It was not too long ago when lonely widow Usha Parmar (Ratna Pathak Shah) in Alankrita Srivastava’s Lipstick Under My Burkha scorched the screen with her burning desire for intimacy. Parmar sought refuge in Hindi pulp novels out of desperation, fantasised about escapades with a young man and, in return, was rebuked and ridiculed for her overt sexuality because her actions were unfitting her age. Subtly, Parmar's character hints that sexuality, desire, activity and intimacy in the elderly don't come with an expiry date. While age-related medical issues have a considerable role to play, the social and cultural aspects too have a bearing on them.
Senior psychotherapist and counsellor Padma Rewari recalls how she recently offered consultation to a 52-year-old woman, well past her menopause, who didn't want to put a pause button on her sex life, much to her husband’s chagrin. “The woman went deep into depression after her husband body-shamed her and made fun of her overtures. She didn't know how to deal with her need for intimacy, which was a social and cultural taboo for her husband. His behaviour made her feel so low about herself that she developed suicidal tendencies,” says Rewari.
Cause of concern
One partner’s overt and other partner’s inert reaction to the other’s needs was the cause of the problem in Rewari’s patient. Although sexuality is a fundamental driving force, human sexuality is frequently misunderstood and often neglected in the case of the elders. “Sexuality and senior citizens seems a weird proposition. There is a mental block. People often suppress those desires and feelings because it is not age-appropriate behaviour,” says Rewari.
It is assumed that older people lose their sexual desires or are physically unable to perform. It is common for older men to fear the loss of sexual prowess, while older women may also express sexual desire but may fear their interest is undignified and disgraceful. “You become a senior citizen as soon as you cross 50. Ageism has a tremendous impact on the subconscious mind. It makes one slowly withdraw and retire when it comes to sexual activity, and expressing the desire and need for intimacy is a strict no-no. It is taboo. If one partner still has such desires, and the other partner doesn’t show such feelings or desires, it leads the partner (who has it still) on a guilt trip,” adds Rewari.
Niyatii N Shah, sexuality educator, intimacy coach and counsellor, has come across many cases where one of the partners and, in some cases, the couple approached her for help. “I have had both types of clients. Many of them seek advice through social media. A few of the most common reasons I have come across are lack of respect, no sexual satisfaction, boredom and abuse,” says Niyatii.
Dealing with the issue
The sexuality, desire, activity and intimacy in the elderly seems to be waning partly because of medical complications and partly because of a general loss of interest due to social or cultural reasons. “It’s a mix of both but mainly because of loss of interest and emotional baggage. Most of the time, partners are very supportive if there’s a medical reason. Intimacy counselling looks into why the couples are not intimate anymore and helps them live a fuller life that they desire from each other,” informs Niyatii.
During a recent webinar organised by Boston Scientific, psychiatrist, clinical sexologist, and sex and intimacy coach Dr Anita Shyam, who regularly meets such couples, said, “I also follow a simple formula in patients — seek a detailed sexual and relationship history. So that pretty much gives me a more comprehensive view of the issue. Is it an organic cause? Or is it a psychological cause? Is it a social cause or whether it is a relationship problem?”
If there is an organic cause, she refers them to the physicians who specialise in that field, but if it is a psychological cause, she digs deeper to ascertain the reason. “Is this person suffering from anxiety or depression? Or is he or she into drugs and alcohol? Sometimes even the partner can have a problem. The partner must be suffering from medical issues, desire disorders or depression that could lead the man to have ED. If not, then the couple must be having a relationship problem. So, I look holistically at the three parts of the triangle — the individual, the partner and the relationship,” she says.
A problem area
A marked increase in life expectancy over the past century has meant that individuals over the age of 65 form an increasingly large proportion of the population. Yet, very little attention has been paid until recently to treating sexual dysfunction in older adults. Older individuals are generally erroneously viewed as asexual people who have lost their interest in sex and their capacity for sexual behaviour. Calling for the need for more attention in psychiatric training to deal with sexuality in the elderly, Rewari adds, “The chain of ignorance needs to break. We need to change the way we think about older people and how they treat each other once they reach a certain age. We say age gracefully but without suppressing the fantasy or the feeling of sexual desires. Leave the guilt out, which plays on every human mind. These are conditioned behaviours and patterns which we have seen all through, but it is normal to have the flame of desire and need for intimacy burning even if you are past a certain age.”
People often refuse to believe that they are depressed and stressed. And sometimes, they could even be on a list of psychiatric medications. “Stress is a major factor for any of the psychological and several medical problems. There are four phases in a sexual cycle. Stress affects the desire, if the desire is affected, it’s going to affect the arousal, it affects the orgasm and also the resolution. It plays a major role in even in an individual’s life and in the relationship, causing a lot of relationship and sexual problems in couples,” says Dr Shyam.
Health issues
While women could blame menopause, older men could have many physical problems because of diabetes, hypertension, high cholesterol and smoking that could affect their sexual capabilities. “There are many issues that men may have. A libido problem means he doesn’t feel the urge for sex. He may have an arousal problem and he’s not attracted to his partner, he may have an erection problem. Then sometimes, he has a problem with early orgasm or premature ejaculation. All of which are different and need different treatments,” says Dr Rupin Shah, consultant andrologist and microsurgeon.
India is the diabetes capital and 50-70% of men with diabetes will eventually develop erectile dysfunction due to the disease. “Lifestyle is vital because, as I tell patients, sex happens when you are at the peak of your health, then you have the greatest urge, the greatest energy, the greatest capability. As your general health diminishes, your sexual abilities decrease, even though that desire may be there. So the middle-aged executive who's overweight, not exercising, overeating sugar, smoking 10 cigarettes a day is going to have a lifestyle-induced sexual problem,” adds Dr Shah.
Why it matters
There was an upsurge in teleconsultation in such cases during the pandemic-induced lockdown. It was because it is comfortable and convenient for the couple or individual to discuss the issue over a phone rather than in person. The key remains communication. “Always communicate how you feel with your partner. Seek professional help, talk to friends, understand what spouses think in general, and seek medical help if required,” emphasises Niyatii.
Communication and conversation become more important as one grows older. “The bond needs to be stronger, and as the empty nest syndrome hits, the couple needs to be there for each other. A relationship which is healthy and respectful needs to be maintained so that the couple live happily,” says Rewari, signing off.
