The psychological impact of aging on sexuality and relationships.

Aging has a powerful impact on the quality of relationships and sexual functioning. The psychological impact of aging after midlife is a particularly timely topic given improved medical and psychological understanding of sexuality in both women and men, as well as more effective treatment for age-related sexual dysfunctions. It is time to dispel the stereotype of the midlife relationship as the continuation of a traditional heterosexual marriage with grown or almost grown children in order to more effectively address emotional and sexual issues arising in relationships. Regardless of the length or nature of the relationship, however, its quality is enhanced by emotional intimacy, autonomy without too much distance, an ability to manage stress and distractions by external factors, and achieving a satisfying sexual equilibrium. Perception of the quality of the primary relationship and sexuality is influenced by the other factors in a person's life. Thus, the relationship must be examined and issues must be addressed taking these external factors into consideration. Among the most powerful external factors is one's occupation or avocation, as it tends to strongly influence one's sense of identity, self-esteem, and self-worth in all areas of life. To understand and treat effects of aging on sexuality, it is important to address the three components of sexual desire: drive, beliefs/values, and motivation, as well as the sexual equilibrium within the primary relationship. It is also essential to understand how the physiological changes in male and female sexual functioning affect desire and equilibrium. Other health-related changes that occur with aging must be recognized and addressed, including the fact that the oldest of old women will outlive their corresponding male cohort. Treatment implications for these issues are discussed.