relationship, the intimacy, and the feeling of having someone close to them, not just about having sex.
But it's also important to acknowledge that sex for seniors doesn't always occur within a serious relationship. We know they engage in casual sex -- which could be about just the sex itself, or about a need for intimacy.
At one senior housing center, we were talking with the staff about HIV and older adults. They were not at all surprised that they were at risk, since they had seen it firsthand. "Every month, when they get their Social Security checks, we see it. We have to remove a mattress from behind the building where they put it at night. And we clean up condoms. Not only are they are having sex, they're hiring prostitutes." I was shocked, but I found that other agencies had similar stories. They knew it was happening, and did what they could to make sure the seniors were safe. But there was only so much they could do.
Sex is a challenging topic to discuss, especially with the amount of stereotyping and stigma associated with both older adult sexuality and HIV. We have a natural discomfort with broaching the topic. Many people don't want to think that their grandmother -- or any older person, for that matter -- could be having sex. And we don't like to think that older people are getting HIV. When I tell providers that one out of every six new HIV infections is in a person over 50, their minds are blown.
HIV is not just a concern for young people. And sex is not just the domain of the young, either!
Change Is Good
One reality about sex is that, just as every part of us changes as we age -- vision, hearing, health, career, social life -- sex, too, must change. Another reality is that many older adults experience profound loss. Losing a partner either through death, severe illness, or divorce changes your life. That loss can have a huge impact on your sexuality -- whether you have a partner who is alive and capable of sex, both physically and mentally, is the biggest factor in having a sex life.
If we do have a partner, we must admit that our expectations of performance, frequency, need, desire, etc., must change as we age. Let's try a little exercise: Stop reading and think about your most recent sexual experience. Get a nice picture in your head. Now compare it to your first sexual experience. They weren't the same, right? And they shouldn't be! Sexually, we don't want the same things today that we did in our teens and twenties. This is what I mean by changing expectations. At some point, we'll all find ourselves saying something like, "I don't like this position anymore, it makes my sciatica act up", or "My tummy gets in the way", and so on.
But change is not a bad thing. Accommodating a new disability or desire may lead you down a path you never thought you'd enjoy, but discover you do. In fact, I spoke with one older woman who said sex for her was better now than ever: "I'm free from worry about pregnancy, from my Catholic guilt, from body image issues. It's just me and him in bed -- or anywhere else! And it's amazing."
Just like the rest of us, seniors want to know what is normal when it comes to sex. Some of the questions I've run into bubbling under the surface are:
- Should I expect that my partner won't be able to get an erection after a certain age?
- Will I become a frigid old woman when I hit 70?
- What if I have pain when I have sex?
- What if I'm just not interested anymore?
- Will I find another partner who will want me?
Many people won't say these questions out loud, so we have to tell them what is normal to expect as we get older. For older men, erectile dysfunction is not inevitable, but is often a sign of other health issues. I always make a point to tell all the men in my trainings, young or old: if you want to stay hard, you have to stay healthy! There are some changes to be expected to the erection, but age doesn't turn that organ off.
Normal Changes for Men
- Most common dysfunction, erectile dysfunction.
- Challenges associated with chronic illnesses and physical disabilities.
- Erections requiring more intense or prolonged physical stimulation.
- Longer time for erectile response.
- Less rigid erection with some softening during sexual activity.
- Decreased intensity of ejaculation.
- Decreased amount of semen.
- Delay in ejaculation.
- Increased time between erections.
Many women are concerned with changes that come with menopause. Increased vaginal dryness is the chief complaint, and it can cause pain or decreased sex drive. I always tell them -- lube is your friend! I've had several women come to me after a workshop, asking me about my favorite lubes and the stores where they can get them. I've also had ladies share rousing endorsements like, "Now I use a lot of lube and it's changed my sex life."
Normal Changes for Women
- Most common dysfunction, lack of desire and lack of arousal.
- Challenges associated with chronic illnesses and physical disabilities.
- Decreased clitoral engorgement.
- Decreased vaginal lubrication.
- Decreased breast swelling.
- Diminished pre-orgasmic sweating.
- Diminished orgasm intensity.
The biggest take-away for seniors is the discussion of safer sex and the fact that your age won't protect you from STDs or HIV.
I once spoke with a group of older women in the Bronx. We had a great time talking about sex and aging, but things got more serious when we discussed safer sex. One of the women opened up: "My boyfriend is in his 70s, and he is a very traditional Hispanic man. He won't wear a condom. And I don't know what to say to him."
This was an "Aha!" moment for me. I can remember being in high school learning "no glove, no love" and other silly sayings, all encouraging us to send the same message: "If you don't wear a condom, we're not having sex." I learned how to have "that talk" with a potential partner. But the women I was talking to -- all in their 60s and 70s -- never got that message. They hadn't learned that they can say "no" if their partner won't wear a condom. Or that they can demand an HIV test before they get into bed. Why wouldn't we teach all women (and men for that matter) that this is the new normal? Many of them are dating for the first time in 30, 40, or even 50 years, but they haven't realized that the rules have changed. That woman inspired me to always include condom negotiation skills in my trainings.
Through eight years of working with seniors and providers to make their world a little sexier, I've learned a great deal. I've heard things like, "I'm a sexy lady over eighty!" I've talked to providers who never imagined they would need to know where in the neighborhood they could send their seniors to buy condoms or lube. Or centers that embraced safer sex and offered bowls of condoms and lube onsite.
The most important lessons I've learned from all the conversations I've had are the following tips for talking with seniors about sex:
- Be comfortable -- if you aren't comfortable addressing the issue, don't!
- Agree on rules for group discussions:
- Feel free to speak your mind -- this is a safe space.
- Like sex, this will be interactive -- please don't just sit there.
- Laughter is healthy and sex is silly -- don't be afraid to laugh out loud.
- If you are younger than the participants, acknowledge the age difference -- they will appreciate it.
- Learn from them -- be an expert, not a know-it-all.
- Treat it as a conversation, not a one-sided lecture.
- Use words that you and your audience are comfortable with -- when in doubt ask them (make a game of it).
- A little respect goes a long way.
- Small groups work best -- some people may want to talk about sex but not with a lot of people listening.
- Have fun and be creative! I hope that everyone reading this will take the opportunity to grab an older person that you love and admire and talk about sex. And stay sexy, seniors!
Karol Tapias is director of training and innovation at LiveOn NY.