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How does sexual life change with age? While physical desire may decline, tenderness gains importance. Couple therapist Stefan Woinoff explains how couples can rediscover their intimacy and why tenderness promotes health.
Tenderness instead of orgasm pressure
Surprisingly little changes at the core. However, where pure lust and horniness may have dominated before, something else very beautiful emerges over the years: tenderness.
One of my patients once described it like this: Her husband used to always be ready immediately, but now, in old age, he needs a little longer to be "ready" – and she experiences this time as a wonderful time of tenderness.
An older patient, with dry humor, once said: "Oh, sometimes the goal is in the way, namely the orgasm, which the man is so focused on. Especially in old age, orgasm should not mean 'orgasm must', but 'orgasm may'!"
Biological changes
As we age, the body changes, and this also affects sexuality:Hormonal changes: For women, menopause is a significant turning point. The decreasing estrogen level leads to changes in the mucous membranes, vaginal dryness, and sometimes pain during intercourse. Local or systemic hormone replacement therapy (e.g., with estrogens) can help.
Changed response time: While young people are usually quickly aroused, older people need more time and stimulation to become sexually excited.Physical illnesses and medications: Cardiovascular problems, diabetes, rheumatic complaints, or medications directly affect sexuality. Men can benefit from medications for erectile dysfunction (like PDE-5 inhibitors).
What is often overlooked in this context, also by doctors: Sexuality and especially tenderness are healthy and maintain health, especially in old age. Regularly experienced tenderness lowers blood pressure, strengthens physical and mental defenses, counteracts dementia, and prevents depression. If tenderness could be prescribed on a prescription, I would do it.
Medical support
For women:
For men:
Shifts in Sexual Desire
Does desire decrease over time? The question is: desire for what? Desire for touch, tenderness, and intimacy may even increase with age. Desire for pure sex usually decreases somewhat, despite individual differences.Men's testosterone levels decline; women experience different developments after menopause. It is important that couples continue to talk about their shared sensuality, eroticism, and sexuality. Both usually want and enjoy time for tenderness.
Psychological and emotional aspects
As important as the physical level are the mental and relational factors. Sexuality in old age strongly depends on self-image, life satisfaction, and relationship quality.
Self-perception: Those who feel attractive despite gray hair and wrinkles often also have more desire for intimacy.
Relationship dynamics: Many long-time partners need to find new forms of closeness after decades together.
Loss and new beginnings: With age, the likelihood of losing a partner increases. Widows and widowers often experience sexuality anew—whether in a new relationship or through self-pleasure.
Social dimensions
Why is this topic so taboo? In earlier times, sexuality was closely linked to reproduction. The fact that older people feel desire and longing was considered secondary.
Today, sexuality is almost exclusively associated with youthful, flawless bodies in the media. This creates pressure—not only for older people but also for younger ones. Nobody is perfect, neither young nor old. This taboo should be overcome: Older people can also radiate beauty, give sensuality, and enjoy it.
Case study: Anna and Karl
Anna (68) and Karl (71) have been married for 45 years. Their children have long since left home. While Karl immerses himself in gardening after retirement, Anna is involved in a literature group.In recent years, Anna noticed pain during intercourse. Karl remained silent about his erectile problems—out of shame.
And then in my practice as a couple therapist they do find the courage to speak openly. Anna described her complaints, Karl spoke about his insecurity. Together we developed strategies: medical advice on local hormone ointment for Anna, an examination by a urologist for Karl with the possibility of using PDE-5 inhibitors. Simultaneously, they practiced rediscovering tenderness—without pressure.
After a few months, they both reported that their relationship had become more intimate again. They took time for touch, laughed a lot, and discovered new forms of closeness. Both experienced their sexual life as "different but deeper."
Tips for couples - 5 ways to fulfilling sexuality in old age:
Talk openly about wishes and boundaries—without guilt.
Consciously cultivate tenderness—cuddling, stroking, massages.
Let go of performance pressure—intimacy without orgasm is just as valuable.
Try new things—share fantasies, expand sensuality.
Seek medical advice if needed—sexuality may be supported.
In Conclusion
Sexual life in old age changes—physically, emotionally, and socially. It does not end but often gains depth.If couples are willing to speak openly, accept medical support, and consciously cultivate tenderness, they can enjoy fulfilling sexuality even in the second half of life."Especially in old age, orgasm should not mean 'orgasm must,' but 'orgasm may!'"
Author: Dr. med. Stefan Woinoff is a specialist in psychosomatic medicine and psychotherapy in Munich. As a psychodrama therapist, author, and relationship expert at 50plus-club, he supports people in individual, couple, and group therapies. He is part of the Fofus.de Experts Circle.
Photo: © Artem / stock.adobe.com
Editor, 23.10.2025
