Sex & Aging

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Sex and Aging

People seem to want and need to be close to others. As we grow older, many of us also want to continue an active, satisfying sex life. But the aging process may cause some changes.

What Are Normal Changes?

Normal aging brings physical changes in both men and women. These changes sometimes affect one's ability to have and enjoy sex with another person. Some women enjoy sex more as they grow older. After menopause or a hysterectomy, they may no longer fear an unwanted pregnancy. They may feel freer to enjoy sex.

Some women do not think things like gray hair and wrinkles make them less attractive to their sexual partner. But if a woman believes that looking young or being able to give birth makes her more feminine, she may begin to worry about how desirable she is no matter what her age is. That might make sex less enjoyable for her.

A woman may notice changes in her vagina. As she ages, her vagina shortens and narrows. The walls become thinner and also a little stiffer. These changes do not mean she can't enjoy having sex. However, most women will also have less vaginal lubrication. This could affect sexual pleasure.

As men get older, impotence becomes more common. Impotence is the loss of ability to have and keep an erection hard enough for sexual intercourse. By age 65, about 15 to 25% of men have this problem at least one out of every four times they are having sex. This may happen in men with heart disease, high blood pressure, or diabetes-either because of the disease or the medicines used to treat it.

A man may find it takes longer to get an erection. His erection may not be as firm or as large as it used to be. The amount of ejaculate may be smaller. The loss of erection after orgasm may happen more quickly, or it may take longer before an erection is again possible. Some men may find they need more foreplay.

What Causes Sexual Problems?

Illness, disability, or the drugs you take to treat a health problem can affect your ability to have and enjoy sex. But, even the most serious health problems usually don't have to stop you from having a satisfying sex life.

Arthritis. Joint pain due to arthritis can make sexual contact uncomfortable. Joint replacement surgery and drugs may relieve this pain. Exercise, rest, warm baths, and changing the position or timing of sexual activity can be helpful.

Chronic pain. In addition to arthritis, pain that continues for more than a month or comes back on and off over time can be caused by other bone and muscle conditions, shingles, poor blood circulation, or blood vessel problems. This discomfort can, in turn, lead to sleep problems, depression, isolation, and difficulty moving around. These can interfere with intimacy between older people. Chronic pain does not have to be part of growing older and can often be treated.

Diabetes. Many men with diabetes do not have sexual problems, but this is one of the few illnesses that can cause impotence. In most cases medical treatment can help.

Heart disease. Narrowing and hardening of the arteries known as atherosclerosis can change blood vessels so that blood does not flow freely. This can lead to trouble with erections in men, as can high blood pressure (hypertension). Some people who have had a heart attack are afraid that having sex will cause another attack. The chance of this is very low. Most people can start having sex again 3 to 6 weeks after their condition becomes stable following an attack, if their doctor agrees. Always follow your doctor's advice.

Incontinence. Loss of bladder control or leaking of urine is more common as we grow older, especially in women. Stress incontinence happens during exercise, coughing, sneezing, or lifting, for example. Because of the extra pressure on your abdomen during sex, incontinence might cause some people to avoid sex. The good news is that this can usually be treated.

Stroke. The ability to have sex is rarely damaged by a stroke, but problems with erections are possible. It is unlikely that having sex will cause another stroke. Someone with weakness or paralysis caused by a stroke might try using different positions or medical devices to help them continue having sex.

What About Surgery and Drugs?

Surgery. Many of us worry about having any kind of surgery-it is especially troubling when the genital area is involved. Happily, most people do return to the kind of sex life they enjoyed before having surgery.

Hysterectomy is surgery to remove the uterus. It does not interfere with sexual functioning. If a hysterectomy seems to take away from a woman's ability to enjoy sex, a counselor may be helpful. Men who feel their partners are "less feminine" after a hysterectomy may also be helped by counseling.

Mastectomy is surgery to remove all or part of a woman's breast. Your body is as capable of sexual response as ever, but you may lose your sexual desire or sense of being desired. Sometimes it is useful to talk with other women who have had this surgery. Programs like the American Cancer Society's (ACS) "Reach to Recovery" can be helpful for both women and men. Rebuilding of the breast (reconstruction) is also a possibility to discuss with your surgeon.

About 1500 American men develop breast cancer each year. In them the disease can make their bodies make extra "female" hormones. These can greatly lower their sex drive.

Prostatectomy is surgery that removes all or part of a man's prostate. Sometimes this procedure is done because of an enlarged prostate. It may cause urinary incontinence or impotence. If removal of the prostate gland (radical prostatectomy) is needed, doctors can often save the nerves going to the penis. An erection may still be possible. Talk to your doctor before surgery to make sure you will be able to lead a fully satisfying sex life.

Medications. Some drugs can cause sexual problems. These include some blood pressure medicines, antihistamines, antidepressants, tranquilizers, appetite suppressants, diabetes drugs, and some ulcer drugs like ranitidine. Some can lead to impotence or make it hard for men to ejaculate. Some drugs can reduce a woman's sexual desire. Check with your doctor. She or he can often prescribe a different drug without this side effect.

Alcohol. Too much alcohol can cause erection problems in men and delay orgasm in women.

Am I Too Old To Worry About Safe Sex?

Having safe sex is important for people at any age. As a woman gets closer to menopause, her periods may be irregular. But, she can still get pregnant. In fact, pregnancy is still possible until your doctor says you are past menopause-you have not had a menstrual period for 12 months.

Age does not protect you from sexually transmitted diseases. Young people are most at risk for diseases such as syphilis, gonorrhea, chlamydial infection, genital herpes, hepatitis B, genital warts, and trichomoniasis. But these diseases can and do happen in sexually active older people.

Almost anyone who is sexually active is also at risk for being infected with HIV, the virus that causes AIDS. The number of older people with HIV/AIDS is growing. One out of every 10 people diagnosed with AIDS in the United States is over age 50. You are at risk if you have more than one sexual partner or are recently divorced or widowed and have started dating and having unprotected sex again. Always use a latex condom during sex, and talk to your doctor about ways to protect yourself from all sexually transmitted diseases. You are never too old to be at risk.

Can Emotions Play a Part?

Sexuality is often a delicate balance of emotional and physical issues. How you feel may affect what you are able to do. For example, men may fear that impotence will become a more common problem as they age. But, if you are too concerned with that possibility, you can cause enough stress to trigger impotence. A woman who is worried about how her looks are changing as she ages may think her partner will no longer find her attractive. This focus on youthful physical beauty may get in the way of her enjoyment of sex.

Older couples face the same daily stresses that affect people of any age. But they may also have the added concerns of age, illness, and retirement and other lifestyle changes. These worries can cause sexual difficulties. Talk openly with your doctor, or see a counselor. These health professionals can often help.

Don't blame yourself for any sexual difficulties you and your partner are having. You might want to talk with a therapist about them. If your male partner is troubled by impotence or your female partner seems less interested in sex, don't assume they don't find you attractive anymore. There can be many physical causes for their problems.

What Can I Do?

There are several things you can do on your own to keep an active sexual life. Remember that sex does not have to include intercourse. Make your partner a high priority. Pay attention to his or her needs and wants. Take time to understand the changes you both are facing. Try different positions and new times, like having sex in the morning when you both may have more energy. Don't hurry-you or your partner may need to spend more time touching to become fully aroused. Masturbation is a sexual activity that some older people, especially unmarried, widowed, or divorced people and those whose partners are ill or away, may find satisfying.

Some older people, especially women, may have trouble finding a partner with whom they can share any type of intimacy. Women live longer than men, so there are more of them. In 2000 women over age 65 outnumbered older men by 100 to 70. Doing activities that other seniors enjoy or going places where older people gather are ways to meet new people. Some ideas include mall walking, senior centers, adult education classes at a community college, or day trips sponsored by your city or county recreation department.

If you do seem to have a problem that affects your sex life, talk to your doctor. He or she can suggest a treatment depending on the type of problem and its cause. For example, the most common sexual difficulty of older women is dyspareunia, painful intercourse caused by poor vaginal lubrication. Your doctor or a pharmacist can suggest over-the-counter, water-based vaginal lubricants to use. Or, your doctor might suggest estrogen supplements or an estrogen vaginal insert.

If impotence is the problem, it can often be managed and perhaps even reversed. There is a pill that can help. It is called sildenafil and should not be taken by men taking medicines containing nitrates, such as nitroglycerin. This pill does have possible side effects. Other available treatments include vacuum devices, self-injection of a drug (either papaverine or prostaglandin E1), or penile implants.

There is a lot you can do to continue an active sex life. Follow a healthy lifestyle-exercise, eat good food, drink plenty of fluids like water or juices, don't smoke, and avoid alcohol. Try to reduce the stress in your life. See your doctor regularly. And keep a positive outlook on life.

For More Information

The following organizations and government agencies have information that may be of help.

American Cancer Society, 1599 Clifton Road, NE, Atlanta, GA 30329, 800-ACS-2345,

American Foundation for Urologic Disease, Inc., 1000 Corporate Boulevard, Linthicum, MD 21090, 866-746-4282 (toll-free), 410-689-6700,

National Kidney and Urologic Diseases Information Clearinghouse . National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 3 Information Way, Bethesda, MD 20892-3580, 800-891-5390,

For more information on health and aging, contact:

National Institute on Aging Information Center, P.O. Box 8057, Gaithersburg, MD 20898-8057, 800-222-2225 (toll-free), 800-222-4225 (TTY toll-free)

To order publications (in English or Spanish) or sign up for regular email alerts, visit:

The National Institute on Aging website is

Visit ( ), a senior-friendly website from the National Institute on Aging and the National Library of Medicine. This simple-to-use website features popular health topics for older adults. It has large type and a 'talking' function that reads the text out loud.

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State Comparisons
States Implementing Laws that Provide Immunity from Prostitution Charges for Minor Victims

State Comparisons

Since the development of state protective response laws is an emerging area fraught with implementation challenges, many state statutory responses have been built on earlier models, with each state identifying an approach that works for that state and adapting it to its unique policy and resource landscape. Within the range of state responses, four general categories of protective system responses have emerged10:

1. Immunity without referral – provides immunity from prostitution-related charges to direct juvenile sex trafficking victims away from a punitive response but does not statutorily direct them into an alternative system or specialized response for access to services.

2. Immunity with referral – provides immunity from prostitution-related charges and directs juvenile sex trafficking victims to an alternative system or specialized response for access to services.

3. Law enforcement referral to a protective system response – does not make minors immune from prostitution charges but directs or allows law enforcement to refer minors suspected of prostitution offenses to child welfare or other system-based services instead of arrest.

4. Diversion process – does not make minors immune from prostitution charges but allows or requires juvenile sex trafficking victims to be directed into a diversion program through which victims can access specialized services and avoid a delinquency adjudication.

States that do not fit into these statutory categories may still be implementing components of a JuST Response. Based on existing research and knowledge gained from the experiences of states that have been implementing protective response laws, three basic elements have emerged as critical to a complete juvenile sex trafficking (“JuST”) response: statutory protective provisions, multidisciplinary interagency state system protocols, and access to an array of funded service options. Georgia and Maryland for example each have protocols for connecting youth to services or avoiding a punitive response. No doubt there are other non-punitive service responses beyond these statutory categories that have not yet been explored or developed.

To explore the methods and challenges of deploying protective responses that integrate the critical elements of statutes, systems and services, the JuST Response Mapping Report merges Shared Hope’s research and policy analysis to provide a national overview of existing state juvenile sex trafficking responses and an in-depth analysis of responses in example states that represent each of the four statutory frameworks most commonly found under existing state laws. While this report goes beyond those frameworks and explores the implementation of system responses and access to services, there are two reasons for organizing state JuST responses according to their statutory frameworks:

(1) The state’s statutory framework is a prerequisite to statewide change: By mandating a fundamental shift in how the state views juvenile sex trafficking victims—from criminals to victims of exploitation—the statutory framework can survive shifts in power that informal policies and executive-led initiatives are less likely to survive. The stability provided by a framework of law makes it less difficult to commit resources and energy to the hard work of implementing a protective rather than a punitive response.

(2) Since four approaches to enacting a statutory framework implementing this paradigm shift have arisen over the past several years, comparing implementation of these responses allows for a more structured analysis, i.e., comparing one state’s immunity response with another state’s immunity response provides a more accurate reflection of how similar laws can play out very differently depending on each state’s policy and resource landscape. Comparing immunity with diversion, for example, illustrates how the different laws play out, but comparing immunity with immunity illustrates how the different approaches to implementation play out.

It should be noted that the division by statutory category is meant to help guide the reader through a comparison of approaches and is not meant to minimize the concurrent importance of system protocols and available services. In addition, a state’s political climate, resources and advocate personalities invariably influences the implementation of its protective response for juvenile sex trafficked victim. Comparing the implementation of immunity laws in Tennessee and Minnesota provides an excellent narrative of these differences. For instance, Minnesota has one of the best funded state governments in the country11 while Tennessee is more resource limited. While their statutes are similar in terms of providing immunity to minors, implementation of their laws has been very different.12

Two approaches to protecting victims that are not included here are an affirmative defense for sex trafficking victims or definitional changes intended to direct victims to an alternative system process, such as the person or child in need of services (PINS or CHINS). These approaches do not amount to a protective response in most cases because these laws—while important in helping to lay a foundation for such —lack a procedure to affirmatively direct minors out of the punitive system response and into services and/or place the burden on the victim to seek protection and services.

This report is a first step in ongoing research and is not inclusive of all promising state protective responses since over half of the states in the country have enacted some form of protective response law. For example, the responses of states such as Georgia13 that have developed strong agency or community protocols in lieu of supportive statutes are not covered herein.

10 See “State Law Survey: Protective System Responses to Child Sex Trafficking Victims.” Shared Hope International, 2014. Accessed on February 24, 2015. This chart reflects See State Law Survey Chart – Protective Responses, reflecting legislation enacted as of 8/1/14. While most state responses fall into one of these categories, some state responses blend more than one approach, for example Delaware provides a diversion process and also requires law enforcement to report commercially sexually exploited youth to child welfare in order to connect youth with services.

11 Kiernan, John S.. “ States Most and Least Dependent on the Federal Government.”,WalletHub. Evolution Finance, Inc., 2014., http://wallethub. com/edu/states-most-least-dependent-on-the-federal-government/2700/. Accessed February 24, 2015.

12 These approaches are further explored in the following chapters,

13 The Georgia Care Connection, recently established by the Governor’s Office for Children and Families, identifies commercially sexually exploited children and links them to services without subjecting them to arrest. The Georgia Care Connection office serves as the single point of entry and care coordination entity for these commercially sexually exploited girls, ages 11-17. Learn more at

States Implementing Laws that Provide Immunity from Prostitution Charges for Minor Victims

By ensuring that all juvenile sex trafficking victims are directed away from a punitive court process that can re-traumatize victims and reinforce mistrust of the system, immunity from delinquency charges for prostitution and status offenses related to juvenile sex trafficking is a critical component of a protective response. However, enacting an immunity statute does not come without challenges. A common concern raised by advocates in states that have passed immunity laws is that youth may still be charged with status offenses that mask the intent to arrest victims for prostitution. This is especially prevalent in areas where law enforcement feel there is a lack of safe placement alternatives or a particularly high risk of re-exploitation. States that enact immunity laws in the absence of a statutory procedure to ensure youth receive a specialized service response may face a situation where child serving agencies are unable to adequately respond to a trafficking situation, leaving exploited youth with limited service options. First line responders such as law enforcement and social workers are thus faced with the heart wrenching decision to return a victim to a situation where there is risk of re-exploitation.

Even in states that have passed immunity laws that mandate law enforcement referral of juvenile sex trafficking victims to child serving agencies, factors such as lack of training or implementable protocols within child serving agencies or a lack of appropriately equipped service providers may still leave victims vulnerable to re-traumatization and exploitation. At the JuST Response Congressional Briefing, panelists from two states, Minnesota and Tennessee, discussed their strategies for enacting immunity statutes as the core of their state’s protective response. Despite the similarity in their laws, which both lack a statutory procedure that specifically mandates a child welfare or alternative system response, the challenges and successes encountered in implementing their laws vary greatly. In Tennessee, immunity laws were enacted prior to identifying funding procedures and protocols to connect youth to services. This progressive law codified thestatus of juvenile sex trafficking as victims of trafficking and created a sense of urgency that has motivated state agencies to come to the table to create a state-wide protocol for identifying and responding to juvenile sex trafficking victims. In Minnesota, amendments to the state delinquency laws established a three-year deadline for the legislature to fund service protocols for responding to juvenile sex trafficking victims before the law establishing immunity for minors became effective. As a result, Minnesota’s No Wrong Door14 campaign was able to secure government funding to establish a comprehensive, multidisciplinary plan to ensure communities across the state have the knowledge to identify and the skills and resources to serve juvenile sex trafficking victims.

Another approach to immunity laws is represented by Illinois and Kentucky, both of which combined immunity with a mandatory referral to child welfare for services. While Illinois enacted its law much earlier, enabling Kentucky to build upon Illinois’ model, similar challenges to implementation have arisen in both states. Such challenges, though similar, provide important learning as solutions are shaped by the policy and resource landscape peculiar to each state.

14 Minnesota Department of Public Safety Office of Justice Programs. No Wrong Door: A Comprehensive Approach to Safe Harbor for Minnesota’s Sexually Exploited Youth. 2013.!2012%20Safe%20Harbor%20 Report%20%28FINAL%29.pdf Accessed on February 24, 2015.

Oregon - State law establishes a protective response for DMST victims through existing systems1 - no

Type of protective system response: Immunity without referral to alternative system / Immunity with referral to alternative system No immunity, law enforcement referral to protective system / No immunity, diversion n/a

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