Most older Americans grew up not talking about sex. Through others' silence, they were taught to believe that sex was shameful and taboo. Any mention of sex between "old folks," in particular, made people shudder.

Sexual activity is a natural and healthy part of life. In fact, you can get better at sex and enjoy it more—at any age. I treat couples in their 80s and 90s who wouldn't dare tell their children or grandchildren that they're seeing a sex therapist. Typically, whatever the state of their sex life, therapy improves it.

With retirement's gift of time, you can learn how the aging body works differently from its younger self, what pleases you individually and how to please each other in new ways.


Yes, bodies change with age. Many women start to feel old and asexual at menopause. Men may develop erectile problems. But most difficulties can be overcome.

Physical change: Chronic conditions, such as diabetes, thyroid disease, cancer, Parkinson's disease and depression, can affect sexual function. With heart disease, sex can cause chest pain, and with asthma, breathlessness.

Remember, intercourse is the equivalent of walking two city blocks. Check with your doctor first.

Physical change: Joint pain and stiffness from arthritis makes sex difficult.

Solution: Relax in a Jacuzzi or bath before sex...vacation together in a warm climate...find new positions that won't stress your sore spots.

Physical change: Many drugs—antidepressant, hypertension, heart disease and some cancer medications, as well as alcohol—can affect sexual function.

Solution: If your sex drive is down or you're having other sexual problems, ask your doctor whether your medications could be the cause and if switching might help.

Physical change: After menopause, vaginal tissue becomes less elastic, the vaginal opening becomes smaller and lubrication decreases.

Result: Discomfort during intercourse.

Solution: Don't avoid sex—increase it. The more tissue is exercised, the more it stretches and the more you relax your muscles. Using your finger or a dildo, gently widen the vaginal opening every day. If the problem persists for more than two months, see a gynecologist or sex therapist.

Meanwhile, smooth the way with a nonprescription water-based lubricant, such as Astroglide or K-Y Jelly.

Not as good: Oil-based lubricants or petroleum products such as Vaseline. They may linger in the vagina and irritate it.

Bonus: Applying lubricant may get you in the mood for sex. Or let your partner apply it as part of lovemaking. Good foreplay makes lubrication flow naturally.

Physical change: With age, men require more manual stimulation for erections, take longer to ejaculate and have a longer refractory period—the amount of time between an orgasm and the next erection.

Solution: Patience. These changes ate an invitation to discover the slow, loving sex that many women, in particular, have always wanted but haven't received.

Erectile problems can be treated medically, too. Discuss the situation with your doctor. You may be referred to a urologist for medication or other treatment.


Couples in their 60s and 70s and older often ask me what to do about erectile problems and other issues that interfere with intercourse. I tell them to slow down—expand their sexual horizons, develop new sexual habits and start all over again. The goal is simply to feel more.

Our society fears low-level arousal—pleasurable excitement that doesn't lead to penetration or orgasm. But those who have always resisted "just touching" become gluttons for such physical connection once they realize how great it is.

Exercise: During the day or with a light on at night, one partner lies back and is touched by the other—but not on the breasts or genitals—for 15 minutes to an hour. The person being touched stipulates what's wanted in a nonverbal way. If you would like your partner to touch more slowly, put your hand over your partner's and slow it down. When the "touchee" is finished, switch places.

Simple interludes set a loving, sensual tone and encourage you both to overcome shyness about requesting what pleases you. Prolonged sensual touching without genital contact removes sexual anxieties...helps you become relaxed, sensitized and responsive...revives a sense of trust and well-being that you may not have experienced since you were stroked as a child.

You'll emerge from the interlude feeling wonderful about each other. Resentments and recriminations will evaporate, Making sensual, uninhibited love often follows naturally. If not, there's always next time.


Our society presumes that only the young and skinny are (or should be) sexually active. As a result, many older people avoid sex out of embarrassment about spotted skin, a protruding stomach, wrinkles and flab. (Do remember that while you are ashamed of your wrinkles and protruding belly, your partner's eyesight has probably also diminished!) A mastectomy or other surgery can interfere with self-esteem, too, especially with a new partner.

Your body is miraculous. Learn to love it the way it really looks. One woman attending my sexual self-esteem workshop said, "I did not learn to love my body until I lost it." But your body at any age is a gift. Value it for itself...not as it compares with anyone else's or to how you looked when younger.

Exercise: Stand together before a full-length mirror. Say what you like about your own body out loud. Do this exercise alone first, before sharing it with your partner. Then try the exercise with your partner, taking turns. Listen, but don't respond.

To learn to appreciate your body, admire it often. Come away from this event loving five things about your body.

If you look better, you'll feel better. I recommend exercise—walking, swimming, Pilates—to couples of all ages. Getting stronger makes both women and men look better and feel more powerful. . .more sexual.


The young body works without thought. As you grow older, you can—and may need to—benefit from learning more about your body and your lover's. The key to intimacy is to express your needs—once you have learned what they are—and to insist on knowing the needs of your partner so that you can try to fulfill them.

Special note to women: If you rarely initiated sex but would like to, take baby steps. Try asking for different ways of being touched, or take his hand and show him how you like to be touched.

Exercise: Turn up the thermostat, and hang out nude together. Sleep nude in the same bed even if you haven't done so for years.

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