Factors Conditioning Sexual Behavior in Older Adults: A Systematic Review of Qualitative Studies

Abstract

The sexual behavior of older adults, especially women, has undergone changes in recent years, though there are still certain stereotypes today related to pathophysiology, beliefs, culture and tradition that negatively affect older adults’ sexual activity. The aim of our review is to present the main qualitative studies analyzing how physiological and psychosocial factors affect sexual behavior in older adults. A systematic review of these qualitative studies was carried out. All stages of this review were carried out peer-to-peer in order to guarantee minimized bias. A bibliographical search was completed between February and April 2019, in Web of Science, Scopus, PubMed Medline, PsycINFO ProQuest and CINAHL. To analyze the findings of the selected qualitative studies, a “Thematic Synthesis Analysis” was performed, using Eppi-Reviewer 4 software (UCL Institute of Education, University of London, UK). The quality of the studies was assessed with a CASP-Qualitative-Checklist. A total of 16,608 references were screened and 18 qualitative studies were included in this review. The studies involved 2603 participants across seven countries, most being women (approximately 80%). We identified a wide variety of physiological and psychological factors that can influence the sexual behavior of older adults, such as the presence of pathologies (erectile dysfunction and menopause), the strength of spiritual beliefs, and patriarchal roles upheld by upbringings conveying that women’s role is to provide men with sexual pleasure. Biological age in relation to stereotypical models of sexual behavior, emphasized as a risk factor in the contraction of sexual diseases, seems to play a relevant role as a factor limiting sexual behavior in older adults.

Effects of sexuality on frailty and quality of life in the elderly: a cross-sectional study

“…In men, genital atrophy occurs; testosterone is reduced; erectile retardation and malfunction; reduced libido, and inability to maintain arousal. In women, we observe reduced estrogen secretion after menopause; atrophy of the vaginal canal; and decreases in lubrication, cervix contraction, and breast size (32) . However, there is hardly any deterioration of sexual desire in healthy aging of such a magnitude as to make sexual practice impossible among the elderly (33) .…”

Sexuality, Quality of Life, Anxiety, Depression, and Anger in Patients with Anal Fissure. A Case–Control Study

“…Previous studies have focused on the relationship between medical diseases or mental disorders including its treatments and patients sexuality, QoL (general or health related), or selected psychological factors highlighting the relationship between these factors and clinical disorders or its treatments [ 5 , 10 , 11 , 13 , 14 , 15 , 19 , 20 , 23 , 25 , 29 , 34 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ]. These include, sex and quality of life [ 10 ]; sexual health and dysfunction in patients with rheumatoid arthritis [ 13 ]; sexuality and mental health [ 15 ]; antipsychotic-related sexual dysfunction [ 19 ]; sexual function in chronic illness [ 20 ]; the impact of physical illness on sexual dysfunction [ 23 ]; sexual dysfunction and chronic illness [ 27 ]; sex and chronic physical illness [ 28 ]; comorbidities in male and female sexual dysfunction [ 60 ]; sexual dysfunction and mental health in patients with multiple sclerosis and epilepsy [ 29 ]; psychiatric disorders and sexual dysfunction [ 63 ]; thyroid autoimmune disease impacting on sexual function in young women [ 64 ]; clinical features associated with female genital mutilation/cutting [ 65 ]; QoL after flatfoot surgery [ 33 ]; anxiety and QoL in patients with type 2 diabetes [ 58 ]; QoL and associated psychological distress in patients with knee arthroplasty [ 59 ]; psychological factors as determinants of medical conditions [ 57 ]; sleep disturbance, depression and anxiety in frail patients with atrial fibrillation [ 61 ]; cognitive behavior counseling in preoperative preparation and enhanced recovery after surgery [ …”

“…Sexual health (SH) includes sexuality-related physical, mental, emotional, and social well-being [ 11 , 12 ]; SH is highly relevant for people’s life fulfillment and is a main component of human QoL, both general and health related [ 11 , 12 ].…”

Understanding Stakeholder Attitudes, Needs and Trends in Accessible Tourism: A Systematic Review of Qualitative Studies

“…For each item, the list offers three possible answers: "Yes", "Can't Tell", and "No". In keeping with the recommendations of previous research [76,77], the following scores were assigned to each of the qualitative response options: "Yes" (1 point), "Can't Tell" (0.5 points), and "No" (0 points). Thus, the ratings could vary between "High" (if "Yes" was obtained in two-thirds of the sections of the CASP list), "Moderate" (when the score oscillated between 4 and 6) and, finally, if more than two-thirds of the responses to the guide items were "No", its quality was evaluated as "Low".…”