1. Sexuality in Older Age

2. 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 .

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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.

11. 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, p