Prof. Dr. Astrid Riehl-Emde
Interview of August 5, 2009 with Dr. Birgit Teichmann
“Sex at old age” is a topic that the media only covers secondary. Movies like “Wolke 9”, whose leading actors are older people, are controversially discussed. But results of a study show, that sex does not become less at old age but with a long-lasting relationship.
You are mentioning something very important: We know today, that the sexuality of a couple- at least until the age of 50, but probably much older- is much more suppressed by the length of a relationship than through the age of the partners. So sexual activity does not so much depend on how old someone is but how long the relationship has lasted. Older couples in “young” relationships lead a much more active sex life than older couples in long-term relationships, which is also shown in the movie “Wolke 9”.
But there are age-related influences on sexuality: As a rule, sexual responsiveness and sexual reactivity declines, while arousal- and orgasm abilities basically remain. Often an apparent reduction of sexual contacts happens above the age of 60, at the latest above 70. But sexual activities, erotic wishes and fantasies often last until the late 80’s and still do not disappear completely even beyond, just the intensity, forms and contents change.
Of course, sexuality at old age also depends on the availability of a sexual interested partner, on the physical condition and how sexuality was experienced and lived in the younger years.
What experiences have you made as a couple-therapist: Are couples that have been together for a long time get your advice or rather freshly in love older couples?
At our institute I offer a special consultation hour for older couples. Those are couples where at least one partner is between 60 and 75 years old. Couples that come to us predominantly live in long-term relationships, one third of the couples have been married between 31 to 40 years, a further third even more than 40 years. The initiative for registration by the way, comes foremost from the woman, sometimes even children give their parents the advice to try a couple-therapy.
What kind of couples come to you? Couples that are unsatisfied with their sexual relationship or couples, where at least one of the partners looks for advice due to physical or illness impairments?
We have a general clinic, meaning our special consultation hour for older couples is broadly ranged, so it draws a different clientele than sexual medicine institutions where people or couples, who in particular have sexual problems or are looking for sex-therapy, will go. The most frequent reasons why older couples come to us are:
- Problems in the timely context of the beginning of retirement: External relationships or fierce arguments can occur when work as a regulator of closeness and distance, ceases to apply.
- Burden through diseases and asynchronous, i.e. not simultaneously, aging processes: Imagine for example, that a man ages much faster than his wife, it stresses both, when one cannot “keep up” and it sometimes needs a reversal of roles, which means a tremendous challenge. When e.g. the once dominant male falls into the role of a dependent and the once subservient woman must decide more what to do.
- Memories can appear, respectively unfinished earlier conflicts can come up and will strain the relationship tremendously.
- Sometimes, something like a “marriage burnout” can happen. That’s what I call couple relationships where positive emotions for each other- thus tenderness, patience and loving attention- have worn out. In which the so necessarily needed appreciation is missing and instead, indifferences and coldness, sometimes even harshness and cynicism are spreading. The burn-out, the hopelessness plays an important part in the feeling and knowledge of not being able to escape the relationship.
- Conflicts with children, which can lead to a lack of contact between grandparents and their grandchildren, cause a lot of sorrow for the grandparents and sometimes lead to therapeutic practice; also worries about grown children can be of concern.
- And of course unsatisfying situations in the joint sexuality. Most couples that come to us are unsatisfied with their sex life, even when they do not mention it as a problem when registering. I remember couples from our consultation, that talk about a very satisfying, sometimes even passionate joint sex life, but ongoing disputes affected their sex life, which then became the main reason for the registration.
Is there no inhibition threshold to get sexual therapy? I would expect that only the ones that have been open with sexuality throughout their life, have the courage to get advice and the ones that, even in younger years, did not talk about possible difficulties or tendencies would not do this, especially in older age- so therefore will not get advice.
Whoever goes into a sexual medicine facility already mastered the first threshold! In general, people of all age groups need courage to talk about their own sexuality, express their wishes and animosities and being able to tolerate that the partner might not react positively towards it. Without this courage sexuality often decreases. Some people have enough courage, others need professional help to inspire that courage and some couples might never find the courage. However, the abandonment of sexuality can allow a couple to avoid the connected conflicts. Within the works with the elderly, it is tremendously important to think in terms of contemporary history, so especially the sexual socialisation of the particular generation and its cultural background needs to be taken into account.
Does (missing or unsatisfying) sexuality play an important role when long-term couples separate?
The importance of sexuality is often overestimated. In my earlier studies about the topic: “ What holds couples together”, the bonds of love and the exchange in dialogues were much more important for the coherence of couples than sexuality. Love in long- term relationships is often experienced differently than love in younger relationships. In long-term relationships it is a special form of connection, a combination of affection, friendship, sexuality, responsibility, joint problem solving and the shared social net of children, friends and neighbourhood. Thereby, the history of the relationship plays a central role.
By the way, a lot of couples end their sex life when they become grandparents- not because their wishes and capabilities vanish but because of the image that grandparents to not have a sex life anymore. Of course there are many people, even at a younger age, that even then, were not very interested in sexuality. Those feel less committed in older age to show interest in sexuality. Then it is only consistent, maybe even an emancipatory act, to say: “You know, we prefer a glass of wine”. This sentence comes from a couple that was questioned within a scientific questioning.
What influence did the development of Viagra have on the sexuality of older people? Did it really solve problems that are beyond medical problems?
Today, an enhanced therapy range of sexual therapy and oral medication is standard. Medication against organic erection disorders can help affected men, especially when a erection dysfunction is created through fear of failure or stress. Because of the side effects, these medications should only be taken by prescription of a doctor and with consultation of the partner. By the way, I hear often, that women are not so happy about the newly stimulated potent partner. On the other hand, insignificant organic deficits can be compensated with psychological consultation or sexual therapy. Sometimes, the information about normally expected, age-related changes of the sexual organs or the effect of diseases and medication, can make it easier to adjust to sexual changes.
It is interesting that, although men have less dramatic hormonal changes than women, their sexual functions are more prone to failure and the age-related changes are often experienced more dramatically. Men that orientate themselves on the ideals of youth, physical fitness, strength and endurance are in particular affected. For older men, sexual satisfaction by coitus plays a much more central role for the experience of intimacy as for women. For women, acceptance of their body and a liberal attitude towards sexual experiences and –expressions but also affection and exchange in communication are important for the maintenance of sexual interest and satisfaction. Personally I like the description of the “second language of sexuality” in older age, which not only knows physical but foremost emotional and communicable aspects and needs empathy. Precisely it means a tender and humorous contact with each other, e.g. a longer “foreplay” and the not so seriously taken occasional impotence. The movie “Wolke 9” shows us a wonderful example of that.
Who is the person to contact for couples that want advice? Does the family doctor or medical specialist have to refer the couple to you or can they directly register with you?
Couples can directly register with us at the secretary’s office at our institute and get an appointment. In most cases it is possible to get some consultations from the healthcare when you have a referral from your family doctor or specialist.
Astrid Riehl-Emde, psychological psychotherapist , is assistant director of the Institute of Psychosomatic Cooperation Research and Family Therapy and Director of the special consulting hour for older couples. Occupational activities are in the ambulatory and residential psychotherapy, in university teachings and research. Lecturer and supervisor in continuing- and advanced education for couples- and familytherapy. Co-editor of the magazine "Psychotherapie im Alter" (PiA). Diverse publications et al. about couple therapy and couple research. Last book publishing: "Liebe im Fokus der Paartherapie" (2003).