UPDATED: February 11, 2025
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I doubt that you'll see many Substack posts extolling the health benefits of sexual activity and skin-to-skin contact. Hence, the need for articles to fill that void, such as this one and the many excellent posts that can be found on Dr. Amber Hull’s Substack website.
I do need to say a few things about some of the perils that accompany sex. The risks go far beyond unintended pregnancies and the consequences that women endure when they are forced to give birth to unwanted children, something that is now happening far too often in states with stringent anti-abortion laws. The sexual transmission of infectious diseases presents both personal and public health challenges.
An Epidemic of Sexually Transmitted Infections (STIs)
Headlines intended to grab our attention are often worded in ways that deliberately scare us. For example, “One in five Americans have a sexually transmitted infection!” The reality is that more than 26 million new STIs are reported each year, half of which occur among people 15-24 years of age. STIs result in a total of about 16 billion dollars in direct medical costs. The CDC's overview of sexually transmitted diseases (STDs) paints a grim picture.
There are over 20 diseases that can be transmitted by bodily secretions and skin-to-skin contact. Some of the most common ones include:
Human Immunodeficiency Virus (HIV)
Human Papillomavirus (HPV)
Hepatitis B
Hepatitis C
Herpes Simplex Virus (HSV)
Molluscum contagiosum
Mpox (Monkeypox)
Chlamydia
Gonorrhea
Syphilis
Trichomoniasis
Scabies
Pubic lice (Crabs)
Tinea (Ringworm)
The serious consequences of untreated STIs, and the fact that many of those infections go undetected, make this an epidemic that requires our urgent attention. It will take a collective public and private effort to increase access to community health services and programs that prioritize STI prevention, and follow appropriate diagnosis and treatment guidelines.
Sex education is an important element of STI prevention. A worthwhile sex-ed program will include accurate information about contraception and STI prophylaxis. However, only 29 states mandate sex education, and teaching abstinence-only is mostly counter-productive. Florida's public schools are have been politically pressured to almost all delete information about sex from their sex education curriculum.
If you are one to engage in adult-adult, consensual casual sex or serial monogamy, it would be prudent to educate yourself about the proper use of condoms and the employment of pre- and post-exposure prophylactic medications. It would also be wise to get vaccinated against HPV and hepatitis B. Practicing good hygiene before and after sex can further reduce STI risks. (BTW, “pre-” means before, and “post-” means after, so linking them together would be preposterous.)
If you are embarking upon a relationship with a commitment to sexual exclusivity, then open and honest communication with your partner is essential. Both of you should get tested for STIs, and get treatment if necessary, before having unprotected sex.
The information provided here should be valid for any sexually active adults, regardless of their gender identification as LGBTQ+, or their transactional preferences, ranging from celibacy to polyamory. For those who haven’t been paying attention to the current cultural zeitgeist, LGBTQ+ is an umbrella term that refers to a variety of sexual orientations and gender identities, including lesbian, gay, bisexual, transgender, queer, and more.
One more thing: If you are over the age of 50, safer sex includes your partner knowing how to perform cardiopulmonary resuscitation (CPR). This is not a joke! A professor at a medical conference I attended had his life saved by his RN wife when he suffered a cardiac arrest during sex. Two other people of my acquaintance died during sex because their partner didn’t know what to do.
The Upsides of Safer Sex
We are, deep down in our DNA roots, social primates. Although our allegedly civilized society doesn't encourage the kind of grooming activities we can observe taking place among chimpanzees, is there anyone among us who doesn't appreciate a warm embrace from a fellow human being? Unlike chimps, human females are sexually receptive throughout their menstrual cycle, which facilitates pair-bonding and male recognition of their progeny.
Sexual activity can offer a variety of physical and psychological health benefits. Its advantages can vary greatly, depending upon the nature of the activity, the emotional connection between the participants, and the overall health and emotional well-being of the people involved. Rewards will depend upon the quality, quantity, and context of one's sexual experiences. It is therefore important to approach sexual health holistically, and in ways that feel right for you and your partner.
Regular sexual activity can serve as a form of physical exercise, similar to high-intensity interval training, and improve one’s cardiovascular health, but sex is not a substitute for regular exercise. Studies have found that people who have regular sex may have a lower risk of heart disease. One study followed heart attack patients and found that those who had weekly sex had a significant reduction in mortality rate.
Sex has been shown to boost the immune system’s function. People who engage in sex more frequently tend to have higher levels of immunoglobulin A (IgA), an antibody that helps fight infections. One study found a lower incidence of disease among those who have sex more than three times a month, in comparison with those who have less sex. Another study found that more frequent ejaculations throughout adult life reduced men’s risk of prostate cancer.
Because sexual activity results in the release of endorphins and hormones, it can help to alleviate chronic pain. The analgesic effect of sex has also been noted with conditions such as menstrual cramps, backache, and headaches. After an orgasm, regardless of how it is achieved, the release of hormones such as oxytocin and prolactin reduce stress, lessen anxiety, promote feelings of relaxation, and can improve sleep quality. Orgasms can elevate mood and relieve feelings of depression.
Regular physical and emotional intimacy can enhance bonding and improve relationship satisfaction. Oxytocin, sometimes referred to as the “bonding hormone,” plays a key role in enhancing feelings of connection and trust between partners. According to one study, sex can deepen attachment and strengthen emotional bonds with one’s partner.
Sexual activity plays a role in balancing some hormones in women. It can help to regulate menstrual cycles and reduce the severity of the premenstrual syndrome (PMS). For men, regular sexual activity can support higher testosterone levels and better sexual health overall. As mentioned before, more frequent ejaculations, through sexual activity or masturbation, are associated with a lower risk of prostate cancer.
Some studies suggest that regular sexual activity might also support cognitive health, particularly in older adults. The release of oxytocin may have neuroprotective effects, promoting mental clarity and potentially helping to reduce the rate of cognitive decline with aging. Some research suggests that people who engage in regular sexual activity have a longer and healthier lifespan.
Positive sexual experiences can also improve self-esteem and body image. Feeling desired, and enjoying physical intimacy, can help individuals feel more confident and valued. When it comes to sexual relationships, people truly want to be wanted by their partner.
Solo Sex
Masturbation doesn't stimulate the release of oxytocin and other mood-elevating hormones as much as having sex with a partner in the context of a loving relationship. However, people without sexual partners can still enjoy the physiological benefits of orgasms, which include pain reduction, better sleep, and better cardiovascular health. There are a number of psycho-physiological changes that take place during sexual activity, and multiple parts of the brain are activated whenever you have an orgasm.
While you don't need to experience an orgasm in order to enjoy sex, for most people it is definitely the frosting on the cake. In contrast, tantric sexual practices seek to postpone male orgasm in order to extend the duration and intensify the enjoyment of a couple’s sexual activities, as well as enhance their emotional bonding.
Aphrodisiacs
Sexual desire, arousal, and orgasm are mediated by complex interactions of the neuroendocrine system, operating at both central and peripheral levels. Aphrodisiacs are substances that are alleged to increase sexual desire and pleasure. The term comes from the Greek goddess of love, Aphrodite.
Some drugs such as phosphodiesterase type 5 inhibitors, a class that includes sildenafil (Viagra) and tadalafil (Cialis), can improve male sexual performance by increasing blood flow to the penis. These medications come with a warning about erections that last too long (>4 hours) because blood trapped in the penis is deprived of oxygen. This medical emergency, if not treated, can result in permanent tissue damage.
Despite many claims, there is no evidence that any food or natural substance can heighten sexual desire or arousal. In fact, one study found an inverse relationship between chocolate consumption and sex drive in women; those who ate chocolate more frequently reported less interest in sex. Chocolate, which stimulates the release of neurotransmitters serotonin and dopamine may produce hormone-mediated feelings of satisfaction for women similar to the post-orgasmic phase of sex, thereby serving as a substitute. This finding did not hold true for men.
It has been said that wealth and power can make unattractive men more desirable, hence the saying that a man will appear taller when standing on his wallet. That seems to have worked wonders for shipping magnate, Aristotle Onassis. Short of stature and with an unappealing countenance, Onassis was able to bed some notable celebrities.
Also physically unattractive, the late Secretary of State, Dr. Henry Kissinger, coined the phrase, “Power is the ultimate aphrodisiac.” He viewed power as the driving force of history, and allegedly used his political status to seduce a number of famously beautiful women.
Said the lead character, Tony Montana, in the 1993 film Scarface, “In this country, you gotta make the money first. Then when you get the money, you get the power. Then when you get the power, then you get the women.”
As legend has it, a man asked his fairy godmother to make him so desirable that he would be irresistible to all women. With a wave of her magic wand, she turned him into an unlimited-spending credit card.
The Coolidge Effect
If there is anything close to being a genuine aphrodisiac, it is sexual variety, in all of its many guises. Variety is the real spice of a healthy sex life, and is a very powerful stimulus for increasing sexual desire and enhancing sexual performance.
The “Coolidge Effect,” named after former U.S. President Calvin Coolidge, is a biological phenomenon observed in the mating behaviors of many different animals, including humans. It derives from the tendency of males, and to a lesser extent, females, to exhibit renewed sexual interest when introduced to a new, receptive partner, even after having recently engaged in sexual intercourse with a different partner. This effect is often applied in animal husbandry in order to increase productivity.
The observed amplification of sexual responsiveness and diminished post-coital refractory period when presented with a new mating partner gets its name from a story about President Coolidge and the First Lady, who were given separate tours of a modern farm in the 1920s. Mrs. Coolidge inquired about how often the roosters mated with the hens, and what she was told about the frequency impressed her. She asked an aide to wait there and make sure that her husband would be given that information when he arrived.
When the aide told the President how often the roosters mated, Coolidge asked the farmer if it was always with the same hens. When he was told that in order to maintain a high mating frequency, each rooster had to be paired with a new hen every few days, the President reportedly told the aide, "Please tell that to Mrs. Coolidge!"
Sex therapists know all too well that monogamy can lead to sexual monotony, dampen desire, and decrease the frequency of a couple's sexual activities. Trying out new experiences and exploring a variety of different sexual pastimes can increase mutual excitement and rekindle passion in the relationship. Open communication between partners, and discussing sexual fantasies, preferences, and secret desires, can result in more enjoyable and satisfying sexual experiences for both people. In her recent article, Dr. Hull explores the different aspects of the sex drive throughout life.
Sexual Buzz-Kills
On the flip side to sexual turn-ons, there are a great many things that can act as turn-offs. Parenthood is one of them. One study found that new fathers have lower testosterone levels than men who aren’t living with their young children. The men who were more involved in childcare had larger drops in their testosterone levels. Monogamy also eventually lowers testosterone, according to a meta-analytic review.
Mothers can be too stressed-out or fatigued to be interested in sex. A preliminary study suggests that adequate partner support and good communication in the relationship may protect against female sexual dysfunction following childbirth. Women with sexual interest and arousal disorder (FSIAD) have a lower quality of life, with more depressive symptoms and lower sexual and relationship satisfaction, which result in negative consequences for their partners.
Even relationships unfettered by parenthood can be compromised by bad breath, unpleasant body odors, sloppy dressing, and poor grooming. The subtle influence of pheromones may play a role in human mate selection, possibly by signaling genetic compatibility through body odor. The steroid androstadienone, present in male perspiration, can be sensed by some women and perceived as a sexual attractant.
Certain behaviors or personality traits evident on a first date can instantly spoil the mood, but keep in mind that one person's yuck factor can be another person's favorite kink. Establishing areas of compatibility is where good communication and negotiation skills can pay big dividends in terms of mutual sexual and relationship satisfaction.
Sexual Dysfunction
A sexual dysfunction is any difficulty that prevents someone from fully enjoying sexual activities or having satisfactory sexual experiences, including their desire, arousal, orgasm, and post-coital resolution. One of the best resources for straight talk about sexual matters are the videos and articles by urologist Rachel Rubin.
Sexual dysfunction can be an acute or chronic disorder, influenced by cardiovascular disease, urological disorders, gynecological problems, neurological conditions, the result of taking certain medications or recreational drugs, and the psychophysiological state that accompanies feeling stressed.
A chronic state of stress can pave the way for cancer, heart disease, infectious diseases, and some psychiatric disorders. Stress impacts our neuroendocrine and immune systems, and can even affect our gut microbiome. It is also inimical to having a healthy sexual appetite. Managing stress effectively should be a priority, and I recommend mindfulness practices, along with exercise, as part of one’s daily routine. It also helps to know more about sexual anatomy and physiology.
While the subject of sexual dysfunction is far too extensive to be adequately covered here, it is worth noting that other psychological conditions besides stress can play a major role. These include grief, acute or chronic anxiety, clinical depression, neuroses, psychoses, and personality disorders. A history of rape, sexual abuse, or childhood trauma involving the genitals and natural bodily functions that engender guilt and shame can also be contributory.
A religious upbringing can exert a significant effect upon a person's sexuality, and their religious beliefs can adversely impact their sexual functioning in a number of ways. Religious indoctrination and repeated reinforcement of inculcated beliefs can warp people mentally, leading them to believe that they don't deserve good relationships, and that they should never ask for what they want sexually.
“Touching oneself impurely” is considered a mortal sin by the Catholic Church. Its Catechism describes masturbation as “an intrinsically and gravely disordered action.” Children who have been indoctrinated with beliefs such as these will suffer the psychological consequences of having committed grave offenses against God and breaking their sacred relationship with Him.
Religious beliefs involving sexual repression and the prohibitions of bodily functions and natural human pleasures can have severe repercussions. Teaching children that masturbation is sinful is tantamount to child abuse. It can lead to persistent feelings of guilt and shame, and drastically interfere with a person’s ability to enjoy sex as an adult. A study suggests that faith-based sex education can contribute to developing sexual disorders.
Added to religious repression is the all-too-frequent sexual abuse of children by the clergy. The resulting psychological scars can be crippling for a lifetime. Sexual repression should be considered a religion-based trauma in which one's human identity has been denied by a toxic ideology. Shame and guilt about normal sexual impulses can deter people from seeking psychotherapy or medical treatment for their sexual dysfunctions.
Love, Sex, and Conflict
In any long-term relationship with a commitment to monogamy there will come a time when the novelty and excitement have worn off. Couples will then find themselves trying to establish a dynamic balance between their individual desires for intimacy and their needs for autonomy. This inner conflict is what keeps couples counselors in business.
Love is a desirable aspect of most sexual relationships, and conflict seems to be an inevitable part of almost every long-term intimate partnership. To state the obvious, people are different, and there are going to be “different strokes for different folks.”
How a couple manages their inner and interpersonal conflicts can either strengthen or weaken their relationship. Effective conflict resolution skills can produce greater trust and increased intimacy, while unresolved conflicts can fester and produce tensions that lead to emotional distancing and weaken those ties that bind.
There's a complex, interlocking network of individual and partner issues that couples bring to counseling. Instead of just one person's description of the conflicts and their feelings about them, couples offer two different and often opposing perspectives. The true picture is always larger, more complex, and more dynamic.
A highly effective approach to couples counseling is based on the pioneering work of Dr. David Schnarch, author of Passionate Marriage, along with research by Dr. John Gottman, author of The Seven Principles for Making Marriage Work. The aim of counseling is to help couples achieve a working balance involving their needs for connection and their conflicting needs for separateness.
It also doesn’t hurt to keep sex from going stale by introducing novelty. Classics such as Joy of Sex by Alex Comfort, and Sexual Secrets by Nik Douglas are examples of books that are definitely worth a read if you’re looking for ways to introduce novelty. Men in particular may need to learn exactly how to please a woman.
Staying Sexually Active
While overcoming social, cultural, and religious taboos can be challenging, remaining sexually active throughout one’s life has numerous physiological and psychological benefits. For a great many older adults, maintaining a satisfying sex life is an essential part of a life worth living.
A recent study suggests that sexual activity, as broadly defined, may slow the progression of chronic diseases and the decline of physical and cognitive functioning that tends to occur with advancing age. Sexual activity benefits overall cardiovascular health, relieves stress, and mitigates depression. Older people who have more frequent sex have a better chance of surviving an acute myocardial infarction, according to one study.
Seniors and Sex
Sexual activity can be a beneficial pastime for older adults, contributing to their physical and emotional health and sense of wellbeing. Studies suggest that sexual activity may be linked to a reduced risk of health problems such as heart disease, some cancers, and possibly dementia. Sex has also been shown to boost immune system activity in ways that can reduce chronic inflammation and fend off infections.
Engaging in sex can provide brief aerobic exercise and release chemical transmitters such as endorphins and hormones that relieve pain, improve mood, reduce stress, and contribute to emotional bonding, strengthening feelings of intimacy and connection with one’s partner. Being sexually active can also contribute to a better body image and improved self-esteem, especially when attitudes towards one’s own body tend to become less positive as we age.
Despite a widespread social stigma against sexuality in later life, especially for those who identify as LGBTQ+, a growing body of evidence shows that sexual pleasure is integral to broader physical and mental health. Engaging in sexual activities can produce overall improvements in one’s sense of wellbeing, while declining sexual activity has been associated with higher rates of anxiety and depression. Among older adults, there is a linear relationship between the amount of sexual activity and feeling contented with one’s life.
According to the National Institute on Aging, “Many older couples find greater satisfaction in their sex lives than they did when they were younger. They may have fewer distractions, more time and privacy, and no worries about getting pregnant. They also may be better able to express what they want and need, which can offer an opportunity for greater intimacy and connection.”
Loss of interest in sex as one ages may be due to lower levels of estrogen or testosterone. It can also be caused by psychological issues or problems with the relationship. People are never too old to benefit from counseling.
Common obstacles to sexual pleasure, such as arthritic pain, impotence (erectile dysfunction), and vaginal dryness or atrophy causing painful intercourse (dyspareunia), can be addressed medically. If advanced cardiovascular disease does not increase a person’s risk, physicians should encourage their senior patients to remain sexually active.
Many, if not most adults aged 65 years and older, continue to engage in sexual activities, or would like to do so. According to surveys, at least 10 percent of men and women over age 90 are still sexually active. Despite a decline in sexual functioning, relationship satisfaction and feelings of sexual wellbeing can be maintained throughout old age, especially when the sexual connection involves emotional closeness and mutual support.
Sexual urges in older adults can be adversely impacted by many psychosocial factors, including unfounded beliefs about growing older that can morph into self-fulfilling prophecies. There are also pernicious religious doctrines that extol celibacy and warp the human spirit by instilling negative beliefs about non-procreational sex.
Cultures and religions with taboos against sex outside of marriage, and sexually repressive religions in general, add to the ample burden of human misery. Religion can abrogate people’s autonomy over their own bodies, as the SCOTUS Catholic Justices finally accomplished after a half-century of religious assaults upon women’s freedom of choice. Sexually repressive religions inflict mental wounds upon their believers, and create a clergy among whom pedophiles can run rampant.
In those cultures where extramarital sex by women is treated as a criminal offense, we find the most vile aspects of human behavior. They have dress codes for women that are enforced by brutal morality police, sex trafficking and sexual slavery, polygyny, and honor killings. The most perverse practice of all is the grooming of young men to become suicide martyrs, with the belief that their reward will be a harem of virgins in the afterlife.
There are, of course, reasonable precautions that should be taken when it comes to sex, especially in non-monogamous relationships. Cheating is always a risky business, regardless of one’s age, and jumping out of a second-story bedroom window to evade an irate spouse is something that seniors would rather not attempt.
The rate of sexually transmitted infections (STIs) has been rising faster among seniors than it has in the younger population. CDC data shows that among those 65 and older, chlamydia diagnoses more than tripled between 2010 and 2023, gonorrhea cases multiplied about sixfold, and syphilis cases increased nearly tenfold. In this age group, men had nearly seven times the rate of gonorrhea and nearly 10 times the rate of syphilis, compared with similarly aged women.
The same medical guidance for STI prevention applies to seniors. That includes screening tests and strict condom use with partners of unknown infectious status. As mentioned previously, safer sex for seniors comes with an added caveat: For anyone over the age of 50, your partner should know how to perform CPR.
In assisted living and long-term healthcare facilities, staff biases can drastically reduce tolerance for any expressions of sexuality. Although the prevalence of sexual dysfunction increases with advancing age, and cognitive impairments can reduce both the frequency of and the satisfaction derived from sexual activity, surveys of sexual satisfaction reveal that only a small minority of seniors report experiencing any significant sexual distress.
Older adults are able to remain joyfully active sexually well into their later life, and their children and grandchildren need to stop cringing about it. Couples need not be married, either formally or under common law, in order to have a mutually satisfying relationship, whether or not they cohabitate. For couples of any age, marriage continues to be the leading cause of divorce.
In fact, some married couples will choose to divorce when faced with the prospect of a spouse’s long-term disability. That’s because, for married couples, nearly all of their combined assets must be depleted before the disabled person is eligible for financial assistance with their long-term care through Medicaid. By not being married, at least one person is able to protect their assets. If you are married and older, I suggest that you seek legal advice and find out what is most appropriate for your situation.
As people age, the youthful notion of sex being about penetrative intercourse tends to evolve into an intimacy-based, partner-centered activity. Seniors tend to experience greater enjoyment from sexual fondling and more concern for their partner’s pleasure, along with a willingness to engage in more varied expressions of physical and emotional intimacy. There is also a greater congruity between women’s and men’s understandings of what contributes to satisfying sex in later life.
It seems that for the majority of us, our capacity to nurture and appreciate loving connections with our fellow human beings increases as we age. It is therefore important for all of us to recognize, accept, and affirm that for a great many older adults, their sexuality is a vital component for enriching the quality of their lives. May “The Force” be with them!
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