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5th Congress of the
EUROPEAN FEDERATION OF SEXOLOGY
Berlin, June 29 - July 2, 2000
"For a Millennium of Sexual Health"

Oswalt Kolle, Amsterdam:

The Great Taboo: Sexuality and Aging

Ladies and Gentlemen,

if any of us doubted that the topic "sexuality and aging" is a great taboo - we were taught a lesson when Pfizer received approval for its little blue pill called Viagra from the American Food and Drug Administration (FDA). Because erectile dysfunction is mainly a problem of men over 5o - and therefore also the problem of aging couples - this age group clearly heard the message of public opinion. Especially the German media showed a negative attitude which still denies older people the right to sexual enjoyment. In other words: Give the older people electrical blankets and a prostatectomies, but let sex be the privilege of the younger generation! Journalists, mostly female, gave the impression that, with this pill, older men would be transformed into hordes of raping apes. Listen to a few of the typical quotations:

The leading German feminist Alice Schwarzer described men with newly "loaded guns", who would now threaten women like wild bulls. She wrote :"Every weenie will feel like Tarzan and will make love á la ram bam, thank you Ma’am." In the German magazine STERN, a young woman advised older men to stop having sex, these "old bucks with their shriveled pendants". She recommended that only women should be allowed to buy the pill.

In the meantime, we all know that the pharmaceutical industry is well on the way to produce a drug which can help women to increase their libido: I don’t even dare to think what these people will then write about elderly women. Still, I do not want to be misunderstood: I share the fear of an increasing medicalization of sexuality. My friends from the German Center for Sexuality and Health and I are aware of the fact that even the best pill in the world cannot replace good communication between partners, cannot replace tenderness and love and caring. We also know that many men attribute their relationship problems to their inability to have erections, and that they are oblivious to issues of intimacy. When Viagra was approved by the German health authorities, a sex therapist said to me in all seriousness: "Now we are all out of a job." I answered :"On the contrary, your job is now to guide patients and their partners and to task questions." For example : What is the problem behind the erectile dysfunction ? Does the man think that real sex is only intercourse and everything else is nothing ? Which impact will the medication have on the couple ? Are they communicating ? Are they talking about what they like ? Do they think that, with Viagra, they have to have intercourse ? Does the patient’s partner insist that an erection is proof of love ? Does the female partner know that the male wants medication and does she agree ?

Nevertheless, we have to be aware that medication in many cases is the golden and even the only way to help a man, to help a couple - often after many years - to make love without stress. I quote Debra Haffner, former president of the Sexuality Information and Education Council of the United States (SIECUS): "Anything that normalizes the fact that people over 50 can have sex is a good thing. The jokes on Letterman and Leno are a good thing. It normalizes the idea that we are sexual beings from birth to death."

Forty years ago, I was an angry young man who fought for the liberation of sexuality and against the discrimination of minorities .Now, 40 years later and 71 years of age, I am an angry old man and will fight for the rights of older people, especially because we know how important sexuality is for their mental and physical health . Here are a few facts about the interdependence of sexuality and health: Satisfying sex improves the immune system. An orgasm promotes the production of T-killer-cells and of the hormone endorphine. An American gynecologist found out that women with breast cancer had a better chance to recover when they had regular orgasms compared to women without satisfying sex lives. Especially important for older women is the training of the muscular system of the pelvis -this prevents incontinence. Sex also improves the production of estrogens - good for skin and hair and for the prevention of osteoporosis. New York heart specialist Dr.Alexander Lowen concluded that sexually active people have a lower risk of a heart attacks than people who never have sex. So much for the physical aspects.

What about the psychological aspects ? The German gerontologist Dr .Klaus Franke said "Love and sexuality are the best cure for the sadness and depression of older people." But why do they have problems with sexuality? We know that around 80 Percent of the older and really old women and men like to have erotic experiences. The main reason why they don’t, is loneliness: They lost their partners through death or divorce and are unable to build up a new partnership. Many men satisfy their desires nevertheless by masturbating or visiting prostitutes, but women are in a more difficult position. This calls for an explanation. Basically, there are two kinds of reasons for it - external and internal reasons. We live in a society which is obsessed with it’s a culture of youth. On all bill boards, in all magazines, in every advertisement, in every soap opera, we only get to see young, attractive women .Elderly women are writing to me in despair :"What shall I do ? Men don’t notice me any more. It is as if I no longer exist for the other sex." Once I told the chief editor of a German magazine that I intended to write a series about the sexuality of aging people. He was enthusiastic and said :"But please, my friend, nobody over 40. Otherwise I can’t illustrate the articles."

For the younger generation it is hard to imagine the benighted times in which this older generation grew up. In a discussion, a young woman asked me: "What is the problem ? Why can’t they speak frankly with their husbands or partners ? When my friend isn’t tender enough the night before I tell him the next morning: My dear, you owe me an orgasm."

However, the majority of the older generation have never learned to speak openly about sex, whether it’s with their own partners, or with their doctor or therapist. It‘s simply too embarrassing. We estimate that in Germany around 8 million men suffer from erectile dysfunction, but only 120 000 per quarter visit a doctor or therapist. The same problem with older women: Every gynecologist will tell you about his experiences with patients who are unable to speak about their sexual problems. Sensitive doctors hear the inaudible "Help me!" and will try to ask some questions. Is this easy? No, says Dr. Andy McCullogh, director of male sexual health and fertility at the New York University School of Medicine: "There is a climate that doesn´t lend itself to asking ‘Mr.Smith, tell me about your sex life. ‘That is the reality, unfortunately."

But the climate in the fifties was even worse: This was the period in which the now aging population was sexually socialized. It was an age of silence about sexuality. Since sex was a forbidden subject, nobody dared to inform young people in sufficient detail, they only heard warnings about the dangerous side of sexuality - venereal disease and unwanted pregnancy. Young women in those days lived with an overwhelming fear of pregnancy. It is estimated that one in three women in Germany had at least one - legally strictly prohibited - abortion. At the same time, German law also prohibited advertising for contraception, and it was also prohibited to sell condoms to unmarried persons. There was a special law to punish parents who allowed sons or daughters to stay overnight with fiancées or friends of the other sex. The reason: They must be aware that this leads to fornication. Maximal punishment: Six years in prison. There reigned a strictly double standard: Boys were allowed to experiment with their sexuality, girls were required to keep their virginity. They grew up with romantic ideas about love and marriage: Sleeping beauty is kissed awake by a prince on a white horse. 90 Percent of the girls in the fifties married the first man with whom they had their first sexual experience. Often they met clumsy men who believed that "real sex" means inserting a penis into a vagina for subsequent powerful thrusting. From older women I often receive letters asking me if their bodies are abnormal, because they need more than that when they have intercourse. This is also a consequence of Sigmund Freud’s ideas about a presumed difference between clitoral and vaginal orgasms, the first being immature, the second mature. Today we know better, but millions and millions of women grew up with this nonsense. Often these women are looking back on a lifelong marriage with unsatisfying sex - without real pleasure, without orgasm, without tenderness. They feel, that they are victims of male-defined sexuality. And when they - after a divorce or after the death of the partner, living alone - have sexual feelings, they do not understand how this is possible. Hadn’t they been told by mothers, fathers, priests and by the whole of society, that women can only have sexual feelings in a loving, tender partnership ? How can it be that the first real satisfying experience happens with a stranger on vacation, how can it be that strange erotic fantasies awaken the desire to masturbate ? the Hamburg clinical psychologist Viola Frick-Bruder tells about a female patient, 76 years of age, who suffered, as she said, from a swelling of the clitoris. Therefore, she asked for a clitoridectomy. There was no swelling, but the old lady complained that she felt it. The then inexperienced psychologist was unable to prevent the operation. Naturally, after the clitoridectomy these strange feelings did not disappear. 25 year later the same story with a 78-year old woman: She complained about a always pulsating clitoris and wanted a clitoridectomy. In long sessions the psychologist found out that the widowed woman, after 4o years of marriage, had never felt any enjoyment having sex with her husband, had never had an orgasm and had never masturbated. Her whole attitude was sex-negative: This is a man’ s world; a woman has no say in it; she has no sexual desires of her own. Slowly and carefully, the psychologist taught her to accept her own sexual feelings and desires. An operation was not necessary.

Of course, there are also many women who emancipated themselves in the troubled years of a so-called sexual revolution. They were able to define their own sexuality. But even for them there are problems after menopause. Some internalize the judgement of younger people who give them the impression that sex is something reserved for the young . They also internalize the idea that you have to have a young face, a young body, a young skin to attract men, forgetting that they now have other qualities - they know what they want and don’t want sexually. There lives are not easy, and they need help, encouragement and compliments. A female Dutch gynecologist told me :" Very often older women are really grateful, because I am a woman. They say: I‘m sure you understand, that at my age I don’t like to undress before a man, not even before my own husband. I then tell them what a wonderful body they have. Then they feel better." Simone de Beauvoir concluded in her book "The Second Sex" that an important part of female lust and libido consists out of the enjoyment over the woman’s own beautiful body - if the body isn’t young and beautiful any more, than sexual desire will also diminish. But there is another reason why some elderly women think or say: It‘s enough. I have had it, I don‘t want any sex any more. Not long ago a female reader, 65 years of age, asked me in a letter: "Isn‘t there a pill for my same-age husband that would reduce his desire? He wants to have sex with me nearly every day. Or does there exists a pill for me, so that I can feel the desire more often?" The story behind this letter: This woman suffered her whole married life because her husband practiced typical macho, coitus-only sex, while she wanted tenderness, skin-contact, and kisses. All he gave her were erections. This can be not only frustrating but also painful. The interior wall of the vagina becomes thinner and the results are irritation and pain. Gynecologists could and should help if they know of these problems. After all, there are estrogen cremes and an estrogen ring which can stay for three month inside the vagina and works only locally. But no gynecologist can replace a unkind partner. Most difficult for the elderly woman is the situation after an operation on the primary and secondary sex characteristics. The self-image of the woman is damaged. She asks herself : Am I still a real woman after my hysterectomy or mastectomy ? Can I still be sexually attractive to my partner or to a new partner ? What will happen to my libido ? Will I still feel desire? Can I have orgasms? I think it is important - not only for doctors but for everybody who is involved with the issue of sexuality - to know that most women after the hysterectomy feel no decrease - often even an increase - of their libido, and there are no changes in the capacity to have an orgasm. Only 10 Percent of these women suffer from decrease of libido and inability to reach orgasm, but most oft these 10 percent of women had these problems before the operation. The problems after a mastectomy are more a psychological than physiological. How does the partner react to the loss of one or both breasts? What about the self-image of the woman ? Here lies a broad task for psychologists before and after the operation - and not only for the woman in question but also for her partner. We must give hope to all these people and help them. When I say "we", I mean all of us - sexologists, psychologists, therapists, journalists, amnd physicians. Not against each other but together, everybody in his or her place.

Sometimes it is necessary to change the sexual attitude of a patient, sometimes a pill may help, sometimes both are necessary. Let’s find the right way.

Finally a few words from a really old lady. For the 103rd birthday of the American artist Beatrice Wood, a television station produced a documentary. Beatrice Woods remembered :"There was this young man, a very handsome reporter from television. After the last take he came, cuddled me and kissed me on the cheek. He said: I love you. For years I had built these emotional walls around me to remember that I live alone and shall further live alone. These walls melted away. I felt an immense joy. I wanted to go away with this young man. The desire for love, my God, what a power, what an indestructible power."

Thank you very much for listening so patiently.

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