“I’m lonely, sure, but there’s a lot more to it than that,” said Mary, a lesbian in her 70s who became a widow in 2022. As someone who isn’t interested in a new partnership at this time, she’s feeling a lot of sexual tension. She laughed at her own frustrations but acknowledged that she needs tangible solutions too.
When Mary would connect with her partner, they could physically support each other’s bodies when needed or take turns pleasuring each other and found other “workarounds” for their differing disabilities and needs. Mary, for instance, can’t reach the areas of her body she’d like to touch for sexual pleasure without significant pain due to a previous injury that has flared up in recent years. And she can’t grip a heavy toy due to arthritis.
There’s a misconception that treats older people as if they suddenly become asexual — and while many people do fall on the ace spectrum, people who want to express their sexuality should be empowered to do so.
“I would like to shift our language to an understanding that people are wired for connection and pleasure,” which can take shape in a variety of ways, emphasized Colby Agostinelli, LMFT, CST — an AASECT-certified sex therapist who is nonbinary and queer. “Not all pleasure is sexual and not all connection is with other people.”
For those who are curious about decreasing interest, Agostinelli said hormonal shifts could be a cause — but so could the environment. For example, someone who finds sex to be painful might stop desiring it because their brains expect discomfort. And those who are disabled might have less energy for it.
For others, aging might bring an increase in desire. This can be a product of circumstance too. Retirees and empty-nesters might have less stress and more time to themselves, for instance. But that doesn’t mean sex is always accessible.
“And it’s a very different experience to do that alone,” Mary added about the emotional component of exploring sex on her own for the first time in her life. She admits she was “sort of afraid of masturbation” during her youth then didn’t feel that she needed it when she had a partner. Now she’s afraid she’ll seem perverted if she tries to talk about it.
That’s left her without an outlet for sexual pleasure — a problem she said has negatively impacted her mental health. This is a common complaint among seniors who have questions and concerns regarding sex but don’t often get the help they deserve.
Acknowledging change
“I’m such a big fan of neutrality as a really important way to navigate changes and transitions of all kinds with our bodies, aging, sex — all of it,” said Agostinelli.
“Beyond neutrality, I encourage softness and empathy rather than gratitude for our bodies — as we may have heard before. It is hard to be grateful to something that is making our life harder at times but we can be empathetic and soft towards it,” they added, explaining that anger and disappointment are valid feelings when dealing with a body that isn’t cooperating. But it’s also important to avoid self-judgment or panicking in reaction.
Studies note that people well into their 90s are sexually active, and at least half of 75-85 year olds in the US have sex two or three times per month. Many of those older adults adapt their sexual behavior as they age.
They often need to accommodate their bodies as they experience erectile dysfunction and vaginal dryness — problems often labeled as sexual dysfunction — but also hormonal shifts, arthritis, low vision, mobility limitations, medication side effects, health conditions or other changes that come with aging. Adaptations might also need to occur after the loss of a partner or if partners begin to experience differences in libido and interests.
Doctors, friends and even therapists might support someone after the loss of a partner — but that doesn’t mean they’ll know how to talk about the intersection of sex with that grief. Mary has had some support, but lacking a place to talk about sex makes her feel like she’s on her own as she figures out how to cope.
Even for people who don’t experience such a profound loss as the death of a partner might grieve as they navigate other aspects of aging — including changes in their sex life.
“Create space for it to live in your memory and your discussion even — without forcing yourself to try and figure out how to do it,” Agostinelli said about previous experiences that need to live in the past.
Talking about sex
It’s normal to experience a variety of “first times” later in life — but like Mary, many don’t know where to start when they need to shift their approach to sex after doing things a certain way for a long time.
“We need to normalize change,” Agostinelli said. “It is normal to need to renegotiate what sex looks like in partnerships — not just the positions you’re in to protect your joints and be more comfortable but also how often, who initiates, what counts as sex, how long it should last, what tools or toys should be included, how much lube is needed,” and more.
They explained that it’s important to talk about those details and other logistics — like when to decide that it’s over, whether or not orgasm is important, how much pain is tolerable, how to communicate about discomfort or emotional distress, how to check in and shift in the moment when something isn’t working, what the initiation and come-down processes should look like, and other needs or concerns that are more specific to each person.
These talks might be scary but don’t need to be overly formal and should occur before a couple gets into bed. Talking openly about changing needs and new ideas over dinner might take the pressure off.
These topics are just as important for people exploring sex without partners, reminded Agostinelli. Single people could journal about their goals and interests and keep track of their new experiences by jotting down comments before and after they experiment.
Anyone who is frustrated with their sex life might also need to unpack what else is getting in the way of their goals — including what Agostinelli described as aspects of sexual dysfunction that aren’t often labeled as such. This can include fears about stereotypes associated with seniors, misinformation about aging bodies, negative body image, the inability to come out and live authentically, shame associated with past criticisms, internalized messages from society, and other concerns.
These are conversations and ruminations people can try to engage on their own — but Agostinelli noted that sometimes people don’t know how to begin or feel too vulnerable. Collaborating with a sex therapist can help some explore their values, needs, desires and hopes — which can evolve over time.
“You don’t know what you don’t know,” they added, highlighting that most people never received quality, LGBTQ-competent sex education and might lack the language or information they need to start troubleshooting on their own later in life.
“The job of a sex therapist is to hold a pretty large amount of information — for education, for resources, for interventions, for cool things to try like for exploration,” they said.
Getting a check-up
Agostinelli asks new clients to seek a medical assessment as part of the intake process — but sex-positive and LGBTQ-competent providers aren’t always accessible. Some aren’t prepared to support the needs of queer seniors.
“Older folks still have sex,” said Michael Danielewicz, MD, director of the Pride program at the Jefferson Center for Healthy Aging. “If people’s providers and physicians are not asking them about sex, they should be.”
Danielewicz said it’s important for doctors to talk with older patients about STIs — because illnesses and prevention methods have changed over time. Condoms, dental dams, PrEP might be familiar, but other medications and interventions are newer and could have changed since someone last talked with a provider.
But safe sex is also about more than educating older adults about infections and protection, which Danielewicz said can “medicalize” conversations that should include more holistic care.
“We get so focused on pathology that we lose the idea of pleasure,” he said. “How do we promote pleasure?”
Danielewicz recently saw a patient with a health issue that would be considered minor from a medical standpoint but whose mood and behavior was impacted due to its interference with sex. He said it shouldn’t be the responsibility of the patient to bring up concerns with their doctors and therapists, but they should feel empowered to talk to their care providers.
“Find a primary care provider who you feel comfortable and affirmed with, who you feel empowered to bring this up to — and to be very open about what the issues or concerns are,” said Danielewicz. “Are they issues of function? Are they issues of pleasure? Are there other medical issues getting in the way?”
“Urologists are great. Neurologists are great,” he added. “But primary care can often start these discussions and start treatments and start workups that can help improve function and pleasure.”
While Agostinelli believes medical treatments — including medications, physical therapy and specialist interventions — can be an important part of finding healing and wholeness, medical approaches aren’t the only option for troubleshooting.
Sometimes, self-acceptance can go a long way. People might find that over time, they feel less interested in finding ways to make their bodies function similarly to how they used to. They might find new ways to express their sexuality and decide that erections, orgasms or other experiences they used to have aren’t a necessary part of sexual encounters for them anymore.
Moving to the bedroom
Agostinelli, who provides a service helping clients find gear, said it can be tricky to navigate the array of products available today. Some websites are more user-friendly than others — such as spectrumboutique.com, which Agostinelli recommends. Agostinelli also noted that fat-positive and disability-focused reviews should come up when searching for specific needs online, and this might give new users ideas about what to try.
Consider goals, sensations and current issues. Agostinelli suggested trying pillows, wedges and toy mounts from Liberators, which might be helpful to those who need support with positioning, for instance — but those with other needs should consider the features necessary for their own goals. Someone with arthritis might want a lightweight device or hands-free tool.
But people who want to get to know their bodies don’t have to start at the doctor or go shopping. Agostinelli noted that they could begin by learning about the five dimensions of touch — which start with affectionate touch and can build to sex.
“In my ideal world, everyone has a regular erotic self-exploration or touch practice,” explained Agostinelli — who said this can include masturbation but also other “solo erotic practice which leaves space for pleasure outside of orgasm.”
“We leave space for curiosity, for gentle touch, for fantasy — all without a goal in mind other than to connect with ourselves and our bodies,” they said. “Pay attention to what feels good and not so good alone and with others and name it.”