1. Mature Sexuality: Who’s Doing What? Association of Reproductive Health Professionals www.arhp.org

2. 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

3. 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

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

5. Sexuality Among Older Adults Covey HC. Gerontologist. 1989.

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

7. Percent U.S. Men & Women, Age 65+ US Census. 2001. 0% 10% 20% 30% 40% 50% 60% 70% 80% MarriedWidowedDivorcedNever Married Total Men Women

8. Marital Status: U.S. Men and Women Age 50+ 0% 10% 20% 30% 40% 50% 50-5455-5960-6465-6970-7475+ Widowed Divorced US Census. 2001. Age

9. Reasons for Stopping Sexual Relations Avis, NE. J Gend Specif Med. 2000. Men Unable to perform (40%) Women Death of spouse (36%) Illness of spouse (20%) Spouse unable to perform (18%)

10. Present Interest in Sex: Men (1977) Brecher, EM. 1984. 1 94 5 50s 88 2 10 60s 76 8 18 70s Strong Weak Absent Age

11. Present Interest in Sex: Women (1977) 4 75 20 50s 67 10 23 60s 59 18 23 70s Brecher, EM. 1984. Strong Weak Absent Age

12. NCOA Survey (1998): % Sexually Active 71 51 60s 57 30 70s 54 18 80s Men Women National Council on Aging. 1998. Age

13. NCOA Survey (1998): % with Partners Sexually Active 84 79 60s 84 77 70s 50 58 80s Men Women National Council on Aging. 1998. Age

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

15. AARP Survey (1999):% Having Sexual Thoughts ≥ 1 per Week AARP. 1999. 84 41 45-59 53 13 60-74 35 5 75+ Men Women Age

16. AARP Survey (1999): % Having Intercourse ≥ 1 per week 55 50 45-59 31 24 60-74 19 7 75+ AARP. 1999. Men Women Age

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

18. ARHP Survey (1999): Sexual Activity vs. Satisfaction in Men ARHP. 1999. 69 61 50s 52 62 60s 35 49 70s Activity Satisfaction Age

19. ARHP Survey (1999): Sexual Activity vs. Satisfaction in Women ARHP. 1999. 60s 9 49 50 60 50s 18 64 70s Activity Satisfaction Age

20. AARP Online Singles Survey (2003) AARP. 2003. US Census Bureau. 2002. Sexual compatibility is important in a partner

21. AARP Survey (2003): % Not Having Sex in Last 6 Months AARP. 2003. 61 39 MenWomen

22. AARP Survey (2003): % with Simultaneous Sexual Partners AARP. 2003. 18 48 MenWomen

23. 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. 2003.

24. AARP Divorce Survey: % Having Sex ≥ 1 time per week 54 57 MenWomen AARP. 2003.

25. Communication Concerns: Patient Fears Marwick C. JAMA. 1999. % Very or Somewhat Concerned 76 Provide no treatment 71 Dismiss problem 68 Uncomfortable

26. 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

27. 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