Life expectancy has been increasing worldwide, with many people living into their 60s and beyond. Contrary to common belief, sexual desire continues into old age, and many older adults remain sexually active and positive about sex.

Nevertheless, aging brings challenges such as menopause, hormonal changes, and physical health issues that can affect sexual activity. Studies show that about half of older adults experience sexual problems, with men often facing erectile difficulties and women experiencing low desire and other issues. Moreover, poor health is linked to sexual dysfunction, and chronic diseases can worsen these problems. Sexual issues in one partner can affect the other, highlighting the need for couple-centered treatment strategies.

The following aims to explore these challenges and introduce new therapeutic approaches, “couplepause” and “doublepause,” to improve sexual health in aging couples.

Challenges in Sexual Life for Midlife Couples

Physical, Psychological, and Social Changes: Midlife brings physical changes like menopause in women and hypogonadism in men, affecting sexual desire and function. Chronic conditions, weight changes, and aging can impact self-esteem and sexual confidence. Psychological and social factors, including changing family dynamics and cultural norms, also play a role.

Gender Differences: Women often experience a decline in sexual desire starting in their 40s, influenced by physical changes and life responsibilities. Men in the same age group may face physical declines with less impact on desire. Cultural expectations and norms also affect how aging and sexuality are perceived differently by men and women.

Couple Dynamics: Communication and shared expectations are crucial for maintaining a satisfying sexual life. Older couples today have different expectations about their sexual lives compared to previous generations. Effective communication can help address sexual issues and find solutions. For long-term couples, intimacy might take precedence over sexual activity, and redefining couple goals can be beneficial.

Nonheterosexual Couples: Limited evidence exists about midlife nonheterosexual couples, but observations suggest that men who have sex with men prioritize sexuality more and are more open to using sex toys. Women who have sex with women may have less frequent sexual intercourse but report higher sexual satisfaction. Homophobic issues and societal stigma can impact the sexual lives of homosexual couples.

Couplepause and Doublepause: Innovative Therapeutic Approaches

Couplepause refers to a diagnostic and therapeutic approach that considers the sexual health needs of both partners in an aging couple, rather than focusing on individuals separately. It aims to address shared sexual health issues and enhance communication and collaboration between partners and healthcare providers.

Doublepause is an extension of the couplepause concept, focusing on simultaneous sexual dysfunctions related to aging, menopause, and late-onset hypogonadism in both partners. This approach recognizes that sexual health problems in one partner can affect the other and emphasizes the need for integrated treatments and lifestyle modifications for both partners to improve overall sexual health.

Discussion and Expert Insights

A discussion on this topic took place among five European sexual health experts (two gynecologists, one sexologist, one psychiatrist and sexologist, and one urologist and sexologist) during an online meeting in June 2023. The discussion was divided into four parts: physical and psychological changes in midlife, factors affecting a couple’s sexual life, perspectives on handling sexual issues, and strategies for improving intimacy-related issues. The experts, from Denmark, Italy, Spain, and the Netherlands, focused on sexual dysfunction in both men and women and how these issues impact couples. Their clinical experiences and a review of the indexed literature were used to support their conclusions.

These researchers aimed to help healthcare professionals (HCPs) better address the sexual health needs of aging couples and highlight the impact of physical, psychological, and sociocultural changes on the couples’ sexual health. Their research emphasizes the importance of a couple-centered approach to address sexual health effectively.

Key Aspects of Couple-Centered Strategies:

1. Involvement of Both Partners: Engaging both partners in discussing sexual health and goals is essential.
2. Education and Training for HCPs: HCPs need training to confidently address sexual health issues and differentiate between physical and psychosocial factors.
3. Collaboration Among Medical Specialties: A holistic approach involving various medical specialists can improve the management of sexual health.
4. Development of Diagnostic Tools: Creating couple-focused tools and questionnaires can enhance couple-focused interventions.

By adopting these strategies, HCPs can better address the sexual health needs of aging couples and improve their overall well-being.

Conclusion

Sexuality remains important for midlife couples, but physical, psychological, and sociocultural changes can affect their sexual health. Couplepause and doublepause address these complex needs by considering physical, psychological, cultural, social, and dyadic factors. Couple-centered strategies promote open communication, address diverse expectations, and involve HCPs, collaboration across specialties, and the development of effective tools. Education and training for HCPs and providing information to couples are essential for promoting couple-focused care.

References:

• Giraldi, A., Nappi, R. E., Palacios, S., Reisman, Y., & Jannini, E. A. (2024). From couplepause to doublepause: The impact of midlife physical, psychological, and social changes on the sexual life of aging couples. Sexual Medicine Reviews, 12(3), 346–354. https://doi.org/10.1093/sxmrev/qeae016