'When you are younger, desire leads to love; as you get older, love will guide you to desire' - Dr Marc Ganem, French sexologist, speaking at the fourth congress of the European Society for Sexual and Impotence Research (ESSIR), Rome, October 3rd, 2001
The end of the taboo does indeed appear to be in sight. Ever since Larry King interviewed senator Bob Dole about sexual dysfunction and his use of Viagra, the notion that people over 60 have a sex life and take pleasure out of it has become a subject for open and honest discussion.
Advertising images showing over-50s in ever more romantic poses reinforce a message that older people live their sexuality more freely than before. And while it may take a few more generations for the taboo to disappear completely, it is significant that the "baby-boomer" generation is now approaching 50. As the original sexual liberationists they are likely to bring with them into their 60s and 70s a proportionate interest in sex.
Medical research suggests that sexual desire is ageless. A US study of people over 70 showed that 55 per cent of women and 75 per cent of men have at least a moderate interest in sex. Despite this, however, there is a reported reduction in both the quality and quantity of sexual intercourse.
According to Dr Ganem, while a broad interest in sex is maintained, peripheral issues can pose difficulties for older people.
"Physical factors such as aches and pains, heart disease, erectile dysfunction and weight problems make intercourse more of a challenge", he says. Psychological issues such as a fear of ageing, anxiety, depression and pre-existing relationship problems can also be a barrier to continuing a vigorous sex life.
With life expectancy on the increase - it is estimated that the percentage of Europeans over 65 will have increased from 7 per cent to 16 per cent by 2020 - now is the time to challenge sexual ageism. Our western culture has become somewhat unkind to old age. In Dr Ganem's words, it is time to encourage "the old to remain young" and not to discard older people to a quality-of-life scrap-heap.
Older people should not feel embarrassed or ashamed of having sexual needs "at their age". Families must be careful not to express expectations of celibacy, especially if a parent has been widowed and is beginning to explore new relationships.
While sexual desires may remain strong it is unrealistic to expect all older couples to have an uninhibited sex life. But many of the so-called "problems" can be anticipated before people reach their senior years, and sexual habits and practices can the n gently evolve around the physical realities of ageing.
Researchers at Sheffield University have found that regular sex is closely linked with well-being among the over-50s. Most participants in their study - married couples with an average age of 67 - felt that "sexual relationships make a valuable contribution to qual ity of life". They identified "shared intimacy" and "feelings of togetherness" as positive benefits of regular sexual activity.
"Sex makes you feel as though you are still wanted and attractive. You know that although you are a bit fat and flabby and everything, your husband or partner has probably known you a longtime and can still remember you when you were 18 or 19. You still see each other as when you were younger. You can think back to what it used to be like," was a typical quote from one of the female participants.
It appears that regular sexual contact improves body image and emotional wellbeing. The researchers also found that older couples were adept at overcoming other health problems. "You may find it slightly more difficult to have an orgasm, but there are ways and means of dealing with that," commented one 78-year-old.
Since the advent of Viagra three years ago, much emphasis has been placed on the oral treatment of erectile dysfunction for older men. A number of other drugs either have reached, or are about to reach, the consumer - all of them offering a relatively quick fix and a non-invasive solution to impotence. Some of these work by altering blood flow to, and relaxing smooth muscle in, the penis, whereas others act centrally in the brain.
Viagra achieved much more than your average pill. It succeeded in making male sexual function an acceptable topic for discussion and in giving voice to a silent taboo.
Dr Stephen Murphy, chairman of the Erectile Dysfunction Information Helpline, says it has received more than 1,500 calls since it was set up last year. Callers are provided with written information and always directed to their own GPs as the most appropriate port of first call.
"We know that, in Ireland, up to 50 per cent of 50-year-old men will suffer from some degree of erectile dysfunction," says Murphy. "This means that erectile dysfunction is more common than high blood pressure. Many relationships suffer strain as a result of this condition so it is important to realise that hundreds of thousands of both men and women may be suffering here."
Dr Alan Riley, professor of sexual medicine at the University of Central Lancaster, told the ESSIR conference earlier this month there is a need to redefine the male patient with impotence. "I believe we are over-estimating the number of people with a purely physical cause," he said, calling on doctors to acknowledge that, even in cases where new drugs work, there are often co-existing psychological factors which need to be addressed.
What about the older woman? Not only are there no dedicated treatments for sexual dysfunction in females, but the level of research lags well behind that for erectile dysfunction. Dr Irwin Goldstein of the US made an impassioned plea to the Rome conference: "We need much more research into this area, please".
Serious intensive research into the physical aspects of female sexual dysfunction has been underway only since 1998, according to Goldstein. Blood flow to the vagina in women is important, with some preliminary studies suggesting that a blockage to the main artery supplying the are area can produce a reduction in blood flow, leading to local dryness.
The research data on hormonal influences is understandably better, given the availability for many years of hormonal replacement therapy for women. Oestrogen has a positive effect on blood flow to the genital area, restoring tissue health. The male hormone, testosterone, is also known to play a role in the ongoing sexual health of older women.
Why the hiatus between male and female dysfunction research? Could it be that the pharmaceutical industry is silently acknowledging the fact that female sexual treatment will always be more complex than a matter of mere "pill-popping"?
Despite some anecdotal evidence that women can benefit from drugs like Viagra, the parlous state of research into the physical aspects of female sexual functioning suggests that dedicated oral treatment for women is some way away.
This may not be a bad thing, according to Dr Gorm Wagner. The Dutch expert says that "true knowledge of the sexual function of females is scarce". He opposes the traditional medical model of a medication-orientated approach to female sexual dysfunction. "It is not for doctors to judge and prescribe on these matters," he says. "Only a humanistic approach is acceptable when dealing with sexual matters."
Female sexual dysfunction used to be referred to as "frigidity", essentially a pejorative male perception of their female partners' attitude to sex. The term entirely excludes the woman's perspective and the feelings that give rise to sexual problems. For example, far from being "cold", many women in the past were afraid of pregnancy in an era when reliable contraception was not available.
What of the present? The latest large-scale US and UK research suggests that 40 per cent of women experience some kind of sexual problem at some point in their lives. The principal complaints relate to painful intercourse, a lack of arousal during sex and orgasm difficulties. Men, in comparison, tend to suffer with performance anxiety and premature ejaculation, although other specific difficulties are shared by both sexes.
Female sexual disorders are categorised into four types: disorders of desire, arousal, pain (including painful intercourse and vaginal spasm), and delayed or absent orgasm.
The conference heard about a typical case of female sexual arousal disorder. A 32-year-old woman had suffered with a lack of arousal and reduced vaginal lubrication during sex for the previous five years. Happily married for nine years, her sexual difficulties followed the birth of their first child. A full gynaecological examination was normal, as were blood and laboratory tests.
Her therapist commenced a course of cognitive psychological therapy, in which accumulated negative feelings about sex were addressed. Her husband and herself were taught a technique called non-demand pleasuring - a form of massage that excludes sexual intercourse. They were encouraged to move very slowly back to full intercourse while making use of an artificial vaginal lubricant. Gradually, her distress diminished as her previous level of sexual arousal returned.
A 1988 German study of the psychological aspects of female sexual arousal found a close connection between sexuality and emotions. Sexually satisfied women achieved a balance between their own needs and those of their sexual partners, they were not afraid of sexual abandonment and they were comfortable with heightened levels of intimacy.
A gynaecologist in a provincial general hospital here has confirmed the growing prevalence of female sexual dysfunction in the Republic. Unlike other European countries, there is no developed multi-disciplinary sexual health service available. Problems of this nature cannot be dealt with in the confines of the busy, "clinical" environment of a typical outpatients' department.
"There is a huge need for trained psychosexual counsellors and nurse practitioners, who are the backbone of any successful team approach to female sexual dysfunction," according to the specialist, who did not want to be named.
In contrast to her experience as a consultant in the UK, she has nowhere to refer women with sexual difficulties. Amazingly, as a consultant within the States public health system, she refers some women to a local GP who has a particular interest in the area of female sexual health. The specialist is clearly unhappy and frustrated that her hard-earned knowledge of psychosexual medicine cannot be used to benefit patients.
The Republic is part of the European Sexual Dysfunction Alliance (ESDA), which has 12 member countries and was launched in Barcelona last year. It aims to help patients by providing helplines and independent advice. Unlike in other countries, the UK and the Republic helplines are male-orientated so far. Website: www.esda.eu.com
The Irish Erectile Dysfunction Information Bureau will soon offer information on female sexual problems. Helpline: 1850-923098.