Chapter 36
Sex and Intimacy — Part 1
There’s a common misconception that as people age, they lose interest in sex and the capacity for sexual behaviour. This is not the case: older people remain sexually active and continue to attribute importance to sex well beyond their fifties – for a substantial proportion, into their seventies, eighties and nineties. Decline in desire with advancing age is not inevitable. Attitudes towards sex are determined by society as much as biology, and much of the biology can be managed by medications, creams and technologies. In the main, sexual activity is an essential part of intimate relationships and happiness as we age.
As evidence for this, our TILDA research reported 80 per cent of couples with an average age of 64 consider sex to be important and 60 per cent are sexually active at least weekly to twice per month. Recent data from an English study showed similar results. Older adults in England enjoy life more when they are sexually active and those who experience a decline in sexual activity report poorer well-being than those who maintain levels of sexual desire, activity and function in later life.
Although being sexually active is largely dependent on having a spouse or cohabiting partner, this is not exclusive and one in ten older persons who are unmarried or not cohabiting report a romantic or intimate partner and almost all are sexually active at an average age of 70, reinforcing the message that sexual activity and pleasure is not solely the dominion of the young. Lindau’s more recent work showed that the frequency of sexual activity in older persons is similar to that of adults aged 18–59 in a US study in 1992.
Chapter 10: Sex and Intimacy
Couples who are regularly sexually active and satisfied with their sex lives are more satisfied overall with life as a couple and have a more positive attitude towards ageing. Data on sexual activity and enjoyment of life consistently shows that sexually active individuals have a better quality of life and better relationships, are happier, less likely to be depressed and, in some studies, even live longer. Men and women who are sexually active have better memory and concentration. Sexual satisfaction and frequency are associated with better communication within couples and synchronicity in sexual desire and activity.
It’s no secret that sex can help to produce that ‘feel good’ factor. This is largely because during sex, in addition to oxytocin, endorphins are released, which generate a happy or elated feeling. People who engage in sexual intercourse also have better mental health, with less depression and anxiety. Higher endorphins benefit the immune system, with all of the same advantages accrued from endorphin release during physical exercise. It is a big leap of faith to suggest that sex reduces diseases such as heart disease and cancer but nonetheless, there is accumulating circumstantial evidence that suggests this could be the case.
Chapter 10: Sex and Intimacy
Masters and Johnson were the amazing pioneers of sexual studies who carried out groundbreaking observations of sexual activity and its biological consequences in the mid-1960s. Theirs was revolutionary work and it’s fair to say that opinions were divided on the value of the studies at the time, which we now know were invaluable and have directed so much of our subsequent work in this field. The couple reported 11 years of physiological observations that involved 382 female volunteers, 18 to 78 years of age, and 312 male volunteers, 21 to 89 years of age. The research confirmed that sex is a physical activity which burns, on average, four calories a minute. During sexual activity, breathing progressively increases to rates as high as 40 breaths per minute. Heart rates also rise dramatically to 180 beats per minute, equivalent to that experienced at the peak of running very fast on a treadmill, and blood pressure also rises, again by dramatic levels of 80 mm Hg. To put this in context, during the day, blood pressure varies by about 20 mm Hg unless we are doing intense physical exercise. This explains why sex is an exercise and why it releases so many of the neurotransmitters or ‘feel good’ factors which are also released during exercise.
More recent studies have used wearable measurement technologies to determine energy expenditure during sex and shown that it compares with a 30-minute moderate intensity endurance running session on a treadmill and is slightly higher in men.
Chapter 10: Sex and Intimacy
Despite the fact that one gains mental and physical health benefits from regular sexual activity, healthcare professionals and even media sources rarely give regular information on and encouragement to older people to explore sexual activity. In many cases, when it comes to older people and sex, doctors, nurses and others often put their heads in the sand and fail to talk about it. Such discussions could help to challenge norms and expectations about sexual activity and help people to live more fulfilling and healthier lives well into older age. Furthermore, most of the biological issues which complicate sex in later life are amenable to investigation and treatment and should be discussed. In studies in both US and UK, over half of sexually active people reported sexual problems in their sixties, seventies and eighties. This is all the more reason for the medical profession to discuss sex and sexual problems with patients at all possible opportunities because most are remediable. Could sex be good for the brain as we get older? In a study of almost 7,000 people aged between 50 and 90 years, volunteers were asked detailed questions about sexual activities in addition to completing tests of mental ability. The study also included a host of other assessments, meaning that the researchers were able to correct for all elements that affect mental health apart from sex and thereby look exclusively at the effects of sexuality on mental ability. Their paper was titled ‘Sex on the Brain’ and confirmed better mental abilities for planning and memory in sexually active older people. In other words, being sexually active was an independent benefit for brain health. The researchers speculated, very reasonably, that the benefits were because of release of oxytocin, dopamine and other endorphins – key brain neurotransmitters that control the transfer of messages from cell to cell. Other research in both humans and animals in the last decade underscores that frequent sexual activity might enhance performance on brain abilities – particularly memory. In addition to vaginal and oral sex, masturbation, kissing, petting and fondling are all associated with better memory function.
Chapter 10: Sex and Intimacy
Sex is even good for animal brains. A 2010 study discovered a link between sexual activity and growth of new brain cells in male rats. Specifically, rats permitted to have sex daily over a two-week period demonstrated more new brain cells than rats only allowed to have sex once during the same period. Building on this, further male rat studies found that daily sexual activity was not only associated with the formation of new brain cells but also with enhanced brain function. In this case, the older rats that were exposed to daily sex grew new brain cells and performed better on memory tests. When the rats were deprived of sex the new cell formation stopped and the tests of memory deteriorated. The authors concluded that sexual activity is good for the brain provided it is repeated and persists. Of course, these experiments were not carried out on humans and whether they can be extrapolated has yet to be proven. Furthermore, we need studies on female rats’ brains to understand their experience!
There are a number of possible explanations as to why engagement in sex might result in new brain cell formation and improved memory. In animal studies, penetrative sex is a form of physical activity which enhances cognition. Furthermore, the ‘reward’ aspect of intercourse may be a mechanism by which new brain cells form. The reward system is the ability to learn from positive experiences and understand motivation. Exposure to male pheromones both activates the female reward system and stimulates formation of new brain cells. Also, engaging in sex is associated with decreased stress and decreased depression. Stress and depression both blunt the formation of new brain cells. Finally, vaginal sex increases levels of serotonin and oxytocin, two neurotransmitters involved in stimulating new brain cell formation.