Older couples may need pillow talk, not pills

Consider the older man who slips into the bathroom before bedtime and surreptitiously swallows a Viagra pill. He decides against telling his wife, afraid she might think he’s having a problem because he’s no longer attracted to her.

Now consider the older woman who admits to her girlfriend that sex with her husband isn’t what it used to be. She’d like to suggest he try Viagra but hasn’t, afraid that he’ll feel more inadequate than she suspects he already does.

A widely reported survey showed recently that older Americans have active sex lives. They are supported in this endeavor by an active pharmaceutical industry that reaps increasing profits from sales of sex-enhancing drugs. Viagra, used to treat erectile dysfunction, brought in $1.7 billion in 2006, for example; its rival Cialis, $971 million.

But no matter how many pills, shots and creams drug companies dispense, therapists say, they are far from finding the potion that will truly enhance the sex lives of an aging population: the ability to talk freely about sex, or the lack thereof. Mortgage payments, Iraq, even a sick child are easier to discuss than sex, especially for boomers who grew up thinking they could have all the sex they wanted, at any time, only to find that they no longer can.

When people are younger -- in their 20s and 30s -- the parts hum. But as bodies age, hormonal levels in both men and women change, sometimes not at the same time. One partner may be up for sex, the other not. A woman in her 40s, therapists say, frequently experiences an increase in desire while a man’s performance in those years is taking a dive. At about 50, the average age for menopause, her desire may begin to decline and reach a level lower than his.

Add to this the routine of a marriage or long relationship, as opposed to the fireworks of new attraction, and you’ve got the setup for a long night’s snooze every night.

“Most of us really care about our partners and want to be in those relationships,” says Gina Ogden, a Cambridge, Mass., sex therapist. “But sexual pleasure after 20-plus years of being together? The blush is off the rose. And we don’t have a language for talking about it. The experience is larger than you can count or measure.”

Sexual satisfaction contributes to overall health, experts say. Couples who enjoy sex together fight less often and relax more easily. If they have children, family life runs more smoothly.

A good sex life “helps build the bond of family and makes up for things that wear and tear on the family,” says David Scharff, a Washington psychiatrist and former president of the American Assn. of Sexuality Educators, Counselors and Therapists. Carolyn Shaffer, a Bethesda, Md., psychologist, has seen this pattern among her clients as well, particularly men.

“A man can have all these problems with his wife, but when we fix the sex life, the other things go away,” she says.

That said, older Americans, in large numbers, are enjoying sex. The recent survey of Americans ages 57 to 85, which was headed by researchers at the University of Chicago and published in the New England Journal of Medicine, revealed that more than half were sexually active at least two or three times a month.

But almost half of the sexually active also said they had problems with sex.

No. 1 for men, according to the Chicago study, was erectile dysfunction, or ED. Most sexual problems have multiple possible causes, which is why they’re difficult to talk about with any clarity, and ED is no exception. It can occur because of disease, excessive drinking, concerns about work or family.

“Is it that he can’t or doesn’t want to? He may not know,” Scharff says.

In the Chicago study, women reported more problems with sex than men; almost half had experienced lack of desire. For some, that may have been for physical reasons such as pain during intercourse. They may be quite happy simply spending a quiet evening together watching a movie. “I don’t have a lot of these women saying, ‘I want my husband to take Viagra,’ ” Washington social worker Gwen Pearl says.

Emotional reasons, particularly if tied to their relationship with their partner, can also diminish the quality of sex for women. Sex, Scharff says, is a true psychosomatic function for both sexes; if a woman is angry at her partner, that will show up in bed.

Once couples agree on change, therapists advise them to vary what leads up to the lovemaking. Some couples enjoy watching a sexy movie, or reading erotica together, or taking a bath, says Lawrence Sank, a psychologist who shares an office with Shaffer, his wife.

Shaffer recommends her clients go on a weekly date, a picnic or long walk, anything that reminds them why they picked each other. She also suggests couples relax together each night, alone.

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Finding the right words

Therapists advise two approaches to having a conversation with a partner about sex:

* The straightforward: “We’re both getting older, things are changing a little bit, and I think we need a little help. It might help our sex life if . . . “

* The compliment: “I love how you . . . ,” followed by “I was hoping we could . . . ,” then something else positive: “It could add so much to our relationship.”

Be clear about what you want. Is it variety? More time spent holding each other? Having intercourse more often? Or taking more time when you have it?

Conversation takes practice. When it comes to sex, most people grow up feeling not only inadequate but inarticulate.

Find out what your partner wants by asking something like, “What more can I do for you?”

SOURCES: Hilda Hutcherson, professor of obstetrics and gynecology, Columbia University and author of “Pleasure: A Woman’s Guide to Getting the Sex You Want, Need and Deserve”; Gina Ogden, marriage/family/sex therapist and author of “The Heart and Soul of Sex”; Lawrence Sank, psychologist and sex therapist; Judith Steinhart, health and sexuality educator.

-- Washington Post