The term sexuality has many definitions. A simple definition is "the state of being sexual or sexually active. It is a common myth that the elderly have no interest in or are unable to maintain healthy sexual relationships; numerous surveys and studies indicate that both elderly men and elderly women remain sexually active throughout their lives. It is important to note that most research on this topic is tainted by gaps in social scientific research
Advertising using sexuality and aging. For example, study Advertising using sexuality and aging for "the aging population" may include people in their 40s.
Another problem Advertising using sexuality and aging evaluating the literature related to sexual activity in this population is that many researchers define "sexually active" only as "vaginal intercourse.
Despite these limitations, it is universally recognized that this is a subject that warrants more thorough investigation, but more important, it is a subject that needs to be better addressed with all senior patients. Inthe sexologist Dr. Alex Comfort
Advertising using sexuality and aging asked, "Why do old people stop having sex?
Medications known to cause sexual dysfunction and opportunities for the pharmacist in counseling these patients will also be discussed. InMasters and Johnson defined the human sexual response cycle; these phases are excitement, plateau, orgasm, and resolution. The excitement or desire phase requires functioning neurotransmitters, androgens, and an intact sensory system.
DHEA, the precursor of androstenedione, testosterone, and estrogen, begins to decline in the third decade, and levels are quite low by age Men in their 50s begin Advertising using sexuality and aging experience a decline in their serum testosterone, and the decline continues steadily as men age.
Bioavailable testosterone has been linked to the frequency of sexual thoughts and degree of sexual desire. The decline in estrogen can affect the comfort of sexual intercourse; one third of postmenopausal women experience dyspareunia--painful intercourse caused by poor vaginal lubrication. The excitement phase is also influenced by environmental, psychosocial, and cultural processes discussed later Advertising using sexuality and aging this article. The plateau or arousal phase requires an intact parasympathetic nervous system and vascular system and is the phase
Advertising using sexuality and aging affected by aging.
Diminution of vaginal lubrication could reduce Advertising using sexuality and aging response. The arousal phase is also aided by memory and the senses--visual stimuli, smell, taste, sound, and touch. Alterations in any one of these as a result of advancing age e. For both elderly men
Advertising using sexuality and aging elderly women, the ability to achieve an orgasm remains intact; however, compared
Advertising using sexuality and aging those of their youth, the orgasm may be shorter and less intense.
Both genders may require longer duration of direct physical stimulation to Advertising using sexuality and aging an orgasm. In women, significant decreases in clitoral perfusion and size are contributory causes. While older women maintain the capacity for multiple orgasms, a diminished peak of orgasm may result.
The resolution to prearousal state, the final of the human sexual response cycle, occurs more rapidly in elderly men and women than during their youth. Following an orgasm, it may take 12 to 24 hours before an elderly man can achieve another orgasm, and this time period can increase as he gets older.
In addition to the physiologic changes in sexual function with aging men and women, many chronic medical conditions can negatively affect sexual function as well. Comorbid factors are thought to have a major role in the presence of sexual dysfunction in the elderly.
Moreover, some researchers speculate that these elements are primary causative factors of sexual dysfunction. Musculoskeletal disorders, such as arthritis and Parkinson's disease, can cause pain and discomfort and may also result in muscle weakness. For these patients, a change in sexual position may be required to lessen joint pain, or the Advertising using sexuality and aging of the sexual encounter may need to be planned for when pain or dyskinesia is minimal.
Patients with chronic pain syndromes can also have diminished sexual desire. Vascular disease, and hypertension are common causes of erectile dysfunction ED. Diabetes has also been shown to cause sexual dysfunction.
Angina may be precipitated in an individual who becomes overexerted, thereby instilling fear of participating in sexual intercourse. Additionally, patients with a recent myocardial infarction MI or stroke may be fearful that intense Advertising using sexuality and aging activity could precipitate another event.
These patients should counseled that sexual exertion rarely causes a heart attack or stroke, especially when sufficient time for recovery is allowed, and patients should discuss resuming sexual activity with their physician.
ED is commonly reported by men following hospitalization for MI. Chronic obstructive pulmonary disease COPD can negatively impact sexual behavior due to increasing shortness of breath in patients, who often have poor stamina.
The use of inhalers prior to sexual intercourse may benefit some patients with COPD. Careful selection of sexual positions may also help patients who quickly become short of breath. Genitourinary conditions such as prostate cancer and its many treatments can lead to impotence and sexual dysfunction.
Prostatitis can cause decreased sexual desire and pain following ejaculation. Patients requiring self-catheterizations may feel less sexual and fear
Advertising using sexuality and aging from their partner.
Psychogenic factors such as anxiety and depression are strongly linked to sexual impairment and can be exacerbated by daily stressors such as career, finances, and fatigue. When this occurs, it becomes difficult to ascertain which came first, as problems with sexual expression may lead to an increase in psychological Advertising using sexuality and aging. Cognitive behavioral therapy may alleviate anxiety-induced sexual dysfunction.
Patients with Alzheimer's disease AD often exhibit changes in their sexual behavior. It Advertising using sexuality and aging important to inform family members that this behavior is due to symptoms of the dementia and is not related to someone's character.
It also warrants mentioning that spouses or partners of those diagnosed with AD may avoid sexual intimacy as a result of emotional disconnection. Surgery can present as another barrier to sexual expression.
While neither a hysterectomy nor a mastectomy has been shown to negatively impact a
Advertising using sexuality and aging biological sexual response, these surgeries can cause a psychological barrier. A woman may view herself as "less feminine" or "less desirable" to her partner, thereby diminishing her interest in a sexual relationship.
Alcohol and tobacco consumption can also impair sexual performance. The Advertising using sexuality and aging commonly cited medication-induced sexual adverse effects are decreased libido, erectile and ejaculatory dysfunction, and diminished orgasm. Table 1 summarizes some of the commonly used medications in the elderly that are associated with effects upon sexual response. Most data related to this topic have focused on men, Advertising using sexuality and aging sexual problems are easier to quantify given men's external genitalia and the treatments available for ED.
Medications affecting the central nervous system, altering blood flow, or causing dry mucous membranes may disrupt normal sexual function. Benzodiazepines, antipsychotics, and antidepressants, for example, have been shown to decrease libido in both men and women by limiting the ability to process sexual stimulatory signals. All classes of antidepressants have been associated with drug-induced sexual disorders; however, selective serotonin reuptake inhibitors SSRIsthe most widely prescribed agents for depression in the elderly, receive the most attention.
Erection is triggered by both parasympathetic and sympathetic neuronal stimulation and is adversely affected by anticholinergic agents, such as tricyclic antidepressants TCAs that block this neurotransmitter. TCAs also have peripheral alpha-adrenergic blocking effects, which can cause emission failures and retrograde ejaculation. Examples of TCAs include amitriptyline and nortriptyline. In the elderly, nortriptyline is preferred because, as a secondary amine, it has fewer anticholinergic side effects.
Thus, Advertising using sexuality and aging addition to possibly lowering the risk of ED, it causes less sedation and confusion and less drying of the mucous membranes. Antihypertensives are well implicated in causing sexual dysfunction in patients of all ages. While the occurrence of diuretic-induced sexual dysfunction is
Advertising using sexuality and aging, it is more commonly reported in patients who are prescribed unusually high doses.
The highest incidence of antihypertensive-induced sexual side effects occurs with nonselective beta-adrenergic receptor antagonists e. Although calcium channel blockers, alpha-blockers, and angiotensin-converting enzyme inhibitors are all noted to cause occasional difficulties with erection, these drugs are associated with fewer problems than the aforementioned agents.
While the sexual side effects exhibited by all of these agents are not life-threatening, Advertising using sexuality and aging and subsequent achievement of therapeutic benefit could be reduced. Sexual difficulties for both men and women can perpetuate depression, anxiety, and problems with self-esteem and confidence.
Advertising using sexuality and aging patients may not discuss the suspected "personal" side effects of their medications and may not admit to medication noncompliance. When identified, the causative agent should be assessed and discontinued if possible. A decrease in dosage may also prove helpful if the agent cannot be stopped or changed to another drug class. For example, common age-related changes resulting in loss of skin elasticity and subcutaneous fat and a decline in muscle mass can lead to wrinkles and sags.
Poor dentition or ill-fitting dentures could also translate into lower self-esteem and feelings of insecurity. Scars from surgery, excess weight, and problems with ED may also
Advertising using and aging influence sexual desire.
It is important to note that self-perception has a major role in a woman's sexuality. Intimacy, an element of the WHO's working definition of sexuality, is usually thought to involve more of a psychological to sexual expression than a physical one and is considered a viable part of a healthy sexual relationship among the elderly.
However, for all individucals, fear can impact sexual desire and response, including expressions of intimacy, and this is especially true in the elderly. Contributory causes of fear may include historical factors e.
In a new relationship, fear of embarrassment or rejection can affect sexual expression, while boredom can do the same in a long-term relationship. Another aspect to Dr. Comfort's reasoning may be society's views on aging and sexuality. Cultural norms usually depict sexual expression among people of youth, potentially making older people feel ashamed of their sexual desires. These stereotypes, combined with the fear of "What will think," may keep patients from addressing sexual problems with their physician or pharmacist.
Assumptions of a lack of desire for intimacy or sexual contact, as well as the myth that sexual dysfunction in the elderly is a normal part of the aging process, may keep the health care worker Advertising using sexuality and aging discussing the topic with the patient.
The addition of drugs for ED in the late s extended additional
Advertising using sexuality and aging to patients. Women Advertising using sexuality and aging a longer lifespan than men, and by age 83, women outnumber men 2.
Therefore, the availability of a suitably aged partner can be a hindrance for an elderly woman if she is interested in pursuing a new relationship.
This has been termed widower's syndromea subconscious feeling of unfaithfulness to the deceased spouse; consequently, a person may avoid intimacy at all levels. Census survey. Despite divorce being common in our society, the psychological consequences of divorce in elderly men and women may mimic widowhood, with consequent depression, sadness, anger, and guilt.
The divorced senior often copes with a decline in physical health, concurrent other losses, and the ending of an often long-standing relationship.
As a result, feelings of despair, increased anxiety, and Advertising using sexuality and aging self-esteem can also negatively affect sexual behavior. As health and independence decline, aging adults often become displaced, turning to
Advertising using sexuality and aging members or nursing facilities for living arrangements. Caregivers may Advertising using sexuality and aging negatively to or be unsupportive Advertising using sexuality and aging the senior's need for intimacy and privacy.
The elderly adult may be too embarrassed to discuss such sensitive issues with family
Advertising using sexuality and aging or health care providers.