Sexuality in older age

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Exchange of affections among seniors in an old people's home Altenheim 21.jpg
Exchange of affections among seniors in an old people's home

Sexuality in older age concerns the sexual drive, sexual activity, interests, orientation, intimacy, self-esteem, behaviors, and overall sexuality of people in middle age and old age, and the social perceptions concerning sexuality in older age. Older people engage in a variety of sexual acts from time to time for a variety of reasons. Desire for intimacy does not disappear with age, yet there are many restrictions placed on the elderly preventing sexual expressions and discouraging the fulfillment of sexual needs. Sexuality in older age is often considered a taboo, yet it is considered to be quite a healthy practice; however, this stigma can affect how older individuals experience their sexuality. While the human body has some limits on the maximum age for reproduction, sexual activity can be performed or experienced well into the later years of life.

Contents

Physical changes

Both male and female libidos tend to decline with increasing age, and women tend to lose their libido faster than men. However, desire for sexual activity is not lost completely. Neither does it decrease for everyone. Menopause, a female biological process, has been linked to a loss of interest in sexual activity and to a desensitization of the genital area. [1] In some cases, vaginal penetration can be painful for older women (see, for example, vaginismus). [2] Vaginal atrophy is another example of a bodily change in women that may make penetration painful, characterized by the thinning of vaginal walls. However, with the advent of hormone replacement therapy (HRT) treatments, the effects of menopause have lessened and women have more opportunities to continue experiencing a pleasurable and active sex life. Similarly, treatments for erectile dysfunction can make it possible for men to enjoy sexual activity again.

Health benefits

It has been suggested that an active sex life can increase longevity among the elderly. Positive sexual health in older age is slowly becoming more of a commonplace idea with the steady increase in the percentage of the older population. This population percentage increase requires placing more attention on the needs of this age group, including their ideas on sexual health, desires, and attitudes. This shift in attitudes and behaviors has combined with medical advances to prolong a sexually active life and change the landscape of aging sexuality. [3]

Sexual health and expression reflects a physical, mental, and emotional need that affects individual health and intimacy quality for older couples' relationships. Dr. Syme found that, "Having a sexual partnership, with frequent sexual expression, having a good quality sex life, and being interested in sex have been found to be positively associated with health among middle-aged and older adults." [3]

There are a number of associated health benefits with practicing positive sexual health. Positive sexual health often acts as a de-stressor promoting increased relaxation. Researchers also report health benefits detailing decreased pain sensitivity, improved cardiovascular health, lower levels of depression, increased self-esteem, and better relationship satisfaction. [3] The former could also imply the consequences of negative sexual health and lack of sexual activity, such as depression, low self-esteem, increased frustration, and loneliness.

Health risks and education

There are already numerous health concerns linked primarily with aging, but when sex is added into consideration, this opens up discussion for many other related concerns. Sex and aging come with many challenges for the older population as well as their primary care providers. The task for these care providers is to accommodate to the changing needs of this older sexually active generation. [3]

Common health conditions hindering older adults are illnesses such as cardiovascular disease, diabetes, degenerative and rheumatoid arthritis, stroke, cancer, kidney disease, and spinal cord injury. These conditions heavily impact individual sex lives. [3] Separate from these are physical concerns related specifically to sexual health and bodily functions. Researchers gathered that, "the most common concerns for older adult men include erectile dysfunction and premature climax, and older adult women most commonly report lack of desire, problems with vaginal lubrication, sexual pain, and inability to reach orgasm." [3] Consideration of these aging-related health problems and sexual-related health problems together require primary care providers and professionals to be updated on the latest health findings and to know patients' needs and possible solutions.

A major problem with improving education and seeking solutions for aging sexual health risks is the lack of verbal discussion on these matters from older individuals. "Older adults often avoid seeking help for sexual concerns because of a lack of knowledge about their sexual problems, embarrassment or discomfort talking about sex, and stigma-related beliefs about older adults and sexuality in older age being inappropriate." [3]

Another major problem with improving education and seeking solutions for aging sexual health risks was found after researchers looked at the readiness and training of 777 physicians and 452 nurse practitioners from the American Medical Association Masterfile. [4] Researchers noted that amongst their representative sample there were reports of limited training in sexual health as a general topic. From this information, they assumed that "training that is specific to older patient’s sexual health is limited, if available at all." [4]

The purpose of the study was to test how knowledgeable U.S. primary care providers were on the topics of sexual health and sexuality in older age. [4] The results of the study showcased that U.S. health care providers on average were less knowledgeable than U.S. graduate nursing students on the topics of sexual health and aging sexuality. In a comparison survey, it is also worth noting that they were reported less knowledgeable than Turkish physicians and U.S. Ob/Gyns. However, the group reported to be even less knowledgeable on aging sexuality than U.S. primary care providers consisted of nursing home staffs and older adult care workers. [4] Educated health providers are needed to educate the general public and older adults (active and inactive) on sexual health and healthy expression.

Sexually transmitted infections (STDs/STIs) can also be prevalent in later life, despite common misconceptions that STDs only affect younger people and groups. There has been a steady increase in the number of STDs found in elderly individuals in nursing homes and other residential living communities, belying the perception that elderly people do not engage in sexual activity. [5] Many men in older age do not believe they need to use protection, such as condoms, as they age, and their partners often feel likewise, so it can be difficult to stress the importance of continued use of protection for elderly couples. [6] One of the main reasons they develop this opinion is because of the decreased risk of pregnancy, but they often fail to acknowledge that protection is necessary to prevent the circulation of STDs.

Including Older Adults in Sexual Health Resources

To better support the aging population, we need to actively involve older adults and disabled individuals in policy making, research, and tailored messaging programs. Research should be used to identify gaps and improve health systems. Policymakers must take into consideration the impact of sexual health (SH) on older adults’ wellbeing. Finally, SH programs and messaging must include and cater to older adults to incorporate the entirety of the sexually active population.

Research

Population aging has direct implications for SH researchers. Older adults are often excluded from population-based SH research studies. A review of STI treatment clinical trials found that 72.7% of risk-reduction clinical trials excluded participants over the age of 50, and 88.8% excluded those over the age of 65. [7] In order to generate more responsive SHS and engage a population that is often excluded from participatory research, researchers need to include older adults in cohort studies, trials, and other research.

There is a need for empowerment and incorporation of older and disabled adults’ ideas. The Sexual Health in Older Adults Research team used co-creation and related participatory approaches to solicit feedback from older adults in the United Kingdom to improve health services. [8] This included workshops, open calls, and community discussion involving participants from all backgrounds, including those of “older age” (referenced as >45 years in this study) and those with disabilities. Their collaborative design and process demonstrates that social innovators could use co-creation methods to identify and develop health services that are more responsive to the needs of older adults and people with disabilities. A research agenda that specifically includes these underrepresented groups promotes inclusivity and diversity and generates more evidence for best-practice guidance and programming.

The Sexual Health in Older Adults Research (SHOAR) program [9] is one of the few research studies devoted to the sexual health preferences of older adults. Their overall aim was to obtain evidence for improving sexual health services among middle-aged and older adults (45 and older) and generate relevant policy recommendations for local authorities.

Another research team was the Sexual Health in Over ForTyfives (SHIFT). “The project’s objective was to identify and address inequalities related to the sexual health of those aged 45 and above, and to co-design a model to empower those aged 45 and over to improve their overall sexual health, improve access to services, and remove the stigmas and preconceptions associated with sex and older age.” [10]

In the United Kingdom, the English Longitudinal Study of Ageing (ELSA) includes sections about sexual wellbeing as a pillar of healthy ageing. It found that poorer health was related to lower sexual activity, and could be attributed to poorer aging and lower quality of life. [11]

These are some of the very limited research studies on sexual health in older adults.

Policy Making

SH policymakers should prioritize the needs of an aging population, ensuring SHS receive funding for accommodating older adults, especially those with disabilities. Anti-discrimination training in health services should cover ageism and ableism. Public health messaging should challenge stereotypes about SH in later life.

Communications

Public health communications play a crucial role in enhancing SHS for older adults. Physiological changes associated with aging and a greater prevalence of chronic illness can negatively affect sexual functioning and discourage intimacy among older adults. [12] Ongoing social stigmas surrounding sexuality, embarrassment and dissatisfaction with clinical interactions, and seeming disinterest from doctors are not new obstacles to older populations concerning SH. However, these obstacles are causing increasingly salient effects as global populations age while continuing to be underrepresented in SH programs, messaging, and education. [13] HIV and STD sexual health campaigns are common among young people, and older adults are rarely included despite a prevalence of STIs and STDs in sexually active older adults. [14]

Social attitudes

It is a common misconception that people lose interest in sex or become sexually inactive in older age. [15] One survey in England of people aged 60-69 recorded 86% of men and 60% of women as sexually active. [15]

Sex between elderly people is often treated as a taboo by society. Cultural norms dictated social opinions which painted older adults as being asexual creatures. This opinion was supported and replicated in the media by showing sex only being popular among youth. [16] This attitude has gradually changed because a greater number of people are reaching 55 and above, and are remaining sexually active far into their senior years.

Back in 1930, less than 6 percent of the U.S. population was over 65 years old. By 1950, the number was 8 percent. By 2015, that number has risen to almost 15 percent. Population experts at the U.S. Bureau of the Census expect the percentage to continue to rise dramatically during the next 20 years, eventually reaching 21 percent by 2050, which is more than one in five. The number of seniors in the United States and throughout the world continues to increase rapidly. [17] [18]

While sexual activity itself is a sensitive topic due to its private nature, sexual activity between seniors is often treated with extra care. This attitude is especially common among younger people and it has been suggested that this may be caused by younger people's belief that the lust and ability to have sex diminishes once a perceived primary reason for sex is no longer present. [19]

Even though the topic may be taboo or denied, sexuality in older age has gained visibility in the media. [20] [21] Some sources promote "active" and "healthy" sexuality among the elderly, [22] or address issues such as sexuality in retirement homes and assisted living facilities. These representations create in turn social injunctions that position sexual activity as a marker of fulfillment, [23] a discourse already affecting younger people and amplified by various products, pills, and available medical treatments.

Research conducted in the social sciences changes the miserable depiction often made of elders' sexuality. [23] Quantitative and qualitative studies show that sexual satisfaction can improve with age, and they present data such as the following. Half of women are sexually active into old age. [24] Widows either stop any kind of sexual activity, find a new male partner, or choose not to reproduce the same kind of relationship where they take care of a man, instead entering into a nonresidential relationship with a man or in a relationship with another woman, for example. [25] Women and gay men sustain the most pressure to live up to beauty ideals associated with youth. [26] LGBT people suffer from invisibility in retirement homes and assisted-living facilities. [27]

LGBTQ+ representation

In general, many older adults that define themselves as a part of the LGBTQ+ community do not feel as comfortable talking to their physicians about sexual health. Many fear homophobic responses, or believe that their GP is not willing to talk to them about sexual health. [28]

Representation in film and television

To many, The Golden Girls was groundbreaking in its depiction of healthy active sexual lifestyles and frank sexual discussion among seniors.

The concept of active sexual relationships between older people has in recent years become a more mainstream topic. The film Something's Gotta Give , starring Jack Nicholson and Diane Keaton, explores the relationship that develops between two people in later life.

The HBO series Tell Me You Love Me has caused controversy by showing several explicit sex scenes involving two senior citizen actors on the show, Jane Alexander and David Selby.

On a related topic, intergenerational relationships, also quite taboo, were the focus of the film Gerontophilia (between a very old and a very young man), and in the last years many TV shows represented "cougars" (middle age women with younger men), for example The Cougar and Cougar Town .

The Netflix original, Grace and Frankie , features Jane Fonda and Lily Tomlin as two elderly women recently divorced from their husbands seeking guidance through life with the help of each other. Not only does the show highlight their sexual quests and struggles with their new partners, it also mentions their new partnered business-seeking venture to encourage personal, private intimacy for women their age. The "Ménage à Moi", as they have it named, is a vibrator targeting elderly women to use for sexual satisfaction, and the show features the struggles surrounding marketing such a product.

Related Research Articles

<span class="mw-page-title-main">Human sexual activity</span> Manner in which humans engage sexually

Human sexual activity, human sexual practice or human sexual behaviour is the manner in which humans experience and express their sexuality. People engage in a variety of sexual acts, ranging from activities done alone to acts with another person in varying patterns of frequency, for a wide variety of reasons. Sexual activity usually results in sexual arousal and physiological changes in the aroused person, some of which are pronounced while others are more subtle. Sexual activity may also include conduct and activities which are intended to arouse the sexual interest of another or enhance the sex life of another, such as strategies to find or attract partners, or personal interactions between individuals. Sexual activity may follow sexual arousal.

<span class="mw-page-title-main">Sexual intercourse</span> Penetrative sexual activity for reproduction or sexual pleasure

Sexual intercourse is a sexual activity involving the insertion and thrusting of the male penis inside the female vagina for sexual pleasure, reproduction, or both. This is also known as vaginal intercourse or vaginal sex. Sexual penetration has been known by humans since the dawn of time, and has been an instinctive form of sexual behaviour and psychology among humans. Other forms of penetrative sexual intercourse include anal sex, oral sex, fingering and penetration by use of a dildo, and vibrators. These activities involve physical intimacy between two or more people and are usually used among humans solely for physical or emotional pleasure. They can contribute to human bonding.

Sex therapy is a therapeutic strategy for the improvement of sexual function and treatment of sexual dysfunction. This includes dysfunctions such as premature ejaculation and delayed ejaculation, erectile dysfunction, lack of sexual interest or arousal, and painful sex ; as well as problems imposed by atypical sexual interests (paraphilias), gender dysphoria, highly overactive libido or hypersexuality, a lack of sexual confidence, and recovering from sexual abuse ; and also includes sexual issues related to aging, illness, or disability.

<span class="mw-page-title-main">Sexual and reproductive health</span> State of the reproductive system without evidence of disease, disorders, or deficiencies

Sexual and reproductive health (SRH) is a field of research, health care, and social activism that explores the health of an individual's reproductive system and sexual well-being during all stages of their life. Sexual and reproductive health is more commonly defined as sexual and reproductive health and rights, to encompass individual agency to make choices about their sexual and reproductive lives.

<span class="mw-page-title-main">Sexless marriage</span> Marital union with little or no sexual activity between the spouses

Sexless marriage or platonic marriage is a marital union that occurs between spouses in which there is little or no sexual activity involved in their relationship. Taking into account what is defined as any form of sexual activities by the respective partners. The most common cause of a decline in sexual frequency is aging, followed by marital unhappiness. Having children, sexual boredom, busy work schedules, and spousal infidelity are all factors that can lead to a sexless marriage. Marriage in some cultures culminates in a sexless union for cultural, religious, or political reasons.

Comprehensive Sexuality Education (CSE) is a sex education instruction method based on a curriculum that aims to give students the holistic knowledge, attitudes, skills, and values to make healthy and informed choices in their sexual lives. The intention is that this understanding will help students understand their body and reproductive processes, engage in safer sex by reduce incidents of contracting sexually transmitted infections (STIs) such as human immunodeficiency virus (HIV) and human papillomavirus (HPV), reduce unplanned and unwanted pregnancies, as well as lowering rates of domestic and sexual violence.

Adolescent sexuality is a stage of human development in which adolescents experience and explore sexual feelings. Interest in sexuality intensifies during the onset of puberty, and sexuality is often a vital aspect of teenagers' lives. Sexual interest may be expressed in a number of ways, such as flirting, kissing, masturbation, or having sex with a partner. Sexual interest among adolescents, as among adults, can vary greatly, and is influenced by cultural norms and mores, sex education, as well as comprehensive sexuality education provided, sexual orientation, and social controls such as age-of-consent laws.

The sexuality of US adolescents includes their feelings, behaviors and development, and the place adolescent sexuality has in American society, including the response of the government, educators, parents, and other interested groups.

<span class="mw-page-title-main">Masturbation</span> Sexual stimulation of ones own genitals

Masturbation is a form of autoeroticism in which a person sexually stimulates their own genitals for sexual arousal or other sexual pleasure, usually to the point of orgasm. Stimulation may involve use of hands, everyday objects, sex toys, or more rarely, the mouth. Masturbation may also be performed with a sex partner, either masturbating together or watching the other partner masturbate.

<span class="mw-page-title-main">Sexual practices between women</span> Sexual activity between women

Sexual activities involving women who have sex with women (WSW), regardless of their sexual orientation or sexual identity, can include oral sex, manual sex, or tribadism.

Sexual desire discrepancy (SDD) is the difference between one's desired frequency of sexual intercourse and the actual frequency of sexual intercourse within a relationship. Among couples seeking sex therapy, problems of sexual desire are the most commonly reported dysfunctions, yet have historically been the most difficult to treat successfully. Sexual satisfaction in a relationship has a direct relationship with overall relationship satisfaction and relationship well-being. Sexual desire and sexual frequency do not stem from the same domains, sexual desire characterizes an underlying aspect of sexual motivation and is associated with romantic feelings while actual sexual activity and intercourse is associated with the development and advancement of a given relationship. Thus together, sexual desire and sexual frequency can successfully predict the stability of a relationship. While higher individual sexual desire discrepancies among married individuals may undermine overall relationship well-being, higher SDD scores for females may be beneficial for romantic relationships, because those females have high levels of passionate love and attachment to their partner. Studies suggest that women with higher levels of desire relative to that of their partners' may experience fewer relationship adjustment problems than women with lower levels of desire relative to their partners'. Empirical evidence has shown that sexual desire is a factor that heavily influences couple satisfaction and relationship continuity which has been one of the main reasons for the interest in this research domain of human sexuality.

Various issues in medicine relate to lesbian, gay, bisexual, and transgender people. According to the US Gay and Lesbian Medical Association (GLMA), besides HIV/AIDS, issues related to LGBT health include breast and cervical cancer, hepatitis, mental health, substance use disorders, alcohol use, tobacco use, depression, access to care for transgender persons, issues surrounding marriage and family recognition, conversion therapy, refusal clause legislation, and laws that are intended to "immunize health care professionals from liability for discriminating against persons of whom they disapprove."

<span class="mw-page-title-main">Sexuality and disability</span>

Sexuality and disability is a topic regarding the sexual behavior and practices of people with disabilities. Like the general population, these individuals exhibit a wide range of sexual desires and adopt diverse methods of expressing their sexuality. It is a widespread concern, however, that many people with disabilities do not receive comprehensive sex education, which could otherwise positively contribute to their sexual lives. This roots from the idea that people with disabilities are asexual in nature and are not sexually active. Although some people with disabilities identify as asexual, generalizing this label to all such individuals is a misconception. Many people with disabilities lack rights and privileges that would enable them to have intimacy and relationships. When it comes to sexuality and disability there is a sexual discourse that surrounds it. The intersection of sexuality and disability is often associated with victimization, abuse, and purity.

Research published from 2000 to 2020 illustrates increased prevalence rates of sexual violence against people with intellectual disabilities, compared to the general population.:61 The World Health Organization (WHO) funded a study which concluded that 15% of the adult population worldwide in 2012 had a disability, putting them at increased risk of physical, sexual, and intimate partner violence. Of that 15%, 6.1% had intellectual disability with 5.5% experiencing sexual violence. In another 2012 report, the WHO found that worldwide, children with intellectual disabilities experienced a 4.6 times greater risk of sexual violence than those without disability.

Sexually active life expectancy is the average number of years remaining for a person to be sexually active. This population-based indicator extends the concept of health expectancy to the measure of sexuality. Calculation of sexually active life expectancy uses the age-specific prevalence data on sexual activity in conjunction with life table data on survival probabilities to partition the number of person-years into years with and without sexual activity, which is based on the Sullivan method. The Sullivan method's objective is to understand the change of health in a given population over time.

Adolescent sexuality in Canada is not as well documented as adolescent sexuality in the United States; despite the proximity of the two nations, Canada has its own unique culture and generalizations about Canadian adolescent sexuality based on American research can be misleading. Because of this, several surveys and studies have been conducted which acquired information on Canadian adolescent sexuality. Surveys which provide this information include the Canadian Community Health Survey (CCHS), the National Population Health Survey (NPHS) and the National Longitudinal Survey of Children and Youth (NLSCY). According to information drawn from the Canadian Community Health Survey and the National Population Health Survey, in 2005 43% of teens aged 15 to 19 reported that they had had sexual intercourse at least once.

Hookup culture is one that accepts and encourages casual sex encounters, including one-night stands and other related activity, without necessarily including emotional intimacy, bonding or a committed relationship. It is generally associated with Western late adolescent sexuality and, in particular, United States college culture. The term hookup has an ambiguous definition because it can indicate kissing or any form of physical sexual activity between sexual partners. The term has been widely used in the U.S. since at least 2000. It has also been called nonrelationship sex, or sex without dating.

<span class="mw-page-title-main">Sexuality after spinal cord injury</span> Aspect of human sexuality

Although spinal cord injury (SCI) often causes sexual dysfunction, many people with SCI are able to have satisfying sex lives. Physical limitations acquired from SCI affect sexual function and sexuality in broader areas, which in turn has important effects on quality of life. Damage to the spinal cord impairs its ability to transmit messages between the brain and parts of the body below the level of the lesion. This results in lost or reduced sensation and muscle motion, and affects orgasm, erection, ejaculation, and vaginal lubrication. More indirect causes of sexual dysfunction include pain, weakness, and side effects of medications. Psycho-social causes include depression and altered self-image. Many people with SCI have satisfying sex lives, and many experience sexual arousal and orgasm. People with SCI may employ a variety of adaptations to help carry on their sex lives healthily, by focusing on different areas of the body and types of sexual acts. Neural plasticity may account for increases in sensitivity in parts of the body that have not lost sensation, so people often find newly sensitive erotic areas of the skin in erogenous zones or near borders between areas of preserved and lost sensation.

Gerodiversity is the multicultural approach to issues of aging. This approach provides a theoretical foundation for the medical and psychological treatment of older adults within an ecological context that includes their cultural identity and heritage, social environment, community, family system, and significant relationships. Gerodiversity encompasses a social justice framework, which considers the social and historical dynamics of privilege and inequality. In addition to issues of aging, gerodiversity includes race, ethnicity, language, gender identity, socioeconomic status, physical ability or disability, sexual orientation, level of education, country of origin, location of residence, and religion or spirituality.

Sexuality in the United States varies by region and time period.

References

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  2. ↑ Dennerstein, L.; Dudley, E. & Burger, H. (2001). "Are changes in sexual functioning during midlife due to aging or menopause?" (PDF). Fertility and Sterility. 76 (3): 456–460. doi:10.1016/s0015-0282(01)01978-1. PMID   11532464. Archived from the original (PDF) on 2016-03-04. Retrieved 2013-07-23. dyspareunia
  3. 1 2 3 4 5 6 7 Syme, Maggie (2014). "The Evolving Concept of Older Adult Sexual Behavior and Its Benefits". Generations. 38 (1): 35–41 – via DISCOVER.
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  21. ↑ "How Sex Toys Help Seniors". 20 February 2014.
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