Sexuality and Aging: Q&A with Dr Tonia Mezzini

How does sex change over the different phases of adulthood?


Sexuality and Aging: As part of my work at Adelaide University, I was interviewed about sexuality and ageing. Some tough questions were asked! I hope you find the answers useful.


What are the reasons for sex?

This is a big question! I might need a glass of wine here…How philosophical have we got time for me to be? Well, in no particular order: procreation, as a physical expression of love, fun, to stave off boredom, to treat insomnia, to maintain intimacy and connection in a relationship, economic necessity, self-validation, to stave off fear of death and illness, to challenge the dominant paradigm, as an act of rebellion, or as an act of domination. And power. Just ask Harvey Weinstein. 

Is sex good for you? What are the benefits of sex?

If it’s good sex; mutually satisfying, consensual, then yes. Physical benefits include: lowering your blood pressure, decreases pain – orgasm is very good for period cramp, it can reduce the risk of prostate cancer in men, it’s a little cardiovascular workout, reduces anxiety and promotes deep sleep. Many of these effects are mediated through hormones and chemicals such as oxytocin and prolactin. It also boosts your immune system and improves your pelvic floor function.

Can sex be bad for you?

If you are having sex for the wrong reasons, reasons that may damage you emotionally or physically then yes, it can be bad. The physical consequences are easy to deal with, the psychological…much more complicated. It’s part of human behaviour that is fascinating – it can be very good and very bad. Humans are pretty good at mucking this up.

Sexuality and Aging: Tell us about the changes that can occur in each phase of adulthood?

To start with, I’d have to say that identifying and becoming comfortable with your sexuality in terms of orientation is often the most consuming and important focus of sexual development. For some, this is relatively easily and doesn’t require much pondering or examination. For others, it can take years and may change around a bit as they ‘try things on for size’, so to speak.

For women, the changes can tend to centre around fertility – which is hormonally dependant, so we talk about the reproductive years from 15 to 45, middle age is about 45-60, and the older years are 60 and beyond. But that’s not the only part of the story. There are social factors influencing sexuality.

Sex can be about having fun, exploring your body, finding out what works and what doesn’t work for you. Younger women sometimes struggle with body image issues and this can impact on sexual confidence. Sometimes it becomes about finding a partner to raise children with. Sex can be less of a priority with the demands of a young family, and tiredness can get in the way of opportunities for sexual expression. Lack of sleep never improves anybody’s libido!

By the middle years, menopause and declining testosterone can impact negatively on libido, but testosterone is only just part of the story. As women get older, they are sometimes even more comfortable to explore their sexual orientation. There is a great deal of research, dating back to Alfred Kinsey in the late 1940’s that supports the notion that sexuality and attraction are more fluid, less fixed for women and may even change over a woman’s lifespan. Male sexuality tends to be more fixed and less fluid.

For men, the changes or life stages aren’t as hormonally defined – testosterone can decline gradually from about 30 years of age, and Androgen Deficiency affects up to 1 in 10 men over 60 years. Erections might not be as reliable, or last for as long, as men get older. The refractory time – the time between ejaculation and the ability to sustain another erection increases. This can require a couple to expand their sexual repertoire – which is not a bad thing – in order to maintain a sexually intimate relationship.

For young men, and sometimes, not so young men, the focus can be on quantity rather than quality. Learning how to manage testosterone and sexuality is a life skill.

We don’t really manage this aspect of sexual health education very well at all.

What are the main sexual health issues in each phase?

Again orientation will influence this to varying degrees. For young women, it’s often about avoiding pregnancy and STIs as well as managing periods and PMS. Then, it’s about trying to get pregnant. For some this happens easily, for others it can require varying degrees of medical intervention.

In the middle years, declining hormone levels can cause menopausal symptoms such as atrophic vaginitis: the vagina produces less secretions, the tissue becomes less elastic, sensitivity and responsiveness decline and sex can be uncomfortable and less pleasurable. Uncomfortable sex reduces libido and sex can be lower down on the list of a woman’s priorities. The pelvic floor can also lose elasticity and urinary tract issues such as stress incontinence and recurrent UTIs may be problematic.

For young men it’s often about avoiding STIs and not getting someone pregnant. Managing issues such as premature ejaculation or delayed ejaculation may occur. As men get older, their erections may not be as reliable, or as easy to attain and maintain.

Is sex different in late adulthood?

Yes. All of our body parts change as we get older: backs ache, hips aren’t as flexible; we might be on medications that affect our heart rate and blood pressure. We might have had hormonal treatments for cancer that reduce libido and sexual responsiveness. We might have also had operations that leave us with scars, or minus a breast or two. The effect of gravity and decreased collagen becomes more apparent. We are a bit less elastic. We might experience vascular and neurological complications of chronic health conditions such as diabetes, cardiovascular disease, smoking, alcohol and drug misuse.

The meaning of sex might also change – it’s normal for sex to change over time. We sometimes don’t manage or understand that very well.

Why is sex important in late adulthood?

For the same reasons it’s important at any life stage. Just because we look different on the outside, doesn’t make us different as people. Hopefully, people have the time and accumulated wisdom to be more varied in their sexual expression. Be a little more creative, not be in such a rush, be liberated from anxiety about pregnancy, be spontaneous about when they can have sex. Hopefully they can be more confident, and maybe not so anxious about talking about what they want from sex.

Some people, however, may be very happy to have left that part of their lives behind them. They have fulfilling relationships and enjoy time with their partners, friends and family and sex just isn’t a focus or priority for them.

Others, may have lost a life partner either through serious illness, death, divorce and may be looking to re-partner, to have an intimate sexual relationship.

It’s a big issue in Nursing Homes – one that often isn’t handled very well. We can tend to be a bit puritanical when it comes to older people and sex. By denying older people the opportunity to explore consensual sexual relationships – we are pretty much stomping over their human rights. We do tend to infantilise older people in Western Society.

Some of the most valuable and useful conversations I’ve had about sex and relationships have been with my Nonna – at 95, she’s seen it all. She’s been a girlfriend, a wife, a mother and a widow. Don’t assume that old people aren’t sexual beings, or that they don’t know anything about sex.

Dr Tonia Mezzini is known for offering the best possible advice and treatment options for a person’s sexual health care needs. In particular, she cares for patients with: