SEXUALITY/INTIMACY/COMPANIONSHIP
/FAMILY

REFERENCES

INTERNET REFERENCES

Sexuality/Intimacy/ 
Companionship/Family 
   
    Sexuality is often defined as important to the young and forgotten by the old. Cultural attitudes that emphasize reproductiveness and youth contribute to this perspective. In reality, sexuality is not jut about reproduction nor about age. Sexual expression and physical contact can satisfy needs for intimacy, love, and pleasure throughout the life span. The research on sexuality and aging is limited in that samples have had limited numbers of older adults and have included primarily heterosexual European Americans.

    Intimacy is the freedom to respond to and express human closeness as long as the closeness is mutual and doesn't hurt other people. Avenues for expressing intimacy include: sensory, sensual, sexual. The need and desire for intimacy varies greatly among individuals.
                            (Genevay, 1999)

    Factors affecting sexual behavior:
     

    • Illness
    • Lifestyle - smoking, alcohol consumption, stress
    • Emotional distress - depression, anxiety


    Physical challenges Older Adults may face that affect sexual behavior:
     

    • Heart problems and medication taken for them
    • Vascular disease (men)


    Changes in sexual function for women in later life:
     

    • Arousal time increases
    • Less lubrication, may result in pain
    • Vaginal thinning, may result in pain


    Changes in sexual function for men in later life:
     

    • Increased time to achieve erection
    • More control over ejaculation, but flow is reduced
    • Increased refractory period before second erection is possible


    Statistics from NCOA 1998 survey:
     

    • 48% of men and women over 60 are sexually active (some form of sexual activity once a month).
    • 39% men and women over 60 would like to be more active than they are.
    • About 75% of sexually active older Americans say their sex life today is as emotionally satisfying or even more satisfying than it was when they were in their 40's.


    Statistics from NCOA 1998 survey:
     

    • 48% of men and women over 60 are sexually active (some form of sexual activity once a month).
    • 39% men and women over 60 would like to be more active than they are.
    • About 75% of sexually active older Americans say their sex life today is as emotionally satisfying or even more satisfying than it was when they were in their 40's.


    Women over 60:
     

    • 37% are sexually active
    • 62% say sex is better or at least equally as physically satisfying as it was at 40.
    • Women who are not sexually active often give the reason of not having a partner.
    • 69% say sex is equally as emotionally satisfying as it was at 40.
    • 47% say sex is important to a relationship


    Men over 60:
     

    • 61% are sexually active.
    • 61% say sex is better or at least equally as physically satisfying as it was at 40.
    • 76% say sex is equally as emotionally satisfying as it was at 40.
    • 72% say sex is important to a relationship.


    Reasons given for less sexual activity and less satisfied:

    • Medical condition prevents from having sex (51% men, 12% women)
    • Partner with a medical condition that prevents having sex
    • Less physical desire to have sex (55% of both men and women)
    • Taking medications that seem to reduce sexual desire (44% men, 16 % women)
         
    Loss of estrogen as a part of the menopause process is related to many of the age related changes for women. These symptoms are often reduced by hormone replacement therapy (HRT) which restores the hormone levels similar to before menopause. It appears that HRT is a major factor in prevention of osteoporosis, cardiovascular disease, and maintaining cognitive function. There is evidence that beneficial effects of estrogen occur even when started after age 60. There is some evidence that HRT may increase the risk of breast and endometrial cancer so it is important to know your own risk factors and discuss the choices with a physician.
         
    Erectile dysfunction (ED) is a common sexual problem for older men. This may be caused by high blood pressure, diabetes, heart disease, high cholesterol levels, prostrate surgery, depression, side effects of medication, smoking, alcohol/drug abuse, and stress. ED is treatable. Once a physician has determined the cause, proper treatment can be determined. These treatments include: vacuum devices, self-injection drugs, surgical implants, intra urethral suppositories, oral therapy (ex. Viagra), counseling.

    Psychosocial Factors:

       
    • Sexual activity in middle age is a strong predictor of sexual activity in old age.
    • Negative attitudes toward sexual activities other than intercourse such as kissing, masturbation, interfere with the openness to try new ways of expressing intimacy.
    • Reactions and beliefs about physiological changes or illness induced changes have negative impact on function.
    • Reactions to attitudes of others, society or adult children have powerful impact on self concept.

    • Living arrangements that do not allow for privacy, such as long-term care facilities create a barrier to sexual activity.
       
    Diversity and sexuality:

    Sexual function and dysfunction have largely been defined from a heterosexual, masculine, and European American perspective that focuses on intercourse. The research on homosexuality and bisexuality has ignored older persons so the needs of these individuals are not clearly identified.

    The current cohort of older adults have not experienced much acceptance of different sexual preferences and therefore many older gay, lesbian and bisexuals may not be open about this aspect of their life. There is very little research about the sexuality of elders from diverse cultures. What cross cultural research there is has focused on teenagers. Within this literature there is sufficient information to suggest that there are cultural differences in sexuality; however, since this is based on a younger population it cannot be inferred that it includes elders. (ASA's Lesbian and Gay Aging Issues Network)

    Safe sex is just as important for older adults as it is for the young. Sexually transmitted diseases do not differentiate based on age. Many older adults have ignored the warnings related to human immunodeficiency virus (HIV) which can become acquired immune deficiency syndrome (AIDS). In the late 1980's approximately 10% of persons with AIDS were 50 years of age or older  and these numbers have been increasing. To date, the most distinctive transmission source among the elderly has been blood transfusions that occurred even 16 to 18 years earlier. Other high risk factors are male-to-male sexual contact, heterosexual women that have sexual contact with a bisexual male, or past (or present) intravenous (IV) drug use.

    REFERENCES:

       
    Bane, S. (1996). Mental Health and Aging, Kansas City, MO., University of Missouri-Kansas City.

    Genevay, B. (1999). Intimacy and Older People: Much More than Sex. Dimensions Vol.6, No.3.

    McCormick, W., & Wood, R. (1992). Clinical decisions in the care of elderly persons with AIDS. Journal of the American Geriatric Society, 40 917-921.

    The National council on the Aging. Healthy Sexuality and Vital Aging. Executive summary. September 1998; 1,3.

    Love and Life A Healthy Approach to Sex for Older Adults,(1999) National Council on Aging and Pfizer.

    Schmidt, R. (1989). Biomedical parallels and relationships in research and treatment of HIV and aging-related diseases. Generations, 13, 6-14.

    INTERNET REFERENCES:

    NIA Age Page: Sexuality in Later Life
     
     

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