As we age, our sleep patterns and sexual experiences can shift significantly. Knowing how and why these unexpected changes occur can help alleviate the distress they cause, which is an important step towards healthy aging. With this objective, physicians from GW’s School of Medicine and Health Sciences (SMHS) gathered April 28 for “Healthy Aging Part II: Sleep and Sexual Health,” the most recent lecture in the innovative Frontiers in Medicine series. The series, which explored hearing, sight, and skin in “Healthy Aging Part I” in late 2013, aims to connect members of the Washington, D.C. metropolitan community with renowned health care experts.
Alan Wasserman, M.D., M.A.C.P., Eugene Meyer Professor of Medicine and chair of the department of medicine at SMHS, opened the evening by introducing the panel of physicians — Vivek Jain, M.D., assistant professor of medicine at SMHS and medical director for the Center for Sleep Disorders at the GW Medical Faculty Associates (MFA); Michael Irwig, M.D., associate professor of medicine at SMHS and director of andrology at the MFA; and Patricia Smith, M.D., FACOG, assistant professor of obstetrics and gynecology at SMHS.
Jain began with an explanation of how aging affects sleep, the importance of which the medical community has come to recognize more in recent years. “With retirement, we lose routine. And sleep is very dependent on routine,” he explained. “When we lose routine, our sleep is naturally affected.”
Despite these expected changes, Jain warned the audience of two common myths about sleep and age — that it’s natural for the elderly to nap and that sleep requirements decline with age. “It’s normal to take a short nap after lunch, but falling asleep during the daytime when you shouldn’t be isn’t normal,” he said. “Our need for deep sleep decreases as we get older, but our need for a certain number of hours of sleep does not. We in sleep medicine are not yet sure whether that affects the rest of the quality of sleep.”
Jain noted a number of health problems that can occur as a result of sleep deprivation or disturbance, such as difficulty sustaining attention, slowed response time, memory loss, and decreased sexual performance. “These issues are often mistaken for signs of early dementia, when they might just be disturbed sleep.”
Next, Irwig addressed the topic of male sexual health, focusing on the effects of decreased levels of testosterone in aging men. He cited the Massachusetts Male Aging Study, a cross-sectional survey of about 1,700 men, age 40–69, which found a correlation between libido and testosterone level, as well as a Chicago study that found that sleep loss causes reduction in testosterone levels.
“About 5 to 10 percent of men with erectile dysfunction (ED) have low testosterone, but most ED is due to aging, the side effects of medications, and chronic conditions,” Irwig noted. “It’s essentially a vascular condition. Similar to heart arteries getting clogged, other arteries also get clogged.”
Finally, Smith spoke about female sexual health during perimenopause and menopause. “Many of the symptoms of these stages of life — irregular periods, hot flashes, night sweats, mood changes, and vaginal dryness and irritation — are interrelated,” Smith explained. “Decrease in testosterone in women is age-related, and it’s important to remember that having less interest in sex isn’t necessarily a medical condition. If it’s not causing a problem for the woman or her partner or both, you don’t need to seek treatment.”
According to Smith, sex can become more difficult for women with age, especially as the tissues in the vagina and vulva become thinner and less elastic. “Water-based lubricants are a good place to start, but low-dose vaginal estrogen therapy is also an option,” she said. “Keep in mind that if you don’t use it, you lose it. Regular sexual activity or stimulation can promote vaginal health by promoting blood flow to the area.”
Smith recommended the North American Menopause Society’s website for more detailed information, and encouraged the audience to seek their physicians’ guidance. “A lot of people feel a little bit shy or embarrassed about talking about these symptoms, but I want to remind you that this is what we’re here for – to partner with you and to help you with your symptoms,” she said.
The next Frontiers in Medicine lecture, which is scheduled for June 9, will address issues surrounding trauma and critical care.