Mature Sexuality: Who’s Doing What? Association of Reproductive Health Professionals

Expert Medical Advisory Committee Jean Fourcroy, MD, PhD, MPH Kirtly Parker Jones, MD (chair) Louis Kuritzky, MD Sharon Schnare, FNP, CNM, MSN Michael A. Thomas, MD

Learning Objectives Understand why assessment of sexual function should be included in the health care of middle-aged and older adults Identify factors that may affect sexual function in older men and women

Realities of Mature Sexuality People “…don’t lose their libido or become instantaneously impotent as they age...” San Francisco Examiner November 17, 1999

Sexuality Among Older Adults Covey HC. Gerontologist

How Do We Know Who Does What? Kinsey ReportSelf-selected reporting in questionnaires Telephone surveys Online surveys

Percent U.S. Men & Women, Age 65+ US Census % 10% 20% 30% 40% 50% 60% 70% 80% MarriedWidowedDivorcedNever Married Total Men Women

Marital Status: U.S. Men and Women Age 50+ 0% 10% 20% 30% 40% 50% Widowed Divorced US Census Age

Reasons for Stopping Sexual Relations Avis, NE. J Gend Specif Med Men Unable to perform (40%) Women Death of spouse (36%) Illness of spouse (20%) Spouse unable to perform (18%)

Present Interest in Sex: Men (1977) Brecher, EM s s s Strong Weak Absent Age

Present Interest in Sex: Women (1977) s s s Brecher, EM Strong Weak Absent Age

NCOA Survey (1998): % Sexually Active s s s Men Women National Council on Aging Age

NCOA Survey (1998): % with Partners Sexually Active s s s Men Women National Council on Aging Age

AARP Modern Maturity Sexuality Survey (1999) AARP Desire Remains High But declines with age Presence of Partner Increases sexual thoughts

AARP Survey (1999):% Having Sexual Thoughts ≥ 1 per Week AARP Men Women Age

AARP Survey (1999): % Having Intercourse ≥ 1 per week AARP Men Women Age

ARHP Sexual Activity Survey (1999) May have less frequent sexual activity Not necessarily less satisfied ARHP

ARHP Survey (1999): Sexual Activity vs. Satisfaction in Men ARHP s s s Activity Satisfaction Age

ARHP Survey (1999): Sexual Activity vs. Satisfaction in Women ARHP s s s Activity Satisfaction Age

AARP Online Singles Survey (2003) AARP US Census Bureau Sexual compatibility is important in a partner

AARP Survey (2003): % Not Having Sex in Last 6 Months AARP MenWomen

AARP Survey (2003): % with Simultaneous Sexual Partners AARP MenWomen

AARP Survey: The Divorce Experience Men Sex with a new partner as a way to cope Women Exercise and a retreat into work to cope AARP

AARP Divorce Survey: % Having Sex ≥ 1 time per week MenWomen AARP

Communication Concerns: Patient Fears Marwick C. JAMA % Very or Somewhat Concerned 76 Provide no treatment 71 Dismiss problem 68 Uncomfortable

Addressing Patient Concerns STOP: Ask open-ended questions; don’t press if no interest is expressed LOOK: Examine the patient LISTEN: A non-judgmental listener goes a long way to open communication

Mature Sexuality: Summary Mature Americans are both interested in and engaging in sexual activity Many find sex satisfying emotionally and physically Many are single and have sex with different partners, and thus are at risk for STIs