2. Sex

3. Delicious Languages Physiology Population studies Film Clip Practical issues Equipment

5. “Sex… is the deep delicious undercurrent that runs beneath all our lives and thoughts” Rosie Scott Language of sex

6. Two Languages

8. Quotations from “You Are My Darling Zita” by Glen Bush Publisher Godwit 1991

10. Muriel Morrison As we have become older the sexual act itself has become very much less important … Certainly there is a real need for kissing, hugging and all kinds of gentleness. What we have now is not less intimate, it’s just different.

11. We were funny creatures… bursting our boilers to get there… ejaculation…orgasm! At our age any sort of pressure to perform is long gone. What feels good now is to be relaxed, quiet and just enjoy the moment with John…

12. John Morrison … the purely erotic side of my life has practically gone, that I can now enjoy the subtleties of affection and delight in another's presence, that I am able to touch or cuddle without the kind of sexual stimulus that was inherent in that at a younger age - that is a tremendous relief. Now, you see, that may be hard for a young person to understand

14. “Sex isn’t as powerful a need as when you are young but the whole feeling is there; it’s nice as it ever was. He puts his arms around you, kisses you, and it comes to you – satisfaction and orgasm - just like it always did... Don’t let anybody tell you different. Maybe it only happens once every two weeks, but as you get older, it’s such a release from tensions.

15. I’m an old dog who’s even tried a few new tricks. Like oral sex, for instance … We weren’t too crazy about it though … We take baths together, and he washes my body, and I wash his. I know I’m getting old and my skin could use an ironing but we love each other - sex is beautiful.”

16. Physiology & Ageing

17. Masters and Johnson (1966)  700 subjects  Only 31 over age 60!  Physiological studies and photos during intercourse and masturbation  Established ‘phases’ of sex response  Clitoral vs vaginal orgasm  ? Activity forestalled age change in genitalia

18. The Older Male  Testosterone ↓ - but variable  Fertility ↓  Penile atrophy  Erection slower, softer, less sustained  Orgasm awareness reduced  Ejaculation – less fluid, force and duration  Rapid detumescence, longer refractory period  Libido peaks in 20’s, falls throughout life

19.  Erection is slower, softer, may need manual stimulation  Needs time

20. The Older Female  Oestrogen ↓  Fertility lost  Vaginal atrophy and loss of elasticity  Breast atrophy  Vaginal lubrication slower and reduced  Orgasm shorter but NOT lost  Libido peaks @ 30-40’s,maintained into 60’s+

21. The Older Female  Vaginal lubrication is slower and decreased  Needs time

23. Kinsey

24.  1940’s  Landmark of sex research  10,000+, 2 hr interviews  300+ questions on sexual behaviour  15 years to complete Only 48 men and 31 women over 65yrs

26. Stuff That ! ! !

27. 254 people, age 60 - 94 yrs Followed 3 yearly x 2 50% of 80 yr olds still moderate libido 20% of 80 yr old men still sexually active 15% all subjects increased libido / sex (women 6%, men 25%) - Why? Duke Longitudinal Study Verwoedt et al, 1970

28. Duke Longitudinal Study  Late marriages!  30% married couples over 75 years sexually active  But overall decline in libido / sex

29. Determinants of Sexual Activity  Regression model on 502, 46 to 71yrs  Past activity and enjoyment  Being married  In men being physically well  Use it or lose it Pfeiffer, Davis 1972  Tendency for level of activity to be stable if married George, Stephen, Weiler 1981

30. Swedish X-Sectional Study  1506 (F = 946, M = 560), 70 year olds  1971, 1976, 1992, 2000  As part of broader study of ageing  Increasing proportions in later cohorts report:  Sexual activity (M>F)  Sexuality as a positive factor in their lives

31. Swedish X-Sectional Study  Reporting sexual intercourse  Married male: 52% to 68%  Married female: 38% to 56%  Single male:30% to 54%  Single female: 1% to 12%

32. Swedish X-Sectional Study  Of those sexually active, later cohorts:  Females  Higher proportion report satisfaction and orgasms  Males  Higher proportion report high & low satisfaction  Lower proportion report dysfunction  Men not active due to personal reasons  Women not active due to partner related factors or no partner

33. Why Do People Stop Sex ?

34. “In my experience older people stop having sex for the same reason as they stop riding a bicycle general infirmity think it looks ridiculous no bicycle.”

36. “Innocence” Director Paul Cox

37. Sexuality – Practical Issues  Ask your older patients about their sex lives  They won’t faint !

38. Practical Problems  Women  Dryness  Reduced interest  Orgasm more difficult  Men  Early ejaculation  Erectile difficulties

39. Important Issues Medical  Medications  Diseases  impotence  Surgery:  prostate, uterus  Catheters, pessaries  Mobility  Altered body image  Depression Psychosocial  No partner  No privacy  Social conditioning

40. Equipment