A woman, age 72, with a total hip replacement and arthritis who is interested in continuing sex with her partner. (100 words minimum)

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Chapter 13
Sexuality and Aging

Objectives (1 of 3)

Recognize the importance of intimacy in feelings of sexuality.

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Differentiate between sex and gender.

Define sexuality.

Recognize complications from common diseases that can interfere with the expression of sexuality.

Objectives (2 of 3)

List techniques to ameliorate complications in the expression of sexuality.

Identify some approaches to deal with sexuality issues, including the PLISSIT model.

Recognize the role prescription drugs can play in sexual expression.

Understand the causes of inappropriate client/patient sexual behavior and be able to choose appropriate responses.

Objectives (3 of 3)

Describe gender differences, including those in lesbian, homosexual and transgender persons, in sexual functioning caused by aging.

Recognize the ethical and policy dilemmas for sexuality for institutionalized older adults.

Sex & Sexuality (1 of 26)

  • Sexual innuendo pervades our society
  • Little time or attention devoted understanding our sexuality
  • Exploring our sexuality
  • Lifelong process
  • Frames how we see ourselves
  • Can greatly influence how we act

Sex & Sexuality (2 of 26)

  • Circles of Sexuality model
  • Ring of overlapping circles that represent the five core components of sexuality:
  • Sensuality
  • Intimacy
  • Sexual identity
  • Sexual health
  • Reproduction and sexualization

Sex & Sexuality (3 of 26)

  • FORGE
  • National transgender anti-violence organization
  • Added “power” to the sexualization circle to address issues of power and control often experienced by the LGBTQ community

Sex & Sexuality (4 of 26)

  • Similar models suggest sexuality is influenced by:
  • Feelings and beliefs about what it means to be male or female
  • Relationship(s) with people of similar or other genders
  • How relationships are established
  • How feelings are expressed

Sex & Sexuality (5 of 26)

  • Family, culture, and religious environments influence the development of sexuality
  • Being loved and nurtured fosters and strengthens our sense of competence
  • Abuse can inhibit the development of a positive sense of self-worth

Sex & Sexuality (6 of 26)

  • Sexuality is also influenced by:
  • Our self-perception as sexual beings
  • How our first expressions of overt sexual feelings were received by others

Sex & Sexuality (7 of 26)

  • Aging and sexuality
  • Sexual identity does not disappear with aging
  • Sexual feelings and urges simply change
  • Older adults may have fewer sexual encounters, but may find more pleasure by linking sex and intimacy to quality of life
  • Pleasuring, cuddling, and touching have been found to be more important among older adults

Sex & Sexuality (8 of 26)

  • Lindau study on sexuality among older adults found:
  • The two people involved define the parameters of the sexual relationship
  • An infinite variety of possibilities may prove satisfying to one or both partners
  • Main challenge for women remains finding a partner with whom to be intimate

Sex & Sexuality (9 of 26)

  • Another study identified a strong association between physical health and sexual activity among older adults
  • Identified benefits of mutually agreeable sex:
  • Improved health
  • Increased life span
  • More solid relationships
  • Bona fide escape from reality

Sex & Sexuality (10 of 26)

  • Study participants reporting some sexual problems indicated:
  • Sexual activity only began to substantially decrease after the age of 74
  • Problems experienced included:
  • Erectile dysfunction for men
  • Low libido, vaginal lubrication, and climax difficulties for women

Sex & Sexuality (11 of 26)

  • Findings from an analysis of the 2005–2006 National Social Life, Health, and Aging Project:
  • Sexual problems occurred in response to multiple stressors, not biological aging
  • Sexual health was directly affected by the strength and quality of the intimate relationship

Sex & Sexuality (12 of 26)

  • British study by Gott and Hinchliff found:
  • Older adults identified sex as an important part of a close relationship
  • Health problems and widowhood often led to a reprioritization of the role of sex
  • Intercourse remained centrally important even when viewed as no longer possible

Sex & Sexuality (13 of 26)

  • Study of older adults with lower socioeconomic status found:
  • Participants wanted to engage in sexual activities more frequently than they did, but lacked a partner
  • Touching and kissing were most desired
  • Mutual stroking, masturbation, and intercourse were less desired and infrequently experienced

Sex & Sexuality (14 of 26)

  • Intimacy
  • Requires self-acceptance and risk taking
  • Reinforces feelings of self-esteem and trust
  • Important component of meaningful sexuality
  • Reconciling the differences between one’s masculine and feminine qualities may be a key to vital aging
  • Embracing gender changes can enhance sexual activity

Sex & Sexuality (15 of 26)

  • Physiologic changes in sexual functioning
  • Women
  • Physical changes do not need to preclude sexual activity
  • Reduced sexual hormones only affect response time and intensity of physical response
  • Knowledge and appropriate adaptations can enhance sexual satisfaction in late life

Sex & Sexuality (16 of 26)

  • Menopause
  • Physiologic marker for changes in sexual functioning
  • Medicalization has identified female sexual dysfunction as a new category of disease
  • Culture, religion, family experiences, and level of acceptance of the aging process impact how a woman approaches and manages menopause

Sex & Sexuality (17 of 26)

  • Estrogen replacement therapy (ERT)
  • Recommended to treat “deficiency disease” of menopause
  • Helps alleviate symptoms, but increases risk for conditions such as heart disease, breast and uterine cancer, stroke, and cognitive decline
  • Final decision must be made by the individual considering her own circumstances

Sex & Sexuality (18 of 26)

  • Older women continue to regularly engage in and enjoy sex
  • Can be affected by decreased hormone levels and coexisting medical and psychiatric illnesses
  • Studies have found:
  • Sexually active women report frequent arousal, lubrication, and orgasm into old age
  • Sexual activity was not necessary to attain sexual satisfaction

Sex & Sexuality (19 of 26)

  • Effects of decreased estrogen from menopause:
  • Vaginal changes
  • Vasomotor changes leading to hot flashes or flushes
  • Less rapid and extreme vascular responses to sexual arousal
  • Orgasm with fewer contractions

Sex & Sexuality (20 of 26)

  • Effects of decreased estrogen from menopause (continued):
  • Bladder and urethral changes
  • Diminished fatty tissue of mons
  • Increased susceptibility of clitoral area to irritation by forced manipulation

Sex & Sexuality (21 of 26)

  • Decrease in libido
  • Sexual desire and activity are not necessarily related
  • Women may participate in sexual activity primarily for intimacy
  • Libido may increase post-menopause
  • Decreased desire may be the result of health problems, medication, or lack of partners

Sex & Sexuality (22 of 26)

  • Men
  • Changes in sexual functioning are less dramatic
  • Physical changes are largely due to reduced circulating testosterone
  • Arousal is delayed with less firm erection and less clear sense of impending orgasm
  • Orgasms may involve abbreviated ejaculation, decreased urethral contractions, decreased force and amount of ejaculate

Sex & Sexuality (23 of 26)

  • Other changes in sexual functioning:
  • Rapid loss of erection postorgasm
  • Longer time needed between erections
  • Decreased swelling and erection of nipples
  • Absence of flush
  • Reduced elevation of testicles
  • Knowing about and accepting these changes can contribute to increased sexual pleasure

Sex & Sexuality (24 of 26)

  • Gender differences
  • Meaning of sexuality can change with age
  • Cultural changes for women may include:
  • Different sexual scripts
  • Engagement in role transitions
  • Increased self-esteem
  • Promotion of their own sexual agency

Sex & Sexuality (25 of 26)

  • Masturbation
  • Safe way to relieve sexual tension
  • Continues through life
  • May enhance feelings of autonomy
  • Viewed by many as a substitute sexual activity

Sex & Sexuality (26 of 26)

  • Study findings indicate that:
  • Many men remain sexually active into their 70s
  • Most women are not sexually active, primarily due to a lack of partners or a decreased libido in their current male partner

Raising the Subject of Sexual Functioning (1 of 4)

  • Sexual functioning and sexuality need to be included as part of functional evaluations across the life span
  • Time and practice are needed to normalize the conversation about sexual functioning
  • Recognize your own discomfort
  • Start engaging patients
  • Ask open-ended questions

Raising the Subject of Sexual Functioning (2 of 4)

  • Practitioners should demonstrate:
  • Sensitivity
  • Empathy and understanding
  • Knowledge of physiologic changes
  • Cultural competency and respect
  • Familiarity with potential intervention strategies
  • Knowledge of available referral resources

Raising the Subject of Sexual Functioning (3 of 4)

  • Common misconceptions:
  • Client will initiate discussion about sexual functioning if it is important
  • Client’s sexual preference aligns with practitioner’s views of sexuality
  • Client is monogamous
  • Client share’s practitioner’s views on morality
  • Client’s age explicitly correlates with libido

Raising the Subject of Sexual Functioning (4 of 4)

  • Discussing sexual functioning with older adults can provide them with many benefits
  • Feeling empowered and less alone
  • Decreased inhibitions
  • Accepting their physical changes
  • Increased comfort with their sexuality
  • Enhanced sexual responses
  • Better communication

Assessing and Addressing Sexual Functioning (1 of 15)

  • PLISSIT model
  • Helps practitioner identify the level of intervention needed
  • Assists practitioner in understanding the level at which he or she can provide the intervention
  • Each ascending level requires more expertise from practitioners than the previous level
  • Knowledge of available resources is necessary

Assessing and Addressing Sexual Functioning (2 of 15)

  • Levels of treatment in the PLISSIT model
  • Permission
  • Limited information