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The loss of sexuality is not an inevitable aspect of aging, and the majority of healthy people remain sexually active on a regular basis until advanced old age. However, the aging process does bring with it certain changes in the physiology of the male and the female sexual response, and these along with a number of medical problems that become more prevalent in the mature years, play a significant role in the pathogenesis of the sexual disorders of the elderly. The typical patient over 50 has only a partial degree of biological impairment, which has, however, been escalated into a total sexual disability by a variety of cultural, intrapsychic, and relationship stressors. Fortunately, these problems are frequently amenable to an integrated psychodynamically oriented sex therapy approach that emphasizes the improvement of the couple's intimacy, and the expansion of their sexual flexibility.
The information about age-related sexual disorders as well as the concepts and treatment approaches that are presented in this article are the product of our observations of over 400 patients with sexual complaints who were 50 years or older, over the past 10 years.** Our method of evaluating couples with sexual dysfunctions includes, in addition to the customary sexual, psychiatric, and medical histories and examinations, a highly detailed investigation of their current sexual status and experiences and behaviors (Kaplan, 1983). This has enabled us to compare the adaptive behaviors and constructive interactions of couples who manage to