EXPERT PERSPECTIVE

Expert Perspective Your professional perspective on a topic from your area of expertise that every adult should understand. Growing Older Doesn't Mean Giving Up on Intimacy By Dr. Sanjay PandeyConsultant Robotic-Reconstructive Urologist As a urologist, I often meet people who believe that changes in intimacy are simply something they must accept as they grow older. "It's just age." "These things happen." "What can anyone really do?" Over the years, I've realised that many people don't stop seeking closeness because they no longer value it. They stop because physical changes, medical conditions, embarrassment, or uncertainty gradually make intimacy feel more complicated than it once was. Ageing certainly changes our bodies. But it doesn't remove our need for affection, connection, or physical closeness. Those are deeply human needs that continue throughout life. The conversation, therefore, should never be about whether intimacy belongs in later years. It should be about understanding how it evolves. Our Bodies Change. So Does Intimacy. Just as our eyesight changes, our joints become stiffer, or our sleep patterns shift with age, our intimate lives also evolve. For men, this may include changes in: Erections Ejaculation Urinary symptoms Testosterone levels Recovery after prostate surgery For women, changes may include: Menopause Hormonal changes Pelvic floor weakness Vaginal dryness None of these changes mean intimacy has come to an end. They simply ask us to approach it differently. One of the Greatest Barriers Isn't Physical Medicine has made remarkable progress in helping people manage many conditions that affect sexual wellbeing. Yet one obstacle continues to appear in consultation rooms far more often than disease itself: Silence. Many couples never discuss the changes they are experiencing. Partners often assume the other has lost interest. Some avoid intimacy altogether to escape awkwardness or disappointment. Others simply accept years of distance without ever knowing that help may have been available. In my experience, the absence of conversation often creates more suffering than the medical condition itself. There Is Rarely One Simple Cause People often expect a single explanation. In reality, intimate wellbeing is influenced by many factors working together: Diabetes High blood pressure Certain medications Sleep disturbances Stress Pelvic surgery Hormonal changes Mental wellbeing Relationship dynamics Good care begins by recognising that intimacy is not controlled by one organ or one hormone. It reflects the health of the whole person. Looking Beyond Performance One of the biggest misconceptions surrounding intimacy is that it must always be measured by performance. Medicine can certainly help address physical concerns when they arise. But healthy intimacy is about far more than a physical response. It includes: Comfort Communication Trust Affection Feeling emotionally safe When we reduce intimacy to performance alone, we often overlook everything that gives it meaning. When Should Someone Seek Help? If changes in your intimate life are causing frustration, avoidance, anxiety, or affecting your relationship, it is worth speaking to a qualified healthcare professional. Many people delay these conversations for years because they feel embarrassed or assume nothing can be done. In reality, understanding the cause is often the first and most important step. Sometimes reassurance is enough. Sometimes lifestyle changes help. Sometimes medical treatment makes a significant difference. The important thing is knowing you don't have to navigate these changes alone. A Perspective I'd Like to Leave You With Growing older changes many parts of our lives. It changes how we work. How we recover. How we see the world. It is only natural that it changes intimacy too. The goal isn't to hold on to the version of intimacy we had twenty years ago. It is to understand the one that belongs to this stage of life. When we stop expecting our bodies to remain unchanged and instead begin understanding how they evolve, we create space for greater confidence, healthier relationships, and more meaningful conversations. Because intimacy doesn't end with age. Like the rest of life, it simply asks us to grow with it. From My Practice Lessons and observations drawn from daily clinical practice that may help others. When We Begin Living Around a Problem Instead of Solving It By Dr. Sanjay PandeyConsultant Robotic-Reconstructive Urologist There are certain changes women rarely speak about openly. Not because they are uncommon. But because, somewhere along the way, they begin believing they are simply a part of life. In my practice, I often meet women who don't come in saying, "Doctor, I have urinary leakage." Instead, they tell me about everything they've stopped doing. "I avoid long walks." "I've stopped laughing too freely." "I always check where the nearest washroom is." "I carry an extra pair of clothes, just in case." Some no longer enjoy exercising. Others become hesitant during moments of physical closeness with their partner. Many simply learn to organise their lives around a problem they quietly assume they have to live with. Over time, what began as a small adjustment slowly becomes a way of life. The difficult part is that many women never realise it doesn't have to be. The Problem Often Has a Name One of the most common reasons for this experience is stress urinary incontinence—the involuntary leakage of urine during activities that increase pressure on the bladder. Despite its name, it has nothing to do with emotional stress. It can happen while: Laughing Coughing Sneezing Lifting something heavy Exercising Climbing stairs Making sudden movements Because the leakage is often small in the beginning, many women dismiss it or quietly adapt to it instead of seeking help. Why Does It Happen? The muscles and tissues supporting the bladder naturally change throughout life. Pregnancy and childbirth can weaken these support structures. Ageing and menopause may further reduce muscle strength and tissue support. Weight gain, chronic coughing, constipation, repeated heavy lifting, or previous pelvic surgery can also contribute. These are changes many bodies experience over time. They are not a reflection of weakness or something to feel embarrassed about. The Impact Is Rarely Just Physical What often concerns me most isn't the leakage itself. It's the quiet ways women begin changing their lives because of it. Choose different clothes. Avoid certain exercises. Hesitate before long journeys. Say no to activities they once enjoyed. Others withdraw from intimacy—not because they no longer desire closeness, but because they worry about what might happen. These changes are rarely discussed, even with family members or partners. Yet they can slowly affect confidence, relationships, and the way a woman experiences her own body. You Don't Have to Simply Accept It One of the biggest misconceptions I encounter is that urinary leakage is an inevitable consequence of childbirth or ageing. While it is certainly common, it is often treatable. Depending on the cause and severity, treatment may include: Pelvic floor muscle exercises Bladder training Lifestyle modifications Weight management Medication Minimally invasive surgical procedures (when appropriate) The important first step is not choosing a treatment. It is recognising that the problem deserves attention. When Should You Speak to a Doctor? If urinary leakage is making you: Avoid exercise Change your daily routine Wear protective pads regularly Limit your travel Lose confidence Affect your intimate relationships …it is worth speaking with a urologist or your gynaecologist. Many women wait for years because they believe nothing can be done. In many cases, that simply isn't true. A Thought I'd Like to Leave You With Over the years, I've realised that women are remarkably good at adapting. They adapt to discomfort. They adapt to inconvenience. They adapt to changes they never imagined their bodies would go through. Often, they do it so quietly that even the people closest to them never realise what they've been carrying. But adaptation should never become acceptance. Our bodies change through different stages of life. Understanding those changes is part of caring for ourselves. Seeking help when something no longer feels right is just as much a part of that care. Because living well isn't about adjusting to every limitation. Sometimes, it's about recognising that you deserve better than silently living around a problem that may well have a solution.