Sexuality and aging

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A comprehensive national survey of sexuality has never been done for any age group. Therefore, the nature and frequency of sexual activity among the elderly, including its association with marital or health status or any other variable, is unknown. Available data consist of the important but now historic and limited Kinsey studies (1948 to 1949), the physiologic investigations of Masters and Johnson, and the findings of both the Duke Longitudinal Studies and the Baltimore Longitudinal Study on Aging. Questionnaire surveys of self-reported sexual activity have been conducted by mail (eg, by Consumers Union).

The most important conclusion is that contrary to prevailing beliefs, sexual desire and satisfaction are important to many elderly persons. A number of factors (eg, low intrinsic drive dating back to youth, physical disability, poor marital relationship, or the death of a spouse or companion) may be responsible for an older person’s being disinterested in sex or having an inhibited sexual drive.

A sexual history, with emphasis on current sexual function, should be part of the general medical evaluation of an older person. Physicians should handle sexual issues with dignity and skill. The discomfort physicians may feel in discussing the subject is often the result of negative stereotypes, personal anxieties, objections to the expression of sexuality by the elderly, or simply ignorance.

Social, Emotional, And Psychologic Issues

Sexuality is associated more with intimacy than just with the act of sexual intercourse. Sexuality in old age is often described in terms that include the opportunity to express passion, affection, admiration, and loyalty; the affirmation that one’s body is functioning well; the maintenance of a strong sense of identity; a means of self-assertion; a protection from anxiety; a renewal of a sense of romance; a general affirmation of life, especially the expression of joy; and a continuing opportunity to search for new growth and experience.

However, not all older persons have such positive attitudes. Even physically and mentally healthy persons may internalize the negative image of the typical older person as a desexualized invalid. Another social prejudice is one that falsely characterizes an elderly person who seeks sexual satisfaction as either a “dirty old man” or a “lecherous old woman.” The inability to come to terms with aging may lead some people to envy the young and to feel hostility and bitterness toward them, to show prejudice against other older people and refuse to associate with them, to reject an aging partner, and to make frantic attempts to appear young.

Feelings of guilt and shame may surface. Brought up during an era of Victorian-like prudery, some older persons are probably misinformed about issues of sexuality and feel guilty about their desires. They may refuse to discuss the issue of sexuality or to accept help when problems are obvious. Reassurance and information from a physician may help these persons achieve a more positive self-image.

Boredom, fear, fatigue, grief, and problems with a mate affect the sexual behavior of all persons. However, the elderly are also more likely to experience depression and illness or incapacitation of a partner. While some people look forward to the freedom of retirement, others react to it with feelings of low self-esteem and self-worth.

With advancing age, women outnumber men, and women living alone are more likely to be poor and to have complex physical and psychosocial problems. Over 50% of older women are widows, 7% have never married, and 2% are divorced. Thus, about 60% of older women are without a spouse, in contrast to about 20% of older men. Partners are in short supply, especially for women. When opportunities do arise, older persons often feel unfamiliar with the practices of dating and courtship. They may not have undertaken such activities for decades. Physicians should be aware of their older patients’ needs and should be especially sensitive about the reluctance of those who have lost their companions to reenter the world of dating.

Negative societal attitudes about masturbation and homosexuality also can interfere with sexual expression. Some men require sexually arousing photographs and videos to assist fantasy as well as physical manipulation by their partners to achieve an erection. Both men and women without partners, heterosexual or homosexual, may seek out pornography or prostitutes. An estimated 10% of the population including the elderly is homosexual, and while long-term relationships are common, many elderly homosexual persons have not publicly revealed their sexual preference. Their relationships and physical problems are not much different from those of heterosexuals and require the same thoughtful approach and treatment.

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