Sexuality in elderly people is a subject usually met with silence. Doctors are sometimes not prepared to talk about it, while the affected people can feel ashamed or are worried they will hurt either their partner's feelings or their own.
Sexuality changes as people grow older and sickness can also play a role in the love lives of senior citizens.
"Talk about your feelings of shame and fear. You'll be amazed how positive your partner will react," advises Prof. Wolfgang Berner, head of the Department of Sexual Research at Hamburg University.
The human body changes as people grow old; the skin begins to sag and our muscles weaken.
But at the same time, sexuality changes as well. In men, erections become more infrequent and periods of impotency are normal, according to Kirsten von Sydow, a psychologist at Hamburg University.
In women, the lining of the vagina becomes thinner, drier and more sensitive after the menopause.
In addition, to those natural developments come illnesses that can affect sexuality.
Diabetes or high blood pressure cause blood vessels to narrow, which in turn can lead to erectile dysfunction in men, according to a brochure produced on "Sexuality and Growing Old" published by the German sexual health organization Pro Familia.
Erectile dysfunction can also happen when the prostate gland enlarges or if a tumour is removed. Elderly women can feel uncomfortable with their bodies, especially when they become scarred such as after a mastectomy.
"Some women don't feel right showing their naked body to their partner," says Annette Baumann-Nitsche, a Pro Familia adviser.
Psychology also plays an important role. Some men are afraid to have sex after a heart attack because they fear overexertion.
Women with incontinence problems avoid sex because they're worried they won't be able to hold themselves. "But you can do something about that with special exercises," says Baumann-Nitsche.
As doctors rarely raise the subject, most patients do not know why life between the sheets has suddenly changed.
Feelings of inadequacy and fear follow, as well as complicated situations.
"Men with erectile dysfunction often avoid anything that could lead to having sex with their partners," says Michael Berner, psychologist and therapist at Germany's Information Centre for Sexuality and Health, an organization that provides help and advice to people dealing with sex life issues.
Berner says that in situations like that, affection and physical contact often suffer as a result.
Experts advise that the best way to prevent a relationship falling victim to circumstances is to discuss the matter with your partner.
Baumann-Nitsche uses role-playing exercises to make her clients feel more at ease. "I ask them: What's the best way to express your problem? And then I ask: What could your partner do to help?"
In most cases, it's fear of talking rather than talking itself that causes most difficulties.
"We often hear back that the partner dealt with the matter in a very relaxed way," says Michael Berner.
"If only you had told me before that that was what was bothering you," is a common reply.
Baumann-Nitsche warns against becoming complacent with fleeting sexuality. "Think about alternatives such as simply lying next to each other and cuddling."
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