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The Joys of Sex in Later Life

The Joys of Sex in Later Life. Lihua Huang, PhD, School of Social Work, GVSU Linda Kirpes, MSW, Certified Gerontologist, Covenant Village of the Great Lakes Alisha Cowell, BSW, MSW Student, Graduate Assistant, GVSU 8 th Annual Art & Science of Aging Conference February 8, 2013.

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The Joys of Sex in Later Life

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  1. The Joys of Sex in Later Life Lihua Huang,PhD, School of Social Work, GVSU Linda Kirpes, MSW, Certified Gerontologist, Covenant Village of the Great Lakes Alisha Cowell, BSW, MSW Student, Graduate Assistant, GVSU 8th Annual Art & Science of Aging Conference February 8, 2013

  2. Older Adults & Sexuality QuizTrue or False • Sexual activity in aged persons is often dangerous to their health (F) • Sexuality is typically a lifelong need (T) • The sex urge typically increases with age in males over 65 (F) • There is a decrease in frequency of sexual activity with older age in males (T) • Prescription drugs may alter a person's sex drive (T) • Sexual behavior in older people (65+) increases the risk of heart attack (F) • Most older females are sexually unresponsive (F) • The firmness of erection in aged males is often less that that of younger persons (T) • There is evidence that sexual activity in older persons has beneficial physical effects on the participants (T) • There is a greater decrease in male sexuality with age than there is in female sexuality (T) • Fear of the inability to perform sexually may bring about an inability to perform sexually in older males (T) • There is an inevitable loss of sexual satisfaction in post-menopausal women (F) • In the absence of severe physical disability males and females may maintain sexual interest and activity well into their 80s and 90s (T)

  3. Letter Reading

  4. Joys of Sex: Rights of Older Adults • Sexuality is an integral part of the personhood of every human being in all societies. • Sexual rights are human rights related to sexuality; • Sexual rights are universal, interrelated, interdependent and indivisible; • Sexual rights’ protection and promotion should be part of the daily existence of all individuals; • Sexuality should be recognized as a positive aspect of life

  5. Declaration of Sexual Rights • International organizations have recognized and demanded sexual rights as universal rights based on inherent freedom, dignity and equality of all human beings (WHO, 2000; IPPF, 2006); • Older adults shall have rights to: • Access the highest attainable standard of sexual health; • The absence of sexually transmitted disease; • Access to sexual education, and • Decisions to be sexually active or not

  6. The Origin of Sexual Health Movement • Where does the sexual rights movement come from? • Population aging? • The rise in incidence of STIs/HIV among older adults? • Pharmaceutical conspiracy in marketing drugs for sexual dysfunction? • Pangman and Seguire (2000) made sexual rights a social justice issue by recognizing how society and long-term care facilities have been denying older adults’ sexual expression and excluding them from meaningful relationships and intimacy.

  7. Sexuality, Central to the Self-Concept • Gerontology and research have echoed above demands for sexual rights in later life since late 1990s. • Gerontologists have described sexuality central to sense of self, self-esteem, and body image in later life (Johnson, 1996; Moore, 2010).

  8. Sexuality makes individuals who they are, including biological, psychological, social, cultural, and spiritual aspects of self (Johnson, 1996); • Moore conducted a life history interview study in Japan in 2004-2008. The results from the large set of interview material indicate gender, culture, and other environmental characters.

  9. Men were more accustomed to speaking about their sexual experiences and embodying an active sexuality as part of their identity; • Women were generally much more reserved in their commentaries about sexual relations; • Differ from previous assumptions about Japanese men’s sexuality in later life, male participants convicted that sexual desire continues to be an important barometer of wellbeing in later life even if it is not channeled into sexual acts.

  10. Barriers to Sexual Health • Society helps to impose barriers which results in the sexuality of older adults being devalued (DeLamater, 2012). • Older adults are often not seen as sexual beings which matriculates into interactions between caregivers and residents (Rheaume & Mitty, 2008). • The inaccurate views people have in regards to older adults and sexuality negatively affects the professional relationships older adults have with their physicians and care givers.

  11. Many healthcare providers do not ask questions about sexual health during examinations with their patients (Farrell & Belza, 2012). • Some of the reasons stated: • Lack of adequate training in school • Not enough time to discuss sexual health • Not wanting to offend or embarrass their patients (Farrell & Belza, 2012).

  12. Barriers to Sexuality and Intimacy • Rooted in perceptions of body image, beliefs and values dealing with sexual expression and lack of knowledge or comfort with sexuality (Rheaume & Mitty, 2008). • Loss of partner through death or incapacity. Relationships status is a major influence on whether or not a person engages in partnered activity (DeLamater, 2012). • Lack of privacy in communal living environments of assisted living or nursing homes.

  13. STIs • Older adults lack accurate information about sexuality. • Sex education was not part of standard curriculum during the formative or college years of today’s older adults (Rheaume & Mitty, 2008). • As a result, there has been rising rates of HIV/AIDS in older adults. • Diagnosis tends to be made later and the disease course is faster. • Often perceived as low risk for HIV/AIDS and are not targeted as high risk population for HIV by public health agencies.

  14. Sexual Assault • Sexual assault is often perceived as an act only against younger people. • For example, older women are also victims of sexual assault regardless of the setting: domestic, institutional, or homeless (Baker, Sugar & Eckert, 2009). • “Acute and long-term stress associated with victimization contributes to negative health outcomes (Baker, Sugar &Eckert, 2009)”

  15. Quality of Life • The majority of older adults are engaged in spousal or other intimate relationships and consider sexuality as an important part of life (Lindau, Schumm, Lauman, Levinson, O’Muircheartaigh & Waite 2007). • “Sexuality has been described as an important component of health and as an integral part of self-expression (Robinson & Molzahn, 2007).” • Regular (consensual) sexual expression contributes to physical & psychological well-being (DeLamater, 2012).

  16. Quality of Life • Consistent sexual expression has been found to reduce physical and mental health problems associated with aging (DeLamater, 2012). • Studies also report that engaging in penile-vaginal intercourse is correlated with higher quality of intimate relationships, low rates of depressive symptoms and improved cardiovascular health (DeLamater, 2012).

  17. Video • http://www.dailymotion.com/video/xspfg_libido-old-people-sexuality-sexe-er_sexy

  18. How to Empower • Recognize and demand sexual rights of all older adults; • “Too often denied and too long neglected, sexual rights deserve our attention and priority. It is time to respect them. It is time to demand them.” (Jacqueline Sharpe, President of IPPF, WHO)

  19. Understand the underlying social, cultural and economic factors that make individual older adults vulnerable to risks of discrimination, prejudice, STIs and HIV, and lack of sexual education. • Establish a legal policy and regulatory environment where the sexual rights of all people are upheld; • Build a functioning referral system that have preventive measures and treatments; • Train sexual health providers; • Listen and understand needs for love, sex and intimacy in later life.

  20. Sexual Expression • Physical and mental health is important to sexual expression • Older women and men in good health are more likely to be sexually active than those in fair to poor health (Lindau & Gavrilova, 2010); • There is a strong, positive association between the rating of one’s health and repors of engaging in sexual intercourse at least once per week (AARP, 2010); • Women and men in excellent or good health are estimated to gain 3-7 additional years of sexual activity compared to women and men in fair or poor health (Lindau & Gavrilova, 2010);

  21. Lindau and Gavrilova created “Sexually active life expectancy,” which calculates “the average number of years remaining spent as sexually active” (2010, p.3): • According to their calculation, at age 55, the estimated sexually active life expectancy is 15 years for men and 10.6 years for women; • The expectancy for people with a partner is very similar for men and women.

  22. Sexual Functioning • There is little evidence that normal physical changes associated with aging necessarily or irreversibly impact sexual functioning in women and in men: • Women may experience vaginal dryness and atrophy, as a result of gradual decline in levels of estrogen in the body; • The studies on effects of menopause on sexual functioning suggest it contributes to meaning women attribute to menopause rather than menopause itself; • Men may experience slower erections, less firm erections, decreased likelihood of orgasms, and longer refractory periods as a result of a slow decline in testosterone production;

  23. Sexual Desire • Sexual desire/interest can be measured by • Frequency of sexual thoughts. • Frequency of enjoyment of sex, and • Sexual arousal. • Literature on sexual functioning presumes, implicitly or explicitly, that sexual desire is important; • Frequency of desire predicted frequency of sexual intercourse (Kontula & Haavio-Mannila, 2009); • Sexual desire is significantly associated with reported frequency of sexual touch and sexual intercourse for both men and women; • Desire is associated with frequency of masturbation (DeLamater & Moorman, 2007).

  24. Medical Illness and Sexual Desire and Behavior • It is evident that diabetes is associated with reduced female sexual activity and increased erectile difficulties among males (Lindau et al.,2007: Moreira et al., 2008); • Less frequent masturbation by both men and women; • Pain during intercourse are associated with diabetes in men and arthritis in women; • Lack of pleasure associated with reports of hypertension among men; • Diabetes and hypertension are associated with sexual dysfunctions among older men and women (Lindau et al., 2007). • However, the evidence does not support that medical illnesses are a major influence on declining sexual desire and behavior or increasing sexual distress and dysfunction in later life.

  25. Empowerment: An Ethical Issue • Research has suggested that sexual functioning and sexual health are influenced greatly by psychosocial factors rather than physical changes associated with aging (AARP, 1999; DeLamater, 2012; DeLamater & Moorman, 2007).

  26. Let’s Talk!Sexual Health History • A sensitive subject • Establish trust first • Begin with easy topics • Ask open-ended questions • Integrate midway into health assessment • Never assume heterosexuality • Sexual education materials • Be an ongoing resource

  27. Questions to Guide Sexuality Assessment Among Older Adults • Can you tell me how you express your sexuality? • What concerns or questions do you have about fulfilling your continuing sexual needs? • In what ways has your sexual relationship with your partner changed? • What information or interventions can I provide to help you fulfill your sexuality?

  28. Sexual Health HistoryMale and Female • ______1. Are you currently sexually active? • ______2. Are you currently sexually active with more than one partner? • ______3. What kinds of protection do you and your partner use during sexual activity? • ______4. How has your illness and/or medication affected your sexual activity? • ______5. Do you have questions or concerns about your sexual activity? • ______6. Have you ever had a sexually transmitted disease, or knowingly been exposed to somebody with a sexually transmitted disease? • ______7. Have you ever had, or do you now have, discharge, rashes, or sores in the genital area? • ______8. Is there anything you would like to discuss concerning sexual issues? • Source: Levtak, S., & Schoder, D. (1996). Sexually transmitted diseases in the elderly: What you need to know. Geriatric Nursing, • 17(4), 156-160.

  29. Best Practice

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  31. References • Baker, M. W., Sugar, N. F., & Eckert, L. O. (2009). Sexual assault of older women: Risk and vulnerablity by living arrangement. Sexuality Research & Social Policy, 6(4), 79-85. • DeLamater, J. (2012). Sexual expression in later life: A review and synthesis. Journal of Sex Research, 49(1/2), 125-141. • Farrell, J., & Belza, B. (2012). Are older patients comfortable discussing sexual health with nurses?. Nursing Research, 61(1), 51-57. • Giami, A. (2002). Sexual health: The emergence, development, and diversity of a concept. Annual Review of Sex Research, 13(2), 1- 35. • Gott, M., & Hinchliff, S. (2003). How important is sex in later life? The views of older people. Social Science & Medicine, 56, 1617-1628. • Gott, M., Hinchliff, S., & Galena, E. (2004). General practitioner attitudes to discussing sexual health issues with older people. Social Science & Medicine, 58, 2093-2103. • Hinchliff, S., & Gott, M. (2008). Challenging social myths and stereotypes of women and aging: Heterosexual women talk about sex. Journal of Women & Aging, 20(1/2), 65-81. • Hordern, A. J., & Street, A. F. (2007). Constructions of sexuality and intimacy after cancer: Patient and health professional perspectives. Social Science & Medicine, 64, 1704-1718. • Lindau, S. T., Laumann, E. O., O, C. A., Waite, L. J., & Waite, L. J. (2007). A study of sexuality and health among older adults in the united states. New England Journal of Medicine, 357(8), 762-774. • Minichiello, V., Hawkes, G., Pitts, M. (2011). HIV, sexual transmitted infections, and sexuality in later life. Current Infectious Disease Reports, 13(2), 182-187. • Potts, A., Gavey, N., Grace, V. M., Vares, T. (2003). The downside of Viagra: Women’s experiences and concerns. Sociology of Health & Illness, 25(7), 697-719. • Rheaume, C., & Mitty, E. (2008). Sexuality and intimacy in older adults. Assisted Living in Nursing Practice, 29(5), 342-349. • Robinson, J. G., & Molzahn, A. E. (2007). Sexuality and quality of life. Journal of Gerontological Nursing, 33(3), 19-27. • Skultety, K. M. (2007). Addressing issues of sexuality with older couples. Generations, 31(3), 31-37. • Smith, K. P., & Christakis, N. A. (2009). Association between widowhood and risk of diagnosis with a sexually transmitted infection in older adults. American Journal of Public Health, 99(11), 2055- 2062. • World Health Organization. (2006). Defining sexual health: Report of a technical consultation on sexual health. Geneva: WHO.

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