Don’t Give Up on Sex

Maslow’s Hierarchy of Needs was first published in 1943. He based his research on observations of rhesus monkeys at the University of Wisconsin. He established that the most basic physiological needs are the solid platform from which one can reach higher goals. Without satisfying basic needs of food, drink, sex, air and sleep, we are unable to move towards self actualization. This does not change as we age. 

As a psychiatrist, I have noted that while we take care of eating and drinking pretty well, sex is often given up, relegated to the young. Relationships are in mayhem because of it. One partner may need it to feel safe and secure, while the other feels like if it never happens for the rest of life, that would be just fine. 

I would like to make a case for the fact that giving up on a sex life- in whatever form you see it- is not a wise option, especially as we age. I’m focusing on the medicine side of Love + Medicine in this post. Putting on my white coat.

What happens during sexual arousal
and why does it matter?

The key element in arousal is blood flow. I know, that doesn’t sound very sexy. During sexual arousal there is an increase in blood flow to the heart, genitalia and brain. In sex therapy training, a full physical exam was part of the evaluation of patients with sexual dysfunction. I have seen atrophy, a loss of elasticity and vigor. Without blood flow, without use, our bodies atrophy. It is a direct consequence of underuse or neglect. 

In women, there is a thinning, drying and inflammation of the vaginal walls and labia due to the absence of estrogen. Less blood flow to the clitoris and lower vagina causes diminished clitoral sensitivity. This is often accompanied by urinary symptoms and painful intercourse. Fear of pain can cause anticipatory anxiety. Nearly 50% of women experience this but do not share it with their doctors. 

In men, with the decrease in testosterone and subsequent decrease in blood flow, the head of the penis loses its purple color. There is a reduction of both length and thickness of the penis and shrinkage of the testicles as well as increase in sexual dysfunction. This is all due to blockages in the tiny arteries in the penis, again blood flow. 

Lack of blood flow leads to genital area atrophy. Atrophy is already a natural part of the aging process. Why hasten it? We are constantly trying to extend our youthfulness. This needs to be a part of that discipline. 

By increasing blood flow, lubrication increases. Lubrication has a “kindling effect”- by increasing lubrication, libido increases. This feedback loop to the brain helps to make intercourse pleasurable rather than painful.

Painful intercourse is not normal and should be investigated. Chronic health conditions and extremely common medications can effect energy levels and sexual functioning. There are common illnesses that increase with age that can be treated, but first they need to be diagnosed. Lichen sclerosis is one of those that can easily be missed. See my Why We Need to Talk About Sex post and please talk to your doctor about painful intercourse. It is not a natural consequence of aging. 

I want to emphasize that this is not only directed to couples. Masturbation will accomplish the same goals. Regular sexual activity, with or without a partner, can help maintain healthy sexual organs. 

Sex changes, no doubt, with age. Its prominent place on Maslow’s pyramid does not change. It remains an important drive that should not be ignored. We are all either out there exercising or talking about going out to exercise. Make this part of that routine and get the blood flowing!


  1. Terri Roberts on May 9, 2017 at 1:04 pm

    I love this entry Anne, not only interesting on it’s own, (when is sex not interesting?) but also a cool biology lesson!

    • Anne Koplin on May 16, 2017 at 2:18 am

      We tend to focus on certain parts (wink, wink) while there is an entire cascade of events going on all over the body. It’s totally fascinating!