Misinformation and misunderstanding about sexuality during the middle years and beyond have victimized older adults. Instead of supporting the need among older adults for companionship and sexual pleasure, health care providers frequently reinforce the 'dirty old man' or 'sexy grandmother' stereotype and ignore current research on sexual physiology and behavior in later life. That research contributes to a more realistic and individualized understanding of sexual physiology and behavior in later life.

Sexuality is that part of ourselves that includes our concept of maleness and femaleness and enables us to share ourselves both physically and emotionally with a partner. Sexual function lasts into the 60s, 70s, and beyond unless there are physical problems that prohibit sexual intercourse. However, there are few situations that would restrict anyone from sharing the warmth of holding, caressing, or fondling.

For some people the need for and comfort with sexual communication may decrease because of psychological and social problems in later life. One-fourth of people over age 50 have decreased sexual interest for which no apparent physical cause can be determined. These changes are rarely sudden. A person's needs for sexual communication may decrease over time or there may be something about his or her partner that prompts a loss of interest in sex. The most common cause of a loss of interest in sex, however, are problems with erectile response or lubrication that are not addressed early. Researchers Masters and Johnson found that 50% of American couples find their sexual relationship less than satisfactory. This lack of satisfaction is not limited to those over 50 years of age.

Misunderstandings

A person's dissatisfaction with his or her sexual relationship may stem from misconceptions such as the following:

• Sex is hazardous to those with heart or other health problems.

• Sexual intercourse is a 'duty.'

• Sex is intended primarily for having children.

• Sex is intended only to satisfy the man's ego and needs.

• Women do not have the same sexual drive and needs as men.

• Pleasurable sex is contrary to religious teachings.

• Age is an acceptable reason to abstain for those who have never really enjoyed sexual intercourse.

Comparison of Sexual Performance

Psychologically the most common error is trying to rate one's sexual performance against so-called norms. What are these norms? Who sets those standards? People have different needs and what may be satisfying for one couple may not be for another. In truth, there are no norms or standards.

Although children and adolescents learn by observing parents and other role models, most adults are willing to change the patterns of sexual behavior they learned as children if these changes will enrich their relationships.

Videos and movies offer the opportunity to observe sexual behavior a couple may want to discuss and try if they feel it might improve their relationship.

Lack of Self-Love

If a person does not love herself or himself for whatever reason, it is hard to accept the love of another as being honest and sincere. Insecurity can produce problems in a relationship.

Self-esteem may be injured by fatigue or by how we feel about how we look. An exercise and diet program can help turn things around. Most people can begin this process by simply increasing such activities as walking, gardening, or doing other mild-to-moderate exercise, such as working out to a favorite exercise video. If you have a medical condition, however, it is important to consult your doctor before starting any exercise program.

Fear of rejection and ridicule can be a serious problem for older adults, who may therefore be less willing to communicate needs and desires to their partners. Group therapy can do much to alleviate these fears.

Stress and Disappointments

Stresses and disappointments that may affect sexuality in older adults include the following:

• the realization that further career advancement is unlikely

• news of a child's failure in college or the family-owned business

• child's or partner's drug or alcohol dependency

• the necessity of coping with illness and disability.

The Empty Nest Syndrome

Most men work until their middle 60s. Women who have had the responsibilities of homemaking and child rearing find that these roles end before their mid-50s. A woman's concept of her importance may change when her children leave home to pursue their own lives. They sense a loss of worth in their marriages.

Many women face an identity crisis. The difficulties of facing a changing family role may mean a period of close self-examination. Some become too focused on self or overly concerned with their health. Some women may become sexually assertive for the first time. Their partners may either welcome the change or feel threatened by it. It is not easy to develop a new identity, and partners need to be supportive of and to share in the decisions a woman may make in pursuit of that goal.

Problems of Menopause

Menopause does not have to mean a drastic change in lifestyle. Women should educate themselves about menopause by talking to their doctors. Women should learn about the benefits of estrogen replacement therapy and its role in preventing osteoporosis, vaginal dryness and irritation, hot flushes, and cardiovascular problems. The benefits of estrogen replacement generally outweigh the risks for most women. Replacement therapy also helps women to preserve energy and drive and to avoid mood shifts, irritability, tension, headaches, and insomnia. Women going through menopause should communicate their feelings and needs to their partners. Sexuality in mid-life and beyond are enhanced when partners share their desires and expectations.

Failure to communicate with their partners can lead to:

• problems in all aspects of the relationship

• low self-esteem and withdrawal from the relationship

• decreasing sexual interest.

Depression

A loss of sexual interest in what had been a good relationship may be one of the earliest signs of depression. Some signs of depression relating to sexual interest include:

• decreased enjoyment of sexual intercourse

• sudden refusal to have sexual intercourse

• orgasmic or erectile failure in previously functional partners

• inattention to appearance or personal hygiene.

Extramarital Affairs

Extramarital affairs often occur when either partner feels his or her sexual and psychological needs are not being met and seeks affection elsewhere.

Divorce

Divorce, which can feel like a failure of sorts, can cause loss of self-esteem and adversely affect both partners' sexuality.

Beginning a new sexual relationship after divorce can be difficult. The adjustment to a new partner can bring out insecurities and concerns about one's sexuality.