Sexuality in Older Age

The Facts Older adults maintain their ability to respond to sexual stimulation, but response is slower and less intense Sexual interest does not decline but sexual activity may be less frequent Regularly engaging in sexual activity helps older adults respond to sexual stimulation Any major changes in response are associated with risk factors rather than aging Miller, 2009 .

Age Related Changes to Sexual Function Considerable Individual Variation Female Atrophy of reproductive organs Thinning & drying of vaginal wall Decreased Length and width of vagina Vaginal lubrication Male Erections are less firm Decreases volume of seminal fluid Ejaculation less forceful Increased refractory period Erectile dysfunction more common; and often associated with risk factors MORE than age-related changes Miller 2009 Atrophic vaginitis is inflammation of the vagina due to thinning tissue and decreased lubrication. It is related to reduced estrogen levels. Improved with lubricant and increasing sexual activity

Risk Factors to Sexual Function Myths and misunderstanding Loss of a partner Medications Relationship problems Illness of partner Environmental factors e.g. lack of privacy Alcohol, Nicotine Miller 2009 Medications are the single largest cause of erectile dysfunction in men. It is likely that medications can interefere with sexual function in women, not enough research Besides erectile dysfunction, some meds lead to loss of libido, vaginal dryness and inability to achieve orgasm

Risk Factors to Sexual Function; Chronic Conditions COPD Cardiovascular disease Diabetes Arthritis and other musculoskeletal disorders Urinary Incontinence CNS Diseases Cardiovascular disease and diabetes are the two most common risk factors causing sexual dysfucntion in both men and women

Negative Functional Consequences Less intense & slower response to sexual stimulation due to age-related factors Decreased sexual activity due to risk factors May affect quality of life Miller 2009

Self Assessment of Attitudes About Sexual Function in Older Adults Nurses are often uncomfortable discussing sexuality with their patients Significant cultural differences between the nurse and patient may increase the difficulty of discussing sexual function. Assess your attitude toward Sexuality and Aging

Assessing Sexual Function in Older Adults The Goal of assessment is to: Provide an opportunity for the older adult to address any issues related to sexual function To identify risk factors that interfere with one’s sexual functioning and quality of life. To provide information or interventions. Miller 2009

Questions to Guide your Assessment Can you tell me how you express your sexuality? What concerns or questions do you have about fulfilling your continuing sexual needs? In what ways has your sexual relationship with your partner changed as you have aged? What interventions or information can I provide to help you to fulfill your sexuality? The Harford Institute for Geriatric Nursing, College of Nursing, New York University Adapted from Wallace, M. Intimacy and Sexuality. Consultgerirn.org

Nursing Interventions Educate the older adult about sexual function Provide education about medication side effects that can affect sexual function Provide education about pathological conditions that can affect sexual function Provide education about interventions that improve sexual health Risk factors that cannot be ameliorated should be addressed through referrals and/or counseling Teaching points to consider: For men; explaining that periodic difficulties with erection do not mean impotence. After orgasm, it may be 1-2 days until full orgasm can be achieved again. Treatment for erectile dysfunction is available. For women, use of a water soluble lubricant or estrogen cream. Discuss risk/benefit of estrogen replacement with physician. Empty bladder before/after intercourse – atrophic vaginitis increases risk of UTI.

Health Education to Enhance Sexual Health Exercise regularly Maintain Optimal health and nutrition Avoid or limit alcohol Wear hearing aid and corrective lenses as needed Engage in sexual activity when feeling relaxed and energy level is at its peak Use it or lose it Seek advice from health professional if experience problems Miller, 2009 p. 555-557