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DeLamater & HasdayPage 24

the ages of 40 and 60.  The decline in estrogen causes the vaginal walls to become thin and inelastic, and the vagina itself to shrink in width and length. By 5 years after menopause, the amount of vaginal lubrication often decreases noticeably.  These changes make penile insertion more difficult, and vaginal intercourse uncomfortable or even painful. There are a number of ways to deal with these changes successfully, including estrogen replacement therapy, supplemental testosterone, and use of a sterile lubricant.

As men age, they experience andropause (Lamberts, van den Beld, & van der Lely, 1997), a gradual decline in the production of testosterone; this may begin as early as age 40.  Erections occur more slowly. The refractory period, the period following orgasm during which the man cannot be sexually aroused, lengthens. These changes may be experienced as a problem; on the other hand they may be experienced as giving the man greater control over orgasm.

In addition to such biological changes, an important influence on sexuality is the attitudes held by others and derived from the culture, especially those attitudes that define specific behaviors as acceptable or unacceptable.  This is especially evident with regard to older persons.  In the United States, there is a negative attitude toward sexual expression among the elderly.  It seems inappropriate for two 75-year-old people to engage in sexual intimacy, and especially to masturbate.  These attitudes are particularly obvious in residential care facilities where rules prohibit or staff members frown upon sexual activity among the residents.  These attitudes affect the way the elderly are treated, and the attitudes of the elderly themselves.  These attitudes may be a more important reason why many elderly are not sexually active than the biological changes they experience.  In the United States, analysis of survey data from a representative sample of more than 1,300 persons age 45 and older found that negative attitudes toward sex for older persons was associated with reduced sexual desire (DeLamater & Sill, 2005).  Another major

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