Sexuality in older women with mental health problems

Abstract

As women age, physiological, anatomical and psychological changes may affect sexual function. They may develop physical illnesses or take prescribed drugs which also affect their sexual functioning. Heterosexual women may be disadvantaged by the relative unavailability of partners. Sexual dysfunction may occur in the context of mental ill-health, particularly the dementias and depressive illnesses. Consent to sexual activity may present ethical dilemmas. Education is an important aspect of management. Psychological and social treatment approaches are often appropriate before consideration of drug treatments. The recognition, assessment and treatment of sexual dysfunction in elderly women with mental health problems may improve their quality of life.

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

“…Regarding mental health, over a quarter of the sample reported depressive symptoms, with depressive symptomatology being present in all four quadrants of analysis. Although prior research shows an inverse relationship between depression and sexual desire in older women (e.g., Benbow and Jagus 2002), our findings do not exactly support this, as there were marked differences between the quadrants’ sexual findings (although both women in the 4 th quadrant reported being depressed). Perhaps the influence of depression on sexual desire in our sample was less profound than that of other variables such as the availability of a suitable sexual partner, due (at least partially) to the emphasis placed within traditional Mexican culture on older women’s sexual restrictions.…”

“…Although almost half of the sample reported having neither sexual fantasies nor desire, many respondents expressed having such fantasies and/or desire, confirming prior findings on this topic (e.g., Benbow and Jagus 2002). However, a variety of socio-cultural issues reportedly restricted several women from acting upon their sexual urges, which were perceived as unacceptable in their culture.…”

“…Indeed, stereotypes of the older woman continue to persist: according to Spence (1992), with older women being expected to be sexually undesirable, to not desire sex, and to be incapable of having sex. However, although the frequency of women’s sexual activity typically declines with advanced age, sexual interest and ability generally do not (Benbow and Jagus 2002). …”

“…These include: (a) outliving men (in almost every country in the world; Austad 2006), which typically results in the lack of access to a partner (Pennell Initiative for Women’s Health 1998) and forces older women into sexual abstinence (Vincent 2002); (b) an emotionally distant relationship with an intimate partner (Johnson 1998); (c) misinformation, misconception, and prejudice (Butler and Lewis 1988); (d) the culturally induced belief that sexual activity is for the young (Lobsenz 1974); (e) boredom and fear of failure (Rubenstein 1978); (f) needs of family members that result in strained emotional energy within the older couple (Kingsburg 2000); (g) lack of privacy (Le Gall, Mullet, and Shafighi 2002); (h) reduced levels of oestrogen and other hormones (during and after menopause) resulting in lower levels of sexual desire (Benbow and Jagus 2002), as well as in decreased vaginal lubrication and related painful intercourse (Dennerstien 1996); (i) illness and medication use (Gefland 2000), which often disrupt women’s sexual functioning at all ages (Laganà et al 2001); (j) poor body image (Leiblum 1991); and (k) erectile dysfunction in a sexual partner (Kingsburg 2000), with over 50% of men experiencing it by age 50 at a rate increasing by nearly 10% every decade (American Psychiatric Association 2000). …”

“…Regarding depression, deficiencies in sexual desire are often related to severity of depressive symptomatology (Benbow and Jagus 2002). Concerning our target population, there is empirical evidence showing that low-income immigrant Mexican-American older women are at heightened risk for depression (Chiriboga et al 2002), which could affect sexual desire adversely.…”