Older women's sexuality

Abstract

SEXUAL PROBLEMS are relatively common in women, occurring in up to 43% of younger women 1 and increasing with age. 2 These result from an interaction of biological, psychological and social factors. 3 As the population in the Western world ages, there is more attention focused on quality-of-life issues as they affect older people. (In Australia, older people are defined as those aged over 65 years. 4 ) The proportion of older people who remain sexually active varies considerably with age, sex, marital status and general health. Estimates indicate that about 55% of married women over 60 years and up to 24% of married women over 76 years are sexually active. 5 In Australia, 12.4% of the population in 2001 was aged over 65 years, a proportion that is projected to rise to 21.3% by 2031. 6 As physicians, we are increasingly likely to see more sexual problems in older women as this present generation remains healthier and independent for longer.Sexual intimacy is an important aspect of human relationships, and sexual problems should be addressed as part of a holistic health assessment. However, doctors are often uncomfortable talking about sexuality, and the topic is often ignored in consultations with older patients. 7 While many doctors report that they would be willing to discuss sexuality if patients broached the subject, studies indicate that most older women patients will be hesitant to do so. As these women grew up in a generation in which sex and sexuality were rarely discussed, the onus of initiating discussion of sexual issues often rests with the doctor. Physical causes of sexual problemsPhysical problems associated with hormonal changes and acute and chronic illness become more prevalent later in life. These inevitably affect a woman's physical wellbeing and may alter her sexual response or ability to physically engage in intercourse. 8 Physical causes of sexual problems in older women include: 9 ■ hormonal changes (Box 1); ■ vascular disorders (eg, high blood pressure, high cholesterol levels, heart disease); ■ diminished pelvic blood flow, secondary to ageing, trauma or surgery; ■ atherosclerotic disease causing vaginal wall and clitoral smooth muscle fibrosis; ■ neurological disorders (eg, spinal cord injuries, diseases of the central or peripheral nervous system); ■ side effects of drugs such as antidepressants, ␤-blockers, antipsychotics, anticholinergics; ■ effects of alcohol or recreational drugs; and ABSTRACT ■ In consultations with older women, doctors should ask about sexual problems. A holistic approach is needed to examine the many different factors that can affect sexuality.■ Hormonal changes associated with ageing have an impact on women's sexuality. Doctors need to have a clear idea of the place of hormonal treatment for different sexual problems.■ Physical changes associated with ageing, including illness and disability, may interfere with sexual expression. Diseases of the endocrine, vascular and nervous systems will most commonly affect sexual function.■ A broad range of psychosocial facto...

Sexual desire among Mexican-American older women: a qualitative study

“…Moreover, we used a cross-sectional design, thus our results do not imply causation; additionally, to limit the scope of this study, the interview protocols covered several, but not all factors that could be related to sexual desire and fantasies. For instance, acculturation was not measured, and neither were other variables often related to women’s sexuality in later life, such as masturbation or sexual activity at a younger age (Yee and Sundquist 2003). Another limitation concerns the assumptions and interpretations that the present authors have made about the sexual culture of older Mexican-American women, as it is evident in the way in which some questions were formulated.…”

“…In contrast, researchers have discovered that ageing does not necessarily precipitate decreased longing for sexual intimacy (National Council on the Aging 1998; Laumann, Paik, and Glasser 2002). In fact, older women’s sexual satisfaction is highly related to overall well-being, life satisfaction, and physical health (Yee and Sundquist 2003). To better understand the sexual needs and behaviours of minority ethnic older women in particular, researchers must acknowledge that these women traditionally place a strong emphasis on cultural prescriptions and norms (Phinney and Flores 2002).…”

Older Women’s Sexual Desire Problems: Biopsychosocial Factors Impacting Them and Barriers to Their Clinical Assessment

“…Testosterone deficiency and decreased secretion of estrogen may result in vaginal dryness and painful intercourse, atrophic skin changes, shrinkage and atrophy of the clitoris and vagina, diminished sensation, urogenital prolapse, and urinary incontinence. Other empirical results documented in the literature include reduction in skin's sensitivity to touch, reduced olfactory epithelium's sensitivity to smell, loss of muscle bulk and bone mass, loss of sense of well-being, cognitive slowing, and loss of concentration [1, 12]. Researchers have reported that hormone replacement therapy (HRT) could improve quality of life for some women [13].…”

“…Continual sexual activity carries numerous health benefits throughout the life span: because sexual intimacy impacts sexual desire necessary for ongoing healthy sexual interactions in human relationships, problems in any area of the sexual experience should be addressed as part of a holistic health assessment (as discussed by Yee and Sundquist [1]). Sexuality and older women are issues, however, that are typically dichotomized rather than considered a naturally occurring combination to be explored and nurtured in their intersection.…”

“…Positive attitudes toward sexuality and the availability of a sensitive partner may facilitate the resumption of sexual interaction. In particular, Yee and Sundquist [1] listed five specific factors that appear to encourage sexuality (thus increasing sexual desire) in older women: a positive attitude towards sexuality, an active sex life in younger and middle years, good health, an interested and interesting partner, and the willingness to experiment sexually. Additionally, Persson [7] discovered that the following factors best predict engagement in sexual intercourse: (a) good mental health; (b) high levels of interest in sex among men when they were 20 years old; and (c) for women, having experienced premarital sex.…”