Conversations about sexualities, aging, and death can be difficult in long-term relationships. Sex therapy focusing on new ways of doing partnered relationships can be helpful in rehabilitating sexual health and establishing a more playful and adaptive sexual relationship. Older partners are much more willing than younger partners to make systemic changes in their relationship because of their lived experience with physical limitations and death. The movement in older partners toward sexual health can have impressive psychological and physiological benefits, quelling anxiety and establishing a more balanced perspective toward each other.
pleasure, sexual health, play, touch, partners, hearing loss, death, pleasure, sex and disability, erotic fantasy.
The words “couple” and “partner” are used interchangeably in this article so as not to preference either monogamy or heterosexuality. Jack and Marion are a composite of many couples—queer, gay, straight, bi, trans, and non-binary. Making the plural of sexuality into sexualities is intentional.
“Toward the end of their lives my parents ate nothing but ice cream—though my father liked to put peanut butter on top of his.”
—Andrew Holleran, The Kingdom of Sand (Farrar, Straus, Giroux, 2022)
Over the past decade or so, younger therapists often refer older couples to me for sex therapy. This has increased as I have aged. Frequently, I suggest that I might assist the therapist’s work, so that working with aging and sexuality becomes more of a regular part of their psychotherapeutic work. This offer of supervision is often declined, mostly because of a denial of the relationship between sex and aging and death. But sexual relationships later in life are at the heart of it all; it is the peanut butter on top of the ice cream. A renewed focus on our bodies late in life, and our sexual selves, can make Waiting for Godot more comic and less tragic.
Older partners, and by older I mean from the late 60s to late 80s, sometimes give up on the idea of an active sexual life in exchange for a comfortable relationship. But eventually the comfort becomes discomfort. The body must be served. And the call to a therapist, awkward as it is, is a recognition that sex and intimacy are linked more viscerally than comfort and relationship.
If two men are in relationship, one will call and suggest that their partner will only meet for one session, which usually results in many sessions. If a straight couple calls, it is usually the female partner, which is a great surprise to the husband. If two women call, it is likely to be on a speaker phone. And if we are to discuss a change in sexuality itself, a movement toward another orientation, for example, or another kind of relationship (open/poly), or a movement into bondage or cross dressing, all partners are integrally involved in the questioning.
Sex is developmental (and queer). This means that it is ever changing across the life span. If you live long enough, the root of your sexuality will emerge (Morin, 1995). Sometimes this happens after a loved partner has died, which seems tragic to me. It means that the partnership never had the kind of conversation that would have caused positive sexual development. Instead, comfort and an avoidance of conflict squelched any movement toward growth and differentiation. More so than at any other time in their life, older couples are willing to change, because death is at hand, and time is not endless.
Jack and Marion, a cisgender bi-racial (White and Hispanic) straight couple, in their early 70s, retired into what Marion called an abyss, a routine of habit and security made worse by the confines of Covid, and the death of friends and family members. Feeling imprisoned and hopeless, attending many funerals and few weddings, Marion read an article about bondage, and was intrigued. She wanted Jack to tie her up, carefully and playfully. The very thought of it aroused her. She could not have this conversation unaided and called to set up a meeting to introduce her husband of 40 years to this sexual development.
Both Jack and Marion were physical throughout their lives. Jack played basketball in college and continued to hike and exercise regularly. Marion, up until her 50s, participated in road races, and remains a regular at her yoga studio. In the first session, neither could remember the last time that they had sex. Jack thought it was 7 or 8 years ago, Marion thought it was longer. They report that they have a good relationship.
The first rule: sex and relationship are not the same.
Younger partners confuse sex and relationship all the time and have a hard time with this rule. Older partners understand it at once: their relational comfort with one another moved them away from sex and body. And their comfort with one another moved them into sexual scripts that became so normal and routine that there was no incentive to develop an ongoing discussion of sexual health without disturbing the perceived equilibrium of their “successful” coupling/partnering.
‘Sex is developmental (and queer). This means that it is ever changing across the life span.’
The relative sexual arousal of so-called affairs (I hate the word affair; it is meaningless. Might “relational lapse” be more descriptive? “Affair” seems like a catered event.) is based primarily on novelty. Novelty diminishes in long-term relationships in favor of relationship and not sex. This is a crucial mistake in sexual development caused by an inability to have vertical discussions. Vertical discussions of sexual health occur standing up, or sitting over an afternoon tea, or at a quiet dinner at a restaurant. Few couples that I see do this, because if this were an ongoing process in the system of the partners across time sexual health would be a strength. They may have brief horizontal discussions: “Thanks” or “That was good” after having some kind of sexual interlude, but ongoing discussions about sexual health and novelty are lacking.
Normal, What’s Normal?
What is “normal” sex after all? From a developmental and systemic framework, normal devastates both relational sexuality, individual sexuality, and differentiation. Gay, bisexual, straight, and queer men, for example, after prostate cancer, which generally occurs later in life, all have the same dilemma: how do I perform sexually now? There is some data to suggest that gay, bisexual, and queer men suffer more and disproportionally compared to straight men after prostate surgery (Ussher, 2016). In clinical practice, men suffer after prostate cancer from a perceived loss of a sexual identity focused on an erect penis. This suffering is relieved by moving toward a broader perspective of relational sexuality, a movement that women understand much better than men. This is also the key to moving partners quickly to emergent pleasure again.
In the case of Jack and Marion, their sexual script became locked into “normal,” which, without intervention, diminishes into nothing. It is a gradual process that seems almost unconscious, and yet is incontrovertible to the couple experiencing it. There is no agreement about when it began, or how, only an accumulating sadness about the loss, both individually and relationally. This accumulating sadness remains even after sexual rehabilitation, because the return of novel sexuality reminds the couple of the intimate and bodily time lost. This is problematic for their current developmental position, that is, the approaching timeline of death, or even worse, the real possibility of neurodegenerative misalignment, a relational process (Jones, 2022).
In the literature on sex and aging, there is general agreement that penis in vagina or penises in other orifices might not be an optimal goal, which is often expressed without regard to women’s sexuality, or to gay men. Ninety per cent of gay men consider penile-anal sex as the “gold standard” (Sewell et al., 2017). Discounting this penis-centered aspect of late-stage sexualities, then, seems overemphasized.
There is no one answer. The expansion later in life of sexual performance into more curious, and queer, areas, such as bondage, or role play, or more oral sex and mutual masturbation, works because it begins a broader discussion of sexual health. When the sexuality of a long-term relationship is revitalized, and novelty increases over time rather than disappearing, it is not a surprise that penises, vulvas, anuses, and vaginas return to life, at least on occasion. This means the surprising return to penises in available orifices, or tongues in vulvas, or creative oral sex in curated ecologies (such as a hotel room or a forest). When sexualities expand there is something for everyone, and much to explore. Sometimes this is enhanced (or sometimes replaced) by the use of sex toys, or, in the case of Jack and Marion, by rope.
Bondage was an erotic developmental discovery for Jack and Marion, and an erotic fantasy that both could perform. With other couples it could be role play, or carefully arranged edges of pain and pleasure that are congruent with an aging body, or simply a return to regular instances of touch and arousal. In my work, what I see is that emergent pleasure and sexual health late in life causes dramatic decreases in physical pain, visits to the doctor, and other physiological measures (Syme, 2014). On an emotional level, there is a renewed glow to the faces of the participants. There is also better decision making: those commitments to daycare for grandchildren become secondary to the sexual life of the primary relationship. This benefits the grandchildren in the long run in that they get a chance to see an older couple playing.
Rope. I store rope and other toys in my office for the same reason that I keep Legos and puzzles and drawing materials for children. Once we get to discussions of rope (or feathers, or ice, or lube, or kinds of whips and paddles) we are nearing the end of therapy. With children, we begin with toys and games, and end with stories and discussion. With older adults, we begin with stories and discussion and end with toys (and sometimes rope).
‘Emergent pleasure and sexual health late in life causes dramatic decreases in physical pain, visits to the doctor, and other physiological measures.’
We discuss death as well. We talk about time. More precisely, we talk about time and death. And we talk about sex and death, not in the way that Freud theorized with libido and thanatos, but more functionally. Moving forward developmentally, touching becomes more important than words, although both are important. And we need to develop an ongoing sexual script that both partners can see as novel and interesting and ongoing. At first, Jack was reluctant to consider bondage as part of his or their sexual script. At the same time, he was curious about his long-term partner’s erotic interests.
In the beginning, we have a profound failure to play. Each older couple or partnership enters the therapy room having lost the ability to play with their partner. Sex is play:
“…where playing is not possible then the work done by the therapist is directed towards bringing the patient from a state of not being able to play into a state of being able to play.”
—D.W. Winnicott, Playing and Reality, 1971
Especially in sex therapy, if we engage and respond too seriously to a couple’s problems, then we move away from play. Therapy then becomes workmanlike for everyone involved, the opposite of where we would like to go. Older partners have had profoundly difficult lives; they would prefer talking about their sexuality a little less seriously. In training therapists, this aspect of psychotherapy is often misunderstood. Therapists are engaged in serious issues and need to respond appropriately. And with couples or partners, this often means confronting and disturbing a relational system in disrepair. What Winnicott is talking about here is the arc of therapy, from work to play. I love hearing laughter in my sessions. It means we are almost done.
The second rule: move physically closer to touch and talk.
In longer term relationships, we may lose our hearing, both physiologically, psychologically, and metaphorically. It is a bit cartoonish to think of two partners yelling at each other from different rooms. However, even in the first phone call to set up an appointment, I often hear a partner speaking loudly in the background. This is a response to inevitable conjoint hearing loss, but without relational adaptation. The psychological aspect of this centers in annoyance: why can’t my partner hear me? And then resentment. And then we feel that our partner is not responsive. And if we are not having sex, then the resentment grows. We call this parallel process. The metaphoric narrative of the relationship works against constructive conversations about sexual health. But we have an antidote: touch. As Ashton Applewhite suggests, “From cradle to grave, no matter where we live or for how long, human touch remains essential” (Applewhite, 2016).
Over time, we develop habits that seem to work. One partner cooks, another does dishes. One partner initiates sex, the other doesn’t (actually not a good idea). And we stop looking at one another. And then we talk to one another from farther and farther away. So, the second rule suggests that maybe we only talk to our partner when we can touch them. And look in their eyes. This improves hearing on all three levels (physical, social, sexual). And increases instances of touch and positive interaction, which has an impact on sexual health.
When Jack and Marion began communicating more through touch, Jack admitted that Marion’s hearing loss had often made him angry. He did not like repeating himself. And he did not like admitting that his hearing had also declined. Whether it’s hearing, or vision loss, or arthritis, or pain, or prostate problems, structural change in the relationship and in the sexuality of older partners is warranted. Moving from talking to touch helps. It shortens the distance. It is also an ecological change: there is movement from the past and its discontents to today and its nothing. We have to make room for play by putting aside thoughts of yesterday. Anything that happens more than 24 hours ago need not be discussed. An empty mind is not an anxious one.
A third rule: all sex is queer sex.
Gullette (2011) first suggested “queering the whole sexual life course.” And Jane Gallop (2019) makes a link between aging, queer sexualities, and disabilities. Walter Mosley, the novelist, also suggests a greater concurrence, as he said in an NPR interview in 2012: “If you’re old, you’re not good; if you’re a paraplegic you’re not good; if you’re black, you’re not good.” This ageist social construction translates into the perception by older partners that their sexual identity is neither desirable nor relevant. This is a queer feeling, a marginalized feeling. When the therapist identifies this queer feeling, this disconnection between what my body wants and what we are supposed to do, partners feel seen, and a new path forward becomes possible. They don’t care that this insight comes from the queer community. Love and sex is love and sex.
‘Our minds create anxieties, which are not part of the autonomic systems where sex lives.’
When Jack tied Marion up for the first time, they reported a great deal of laughter. We had discussed the method, had discussed safety and safe words, and had talked about rope and older skin. Jack, always wanting to be prepared, had purchased a book on Shibari, which is Japanese rope bondage, and had purchased a soft cotton rope (available on Amazon in multiple varieties). Shibari can complicate matters, so on this first try it was about play and discovery and constraint. A few simple knots unlock arousal. The laughing made way for new touching, and for arousal, and for responsive pleasure. This was the doorway to discussions about sexual health, a doorway made up of novel experiences, of a renewed sense of touching, and of centering sex in an ongoing embodied relationship.
Most all consensual sex is fun. Connecting through touch is easier than language, and more pleasurable. It is a time of empty mind, of being in the present, of response and arousal, of dropping into an autonomic state where sexualities live, and anxiety doesn’t. Our minds are not to be trusted. Our minds complicate things, complicate sexualities. Our minds create anxieties, which are not part of the autonomic systems where sex lives. When we age, we may continue to let our minds run the show. It is better to let our fingertips loose, and to center the other. Even if we live alone, we still have our touch and our fingertips. There are novel pleasures of living alone (Bolick, 2015). We then live mostly in positive interaction, which is far easier. What do you think will happen to our bodies if we continuously and developmentally diminish stress and anxiety through sexual practice?
Not all older couples will arrive with notions of bondage, submission, and rope. Most will simply want to know how to retrieve a sexual life lost. How do we move past our staid reactions to each other, in service to relational comfort, to begin touching, arousing, and pleasuring ourselves and our partner? How do we untie the knots that we have so carefully constructed to avoid discussions of sex and sexual identity? In Stephanie Coontz’s Marriage, a History (2004), she concludes: “Today, as never before, decisions about marriage and family life rest with the individuals involved, not with society as a whole.” In real terms this means that partners have the agency to change how they do their relationships, at any developmental point. Sex is a change agent, a catalyst, which can transform something in its current state into something quite different.
We can beat back the despair of aging, of death approaching, of physical limitations, by touching each other on a regular basis, and in a variety of ways. Our infirmities matter less if someone is continuously interested in using our bodies and theirs for the purpose of pleasure. Suffering is a part of life, and is not assuaged by sexualities, or anything else. At the same time, rehabilitating our sexual health late in life can be curious, and eventful, and surprising enough. Maybe it can be enough to distract us for a few moments.
I once saw a farmer try to shoot two large mature groundhogs who were cavorting on the side of a hill. Almost preternaturally, and deep into sex and play, they moved in unison every time he fired. When they finally stopped, separated, and took a break, he didn’t have the heart to shoot them.
Stephen Duclos, LFMT, CST, has been working as a couples and family therapist, mental health counselor, and rehabilitation counselor since 1972. He is cofounder of the South Shore Family Health Collaborative and the South Shore Sexual Health Center, which are dedicated to providing quality family therapy, couples therapy, sex therapy, and education to the greater Boston area.
Photo credit: Ground Picture/Shutterstock
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