Sexuality in older age
Foto: Rankin/Relate; https://magazin.aktualne.cz
Sexuality in older age
Increase?
Decrease
Different types of sex with people of the oppositesex,
past year (Natsal-3)
Sample: 15,162 UK men and women aged 16-74
Natsal-3 MEN
Natsal-3 WOMEN
Sexuality in older age
• Two contrasting views
“asexual old
age”
“sex crucial
for successful
aging”
Impact on sex?
What do you think may affect (negatively or positively)
sexual functioning among older people?
Menti.com
2935 9179
Biology
Partner
Attitudes
Impact on sex?
* Complex
** Intertwined
Impact on sex: Natural biological changes
• Age-related decrease in physical fitness
• Illnesses (particularly chronic)
Natsal-3: Percentage reporting recent sexual activity (in past 4 weeks)
Impact on sex: Natural biological changes
• Age-related decrease in physical fitness
• Illnesses (particularly chronic)
• Medication (pharmacotherapy)
Impact on sex: Health / illness / medication
Context & subjective health status, not only physical health per se
„Z mého pohledu tam byl velký strach z nemoci jeho [manžela]. Jednou jsem
ho navštívil v nemocnici a viděl všechny ty hadičky a všechno, řekl jsem si,
byl bych rád, kdyby přežil a zůstal naživu.“ (vdaná, 65 let)
„Kvůli hypertenzi užívám tyto léky: Cynt 0,4, Amicloton, Anopyrin, Lusopress, Irbesartan
Actavis 300 mg, Nebivolol Sandoz 5 mg. Asi mám problémy s erekcí. Jelikož mám
partnerku, nechci na ní šetřit. Je možné provést nějaké změny v léčbě hypertenze nebo
přidat nějaké léky, které by zlepšily moji erekci? (muž, 62 let)
“I have a pacemaker, I have atherosclerosis, this, that,
a whole bunch of diseases. So what? Should I sit down
and cry? No. I want to enjoy life and experience lots of
cool things for as long as I can.’(W, 68)
“…physically not good, my health is failing, I keep
on living on pills.
As I said, willingness also fails. [...] Lack of will, lack
of energy.” (M, 70)
Impact on sex: Natural biological changes
• Age-related decrease in physical fitness
• Illnesses (particularly chronic)
• Medication (pharmacotherapy)
• Menopause and andropause: affect sexual functioning
• Menopause: rapid & intense changes, ovaries stop producing estrogen and
progesterone; mood swings, depression, sweating, hot flushes, anatomical
changes, lubrication issues etc.
• Andropause (testosterone deficiency syndrome, PADAM (partial androgen deficiency in
the aging male)): gradual, slow changes
• Careful! Diversity:
“Menopause? What menopause? I had to ask my friends what it was. Myself, I
haven't even notice, only that I stopped menstruating.”
Impact on sex: Natural biological changes
Masters & Johnson, 1966 – sexuálně odpověď u starších lidí
Impact on sex: Sexual dysfunctions
Specific problems with sexual functioning (physiological) + distress
The ICD-11 diagnosis guidelines categorize sexual dysfunction into four main
groups:
• Hypoactive sexual desire and arousal dysfunctions
• Orgasmic dysfunction
• Ejaculatory dysfunction
• Sexual pain-penetration disorder
DSM 5 includes female sexual arousal/interest disorder, female orgasmic disorder, genitopelvic
pain/penetration disorder, male hypoactive sexual desire disorder, erectile disorder,
premature (early) ejaculation, and delayed ejaculation.
16–24 years 25–34 years 35–44 years 45–54 years 55–64 years 65–74 years All age groups p value*
Women
Lacked interest in
having sex
24·8% 31·9% 37·0% 37·9% 38·8% 34·2% 34·2% <0·0001
Lacked enjoyment in sex11·3% 13·2% 11·0% 12·7% 14·2% 8·0% 12·1% 0·0737
Felt anxious during sex 8·2% 8·2% 4·2% 3·6% 2·7% 2·0% 5·2% <0·0001
Felt physical pain as a
result of sex
9·5% 8·0% 5·3% 6·4% 10·4% 5·3% 7·5% 0·0006
Felt no excitement or
arousal during sex
8·6% 8·0% 7·1% 8·9% 9·5% 6·9% 8·2% 0·4626
Difficultly in reaching
climax
21·0% 17·2% 14·3% 14·7% 16·3% 13·7% 16·3% 0·0029
Reached climax more
quickly than you would
like
3·8% 2·5% 1·7% 2·6% 1·6% 1·1% 2·3% 0·0136
Uncomfortably dry
vagina
9·4% 9·7% 7·5% 14·1% 26·9% 20·0% 13·0% <0·0001
16–24 years 25–34 years 35–44 years 45–54 years 55–64 years 65–74 years All age groups p value*
Men
Lacked interest in
having sex
11·5% 14·5% 17·2% 15·3% 16·0% 13·6% 14·9% 0·0961
Lacked enjoyment in
sex
5·4% 6·7% 5·0% 3·3% 4·6% 1·8% 4·8% 0·0071
Felt anxious during sex 5·7% 6·3% 5·8% 4·4% 5·5% 3·8% 5·4% 0·4269
Felt physical pain as a
result of sex
1·8% 1·7% 1·8% 2·0% 1·9% 1·0% 1·8% 0·9243
Felt no excitement or
arousal during sex
3·3% 4·3% 3·3% 2·2% 2·6% 2·7% 3·1% 0·2245
Difficultly in reaching
climax
9·2% 9·8% 8·3% 7·9% 10·6% 10·4% 9·2% 0·5100
Reached climax more
quickly than you would
like
16·5% 19·1% 15·8% 13·6% 10·0% 10·8% 14·9% 0·0002
Trouble getting or
keeping an erection
7·6% 7·9% 7·9% 13·4% 23·5% 30·0% 12·9% <0·0001
Impact on sex: Societal and personal attitudes
• Societal stereotypes (normative barriers)
• Media
• Family
• Friends
• Healthcare providers
• Presence or absence of models of sexual life in later life
• Restrictive stereotypes in older research, new research more permissive
(Syme & Cohn, 2017)
Impact on sex: Societal and personal attitudes
• Societal stereotypes (normative barriers)
• Media
• Family
• Friends
• Healthcare providers
• Presence or absence of models of sexual life in later life
• Restrictive stereotypes in older research, new research more permissive
(Syme & Cohn, 2017)
Old people are asexual
Old people are not
interested in sex It is not normal for an old person
to show sexual interest
Dirty old man
Couguars on a prowl
It is ok for an old man to have a young wife, but
an older woman with a younger man? No way!
It’s sad. They should age with dignity
and not behave like youngsters
Impact on sex: Societal and personal attitudes
• Individual, personal attitudes toward sex
„Sex was important in my life, is important and
will continue to be important.
Why should I give it up just because I went
through menopause?”
“I would like to, perhaps, but
what would my friends say […]
how would the children react?
No, that's not really an option.”
“I feel great about myself, as I’ve never have.
Sex hasn't been a part of my life for many
years. Why would I change that now?”
Impact on sex: Societal and personal attitudes
• Individual, personal attitudes toward sex
• Also:
• The role of sex (why do I engage in sexual activity?)
• Component of pleasure?
• The meaning of sex (does sex=sexual intercourse or is there more to it?)
• And other issues…
Impact on sex: (Not) having a partner
• Being partnered/ Lack of partner/ loss of a partner
• Strongly associated with sexual activity in most research.
Impact on sex: (Not) having a partner
Impact on sex: (Not) having a partner
Impact on sex: (Not) having a partner
• Lack of partner/ loss of a partner
• However, psychological interpretation also important
• Re-partnering?
• Gender gap
• Social acceptance?
„I dont have any sex problems. My only problem
is that I don’t have a partner.” (M, 62)
“When I think of intimacy, it’s always with him [husband].
I don't feel attracted to anyone. I wouldn't let any other man touch me.
Absolutely not, out of the question! […]
I simply still love my husband, even though he is not here anymore.”
And this is just a tip of an
iceberg…
Thank you for listening ☺