Medically Reviewed On: July 06, 2008

MARK POCHAPIN, MD: Hi, welcome to our webcast. I'm Dr. Mark Pochapin, and we're going to discuss some of the issues that people have when they get older. But we're not talking about arthritis or chronic lung disease. We're talking about having sex, that is, sex in the elderly. It's really something that doesn't get much attention, but needs to be addressed, because there are new drugs now that are available, and there are things both physiologic and psychosocial, that need to be addressed with people as they get older and start engaging again in sex.

Today I have with us some expert panelists. Sitting to my left is Dr. David Kaufman. He's an assistant professor of clinical urology at Columbia University. Welcome, David. Sitting next to David is Dr. Patricia Bloom. She's Chief of Geriatric Medicine at St. Luke's/Roosevelt Hospital in New York City, with us here today. Thank you, Pat. Sitting next to Pat is Dr. Dagmar O'Connor, who is a psychologist, a sex therapist, and the first woman sex therapist to be trained by Masters and Johnson in New York City. Welcome. Appreciate you all with us.

Viagra has really revolutionized this discussion about sex in the elderly. It's obviously a couple-related thing, as sex is a couple-related thing. What has happened, in terms of discussing this, or just the psychosocial aspects of sex in the elderly, that has maintained the ability to not only develop a new drug, but also develop things like this webcast to discuss this issue? Pat, you want to address that? How do we now, as a society, sort of embrace sex in the elderly, and get rid of the taboo that has generally been there about Grandma and Grandpa having sex?

PATRICIA BLOOM, MD: There's a lot of different aspects to that question. First of all, the aspect of what do elderly people themselves think about sex. I think it's true that we are going through a revolution, partly due to Viagra. But a lot of elderly people grew up with thinking that sex was something that was secret. You didn't talk about it. If you're interested in sex when you're an older man, you're a dirty old man. So just having brought it more out into the open, I think, has been helpful.

We still live in a society -- I can tell you that when I mention sex in the elderly, my teenage son goes "Ewww!" It's like there's still this whole thought that that's not something that's okay for elderly people to do. People get nervous thinking about it. So there's a real kind of dichotomy there.

But, to elder citizens' credit, I think they're getting much more out front in expressing their interests and their desires, and talking about sex. Of course, that can create some problems too, because there can be a mentality that Oh, well, you have to be having sex in order to be a with-it old person. Some elderly people are just not particularly interested in having intercourse, but, again, I think back to the point that they may be interested in some other aspects of sexuality which they just haven't had occasion to participate in. There's also a problem of whether partners are available to elderly people.

MARK POCHAPIN, MD: Dagmar, when you have an elderly couple, as a sex therapist, what are the main issues that need to be addressed with them?

DAGMAR O'CONNOR, PhD: Some of them that we just talked about is the incest taboo in a family is such that parents don't approve of children's sexuality, children don't approve of parents' sexuality, and parents and children do not approve of grandparents' sexuality. So that the first issue here is to get these grandparents, who are now in sex therapy, and they do weekly touching sessions, and then their children come to visit. They say "We can't do anything."

And I say, "Do you realize, this is your responsibility to lock the bedroom door and have privacy?" Because that's the only sex education there really is. The other is only verbal education. You will give your children and your grandchildren permission to be sexual when they grow older, because they will remember that that bedroom door was locked, and there was some privacy in there. That's important, that every generation will do that.

DAVID KAUFMAN, MD:That's a wonderful point.

MARK POCHAPIN, MD: This taboo issue is so powerful. You're absolutely right when you mention your son. I could just imagine what people would say, years ago, about talking about sexual activity in elderly people. I think we've gotten a little more familiar with it with the advent of some of the drugs, but clearly there's a long way to go.

Let's just talk about some of the problems that could develop. Someone now gets a hold of Viagra. All of a sudden, things change. Something that couldn't happen, can. What has to be, what do you worry about? What about heart disease and lung disease in elderly people, both male and female?

DAVID KAUFMAN, MD:Viagra has certainly gotten a bad rap by the lay press, about all these heart problems and heart attacks, and people dying after taking Viagra. I think the point that needs to be made is that they're not dying from Viagra. They're having myocardial events because they're suddenly engaging in strenuous activities that they weren't engaging in because they were impotent.

If that same individual went outside and shoveled the snow, he'd be getting the same heart attack that he's getting as a result of Viagra. So I think that leads the medical community to have a certain responsibility to be careful, and to make sure that we're prescribing Viagra to somebody who is physically fit enough to participate in sexual relations.

There are also some pharmaceutical contraindications to Viagra. Everybody pretty much knows by now that nitroglycerine compounds, and that could be the nitroglycerine tablet that you take at the onset of angina, as well as about 100 other cardiac medications that have nitroglycerine in it, is absolutely and definitively contraindicated in somebody who's taking Viagra. So we really do not prescribe Viagra to anybody who has any chance at all of requiring a nitroglycerine compound.

DAGMAR O'CONNOR, PhD: Can I add something to that? Because they end up in my office, they've had a heart attack, and now they're afraid to even have an erection, because they think they're going to have a second heart attack. And I try to say: "Every night, when you go to sleep, you're going to have several erections. And what you don't do during the day, you will do at night, and you will end up having wet dreams. And that isn't going to threaten you, you're going to survive that."

Now, most of the studies of people having heart attacks during intercourse, are mostly people who have extramarital relationships. It's important that the stress, the emotional stress, sometimes can be too much.

MARK POCHAPIN, MD: That emotional aspect. You mentioned touch, being close, obviously is so important in all types of relationships and ages. But in elderly people, we don't think about that too much. Pat, when people come to an internist, older man or older woman or even a couple, should an internist address this? The relationship, the touch, and obviously the sexual activity of that person or couple?

PATRICIA BLOOM, MD: Absolutely. I think it's very important that the doctor ask each and every patient. And, again, we need to not be ageist and make assumptions that you stop asking this question at a certain age. Ask whether the person is sexually active. If so, are there any problems? If they're not sexually active, is that a problem for them?

But I think the aspect of either being sexual or wanting to be sexual, and having a problem, then sometimes opens the door to medical diagnosis of conditions that need to be treated in order to allow that person to be more sexually active. So sexual function is really highly related to other medical conditions, and needs to always be considered when you're treating other medical conditions.

MARK POCHAPIN, MD: That's certainly a nice note to end on. I thank the three of you for being here with us, and of course our audience. We really learned quite a bit about the demystifying of sex in elderly people. And hopefully anybody there who considers themselves someone who may be too old to engage in sex should learn a little bit, and talk to their doctors, and hopefully see that there are things available to help you. It's something that's important, not only from a physical perspective, but also from an emotional perspective as well.

I'm Dr. Mark Pochapin, and thank you for joining us on this webcast.