How Sex Keeps Us Young … and Healthy
What’s Love Got to Do with It?
Imagine two babies crying in a crib. Let’s say they’re identical twins, so that with the exception of their names (we’ll call them Diana and Donna), nearly everything about them is virtually the same — their genetic endowment, their life history, their environment, even their birthday. There’s one crucial difference: every time Diana cries, she’s ignored, whereas every time Donna cries, her mother picks her up, cuddles and soothes her, and asks her what’s wrong.
What happens to Diana and Donna as adults? Diana grows up feeling helpless, worthless, and unloved. By middle age she’s a confirmed addict, several times married and several times divorced, a failure at each of the many jobs she’s held. By 50 she’s dead. Donna, on the other hand, grows up with a solid sense of self-confidence, a feeling of mastery over herself and her life. She lives a rich and healthy life, full of achievement and rewarding relationships, until she dies at 90.
The only difference between Diana and Donna is love: Donna got lots of it early in life, and Diana didn’t. Love, and only love, made the difference between the two. Of course, this is an imaginary story. But to Leonard Sagan, a California physician and epidemiologist, it’s a powerful illustration of what has become his central belief: All other things being equal, the more love you have in your life — especially love at an early age — the longer you’re going to live.
Sagan first outlined this belief in his 1988 book, The Health of Nations, which grew out of 12 years of exhaustive epidemiological research, during which he studied disease and death rates in cultures all over the world, in some cases going back as many as 500 years. Sagan came out of that study convinced not only that love has a powerful influence on the longevity of the individual, but that early love, in the form of a warm and nurturing childhood, is the single-most important factor in the great leap in human life expectancy that has taken place over the past century.
That leap — from an average life expectancy of about 40 in the nineteenth century to today’s industrial-world average of 70-plus — has usually been explained in terms of advances in medicine and sanitation. The advent of antibiotics, vaccines, and modern plumbing, most experts contend, combined to act as a barrier against the infectious diseases — tuberculosis, typhoid, and pneumonia, among others — that had been massive killers throughout history. But Sagan found that these theories “were not borne out by the historical record.” First of all, he discovered, killer diseases like tuberculosis and typhoid were on the decline before the appearance of their medical remedies. Death rates from diseases for which no vaccine had been developed declined at about the same rate as those for which there were vaccines.
As far as Sagan is concerned, there’s only one possible explanation. He attributes the great leap in longevity to the increased strength of the family, and especially to changes in the rearing of children. “Until the late nineteenth century,” he says, “children were seen as miniature adults. Child rearing was mostly a matter of harsh discipline and authoritarian attitudes.” To the rich and ennobled, children were either potential heirs — and often rivals — or marriageable daughters, used to fashion alliances with other powerful families. To the poor, children were extra hands to help around the farm, the mine, or the home.
But Sagan thinks that in the twentieth century, with the spread of democracy and economic bounty, came the rise of smaller, gentler families, families in which the welfare of children was at least as important as the needs of the adults. In general, children came to be treated with the kind of loving care and concentrated attention that meant the development of “disease-resistant personalities” — people who were healthy, strong, and resilient enough to foster vigorous immune systems, which, in turn, help them live longer lives.
Sagan’s contention is considered interesting but controversial, in that most scientists find it hard to give up the idea that medical breakthroughs and improved sanitation have had a huge impact on human life expectancy. But he is certainly not the only expert to preach the vital connection between love and longevity. Over the past several years, a large body of evidence has accumulated to suggest that positive childhoods, strong emotional bonds, and a healthy network of social ties ultimately pay off in better health and longer life.
For the past 25 years, the psychiatrist George E. Vaillant of the Dartmouth Medical School has been keeping track of a group of Harvard men who were sophomores between 1940 and 1942. By the time they reached their mid-60s, Vaillant found, the single-most important factor in determining good health was a “warm childhood environment.”
Of course, what you do as an adult can be just as important as what was done to you — or not done to you — as a child. High on the list of social ties that promote long life is that strongest of all possible bonds between adults — marriage. It’s long been suspected that married people outlive their peers who stay single, and that suspicion was confirmed by a huge study, the results of which appeared in 1990. Yuanreng Hu and Noreen Goldman of Princeton University looked at almost 30 years worth of statistics for 16 industrial countries, including, among others, England, Portugal, Finland, Taiwan, Japan, and the United States. In those countries, the researchers found, the average death rate for unmarried men was over twice that of married men, while the average death rate for unmarried women was about one and a half that of married women. The young divorced and the young widowed fared particularly badly: They had death rates up to ten times higher than their married peers.
Goldman thinks there are two possible explanations. It may be, she says, that healthier people tend to find mates more easily, leaving their unhealthier counterparts in the unmarried category. Or it may be that sharing lives is an effective way of coping with stress — not only the stress that accompanies pure loneliness, but the hassles and nicks of simply being alive in this most stressful of centuries.
Although marriage does seem to be an important plus in the longevity equation, this doesn’t necessarily mean that people who stay single are doomed to live shortened lives. It may be loneliness, not singlehood, that seems to spell the difference. (Indeed, the psychologist Janice Kiecolt-Glaser and the immunologist Ronald Glaser of Ohio State University have found that people who scored high on a “loneliness index” had relatively sluggish natural killer cells, the immune system cells that help fight off tumors and infectious diseases.) The key, apparently, is to develop social and emotional ties that replace the bonds of family life — ties with friends, ties with lovers, ties that can nurture in all sorts of ways.
The epidemiologist Lisa Berkman of Yale University conducted a six-year study of 4,775 residents of Alameda County, California, in which she asked people to list four kinds of social ties that might potentially be important features in their lives: marriage, contacts with family and friends, religious-institution membership, and other sorts of group affiliations. Berkman found that those who scored low on her “social-network index” were more than twice as likely to die during the next nine years as those whose lives were enriched by emotional bonds. A similar study of 2,000 Tecumseh, Michigan, adults by University of Michigan sociologist James S. House came to a similar conclusion — a death rate twice as high in unsociable women, and up to three times as high in unsociable men.
Significantly, marriage in and of itself was not an important factor. According to Berkman, “Unmarried people who maintained many contacts with close friends and relatives had the same mortality rate as married people with fewer contacts. There isn’t any one relationship that’s critical,” she concludes. “What is critical is having — or not having — close connections with people.”
Also critical, if the experts are right, is the style of those connections. Relationships that are characterized by selfishness, manipulation, and exploitation are probably going to create more stress than they alleviate, and thus are not likely to help tip the scales of longevity in one’s favor. The majority opinion has it that the kind of relationship that’s most likely to have a positive impact on health and long life is the one that is cemented by altruism — a willingness to extend a helping hand and, at least in times of crisis, to put the other person’s needs before your own.
The link between altruism and longevity is of great interest to Allan Luks, former executive director of the Institute for the Advancement of Health and now director of Big Brothers/Big Sisters in New York. During the late 1980s, Luks undertook a study of helping behavior in which he distributed questionnaires to 3,000 volunteer participants. Not only was it clear that, in Luks’s words, “people who help others frequently report better health than people who don’t,” but more than 90 percent of those people actually experienced positive physical sensations linked to their helping — feelings of exhilaration, increased
‘“There is no doubt in my mind,” says psychologist Ann Beatty, “that continued sexual expression is a factor in prolonging life.”’
strength, and a deep sense of tranquility. Luks thinks these sensations may be caused by a release of endorphins (the same brain chemicals that are released during exercise to produce the “runner’s high”), or that helping others generates a mental and spiritual state similar to that induced by yoga and meditation. In either case, it’s becoming increasingly clear that a helpful, caring attitude toward others may be a ticket not only to a happier and more productive life, but to a longer one as well.
The watchword is to reach out and — touch someone — not just in the metaphoric sense, as in extending a helping hand, but also in a physical sense. It turns out that physical contact, especially at an early age, has an amazingly powerful impact on health and longevity — in rats, at least. In 1988, the Stanford University neuroscientist Robert Sapolsky and his colleague Michael Meaney of the Douglas Hospital Research Center at McGill University in Montreal spent 15 minutes a day for three weeks handling a group of new-born lab rats. When those rats reached the age of 28 months — doddering old age in rat terms — Sapolsky and Meaney found that they could swim mazes considerably better than their relatively untouched peers: They could swim them, in fact, just as well as young rats.
Fascinated by this finding, Sapolsky and Meaney dug deeper, looking for a biomechanical explanation for the intellectual rejuvenation of the handled rats. They found that the hippocampal regions of the brains of the handled rats had developed extra receptors for glucocorticoids, powerful hormones secreted by the adrenal glands during episodes of stress. These extra receptors apparently made the hippocampus more effective in regulating the secretion of glucocorticoids, keeping the stress hormones at levels that ultimately did less damage to the hippocampus. A healthier hippocampus seemed to spell better performance on the maze tests. Although Sapolsky cautions that what’s true in rats may not be true in humans, he points out that there are similarities in the nervous systems of the two species. In the end, he remains impressed. “Something incredibly subtle that occurs way back in infancy,” he says, “may protect the brain forever.”
The point of all this is that touching can pay long-term dividends in helping to ensure better health and longer life. This seems equally true of almost everyone’s favorite form of touching: sex.
First of all, the sex act — whether intercourse or masturbation — has a number of important rewards in terms of overall health: It helps lower blood pressure, relieve arthritis pain, alleviate insomnia, and reduce stress. Does regular sex also prolong life? The jury is still out on that question — for humans, at least — but many researchers think that once the facts become known, the answer will be a resounding yes. “The evidence is out there,” says Ann Beatty, a psychologist at Southern Illinois University at Edwardsville. “There is no doubt in my mind that continued sexual expression is a factor in prolonging life.”
Of course, sex does change with aging. Some of the changes are purely physical: In men, semen production declines, it takes longer to achieve an erection (“You can’t expect a 70-year-old man to have an erection at the drop of a bra,” says the famous sexologist William Masters), and longer to get to orgasm. Impotence, whether the causes are physical or emotional, becomes somewhat more frequent. In women, the production of estrogen slows down, especially after menopause, while the walls of the vagina become thinner, dryer, and somewhat less elastic. These physical changes can be reflected on the emotional side of sex: a feeling that sex is inappropriate, or that desire itself is on the wane.
Fortunately, science is hard at work on developing new ways to cure, or at least alleviate, the physical problems that can compromise our sexuality as we get older. Perhaps the most common — and the most feared — is impotence in men. In the past, it’s often been difficult to sort out whether impotence is a purely biological problem (that’s true, the experts say, in over half of all cases) or whether it’s caused by some sort of ongoing emotional difficulty. A new test developed by the Boston University School of Medicine urologist Irwin Goldstein and registered nurse Terry Payton can help determine whether impotence is biological or psychological.
In that test, a series of “cocktails” of the drugs papaverine, phentolamine, and prostaglandin E-1 (PE-1) are injected into the penis until a “bedroom quality” erection is produced. In normal men these drugs, which stimulate blood flow to the penis, will produce an erection in about 15 minutes. If there’s no erection, then the doctors know that something physical is impeding the blood flow to the genitals.
Poor blood flow is often due to blood pressure problems, which can be caused by clogging or hardening of the arteries. “If men have high blood pressure and a poor diet,” says Dr. Helen Kaplan, director of the Human Sexuality Program at the New York Hospital — Cornell Medical Center, “the penile arteries will clog up, too.” Luckily, there are remedies, essentially the same remedies for anyone whose arteries are constricted: diet low in saturated fats, exercise, and reduction of stress. “All these,” Kaplan concludes, “can slow down the progression of vascular impotence and maintain penile functioning.”
In some cases, impotence can be an unwelcome psychological by-product of problems with the prostate, the gland near the bladder end of the urethra that manufactures some of the ingredients of semen. In youth, the prostate is about the size of a walnut, but as men age, about 75 percent of them will experience swelling of the prostate. If it swells enough, the gland can choke off the urethra, causing urinary problems that can be severe. In the most troubling cases, part or all of the prostate has to be surgically removed to restore proper urinary flow.
That’s where the psychological sexual problems can come in. The common belief is that prostate surgery almost invariably causes some degree of impotence, or at least a decline in sexual functioning. According to Laura Creti of the Behavior and Sex Therapy Service of Sir Mortimer B. Davis — Jewish General Hospital in Montreal, this can become a self-fulfilling — and sexually self-defeating-prophecy. “Men may fear surgery itself. Not just prostate surgery, but any surgery may interfere with penile and erectile functioning,” says Creti, who studied 32 men who had had prostate and herniography operations. “And it appears that there is a relationship between what men believe will happen and then subsequently what does happen.” On the other hand, Creti found, men who’ve had a healthy sex life before the operation and expect to continue enjoying sex afterward often do. “These well-functioning men,” Creti concludes, “don’t have much to worry about.”
For the men among you who continue to fear that prostatectomy will mean the end of your sex life, there’s further good news. All over the country, scientists are busily at work developing knife-free alternatives to prostate surgery.
In an experimental procedure, doctors at Pennsylvania Hospital in Philadelphia used ultrasonic aspiration on 59 men with B.P.H. (benign prostatic hypertrophy, or noncancerous swelling of the prostate). Eighteen months later, none required further surgery. For those who want nothing to do with hospitals, an experimental drug called Proscar has been effective in reducing prostate swelling in about 30 percent of the cases, and seems to have no effect on sex drive or potency. Proscar could be available by the mid-1990s.
The message here is that the physical and emotional changes that accompany getting older do not necessarily mean that your sexuality is on the wane. It’s just changing, and in some ways it’s changing for the better. The unbridled passion of youth may fade along with the sound of trumpets and violins, but it can and often is replaced by a richer sound — the sweet, slow hum of the cello. Dr. Robert N. Butler, former director of the National Institute on Aging, calls this deeper form of intimate expression “the second language of. sex.” “When you’re 17,” Butler says, “the first language of sex is excited, urgent, often passionate, but also amateurish and primitive. With time, you can broaden your definition of sex and acquire new skills and experience.” Some of those skills can be purely physical — more touching, more fondling, more mutual stimulation. Others are emotional: tenderness, thoughtfulness, sharing — in general, putting the love back in lovemaking.
Basically, as Butler and other experts suggest, much of preserving a healthy sex life is a matter of maintaining a healthy attitude. “As we get older,” says Nancee S. Blum, co-author of Sexual Health in Later Life, “it’s easy to view the body as a repository of pain. It’s good to know that the body can give and receive pleasure as well.” If you believe that sex can be an ongoing feature of your life as you. get older, that it can be even deeper and more pleasurable than it was when you were young — and if you’re willing to adopt an attitude of enthusiasm, adventure, and continuing experimentation — then the chances are that you’ll be able to enjoy sex your whole life through.
Besides maintaining a healthy, adventuresome attitude, there are some other things you can do to help keep your sex life active and fulfilling. One of the most important of these is exercise — exercise outside the bedroom, that is. The behavioral scientists Phillip Whitten and Elizabeth J. Whiteside did a survey in which they compared two groups of 160 active swimmers, one group in their forties and one in their sixties, with a normal population in the same age groups. The swimmers were found to be significantly more sexually active than the sample from the normal population. The swimmers in their forties reported having intercourse at a frequency usually reported by people in their twenties and thirties.
If regular exercise can help keep your sex life bubbling even in your sixties, so, too, can careful attention to your diet. The San Francisco physician and psychiatrist Richard Kunin thinks that there’s a special sexual payoff in keeping your diet low in fats. “Anything that improves circulation,” he says, “tends to enhance one’s love life.” Simple carbohydrates like sugar should also be avoided; these can induce hypoglycemia, drowsiness, and sluggishness, all of which can act to apply the brakes in the bedroom.
On the other hand, there are certain nutrients that act as sexual stimulants. Vitamin A, for example, found in egg yolks, liver, and most fruits and vegetables, helps maintain the production of virtually all the sex hormones. Vitamin B6, found in whole grains, liver, fish, yeast, and avocados, decreases the production of prolactin, which is implicated in depressing sexual desire in women. In men, vitamin B6 increases the production of the hormone that regulates testosterone. Vitamin E, found in green vegetables, whole grains, seeds, and nuts, improves circulation in general, and in women also helps boost levels of prostaglandins, fatty acids that help the uterus contract during intercourse.
Among the nutrient minerals, two in particular can help keep the fires burning. Manganese, found in nuts, whole grains, dried beans or peas, and tea, helps stimulate the brain’s production of two neurotransmitters — acetylcholine and dopamine — that help fuel sexual arousal. Zinc (look tor it in oysters, wheat germ, cashews, green beans, lima beans, and meats like beef and lamb) assists in the formulation of testosterone, which, interestingly enough, has been found to be a sexual turn-on not only in men but in women as well. “All these nutrients,” says Kunin, “are necessary to a rich and energetic sex life.”
If attitude, exercise, and diet fail, there are several drugs now being tested as potential promoters of sagging sexual desire. One of these is quinelorane hydrochloride, a substance that mimics the activity of the neurotransmitter dopamine.
A second drug that may turn out to have an impact on sexuality is buproprion hydrochloride, which goes under the trade name Wellbutrin. Although its manufacturer says the drug has only a modest effect on sexuality, Crenshaw Clinic director of research James Goldberg finds early results more promising. Along with colleagues Theresa L. Crenshaw and Warren Stern, Goldberg gave 225 to 450 milligrams of Wellbutrin per day for 12 weeks to a group of 68 men and women who were suffering from inhibited sexual desire, inhibited sexual excitement, or inhibited orgasm. By the end of the study period, 66 percent of the treated patients reported themselves much improved or very much improved.
While some people may feel their sexuality to be declining as they get older, for others — especially some men — the problem can be quite the opposite: over-excitement, and its anticlimactic consequence, premature ejaculation. For these men there may be some good news on the horizon in the form of the blood-pressure-control drug Dibenzyline. According to a report in the Journal of Sex and Marital Therapy, when Argentine psychiatrist Mario Luis Gospodinoff gave Dibenzyline to 39 overstimulated patients for 28 days, 60 percent of them calmed down to satisfactory — and satisfying — levels.
All this leads us to one happy conclusion: Our pursuit of sexual pleasure need not be interrupted by anything as trivial as aging. Surprisingly enough, the same may soon turn out to be true of nature’s underlying sexual goal — the making of babies. Most of us think that childbearing stops sometime in middle age — late middle age for men, somewhat earlier for most women. Many people, of course, wouldn’t have it any other way.
But for those die-hard parents among you, there may soon be no need to sing the empty-house blues after the last kid heads for college. First of all, the last several years have seen the emergence of a truly amazing variety of treatments for the declining fertility rate that often accompanies getting older. Probably the best known of these is invitro fertilization, or I.V.F., in which a follicle — an egg and its surrounding cells — is taken from a woman’s ovaries and fertilized in a laboratory, using her husband’s sperm. The embryo is then implanted in the woman’s uterus, and if all goes well, which it does about 14 percent of the time, a normal pregnancy and delivery are the happy result.
A newer alternative, for women with functioning fallopian tubes, is the GIFT procedure, which is similar to I.V.F. except that once the eggs and sperm are mixed, they’re immediately implanted in the woman’s fallopian tubes for fertilization. Success rates now average 21 percent, although some doctors have reported success rates of 42 percent.
An older, simpler, and cheaper method is intrauterine insemination, in which the ovaries are stimulated with hormones and the husband’s sperm is inseminated directly into the uterus. At the scientific frontier is cryopreservation: freezing fertilized eggs, or even early-stage embryos, for later implantation into the mother.
There’s another breakthrough looming ahead: male pregnancy. Yes, you heard right. This age-old dream of women (and maybe a few enlightened men, although I haven’t come across any) is actually on the scientific drawing board. At the George Washington University Medical School in Washington, D.C., Cecil Jacobson has implanted chimpanzee embryos into the abdomens of male chimps. Startlingly enough, as many as 50 percent of the male chimps actually gave birth — by cesarean section, of course. Jacobson’s work has inspired Robert Francoeur, a professor of biological sciences at Fairleigh Dickinson University in Madison, New Jersey, to predict that male pregnancy could actually be a reality before the turn of the twentieth century. As in the chimp experiments, Francoeur says, “The embryo could be implanted in the abdominal cavity, and the delivery accomplished by cesarean.”
Male pregnancy aside, the message of all this is obvious: Age is no barrier to the joys of love. You can enjoy the peaceful companionship of marriage, and you can keep sexual passion simmering. You may even be able to start family life all over again. And the happiest news of all is this: Chances are that the more love in your life, the longer you’ll live to enjoy love still more.
As of this writing, you could still find Kathy Keeton’s Longevity: The Science of Staying Young on Amazon. She was an amazing woman, Ms. Keeton. She was with Bob Guccione for over 30 years. Cancer is a bitch. … You can read more about Kathy in these pages.
