Sexual problems in older people

Brief couples work for sexual problems in older people entails 3 or 4 1 ½ hour sessions, for heterosexual couples where at least one partner is aged over 60. There is no upper age limit.

The approach is neurodynamic, focused on body as well as mind, and the neuropsychology of the emotions as well as of thought.

The first session is a careful discussion of the couple’s sexual life, its history, and current problems. Breathing and movement exercises from my book Couple Dynamics may be suggested (with hand-out guides), along with changes in sexual activity. The following sessions review progress and consolidate it. In some cases, the work stops after one or two sessions because it is not progressing as hoped, and in other cases because the couple’s goal in the work has been reached.

This work is not likely to be useful where one or both partners have received a psychiatric diagnosis of psychosis and are being treated for this.

It may be useful in the treatment and management of such conditions as premature ejaculation, delayed ejaculation, and lack of sensation or of orgasm, but is less likely to help if these conditions have been chronic over many years.

This work is most likely to help in problems of healthy aging.

Sexual health in older people

What is sexual health in older people? The scientific evidence is that penile-vaginal intercourse (PVI) is associated with good physical and mental health. Yet there is also evidence that as couples age, they may experience PVI less often, and other sexual activities (masturbation, the use of mechanical aids, drugs, or pornography) more often. Sex often loses its closeness, its coming together, and becomes a mutual servicing of needs, or it stops becoming a joint activity, and becomes detached from the emotional life of the couple.

As people age, they may take more medications, and this is a double-edged sword. On one hand, the new medicines for erectile dysfunction can revive the sex life of couples, but on the other hand, medicines for hypertension or for depression may diminish it or even extinguish it.

Sexual problems with ageing are often physical. But they are also often psychological – in the broad sense of ‘psychology’ to include not only thoughts but emotions. Often a complex psycho-physical situation occurs with ageing, where changing bodies experience thoughts and emotions differently, and where sex between the couple becomes not a source of pleasure and delight, but one of tension, frustration, and despair.

Working psychologically with sexual problems in older people is one way into this complex psychophysical situation. It does not always work, particularly where physical problems are severe. And it cannot promise changes in long-established personality traits (which are in any case largely genetic). We cannot change people. But where the people sense that there is something going wrong which they can change, a few sessions of couples work may help.

At best, couples work with sexual problems can refocus the partners on the PVI which in most cases was a passionate part of their early life together. In some cases, the therapy may lead to more of a compromise. Very occasionally a couple may even decide to separate, which is a risk in couples work or therapy. Individual therapy work encourages the person to face him or her self. In couples work each person also faces the other. Long-term work to ‘save’ a difficult situation may instead, by intensifying it, make it worse.

In brief couples work there is an intensification of feelings and thoughts – of the relationship. But it is a modest enterprise. We cannot change ourselves very much, but we can change our relationship to some extent. And in general, older people have one advantage: they are less ‘armoured’ against emotions, less likely to resist them. Literally their ‘muscle armour’ against open breathing and deep feelings is less rigid than when they were younger. New, more intense feelings – whether of anger or love may emerge. Paradoxically, some older people are made anxious by depths of pleasure which are new to them! Many older people report sexual lives which are more passionately experienced than ever. Others settle cheerfully for less. Brief couples work cannot create love, but it may help the couple clear away some barriers to love.