Chapter 16 Sexuality and Aging Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 1

Lesson 16.1 Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 2

Objectives  Describe how sexuality changes with aging.  Discuss effects of illness on sexual functioning.  Identify the older persons who are most at risk for experiencing problems related to sexuality.  Describe methods for assessing sexual functioning. Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 3

Objectives (cont.)  Identify selected nursing diagnoses related to sexuality.  Describe nursing interventions appropriate for older individuals experiencing problems with sexuality. Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4

Factors that Affect Sexuality of Older Adults Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 5

Normal Changes in Women  Older women experience changes in the reproductive system related to decreased levels of progesterone and estrogen Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 6

Normal Changes in Women (cont.)  Common changes that may result in discomfort or pain during intercourse  Irritation of the external genitals  Thinning and dryness of the vaginal walls  Alteration in the levels of normal microorganisms in the vagina, resulting in an increased risk for vaginal yeast infections Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 7

Erectile Dysfunction in Men  Male orgasm takes longer to achieve and has a shorter duration than at a younger age  Ejaculation is less forceful and a smaller volume of seminal fluid is released  Loss of erection occurs quickly after orgasm  The time between orgasms increases, and orgasm may not occur with every episode of sexual intercourse Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 8

Illness and Decreased Sexual Function  Many disease processes interfere with normal sexual function, as do many of the medications taken to treat illness  Incontinence does not interfere with sexual relations but may cause some people to avoid sex because of the risk of embarrassment Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 9

Illness and Decreased Sexual Function (cont.)  Joint pain resulting from arthritis can interfere with sexual activity  Cardiac problems are likely to interfere with normal sexual activity, although this is more from fear than from actual danger Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 10

Illness and Decreased Sexual Function (cont.)  Stroke need not prevent sexual activity  Neither hysterectomy nor mastectomy changes sexual functioning, although loss of these organs may make a woman feel less desirable or make her fear that she will be viewed that way  Depression can decrease sexual interest and lead to decreased response to intimacy Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 11

Alcohol and Medications  Excessive alcohol intake results in delayed orgasm in women and loss of the ability to achieve or maintain an erection in men  Digitalis, tranquilizers, diuretics, antihypertensives, antihistamines, antidepressants, and even some medications used to treat GERD are likely to cause sexual problems for men and women Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 12

Audience Response System Question 1 A medication that may be effective for many individuals suffering from erectile dysfunction is: A.tadalafil (Cialis). B.cimetidine (Tagamet). C.methotrexate (Trexall). D.atorvastatin calcium (Lipitor). Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 13

Loss of Partner  Single older women experience more of a problem than single older men  By age 85, there are 100 single women for every 39 single men Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 14

Loss of Partner (cont.) Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 15

Marriage and Older Adults Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 16

Marriage  Marriage among older adults garners many different responses, particularly from the families of older adults  Pensions, insurance benefits, and other financial concerns may be contingent on the person’s remaining single  Some older people choose to live together without marrying, which can be a difficult decision for them and their families Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 17

Caregivers and the Sexuality of Older Adults Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 18

Caregivers  Young people may not be comfortable with the thought of sexual activity among seniors, believing that it is offensive or abnormal  Even health care professionals may be unaware of or uncomfortable about addressing the sexual needs of older adults  Fear, shame, or embarrassment causes many older people to hide their sexual interests and activity, even from health care professionals Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 19

Audience Response System Question 2 Some older people choose to live together without marrying because: A.they want to be sure they are compatible. B.their children don’t want them to remarry. C.they may lose a pension or insurance. D.their religion prohibits marriage. Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 20

Sexual Health and Sexual Orientation Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 21

Sexual Health  Older adults often are not considered when sexually transmitted diseases are discussed, yet 10% of acquired immunodeficiency syndrome (AIDS) cases occur in people older than 50 years  All sexually active individuals, no matter what their age, should use safe sex practices  The risk for sexually transmitted disease does not disappear with age Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 22

Sexual Orientation  For personal or social reasons, persons who have concealed their sexual orientation in younger years may be more comfortable expressing it as they age  Health care providers must be careful to recognize the sexual needs and concerns of older lesbian, gay, and transgendered people Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 23

Privacy and Personal Rights of Older Adults  Obtaining adequate privacy may be difficult, even for married couples who reside in the same institution, particularly if regular medical or nursing care is necessary  Touching, hand-holding, and cuddling are encouraged  A closed door must be respected when privacy for intimacy is desired Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 24

Touch and Affection Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 25

Nursing Process for Sexual Dysfunction Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 26

Assessment  Does the person have any discharge or drainage from the genitals?  If the person is sexually active, does he or she complain of any difficulty or discomfort during sexual activity?  Does the person have any diseases or disabilities that interfere with sexual activity?  Are there any emotional issues that interfere with sexual interest or activity? Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 27

Assessment (cont.)  Does the person take any medications that may interfere with sexual activity?  What level of sexual activity does the person desire?  Does the person have any real or perceived barriers to sexual activity?  Does the person have adequate privacy for sexual activity? Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 28

Nursing Diagnosis  Sexual dysfunction Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 29

Nursing Goals/Outcomes  Verbalize feelings about sexual identity  Discuss concerns regarding sexuality  Describe the effects of aging and illness on sexual functioning Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 30

Nursing Interventions  Encourage verbalization of concerns  Provide privacy  Protect the sexual dignity of confused older adults Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 31

Audience Response System Question 3 Masturbation should be discouraged in the older adult. A.True B.False Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 32