Older people’s sexual activity problems and desires are being dismissed by health practitioners due to their age, a new study has suggested.
Research by The University of Manchester’s MICRA (Manchester Institute for Collaborative Research on Ageing) and Manchester Metropolitan University highlighted the obstacles some older couples face in maintaining fulfilling sexual lives, and how they adapt to these barriers.
The study analysed written comments from over a thousand adults aged 50 to 90 who responded to the English Longitudinal Study of Ageing Sexual Health and Relationships questionnaire. Respondents of both sexes emphasised their anxiety at not being taken seriously by health practitioners as they sought to overcome issues affecting their sexual activity, such as a drop in sexual desire or physical difficulties. One man in his eighties reported being refused Viagra for erectile dysfunction on the grounds of cost.
Participants in the study, published in Ageing and Society, cited other elements influencing sexual activity, including health conditions and physical impairment, the evolving status of sex in relationships and mental wellbeing. It was also found that men were more likely to talk about the impact of health conditions on sexual activities, but women were more likely to talk about health-related sexual difficulties in the context of a relationship.
The study recommends that health care practice should positively engage with issues of sexual function and sexual activity to improve the health and wellbeing of older people, particularly in the context of long-term health problems.
“This research further improves our understanding of love and intimacy in later life”, said study co-author David Lee, Research Fellow from The University of Manchester. “It builds upon empirical findings published in our earlier paper (Sexual health and wellbeing among older men and women in England; Archives of Sexual Behaviour) which described a detailed picture of the sex lives of older men and women. However, this new research uses narrative data to better understand how changing age, health and relationships interrelate to impact sexual health and satisfaction.”
“Appreciating individual and personal perspectives around sexuality and sexual health is of paramount importance if we are to improve sexual health services for older people.”
Sexual health can be an uncomfortable or embarrassing topic to discuss for many people, and for patients with cancer, survivors and their partners, it can feel even more awkward. In fact, sex ranks among the top five unmet needs of survivors, and a new digital health startup, Will2Love, has been launched to help fill this void.
Sixty percent of cancer survivors — 9.3 million individuals in the United States alone — end up with long-term sexual problems, but fewer than 20 percent get professional help, according to Leslie R. Schover, PhD, Will2Love’s founder. Among the barriers she cites are overburdened oncology clinics, poor insurance coverage for services related to sexual health and an overall lack of expertise on the part of providers, many of whom don’t know how to talk to patients and survivors about these issues.
Sexual issues can affect every stage of the cancer journey. Schover, who hosted a recent webinar for health care practitioners on the topic, has been a pioneer in developing treatment for cancer-related problems with sexuality or fertility. After decades of research and clinical practice, she has witnessed firsthand how little training is available in the area of sexual health.
“Sex remains a low priority, with very little time devoted to managing sexual problems even in specialty residencies,” she adds.
The problem is twofold: how to encourage oncology teams to do a better job of assessing and managing sexual problems and how to help those impacted by cancer to discuss their sexual concerns.
Schover says that simple, open-ended questions such as: “This treatment will affect your sex life. Tell me a little about your sex life now,” can help to get the conversation started.
Sexual side effects after cancer treatment vary from person to person, and also from treatment to treatment. Common side effects for men and women include difficulty reaching climax, pain during sexual intercourse, lower sexual desire and feelings of being less attractive. Men specifically can experience erectile dysfunction and dry orgasm, while women may have vaginal dryness and/or tightness, as well as loss of erotic sensation such as on their breasts following breast cancer treatment.
Sexual dysfunction after cancer can often lead to depression and poor quality of life for survivors and their partners.
Cancer treatment can impact hormonal cycles, nerves directing blood flow to the genitals, and the pelvic circulatory system itself, explains Schover. In addition, side effects like prolonged nausea, fatigue, and chronic pain also can disrupt a patient’s sex life.
“Simply to give medical solutions rarely resolves the problems because a person or couple needs to make changes in the sexual relationship to accommodate changes in physical function,” Schover stresses. “That kind of treatment is usually best coming from a trained mental health professional, especially if the couple has issues with communication or conflict.”
Schover hopes that Will2Love will bring much-needed attention to the topic by providing easily accessible resources for patients, survivors, their partners and health care providers. (Box)
Currently visitors to the website can subscribe to its e-newsletter and receive a free introductory five-part email course covering topics related to what your doctor may not be telling you about sex, fertility and cancer. After the fifth lesson, users will receive a link to the Will2Love “Sex and the Survivor” video series. “Sexual health is a right,” Schover stresses, and oncology professionals, patients and survivors need to be assertive to get the conversation started.
Penises can be problematic. They are powerful, untameable beasts, capable of wielding immense pleasure but also able to cause devastating emotional wounds. And that’s just anal sex
by Liam Murphy
As well as the obvious physical harm that can be inflicted – skinny jeans have cursed a generation to suffer cock-caught-in-fly related trauma – the magnificent meat mallet can also bring mental torment when, like an untrained puppy, it just won’t do as it’s told.
THE HARDER THE BETTER?
Some of the best things are hard: hard-boiled eggs, biscuits, those rhubarb and custard sweets, Tom Hardy and, of course, the penis. However, sometimes they can spring up at the most unexpected and inopportune times, and just won’t go away.
“I call my hard-on issue uncontrollable as such,” says 21-year-old Ian, “let’s say ‘eager’ or ‘keen’. It doesn’t take much and it’s ‘up periscope’ time. I’ve been this way as long as I’ve appreciated the male form. I went through a phase of wearing an over the shoulder bag in my late teens so I could cover the odd bus boner (the vibrations cause a right disturbance). Rather that than poke someone in the eye on the way past, I guess!”
However, impromptu erections can also lead to embarrassing retail situations, as Ian explains. “Recent men’s fashion means that I’ve become accustomed to skinny fit jeans, and for whatever reason, I went commando that day – I’m sure you know where I’m going with this – and I guess it must have been particularly sensitive or whatever. Anyway, I ended up with a lob-on in Tesco. My skinny jeans/tight t-shirt combo meant there was no hiding, so I did what any self-respecting bloke would do. I awkwardly leant over the shopping trolley for the next ten minutes. On the upside, I can also get hard on demand! It’s just a combination of a high sex drive and an involuntary physical reaction, I think.”
For Kieran, 25, his perilously perky penis is just part of his day. “I wouldn’t say it’s an issue – more just a fact of life. Some people sweat a lot, some people yawn a lot… I get boners a lot. Not getting them would be an issue, but getting too many, yeah that’s a ‘problem’ I’m OK with – at least I know it’s all working well. It does pop up at any time. When I was due to be giving a talk, someone gave me a wink and boom… up popped my friend downstairs to take his moment centre stage. I stood behind the lectern desperately thinking of Margaret Thatcher and trying to kill it so I could step out and begin my talk properly. The worst though, is when someone you don’t fancy or don’t want to have sex with tries it on and it just feels like he’s betraying you.”
And how does one manage the curse (or blessing, depending on your perspective) of a perpetual hard-on? “Like everyone else I learned the ‘tuck it behind your belt’ trick, or to hide it behind my belt. Granted, occasionally there have been times when I’ve had to miss my tube stop and stay sitting down while I waited for one to subside.”
Will, 38, didn’t notice the problem cropping up until he was in a relationship. “I was never aware of it until I met my boyfriend and it became apparent early on that I would get erect whenever I was around him. It has settled down a bit now but whenever we kissed in public I would get a twinge. And in bed it still sometimes feels like I have an erection all night. I would generally be embarrassed that I was getting these erections. I felt immature. This is what happens to a teenager, not an adult. I was going through a difficult break-up once – lots of tears – we were cuddling and I was hard. I realised then that my hard-ons were not always about sex – to me they were about love too.”
Erectile dysfunction can happen to a lot of people, in varying degrees and for many reasons, medical or otherwise.
“It happens to me every time I put on a condom,” admits Steven, 34. “I have no problem keeping it up before fucking – wanking and getting sucked off have never been a problem – but when I go to fuck someone and I slide the condom on, I lose the hardness. Not totally, but enough that I can’t properly put it in someone’s arse and enough that the sensation goes for me.”
Steven tried mixing up condom brands. “I’ve used thin, ultra-thin, ribbed, tingle… every version of a condom you could imagine and I still get the same flaccid result. I think it must be a psychological thing, because it’s not like I can’t get hard at all. It’s fine when I bareback with long term boyfriends, but with one nighters I tend to have to bottom now.”
Anxiety can often be a cause of not being able to maintain an erection, as 27-year-old James confirms: “Sex in general makes me anxious. I hate getting naked and I get so nervous when it comes to getting down to it in bed. I was dating a guy I really liked, so much that when he touched me I would physically shake, but when it came to sex I just couldn’t get hard. He thought I didn’t like him! And now I dread having sex. I love the dating side of it but I always know that heading to the bedroom is going to be inevitable.”
What can cause you to have trouble getting or staying hard?
Stress and anxiety.
Smoking, recreational drugs and alcohol.
Some prescribed drugs – like Prozac and Seroxat.
Diabetes, high cholesterol and highblood pressure.
Psychological reasons – the more you worry about your erection, the less likely you are to be able to get one.
What can I do to make myself hard?
If you think the reason is psychological – a distraction helps, so encourage your partner to focus on something other than your cock for a while – kissing or nipple play might help to get you back in action.
Cockrings can also be used to help maintain a hard-on – leather or rubber straps are safer to use.
Drugs like Viagra or Cialis – consult your doctor for these.
Matthew Hodson, CEO of GMFA told us: “Rolling a condom onto a rock-hard penis isn’t a problem but if it’s a bit soft and you start to get anxious then it’s easy to spiral with anxiety to the point where a condom is really tricky to use. The more you’re concerned that you won’t be hard enough to use a condom, the more likely it is to happen. If it’s just an occasional problem it’s probably best not to make a big thing of it and just do something else that turns you on while you wait for it to get hard again. If it’s becoming more of a problem, you might want to experiment with cock-rings or talk with your GP about it – there’s no need to be embarrassed, you won’t be the first person who will have approached them with the same problem. Most erection problems can be addressed so there’s no reason why a temporarily soft dick should be a long-term barrier to you enjoying sex safely.”
Everyone should be able to enjoy a penis (which is my campaign slogan if I ever run for Prime Minister), especially their own. Whether it’s too hard or too soft, it doesn’t mean you and your cock have to suffer alone. Confide in your partner/lover/friend/doctor and discuss what you can do to get you and your lifelong pleasure companion talking again.
Step 1: When your cock is hard, take the condom out of the wrapper carefully using your fingers. Using your teeth to tear the packet could damage the condom. Squeeze the air out of the teat on the tip of the condom (if there is one) and put it over the end of your cock. Don’t stretch it and then pull it over your cock as this will make it more likely to break.
Step 2: Roll it down the length of your cock – the further down it goes the less likely it is to slip off. Put some water-based or silicone-based lubricant over your condom-covered cock. Put plenty of lube around his arse too. Don’t put any lube on your cock before you put the condom on, as this can make it slip off.
Step 3: Check the condom occasionally while fucking to ensure it hasn’t come off or split. If you fuck for a long time you will need to keep adding more lube. When you pull out, hold on to the condom and your cock at the base, so that you don’t leave it behind. Pull out before your cock goes soft.
What lube should I use?
When you don’t use enough lube, or use the wrong kind, the likelihood of condom failure is increased, making transmission of HIV and other STIs possible. Water-based lubes (e.g. K-Y, Wet Stuff and ID Glide) and silicone-based lubes (Eros Bodyglide and Liquid Silk) work well with condoms. Oil-based lubricants like cooking oil, moisturisers, sun lotions, baby oil, butter, Crisco, Elbow Grease, etc. can also cause latex condoms to break.
They can however be used with non-latex condoms, like Durex Avanti, Mates Skyn or Pasante Unique. Don’t use spit as it dries up quickly and increases the chance of your condom tearing.
Imagine this: You and your partner are getting hot and heavy in between the sheets. You’re feeling sexually aroused — but you’re unable to climax. In frustration you ask yourself: “Why can’t I orgasm during sex?”
The Kinsey Institute indicates 20 to 30 percent of women don’t have orgasms during intercourse, compared to only 5 percent of men who don’t climax every time they have sex. Men and women who are unable to sustain an erection or reach orgasm, respectively, are usually labeled as having some type of sexual dysfunction. However, the inability to orgasm could be triggered by several issues that range from physiological to psychological.
Below are six causes of why you have trouble orgasming during sex.
Condoms are often seen as an “evil” necessity that reduces sensitivity and sensations for men. The truth is condoms can inhibit male orgasm if they do not fit properly. A condom that is too tight can feel like the penis is in a chokehold, which can be distraction, and make it difficult to keep an erection. A 2015 study in journal Sexual Health found about 52 percent of men report losing an erection before, or while putting a condom on or after inserting into the vagina while wearing a condom.
High levels of stress impact your psychological and physiological health, which can interfere with the ability to orgasm. This makes it harder to concentrate on the sensation and relax during sex. Women with high salivary cortisol and stress levels have significantly less desire to masturbate or have sex with their partner.
Stress causes us to produce fewer sex hormones, like estrogen and testosterone, and more cortisol and stress hormones. When the body releases cortisol, a fight-or-flight response kicks in, and redirects the blood flow away from the sex organs, causing you to breathe shallowly.
Depression affects your mood, and even the desire to have sex. A 2000 study in the American Family Physician found 70 percent of adults facing depression without treatment had problems with their sex drive. This is because sexual desire starts in the brain as sex organs rely on chemicals in the brain to jumpstart your libido, and change blood flow. Depression disrupts these brain chemicals, making sexual activity more difficult to initiate and enjoy.
More than 75 million people live with persistent or debilitating pain, according to the national pain foundation, which can often lead to a low sex drive. Chronic pain sufferers find it difficult to feel pleasure during sex since the body hurts all the time. This is unfortunate since having an orgasm can alleviate some pains and aches.
Drugs tend to be among the most common causes of sexual problems. Prescription meds are responsible for as many as one of every four cases of sexual dysfunction. A 2002 study published in Family Practice found statins and fibrates (used in lowering LDL “bad” cholesterol) may cause erectile dysfunction, while later research has found both men and women taking statins showed increased difficulty achieving orgasm. The levels of sexual pleasure declined along with LDL cholesterol.
Negative Body Image
When you feel good about your body, you tend to feel better psychologically as well. The mind-body connection is imperative in sexual pleasure. For example, if you feel bad about your body, it;ll become more difficult to enjoy sex and have orgasms. A 2009 study in The Journal of Sexual Medicine found women between the ages 18 to 49 who scored high on a body image scale were the most sexually satisfied. Positive feelings associated with weight, physical condition, sexual attractiveness, and thoughts about our body during sex help promote healthy sexual functioning.
You’re stressed so you clench. When you clench, it cramps. It’s a cycle that starts in the mind and finds its way down into the body. And I’m not talking about your jaw, I’m talking about your genitals.
Anxiety presents itself in many ways, but one of its more clandestine manifestations takes place below the belt. For men, that can lead to erectile dysfunction, an ailment we’re all familiar with thanks to late-night ads. Far fewer of us can list the effects anxiety has on the female sexual response cycle.
After researching 5,865 adolescents and adults ages 14 to 94, researchers at the National Survey of Sexual Health and Behavior (NSSHB) found that upwards of 30 percent of women report pain during vaginal intercourse. The most common approach to the problem was to “do nothing.”
As Andrew Heartman, a certified sex surrogate based in California, has reminded us,“[Women] can engage in sexual activity, but not really be present, and not really enjoy it… they can perform sufficiently to have their partner be satisfied.”
Sometimes, it’s worse than just a lack of enjoyment.
“I would say one of the main reasons women come in to see a sex therapist is because they have painful sex,” says Houston-based sex therapist Mary Jo Rapini. “When you talk to them further, you start understanding it’s their anxiety.”
She explained that some women are so hard hit with anxiety during sex that their vaginal muscles tighten up to the point that penetration becomes impossible. “When they do try to have intercourse, they can’t,” she says.
Rapini treated one woman who had gone 12 years without having sex because it was too painful. Even on her wedding night, she was unable to consummate the marriage. In other extreme cases she’s seen women unable to undergo a procedure as simple as a pap smear. “They can’t get the speculum in,” she says. “It’s so tight.”
Unfortunately, stigmas surrounding sex, specifically sexual dysfunction, run deep, and most people shy away from addressing the issues head on. “There’s an element of shame, with anxiety and depression. We’re used to seeing it as a weakness or proof there’s something wrong with you,” says Rapini.
As opposed to the platter of pills available to help enhance male sexual performance, the FDA has approved just one pill to treat sexual dysfunction in women. It’s called flibanerin, and it was originally marketed as an antidepressant.
But just because it’s an uncomfortable topic to bring up doesn’t mean it’s uncommon. As Rapini explains, “Anxiety is growing in the population and it’s incredible… Our brains have trouble just throwing stuff out.” According to Rapini, it’s not uncommon for this kind of anxiety-induced vaginal tightening to occur in women the week before their periods. Many women are also affected during the pre-menopausal period. “Your hormones are all over the place,” she says.
But not all instances fit neatly into a timetable. Rapini explains that women can be especially sensitive to situational factors relating to sex. Women who aren’t comfortable with their partners, women in bad relationships, even women turned off by something said during sex can find themselves closing up at a moment’s notice. “As a sex therapist, my job is more finding tools for them to help them relax,” says Rapini.
Within clinical circles, the condition is known as vaginismus, which the American Congress of Obstetricians and Gynecologists defines as a “reflex contraction (tightening) of the muscles at the opening of the vagina.” Because the condition has been linked to stress and anxiety, therapy is recommended. Often, vaginal dilators are also employed. As WebMD notes, “The approach is called progressive desensitization, and the idea is to get comfortable with insertion.” For women who experience more mild symptoms, other approaches may apply such as antidepressants, warm baths, breathing exercises, and heating pads.
Of course, when it comes to arousal issues with women, you’ve also got to give a nod to lubrication. Vaginal dryness is a big issue, and according to Rapini, it often works alongside anxiety to sabotage women’s pleasure. “For an orgasm to happen, first of all, the woman has to create the scene or the excitement in her mind. You can’t do that if your mind is focused or taken over by anxiety… and especially if you’re not using lubricant,” she says.
Experiencing pain during sex may not be the easiest thing to admit to, but Rapini says it’s not as unusual as one would think. “First of all, this is not abnormal. It affects a large part of the population.” Reports hold that women are twice as likely to experience anxiety as men. But the first step to securing sexual satisfaction in women takes place in the mind. “There’s a rhythm to recovery,” says Rapini. “That rhythm starts by slowing down.”