Comedian George Burns once cracked that "sex at age 90 is like trying to shoot pool with a rope." Clearly, he was speaking for his own generation. Today's seniors, their sex lives liberated long ago by one pill and extended indefinitely by another, have every intention of staying in the game. The scope of the sexual shifts launched by Viagra a decade ago—perhaps as monumental as those triggered by the birth control pill—is now becoming apparent. A July study published in the British Medical Journal found that considerably more 70-year-olds are enjoying sex regularly than 30 years ago: 57 percent of men and 52 percent of women today versus 40 percent and 35 percent back then. (And that's before the baby boomers arrive with their outsize expectations.) About one quarter of those ages 75 to 85 are now sexually active, according to recent research from the University of Chicago. "We used to think seniors didn't have sexuality at all," says Helen Fisher, a professor of anthropology at Rutgers University and author of Why We Love. "Viagra has caused many older people to put sex way up front in their relationships."
That could explain why U.S. sales of the little blue pill and two newer drugs have skyrocketed to more than $1.5 billion—or 19 million prescriptions—a year, causing drug companies to salivate over the possibility—still distant—of a "pink Viagra" for women. Further along in the pipeline: a testosterone gel to reverse libido loss after menopause and a pill that boosts desire by acting on serotonin receptors in the brain.
The merits of staying sexually active through the years are obvious and plentiful: joy and excitement, connectedness, and a host of health benefits. Scientists have shown that having sex regularly boosts the immune system and releases hormones that lower stress levels, improve sleep, and might even hold off wrinkles: A Scottish study found that people who enjoy sex every other day looked about seven to 12 years younger than their peers, on average.
Beyond drugs. But it's also clear that fulfillment depends on far more than pharmaceutical fixes. "Erectile dysfunction drugs are marketed to suggest that older men will get back the kinds of erections they had in their 20s," and that's simply not the case, says Barry McCarthy, a professor of psychology at American University in Washington, D.C., and author of Men's Sexual Health. Clinical trials show that about 65 to 85 percent of men with erectile dysfunction find their problem improves with Viagra or one of the other two ED drugs, Levitra or Cialis. Yet, one third of men responding to a recent Consumer Reports survey said they experienced side effects from the drugs like headaches, heartburn, or, in rarer cases, prolonged painful erections. And men tempted to try drugs just for a little boost will most likely be disappointed at what Viagra can't do. "It's not an aphrodisiac and won't make a man bigger," says Abraham Morgentaler, an associate clinical professor of urology at Harvard Medical School and author of The Viagra Myth. "It also won't make a guy's erection any better if he doesn't have a problem in the first place."
When pills do fix the mechanical problems, reliving the passionate and soul-melding sex of younger days appears possible, too—assuming creativity and commitment. Passionate feelings are certainly more associated with the early throes of love, but researchers now believe they can be stirred in long-married folks, too. The proof lies in brain scans: Stony Brook University researchers recently performed functional magnetic resonance imaging on couples claiming to still be head over heels after 20-plus years of marriage and found remarkable similarities to scans of euphoric young lovers. "They both show substantial increases in those 'excitement' areas of brain that produce dopamine," a brain chemical associated with sexual arousal, winning the lottery, and cocaine highs, says Stony Brook social psychologist Arthur Aron.
Turns out the older set may even have an advantage. Whereas early love activates brain regions thought to be responsible for those can't-stop-thinking-about-you love pangs, more mature passion lights up areas where the "bonding" or "cuddle" hormone oxytocin is active. "Sexual liveliness can be equally strong for both," says Aron, "but long-term love doesn't have the jealousy or obsession that occurs when you've just fallen in love."
No one has yet determined exactly how to light up the brain's passion centers. But research shows that couples feel more attracted to one another after they've engaged in novel, challenging activities—like being tied together in a three-legged race—than after taking part in a routine pleasurable activity like sharing an ice-cream sundae. Fisher says it probably has something to do with challenge that causes a surge in dopamine. Rock climbing isn't necessary; Aron and his wife recently found it quite arousing to go to a bar for the first time in 10 years. "It was challenging for us just to walk in and figure out what to order," he says. Making it a point to celebrate good things together, like job promotions or prestigious awards, also has been shown to fuel passion, probably because of that shared dopamine surge. Practice helps, too. "Any kind of sexual stimulation drives up dopamine in the brain," Fisher explains, "and orgasms release oxytocin to trigger feelings of deep attachment."
Still, as baby boomers heading into their 60s are just beginning to realize, Mother Nature makes them feel less driven for sex when reproduction is no longer on the agenda. Testosterone levels naturally decline in both men and women, making them feel less in the mood, and less often. And common middle-age medical problems like diabetes, enlarged prostate, and heart disease can disrupt blood flow to sex organs, making it difficult for men to achieve and maintain erections even with Viagra or Cialis. A host of medications, too, can interfere with sexual functioning.
Prostate cancer treatments, which can permanently damage nerves that cause erections, present the biggest challenge in terms of robbing men of their sexuality. "At best, Viagra helps about half of those with no function," Morgentaler says. But perseverance can pay off. "Susan," 65, a writer in Manhattan who prefers to remain anonymous, donned "black lace teddies and stiletto heels worthy of a 20-year-old" and initiated oral sex twice a week for several years after her husband's prostate surgery. "At first, he looked at me hopelessly," she recalls, "trying to get to that place where his libido had been. Last year, we were finally able to have intercourse again."
For women, the plunging estrogen levels that occur during menopause often lead to vaginal wall thinning and dryness, which can make sex uncomfortable or downright painful. Menopausal mood swings can also be a mood killer. Susan has had to contend with both of these problems but worked with her doctor to find solutions; they opted to slowly lower her dose of hormone replacement therapy instead of her going cold turkey, for example, and she experimented with different over-the-counter lubricants. But many women are uncomfortable broaching the subject of sexual difficulties, and more than 90 percent of doctors don't ask, according to a 2007 survey conducted by the Women's Sexual Health Foundation.
Speak up. "Most gynecologists say they have very little training in the area of intimacy and sexual function," says Lisa Martinez, the foundation's executive director, "yet women expect these doctors to take the lead." After being treated for breast cancer last year, Martinez, 53, initiated conversations with her doctors about her mastectomy scar, vaginal dryness caused by an antiestrogen drug, and the extreme fatigue she felt from chemotherapy—all of which put a big damper on her sex life. She included her husband in these discussions to put him at ease.
Among the best concrete ways to extend a pleasurable sex life: Stay in peak form as long as possible. "I suspect just as good sex promotes good health, good health promotes good sex," says gynecologist Stacy Tessler Lindau, whose findings in the University of Chicago study showed that diabetics, for instance, were more likely to experience lack of pleasure or difficulty maintaining erections. The study also found that a man's physical health was the most common reason couples gave up. Sexually transmitted diseases can lead to painful intercourse and lubrication problems years later, according to a study published last month in the Journal of Sexual Medicine. Beyond the obvious—practicing safe sex—McCarthy recommends such healthful lifestyle habits as keeping regular sleep patterns, maintaining a healthy body weight, and following a nutritious diet of whole grains, lean protein, and fruits and vegetables. Plus, avoid excess alcohol, known to interfere with sexual function, and exercise regularly to improve blood flow and increase energy.
At any age, of course, it's being in a relationship that's cherishing and intimate on many levels that matters most in elevating sex beyond mere mechanics. Joan Price, the 64-year-old author of Better Than I Ever Expected: Straight Talk About Sex After Sixty, says that she had the best sex of her life after meeting her late husband seven years ago. "He saw me as beautiful, and I thought, if he thinks it, it must be so."