Dr Alverston Bailey, Contributor

Sex between the elderly is often treated as taboo. However, while the human body does impose limits on the maximum age for reproduction, sexual activity can be performed or experienced well into the later years of life.

We have sex for several reasons. The primary motivation is reproduction, but sex also promotes intimacy and commitment between two people regardless of age.

The New England Journal of Medicine on August 3, 2007 published a study by Stacy Tessler Lindau, MD, et al, titled A Study of Sexuality and Health Among Older Adults in the United States.

This survey reported the prevalence of sexual activity, behaviours and problems in a national probability sample of 3,005 US adults (1,550 women and 1,455 men) 57 to 85 years of age.

It revealed that the prevalence of sexual activity declines with age, yet a substantial number of men and women engaged in vaginal intercourse, oral sex and masturbation even in the eighth and ninth decades of life.

Nearly one in seven men reported taking medication to improve sexual function.

About one quarter of sexually active older adults with a sexual problem reported avoiding sex as a consequence.

Ageing's impact on women

The lips of the vagina (the labia) and the tissue covering the pubic bone loses some of its firmness.

The walls of the vagina become less elastic.

The vagina becomes drier.

The clitoris can become highly sensitive.

Uterine contractions with orgasm may be painful at times.

Effects on older men:

There is a delay in erection.

There is a need for more manual stimulation to achieve an erection.

The 'plateau' phase, or period between erection and ejaculation, is prolonged.

Orgasm is shorter and less forceful.

The penis loses its firmness rapidly after ejaculation.

The 'refractory period', or time interval before erection is able to be achieved again, can be quite long, as much as a week in very elderly men.

Those old enemies

Many chronic diseases that elderly people experience can also affect sexual expression.

Coronary artery disease: may lead to chest pain with sexual activity, or fear of having a heart attack during sex.

Chronic lung disease: leads to breathlessness.

Arthritis: could impair ability in some sex positions.

Other issues

Embarrassment: Some older persons may find that embarrassment over the loss of a breast or the presence of a colostomy bag or some other apparatus, may inhibit free sexual expression, especially with a new partner.

Medications: taken for many chronic diseases, especially for hypertension and heart disease. May cause either a loss of libido or impaired performance.

Romance Recipe

As you get older, your desire for sex may be undiminished but your capabilities may be compromised. The advice given below should help you to overcome these difficulties:

Take it easy: Remember that sexual arousal takes longer and requires more manual stimulation.

Take your time during foreplay: Take all the time that you often didn't have in your younger days to pleasure each other or yourself.

Communicate: Share what makes you feel good with your partner.

Use your senses: Take time to explore in great detail all the tactile, visual, auditory and even olfactory aspects of being intimate.

Set the right mood: Take your time to set the stage for this special experience. Experiment with lighting, music, candles, oils, perfumes and incense. Try a new location.

Positions of pleasure

Experiment with different positions if you are challenged by pain, strength or endurance.

The 'spoon position', in which both partners lie on their sides, the woman with her back to the man.

The woman lies on her back and the man at a right angle to her on his side.

The person with less strength or endurance lies on her/his back, with the stronger partner kneeling above.

You can still achieve full sexual gratification in your golden years if you inform yourself of the challenges which accompanies ageing and approach intimacy with compassion, gentility and respect for your partner.

Tips for older men

Get a check-up: Please visit your doctor for a comprehensive physical examination and appropriate investigations to identify many treatable medical conditions that may cause impotence.

Be patient: Please remember that more stimulation is required to achieve an erection as you get older.

Heart disease: Men who have heart disease may be quite concerned about whether sex will put too much strain on their heart, and many men who have had a heart attack or heart surgery wonder if they will ever be able to resume sexual activity. Relax! Most men can resume sexual activity within two to four weeks after a heart attack.

Testosterone: If you would like to be more sexually active, but your libido is impaired, you might benefit from testosterone.

Treatment for erectile dysfunction (ED): First-line medications for the treatment of ED are readily available and safe, your doctor will prescribe a suitable one for you.

Other treatment options: If ED drugs are not an option for you, there are other medications that can be tried. Some involve application into the urethra, or injection into the penis. Some men benefit from a vacuum-pump device to aid in erection, and may choose the surgical implantation of a penile prosthesis.