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.

Social attitudes

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. [7] 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. [8] [9]

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. [10]

Even though the topic may be taboo or denied, sexuality in older age has gained visibility in the media. [11] [12] Some sources promote "active" and "healthy" sexuality among the elderly, [13] 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, [14] 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. [14] 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. [15] 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. [16] Women and gay men sustain the most pressure to live up to beauty ideals associated with youth. [17] LGBT people suffer from invisibility in retirement homes and assisted-living facilities. [18]

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. [19]

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

Anal sex or anal intercourse is generally the insertion and thrusting of the erect penis into a person's anus, or anus and rectum, for sexual pleasure. Other forms of anal sex include anal fingering, the use of sex toys, anilingus, pegging, as well as electrostimulation and erotic torture such as figging. Although anal sex most commonly means penile–anal penetration, sources sometimes use anal intercourse to exclusively denote penile–anal penetration, and anal sex to denote any form of anal sexual activity, especially between pairings as opposed to anal masturbation.

<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 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.

<span class="mw-page-title-main">Virginity</span> State of a person who has never engaged in sexual intercourse

Virginity is the state of a person who has never engaged in sexual intercourse. The term virgin originally only referred to sexually inexperienced women, but has evolved to encompass a range of definitions, as found in traditional, modern and ethical concepts. Heterosexual individuals may or may not consider loss of virginity to occur only through penile-vaginal penetration, while people of other sexual orientations often include oral sex, anal sex, or manual sex in their definitions of losing one's virginity.

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.

Sexual medicine or psychosexual medicine as defined by Masters and Johnsons in their classic Textbook of Sexual Medicine, is "that branch of medicine that focuses on the evaluation and treatment of sexual disorders, which have a high prevalence rate." Examples of disorders treated with sexual medicine are erectile dysfunction, hypogonadism, and prostate cancer. Sexual medicine often uses a multidisciplinary approach involving physicians, mental health professionals, social workers, and sex therapists. Sexual medicine physicians often approach treatment with medicine and surgery, while sex therapists often focus on behavioral treatments.

<span class="mw-page-title-main">Oral sex</span> Sexual activity involving stimulation of the genitalia by use of the mouth

Oral sex, sometimes referred to as oral intercourse, is sexual activity involving the stimulation of the genitalia of a person by another person using the mouth. Cunnilingus is oral sex performed on the vulva while fellatio is oral sex performed on the penis. Anilingus, another form of oral sex, is oral stimulation of the anus.

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 HIV and 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. The stimulation may involve the 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.

Human sexuality is the way people experience and express themselves sexually. This involves biological, psychological, physical, erotic, emotional, social, or spiritual feelings and behaviors. Because it is a broad term, which has varied with historical contexts over time, it lacks a precise definition. The biological and physical aspects of sexuality largely concern the human reproductive functions, including the human sexual response cycle.

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.

<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.

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.

<span class="mw-page-title-main">Sexual arousal</span> Physiological and psychological changes in preparation for sexual intercourse

Sexual arousal describes the physiological and psychological responses in preparation for sexual intercourse or when exposed to sexual stimuli. A number of physiological responses occur in the body and mind as preparation for sexual intercourse, and continue during intercourse. Male arousal will lead to an erection, and in female arousal, the body's response is engorged sexual tissues such as nipples, clitoris, vaginal walls, and vaginal lubrication.

<span class="mw-page-title-main">Center for Healthy Sex</span> Community therapy center in Los Angeles, California

Center for Healthy Sex is a community therapy center in Los Angeles that specializes in the treatment of sexual dysfunction, sexual anorexia, sex addiction, and love addiction. The Center is located on Santa Monica Boulevard near Overland Avenue bordering the neighborhoods of Century City and Westwood.

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.

References

  1. ↑ ""Sexual psychophysiology and effects of sildenafil citrate in oestrogenised women with acquired genital arousal disorder and impaired orgasm: A randomised controlled trial"" (PDF).
  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 . 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.
  4. 1 2 3 4 Hughes, Anne (2015). "Aging Sexuality: Knowledge and Perceptions of Preparation Among U.S. Primary Care Providers". Journal of Sex & Marital Therapy. 41 (3): 304–313. doi:10.1080/0092623x.2014.889056. PMID   24512220. S2CID   21265116 – via DISCOVER.
  5. ↑ "Sexually transmitted disease rates rise among elderly: Why?". CBS News .
  6. ↑ "Old Age 'Tsar' Promotes Sex". BBC News. 2001-09-13. Retrieved 2006-12-01.
  7. ↑ Santos-Iglesias, Pablo (2016). "Sexual well-being of older men and women". Canadian Journal of Human Sexuality. 25 (2): 86–98. doi:10.3138/cjhs.252-a4. S2CID   148420838 – via DISCOVER.
  8. ↑ Group, DeLeeuw Research. "My Question - Aging and Myths". www.firepointe.com.
  9. ↑ "Seasoned Romance". www.mybestyears.com.
  10. ↑ Heath, H (2000). "Sexuality and Continence in Older Women". Elderly Care (3): 32–34.
  11. ↑ "Senior Sexuality Is Alive and Well". 14 July 2011.
  12. ↑ "How Sex Toys Help Seniors". 20 February 2014.
  13. ↑ "Old-age 'tsar' promotes sex". 13 September 2001 – via news.bbc.co.uk.
  14. 1 2 Bessin, M., Blidon, M. (2011). Déprises sexuelles : penser le vieillissement et la sexualité. Genre, sexualité & société 6 (online).
  15. ↑ Trompeter, S. E.; Bettencourt, R.; Barrett-Connor, E. (2012). "Sexual Activity and Satisfaction in Healthy Communitydwelling Older Women". The American Journal of Medicine. 125 (1): 37–43. doi:10.1016/j.amjmed.2011.07.036. PMC   3246190 . PMID   22195529.
  16. ↑ Plaud, C., Sommier, B. (2011). Veuves joyeuses ou honteuses ? Sexualité ou a-sexualité après 60 ans suite à la perte du conjoint. Genre, sexualité & société 6 (online).
  17. ↑ Slevin, K. F.; Linneman, T. J. (2010). "Old Gay Men's Bodies and Masculinities". Men and Masculinities. 12 (4): 483–507. doi:10.1177/1097184x08325225. S2CID   145112216.
  18. ↑ Chamberland, L (2003). "Plus on Vieillit, Moins Ça Paraît" : Femmes Âgées, Lesbiennes Invisibles". Canadian Journal of Community Mental Health. 22 (2): 85–103. doi:10.7870/cjcmh-2003-0016.
  19. ↑ Hinchliff, Sharron; Gott, Merryn; Galena, Elisabeth (July 2005). "'I daresay I might find it embarrassing': general practitioners' perspectives on discussing sexual health issues with lesbian and gay patients". Health and Social Care in the Community. 13 (4): 345–353. doi:10.1111/j.1365-2524.2005.00566.x. PMID   15969706.
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