Sexuality and Disability Gerontology 410 Jan 2008

Dysfunction There are commonly reported sexual dysfunctions in the elderly and these include: lack of sexual desire, anorgasmia, vaginal dryness, incontinence during intercourse and dyspareunia, and the issues of the levels of testosterone not estrogen. It is important to add the issue of chronic UTI’s experienced by some women, burning, bleeding, and atrophy. Chronic Medical conditions-it is well documented that the elderly have an increased level of chronic medical issues and exposure to surgical procedures

Chronic Medical issues 1. Cardiovascular Disease. HTN common in elderly women, and treated with medication which is known to cause problems with libido and sexual function. Some of the drugs used decrease lubrication and others delay or inhibit orgasm. Women who have experienced MI’s report a 44% decrease in frequency of sexual intercourse and 27% reported total abstinence. Diabetes. Poor control of type 2 Diabetes will lead to higher risk of vaginal infection

Chronic Diseases Cancer-90% of women with breast Ca experience some form of sexual dysfunction. Lack of orgasm after mastectomy is about 39%. Anxiety and distorted body image lead to psychological problems Cervical cancer can lead to vaginal scarring and pain on intercourse. Testicular and prostate cancer have impacts on male sexuality and may lead again to distorted body image and impotence.

Chronic Diseases Arthritis and Osteoarthritis-hip and knee disease can decrease sexual activity due to pain and joint stiffness and this can cause difficulties with positioning. Hand arthritis may prevent masturbation and vibrators should be used if acceptable. Urinary Disorders-UTI’s and bladder instability can lead to sexual dysfunction. Post coital desire to urinate is common and should not be considered problematic, stress or urge incontinence may cause embarrassment however.

Chronic Disease Many seniors have surgery which leaves them with some form of ostomy (colostomy or iliostomy) These devices have both psychological and emotional sequelae and can impair sexual function, which is higher in cancer patients than those with bowel disease. Neurological disorders-Stroke-decreases libido and sexual pleasure due to fear of repeated events. Dementia-see lecture notes-note increased drive and disinhibition.

The management of sexual dysfunction due to disease First, adequate clinical evaluation, identifying specific problems with detailed histories. Screening scales for depression and cognition can be used to establish baseline data. A complete medication review to identify drugs that contribute to sexual dysfunction-examples include- Antihistamines, Benzodiazepines, psycho-tropics, anti-cholinergics, anti-seizure products. Complete lab work up to check levels of testosterone, estrogen levels