A science-based, stigma-free guide for Nellikka.life readers

Quick note: This article is educational and not a substitute for medical care. If something feels painful, frightening, or unsafe—speak to a clinician.

The biggest myth (and why it hurts us)

Aging does not turn off intimacy. Many older adults desire closeness and remain sexually active; in a national poll of people aged 65–80, 40% reported being sexually active and most rated intimacy as important to quality of life—yet only 17% had discussed sexual health with a clinician.[1]

The World Health Organization is blunt: sexual health is about wellbeing and dignity across the entire lifespan, not just the reproductive years. [2]

So let’s replace hush-hush myths with clear, practical facts.

What actually changes with age (for most bodies)

1) Hormones & tissues

• Menopause & GSM: Falling estrogen after menopause can thin and dry vaginal tissues and change vaginal pH—this cluster is called Genitourinary Syndrome of Menopause (GSM). Symptoms include dryness, burning, pain with penetration, and sometimes urinary urgency.[3]
  • What helps: regular use of vaginal moisturisers/lubricants and, where appropriate, low-dose vaginal estrogen, which is the most effective therapy for GSM and has strong safety data for local use. [4]
• Testosterone in men: Testosterone may decline with age in some men, but treatment is recommended only for proven hypogonadism (symptoms and consistently low levels) because benefits/risks must be balanced.[5]

2) Arousal, erection, and orgasm

• Erectile function commonly changes with age and health conditions. The American Urological Association recommends a proper medical, sexual, and psychosocial history, exam, and selective labs; a range of effective treatments exist (counselling, lifestyle, oral medicines, devices, injections). [6]
• For many women, arousal takes longer and orgasm may feel different due to blood-flow and nerve-sensitivity changes—this can be normal and not necessarily a “dysfunction.” [7]

3) Medications & conditions

Common culprits behind low desire, erection problems, or painful sex include antidepressants (especially SSRIs/SNRIs), some blood pressure drugs, diabetes, heart and lung diseases, arthritis, depression, and anxiety. Don’t stop medicines yourself—ask about alternatives or dose timing. [8]

4) Pelvic floor

Pelvic floor muscles influence continence, comfort, and arousal. Pelvic-floor physiotherapy (with a trained therapist) improves chronic pelvic pain and dyspareunia for many women and can help men after prostate treatments. [9]

Safety truth most people miss

STIs are rising in older adults, in part because people re-enter dating after divorce/widowhood and use condoms less often. Clinicians recommend routine STI screening when sexually active with new partners.[10]

Real-world fixes that work (and how to use them)

Lubricants & moisturizers (first line for dryness/pain)

• When: every time for penetrative sex; moisturizers several times per week.
• What to buy: products with body-similar pH/osmolality (avoid very hyper-osmolar gels that can irritate); silicone or balanced water-based options are both fine. [11]
• If symptoms persist: ask about low-dose vaginal estrogen (cream, tablet, ring). It treats the cause (tissue changes), not just the symptom. [12]

Erectile changes

• Get a cardiovascular and metabolic check (ED often overlaps with heart and vascular health). Treatments span PDE5 inhibitors, vacuum devices, injections, counselling for performance anxiety, and management of comorbidities—chosen via shared decision-making.

Ejaculatory concerns (too fast/too slow)

• There are behavioural techniques and medical options (topical anaesthetics; selected SSRIs or clomipramine on specific regimens) for premature ejaculation; evaluation also looks for comorbid ED.

Pelvic floor & pain

• For painful sex (vaginismus/dyspareunia), evidence supports multimodal pelvic-floor physiotherapy and graduated desensitisation. Pair with GSM care if post-menopausal. [13]

Menopause symptom relief

• For hot flashes/night sweats and GSM, menopause hormone therapy (MHT) is the most effective treatment for eligible women (typically within 10 years of menopause onset/under 60). Decisions are personalised to balance benefits and risks. [14]

Intimacy that adapts (and gets better)

• Expand the definition of sex. Many couples find more satisfaction by focusing on touch, timing, and comfort rather than scripted intercourse.
• Pain-free positions & pacing. Joint issues? Explore side-lying or positions that reduce hip/knee strain; use pillows, wedges, and longer warm-up.
• Talk like a team. Specific, kind phrases (“slower pressure,” “more lube,” “let’s pause and cuddle”) build connection and reduce performance anxiety.
• Mind matters. Sleep, exercise, alcohol, and stress management influence hormones, blood flow, and mood—which all show up in the bedroom.

Inclusive note

Older adults are diverse—single, partnered, remarried, LGBTQIA+. Good care is affirming and person-centred; clinicians should ask inclusive questions and recognise unique barriers faced by sexual and gender minority elders.

When to see a clinician (don’t wait)

• New pain, bleeding, or discharge; persistent dryness; recurrent UTIs
• ED that doesn’t respond to simple changes (screen for heart disease/diabetes)
• Low desire that causes distress, mood changes, medication side effects
• STI risks (new partner, condomless sex) or any coercion/violence
  A primary-care doctor, OB-GYN, urologist, or pelvic-floor physiotherapist can help—and should take your concerns seriously. [15]

Conversation starters (save these)

• “I’m post-menopausal with dryness and pain. What are my options, including local estrogen and pelvic-floor PT?”
• “My erections are unreliable. Can we review meds, check heart risk, and discuss the full range of ED treatments?”
• “I’m dating again. Please order STI screening and advise on condoms and vaccines.”

The Nellikka.life takeaway

Intimacy in later life is normal, healthy, and often deeply satisfying—but bodies change, and so should care. Address dryness and pain early, protect your heart and pelvic floor, treat medical issues that get in the way, and insist on the same respect and safety you would at any age.

You don’t have to whisper about this. Ask. Treat. Enjoy.