Do Mature Women Like Sex? Sex and sensuality never fade

May 8, 2001

Do Mature Women Like Sex? Sex and sensuality never fade

BY LOUISE ATKINSON The London Times

A new report has found that doctors fail to acknowledge how important loving is for mature women

From the enduring sexuality of Jeanne Moreau in Jules et Jim to the easy virtue of Hamlet’s mother and the blatantly predatory Mrs Robinson, there has never been a shortage of fictional examples of older women’s lust. Odd then, according to a new report, Sexuality and Older Women, that the medical profession ignores this important aspect of feminine nature.

The research reveals that, in spite of the fact that today’s mature women are veterans of the Swinging Sixties, doctors fail to acknowledge the important role of sex in their lives. They are likely to be — almost — as sexually active as they ever were, yet the myth that sex stops at the menopause still holds sway.

Inevitably, such wrong assumptions have serious implications for the treatment, health and wellbeing of postmenopausal women. It was to counteract the myths as well as to push for better treatment, that the Pennell Initiative for Women’s Health commissioned the study. The Pennell Initiative is a charity set up three years ago to champion the cause of the health needs of women over the age of 45. The research was conducted by three psychotherapists, Christopher Vincent, Jenny Ridell and Avi Shmueli, of the Tavistock Marital Studies Institute, London. The results of their work will be presented to the Pennell Initiative’s first national Purple Tea at the House of Commons next Tuesday. The name Purple Tea was inspired by Jenny Joseph’s poem that celebrates women in their middle and later years: “When I am old I shall wear purple/With a red hat which doesn’t go and doesn’t suit me . . . ”

To Dame Rennie Fritchie, the president of Pennell — and one of Whitehall’s official watchdogs who oversees appointments — this research is long overdue. “When I flick through my television channels late at night, I come across all these bodies and limbs and thrashings and gruntings,” she says. “I’m 59 and it makes me think what a limited view the younger generation has of sexuality. This report takes us beyond these thrashings, and highlights the fact that sexuality in older age is a whole chapter in itself.”

The Pennell study reveals that the main reason the “old women don’t have sex” misunderstanding has come about is because research has always been restricted to the number of sexual encounters a woman might have in any given period. The term “sexual encounter” has always been given to mean penetrative sex. But according to Julia Cole, the development director of Pennell and an experienced psychosexual counsellor, a menopausal woman is likely to eschew penetrative sex in favour of other more sensual or tactile experiences.

“A researcher asking direct questions might therefore come away with the impression that older women have little sex,” she says, “whereas the woman may merely be having less penetrative sex, and instead enjoying plenty of other forms of sexual or sensual activity which are just as important to her.”

Such narrowly based research has contributed to the misconception that older couples have less active sex lives, or at least implies that they put less emphasis on sex as they get older. This could not be further from the truth.

“I have been a sex therapist for 15 years,” says Cole, “and I’ve found that women in mid and later life have great sexual relationships. They may make love less often than when they were younger, but more frequently than people would imagine, and many go on enjoying sex into old age.”

Older women, she reveals, are much more aware of what they want, and better able to voice those desires. Add to that the fact that they probably have more spare time, no distractions from small children, no sleepless nights that induce “a headache”, fewer financial worries, an acceptance of their bodies, fewer inhibitions, no fear of getting pregnant...and they have a good foundation for a trouble-free sex life.

Vincent, one of the report’s authors, says: “This review seeks to demystify what for many remains a taboo subject. It demonstrates that for many older women sexual experience is a key component of a full and healthy life. Many older women wish to continue to explore sexual relationships and sexuality into old age, but often feel that prejudice from others, particularly those in the caring and health services, acts as a block to the living out of their desires. The over-emphasis on charting the frequency of sexual encounters may be part of what has been termed the masculinisation of sex.”

According to Shere Hite’s latest work, The New Hite Report,older women are more likely to enjoy more multiple orgasms than younger women. “Confusion between reproductive activity and sexual pleasure is playing havoc with our lives,” she says.

“It is true that the capacity to reproduce ends at menopause, and that vaginal lubrication can decrease, but women’s sexual arousal or orgasm capacity actually increases.” And, Hite points out, for the thousands of women taking HRT whose oestrogen levels are back to premenopausal strength, difficulties associated with dryness do not occur.

But sexuality for older women encompasses far more than sex. “One of the things I love about the Pennell report is that it lists having your hair combed as a sensual act,” says Rennie. “If you live on your own, as many older women do, you may desperately miss being touched in a loving or caring way, and having someone comb your hair might be all it takes to make you feel good. If something makes you feel more womanly and good then it is a part of your sexuality.”

Armed with these new findings, Pennell plans to start a training programme for health professionals, social workers, counsellors and therapists, to ensure they are aware of the full spectrum of sexuality

The report states that there ought to be further studies into the feelings of older women, and the elderly. It quotes the notorious American sexologist Alfred Kinsey, who said: “The differences in sexuality between individuals were so great it is impossible to define what is ‘normal’.”

One of the main causes for concern is that key health issues such as heart disease, cancer, arthritis, depression and the menopause have a complex relationship with sexual wellbeing. This relationship is at best misunderstood and at worst ignored.

Some physical illnesses and disabilities also have adverse consequences on sexual life. They may distort body image, impair or restrict physical mobility necessary for sexual contact or require treatments that themselves inhibit sexual desire. Cole explains: “If you go into hospital for a major operation such as a hysterectomy, the health professionals you meet think a woman ‘of your age’ is unlikely to be enjoying an active sex life.

“You may not be told about how removing your ovaries could affect your libido or whether HRT would help or hinder your enjoyment of sex. This sort of information could be crucial to you making a full recovery. It is important to stop making assumptions about women, and listen to what they want. It is so essential for medical staff to spend some time with them.”

Rennie adds: “It simply isn’t enough for a doctor to explain the physical limitations of a particular condition merely in terms of whether or not you’ll be able to get up and down the stairs. They have to look at all these issues in a much wider way.”

She believes the research could help in more subtle ways. “Too many people in the medical profession have a younger person’s view that women have some sort of sell-by date stamped on them,” she says.

“As you get older you become more invisible and less relevant and people make huge assumptions about you, narrowing the road ahead. But if we can talk about sexuality we are broadening the road out. It isn’t necessarily about thinking of you as a sexual being, but more about considering you as a whole person. It is about not making assumptions that sexuality and sensuality belong only to the young.”

But to Rennie, the most significant outcome of this research is the fact that at last it renders it legitimate to put the words “older woman” and “sexuality” in the same sentence. “The best thing you can do is shine a light on the subject in a non-sensationalist way,” she says.

“At least people will begin to talk about it. Sexuality in older women is not about grannies in hotpants. It is about feeling good about yourself. All of yourself.”

Source: http://www.thetimes.co.uk/article/0,,7-125558,00.html

Sexuality and Older Women - Setting the Scene

Pennell Paper No. 1 March 2001

Sexuality and women in mid and later life

Twelve million women in the UK are aged 45 and over. This age cohort is set to increase, as women are likely to live longer than ever before. This paper will demonstrate that issues concerned with sexuality are of importance to women in mid and later life, often having an influence on physical, mental and emotional health.

A literature search undertaken by Christopher Vincent, Jenny Ridell and Avi Shmueli of the Tavistock Marital Studies Institute, commissioned by The Pennell Initiative for Women’s Health (of which this paper is a summary), has revealed that many older women wish to continue to explore sexual relationships and sexuality into old age, but often feel that myths and prejudice from others, particularly those in the caring and health services, act as a block to the living out of these desires. The findings of the literature search demonstrate that:

A broad definition of sexuality is essential when considering the sexual needs of older women. Although there is evidence that sexual drive and intensity diminish in later life, this literature search indicates that, while penetrative sex remains relevant, other forms of sexual and sensual satisfaction become increasingly important.
Simply counting numbers of sexual encounters presents a false picture of sexuality in older women. Most research does this and fails to capture the diversity of different meanings associated with sexual experience for the older woman. The over emphasis on charting the frequency of sexual encounters may be part of what has been termed the masculinisation of sex.
Some physical illnesses and disabilities are likely to have adverse consequences for sexual life. These include illnesses that distort body image, that impair or restrict physical mobility necessary for sexual contact, and/or require treatments that themselves inhibit sexual desire. Where appropriate, it is vital that health professionals should discuss the implications of these conditions for sexual health with older women patients. Older women often report that there is a lack of acknowledgement of sexuality by health professionals.
Sex may be one of several physical activities that has a buffering effect against certain illnesses. Explicit programmes for enriching sexual health, alongside health promotion as an aspect of primary and secondary medical care, and health promotion programmes through the media and environment, could improve understanding of this benefit to the public.
Health professionals, social workers, counsellors and therapists could benefit from training programmes designed to educate specifically on the sexual health needs of older women, including the importance of taking into consideration what is known about the sexual lifestyles of older women.
There is a relative paucity of knowledge about how women define and value sexuality as they age. This deficit is particularly acute for the very old and supports the case for longitudinal studies of normal ageing. There is also little knowledge about how illness and disability affects couples and how being in a couple diminishes or exacerbates the impact of specific illnesses and disabilities.
There is little knowledge of the relationship between ethnicity, race and sexual health in the older population.

The Background to this report

The Pennell Report, published in 1998, covers a wide range of issues concerning women aged 45 and over, including physical, mental, and spiritual health. As the report was compiled, drawing together many different research findings, it was found that there was a lack of research material on women in mid and later life and sexuality. Little was known about the role of sexuality in health, emotional security or mental wellbeing.

Historically, women in mid and later life have been characterised as losing interest in sexuality and the expression of sexual desire. The Victorians preferred to view women in general as asexual creatures. Progressively, throughout the 20^th century, this view has been revised thanks to the pioneering work of Freud, Ellis, Kinsey, Masters and Johnson and Hite. As views about sexuality have changed the recognition that ageing might include continuing sexual activity which reflects a healthy quality of life has been slowly gaining ground. Many studies confirm that sexual health is not only a reflection of good health, in general, but actively contributes to its maintenance.

Even so, many people both young and old, still regard the menopause as a cut off point in the sexual life of women reflecting Havelock Ellis’s view in the early 20^th century that " there is a frequent well marked tendency in women at the menopause to an eruption of sexual desire, which may easily take on a morbid form". In a 1969 publication entitled Everything You Wanted to Know about Sex, Reuben claimed that ‘as estrogen is shut off, a woman becomes as close as she can to being a man’. ‘… decline of breasts and female genitalia all contribute to a masculine appearance.’ ‘Having outlived their ovaries, they have outlived their usefulness as human beings’. Even in 1997 this view was echoed in the Pennell Report where one quoted author reported that ‘the removal of a monthly event (menstruation) [is] central to the perception of femininity and fertility’ ‘age [causes] fear of the loss of sexual attractiveness due to a decline in beauty…’

We live in a culture where sex is predominately defined as the preserve of youth and where the sexual experiences of the middle aged and elderly continue to be clouded in restrictive myths and prejudice. Countering these myths is difficult. Society has an ambivalent attitude to knowing about sexual mores. On the one hand there is a belief that sexual behaviour is a private matter best kept behind closed doors. On the other hand there is recognition that sexuality is an important part of a healthy life for people of all ages and that sexual health requires active promotion. However, the knowledge base for sexual education of the elderly is relatively underdeveloped. Alfred Kinsey, well-known sexologist, said that the "differences in sexuality between individuals were so great that it is impossible to define what is ‘normal’’. Differences between individuals widen as they age, making the task of generalisation even harder. The recommendations that follow are designed to integrate what is known about sexuality and the older woman into current health policies and to expand our knowledge base in this vital area.

Recommendations from this review

The National Service Framework for Mental Health recommends that all patients who contact their primary health care team with a common mental health problem should be adequately assessed and referred to specialist services when required.

We recommend that identification and assessment should include consideration of sexual health issues and that patients should be referred to specialists in the treatment of sexual dysfunction when appropriate. This should be as true for women in mid and later life as for younger women.

The National Service Framework for Older People puts forward a programme to improve their health and quality of life.

In advancing this broadly based programme we would urge The Care Group Workforce Team, set up to develop the skills of those charged with delivering the programme, to hold in mind the importance of sexual health matters for the older person and to ensure that these matters inform recommendations for staff training and policy development.

The National Service Framework for Coronary Heart Disease proposes a guidance model for rehabilitation following a heart attack. (CHD is the number one killer of women in the UK). In all phases of the model there is an explicit recognition that the psychological and social needs of the patient, including sexual health needs, are addressed.

We support this recommendation and suggest that The National Coronary Heart Disease Implementation Group will review how sexual health issues are taken up in the development of rehabilitation services.

The National Cancer Plan was launched with the explicit aim of increasing the numbers of specialist nurses in cancer care.

In seeking to push forward the emergence of this expanded specialist group we recommend that The Department of Health and The Royal College of Nursing encourage educational consortia and cancer training networks to include issues of sexual health in the training programmes of nurses working at screening, clinical assessment, treatment and post treatment stages.

Two comprehensive reports have been drawn on in preparation of this review. The first was produced by the Continuing Care Conference in 1998 and entitled ‘Fit for the Future: The Prevention of Dependency in Later Life’. The second, in 1999, was ‘The Future of Health and Care of Older People: The Best is Yet to Come’ Age Concern. Both make broad ranging recommendations from which the following are pertinent to issues of sexual health.

Both reports argue for long term longitudinal studies of older people in order to monitor trends in health expectancy. We support this proposal and would want measures of sexual health to be included.

The Age Concern Report backs the recommendation of The Royal Commission on Long Term Care to introduce a National Care Commission, which would be responsible for the development and promotion of models of care. We support this proposal and would hope that its work would take account of sexual health issues within long-term care settings.

Research Recommendations

This review was commissioned with the intention of identifying particular gaps in knowledge about the sexuality of women in mid and later life. Pennell has identified the following areas for possible future research:

How women experience the impact of diseases and disabilities on their sexual lives.
How women define and value sexuality as they age. (The particular lack of knowledge, with regard to the very old, supports the case for longitudinal studies of normal ageing.)
How the impact of illness, ageing and disability affects couples and how being a couple diminishes or exacerbates the impact of specific illnesses and disabilities.
The link between ethnicity, race and sexual health in the older population.

Innovative qualitative studies on these subjects could develop understanding about the sexual experiences of women in mid and later life, underpinning further research and pilot projects in these areas.

About this review

The request to seek a literature review about sexuality and the older woman arose from the first report of The Pennell Initiative for Women’s Health. This report identified key health issues, which include heart disease, cancer, arthritis, depression and the menopause, which are known to have a complex but not well understood relationship with sexual well being. Pennell also drew on the experience of advice columnists who frequently hear from mid life and older women about sexual concerns. The columnists confirmed Pennell findings that women over forty-five often felt their sexuality was ignored or misunderstood by health professionals and members of their families. Wishing to bridge this knowledge gap The Pennell Initiative for Women’s Health approached The Tavistock Marital Studies Institute to prepare a literature review which explored the subject of sexuality in women’s later years.

A Pennell briefing paper clarified the aims of the literature review. This document made clear that in addition to providing a review of the literature, the report needed to explore whether, and how, current policies address the sexual health needs of older women and to give examples of good practice where these exist.

Further Information

A copy of the full text of the literature review ‘Sexuality and Older Women – Setting the Scene’ by Chris Vincent, Avi Shmueli and Jenny Ridell of the Tavistock Marital Studies Institute is obtainable by contacting Jacqui McAleer, Co-ordinator on 01865 558000 or by e-mail at pennell@ukgateway.net.

Sources:

http://www.pennellwomenshealth.org/pennellpaperno 1.htm
http://www.tmsi.org.uk/Pennell1.htm

This Pennell Paper and an accompanying Press Release are also available at