People vary a great deal in their sexual attitudes and practices. This makes it hard to define "normal." Some couples like to have sex every day. For others, once a month is enough. Many people see oral sex (using the mouth or tongue) as a normal part of sex, but some believe it is not OK. "Normal" for you and your partner is whatever gives you pleasure together. Both partners should agree on how to make their sex life happy.

It is normal for people with cancer to lose interest in sex at times. Doubts and fears, along with cancer and cancer treatment, can make you feel less than your best. At times, concern about your health may be much greater than your interest in sex. But once you return to your normal routines, your interest in sex may begin to return.

It is also normal to be interested in sex throughout your life. This is an important point because most cancers are more common in people over 50. But there are some who think sex is only for the young, and that older people lose both their desire for sex and their ability to "perform."

Those beliefs are largely myths. Many men and women can and do stay sexually active until the end of life. No one should have to apologize for still being interested in sex at any age. (See the "Additional resources" section for more on sex and aging.)

What is normal isn't always what the media has led us to expect. And the media is a strong influence on our ideas about normal sexuality. Since the 1960s, books, music, TV, movies, and magazines have become more open about sex. For the most part, this has probably helped American adults learn more and talk more about sex. But the media has also promoted some ideas of "good sex" that don't match real life for most people. Men might think they should have instant erections. Women may feel they've failed if don't reach orgasm at least once every time they have sex. If you find yourself feeling inadequate, remember that the only true measure of your worth as a lover is the pleasure you and your partner find together.

It is true that sexual response and function may change with aging. For example, more than half of men over age 40 have at least a little trouble with erections. For some of these men the problem is severe. Sometimes, the problem centers around anxiety, tension, or other problems in a relationship. Other times, it may be a physical condition, a medical condition, or medicines that cause or worsen sexual problems. We now have medicines, therapy, surgery, and other treatments that can help men and their partners deal with most kinds of problems they may have.

Many women also notice changes as they get older, sometimes even before menopause begins. A decrease in sexual desire and problems with vaginal dryness may increase during and after menopause. These symptoms can be treated. If you want to keep your sex life active, you can likely do so.

If you are in a relationship and one of you has a sexual problem, it affects both of you. If you are dealing with sexual problems, it works best when your partner can be part of the solution.

What is a healthy sexual response?

The sexual response of women and men has 4 phases:

• desire
• excitement
• orgasm
• resolution

A person goes through the phases usually in the same order. But the sexual response can be stopped at any phase. You don't have to reach orgasm each time you feel the desire for sex.

Desire is an interest in sex. You may just think about sex, feel attracted to someone, or be frustrated because of a lack of sex. Sexual desire is a normal part of life from the teenage years onward.

Excitement is the phase when you feel aroused or "turned on." Touching and stroking feel much more intense when a person is excited. Excitement also results from sexual fantasies and sensual sights, sounds, scents, and tastes. Physically, excitement means that:

• Heartbeat and pulse speed up.

• Blood pressure goes up.

• Breathing gets heavy.

• More blood is sent into the genital (or "private") area, and the whole area, including the clitoris, swells. (In a man, the surge of blood creates an erection, or a stiff penis.)

• The vagina becomes moist and gets longer and wider, opening up like a balloon.

• The skin of the genitals ("private parts") turns a deeper color of red.

• The body may sweat or get warmer.

Orgasm is the sexual climax. In both women and men, the nervous system creates intense pleasure in the genitals. The muscles around the genitals contract, in rhythm, sending waves of feeling through the body. Men ejaculate (or release) semen when these muscles contract. The person feels pleasure and satisfaction.

Resolution occurs within a few minutes after an orgasm. The body returns to its unexcited state. Heartbeat and breathing slow down. The extra blood drains out of the genital area. Mental excitement subsides.

If a person becomes excited but does not reach orgasm, resolution still takes place but more slowly. It is not harmful to become excited without reaching orgasm, though it may feel frustrating. Some women and men may feel a mild ache until the extra blood leaves the genital area.

Refractory period. Men have a certain amount of time after orgasm when they are physically unable to have another orgasm. This time, called the refractory period, tends to get longer as a man ages. A man in his 70s may need to wait several days between orgasms. Women do not have a refractory period. Many can have multiple orgasms, one after another, with little time in between.

Last Medical Review: 11/10/2008
Last Revised: 11/10/2008