1. Love, Intimacy, and Sexuality in Old Age

2. Sexuality Encompasses many aspects of one’s being as a man or a woman, including one’s sexual self-concept, relationships, and functioning. Encompasses many aspects of one’s being as a man or a woman, including one’s sexual self-concept, relationships, and functioning.

3. Sex Not just a biological function involving genital intercourse or orgasm Not just a biological function involving genital intercourse or orgasm Also includes the expression of feelings – loyalty, passion, affection, esteem, and affirmation of one’s body and its functioning. Also includes the expression of feelings – loyalty, passion, affection, esteem, and affirmation of one’s body and its functioning. A person’s speech and movement, vitality and ability to enjoy life are all parts of sexuality. A person’s speech and movement, vitality and ability to enjoy life are all parts of sexuality.

4. Because our sexuality is so vitally important to all aspects of our lives, it is really important to understand the normal physiological changes that affect sexual functioning and the centrality of intimacy across the life span. Because our sexuality is so vitally important to all aspects of our lives, it is really important to understand the normal physiological changes that affect sexual functioning and the centrality of intimacy across the life span.

5. And, since our sexual nature gores far beyond whether we are sexually active at any particular point in life, older adults need to be comfortable with whatever decisions they make regarding their sexuality. And, since our sexual nature gores far beyond whether we are sexually active at any particular point in life, older adults need to be comfortable with whatever decisions they make regarding their sexuality.

6. Attitudes and Beliefs about Sexuality in Later Life It is most interesting that at a time when our society is increasingly tolerant of sexual self-determination for most of the population, outdated ideas persist in our approach toward sex and aging. It is most interesting that at a time when our society is increasingly tolerant of sexual self-determination for most of the population, outdated ideas persist in our approach toward sex and aging. Stereotypes, misconceptions, and jokes about old age and sexuality can negatively affect older people’s sexual experiences. Stereotypes, misconceptions, and jokes about old age and sexuality can negatively affect older people’s sexual experiences.

7. Most beliefs come from ageism: Most beliefs come from ageism: –Perceptions of older people as physically unattractive and therefore asexual. –Perspective that all older people are the same, lacking energy and devoid of sexual feeling and therefore not interested in sex. –Older people with disabilities are plagued even more regarding sex.

8. It is possible that other attitudes and beliefs stem from misinformation, such as the perception that sexual activity and drive do and should decline with age. It is possible that other attitudes and beliefs stem from misinformation, such as the perception that sexual activity and drive do and should decline with age. Therefore, old people who speak of enjoying sexuality may be viewed as sinful, exaggerating, or deviant – “the dirty old man.” Therefore, old people who speak of enjoying sexuality may be viewed as sinful, exaggerating, or deviant – “the dirty old man.” Old people who hold hands are looked at as “cute” Old people who hold hands are looked at as “cute”

9. Current cohort of older people grew up with restrictive guidelines regarding appropriate sexual behavior such as masturbation. Current cohort of older people grew up with restrictive guidelines regarding appropriate sexual behavior such as masturbation. May believe that sex is for procreation. May believe that sex is for procreation. May not believe that sex is used for communication, intimacy, or pleasure and if it is – it is immoral. May not believe that sex is used for communication, intimacy, or pleasure and if it is – it is immoral. Older adults may withdraw from all forms of sexuality. Older adults may withdraw from all forms of sexuality.

10. Unfortunately, sex is necessary for them to feel alive, to reaffirm their identity, and to communicate with their partners. Unfortunately, sex is necessary for them to feel alive, to reaffirm their identity, and to communicate with their partners. So, we need to know what really happens to the body during the aging process in regard to sex. So, we need to know what really happens to the body during the aging process in regard to sex.

11. Myths and Reality about Physiological Changes and Frequency of Sexual Activity Myth: Age related physiological changes detrimentally affect sexual functioning. Myth: Age related physiological changes detrimentally affect sexual functioning. –Most early research avoided any questions concerning attitudes and sex. –Kinsey focused on number of orgasms or ejaculations as measure of good sex and found that by age 70, 25% of men experienced sexual dysfunction; women reach their peak in late 20’s or 30’s plateau through their 60’s and then decrease slightly in response. –They overlooked psychological aspects of sexuality, they failed to address the subjective experience, meaning and importance of sex at different ages.

12. We know that few age-related physiological changes prevent continued sexual enjoyment and activity in old age. We know that few age-related physiological changes prevent continued sexual enjoyment and activity in old age.

13. Sexual Activity Studies found stability of sexual activity patterns from mid- to late life. Studies found stability of sexual activity patterns from mid- to late life. So, those who were sexually conservative and inactive in young adulthood and mid- life carried that pattern through their later years. So, those who were sexually conservative and inactive in young adulthood and mid- life carried that pattern through their later years. Those who were more sexually active in young adulthood and middle age continued to remain active in old age. Those who were more sexually active in young adulthood and middle age continued to remain active in old age.

14. Later study found older women to be more interested in sex than older men Later study found older women to be more interested in sex than older men However, the rate of sexual activity among older women declined, partly due to absence of partners. However, the rate of sexual activity among older women declined, partly due to absence of partners. In fact, marital status appears to be more responsible in influencing women’s sexual activity than it is for men’s. In fact, marital status appears to be more responsible in influencing women’s sexual activity than it is for men’s. For men, sexual dysfunction or impotence appears to be the main barrier to sexual activity. For men, sexual dysfunction or impotence appears to be the main barrier to sexual activity.

15. Masters and Johnson One of first large scale studies that provided evidence for continued sexuality in old age (1981). One of first large scale studies that provided evidence for continued sexuality in old age (1981). Physiological changes occur with age, but the capacity for both functioning and fulfillment do not disappear. Physiological changes occur with age, but the capacity for both functioning and fulfillment do not disappear. There are no known limits to sexual activity. There are no known limits to sexual activity. Even later studies found that most older adults, especially men, over 80, remain sexually active and some even experience an increase in sex behavior. Even later studies found that most older adults, especially men, over 80, remain sexually active and some even experience an increase in sex behavior.

16. A study in senior studies found most people to be sexually active. A study in senior studies found most people to be sexually active. In fact, 99% desired sexual relations with varying frequencies if they could engage in sex whenever they wanted. In fact, 99% desired sexual relations with varying frequencies if they could engage in sex whenever they wanted. So, sexual inactivity seemed to be based on life circumstances and not desire or interest. So, sexual inactivity seemed to be based on life circumstances and not desire or interest. Also, found that sexual frequency did not decline sharply with age, but ranged instead from 1.5 times a week for people over 80. Also, found that sexual frequency did not decline sharply with age, but ranged instead from 1.5 times a week for people over 80. Some studies found that for people over 60, the average frequency is 4 times a month. Some studies found that for people over 60, the average frequency is 4 times a month.

17. Rates of activity increase to over 80% for men and 60% for women when activity is broadened to include caressing and touching. Rates of activity increase to over 80% for men and 60% for women when activity is broadened to include caressing and touching.

18. So, our biological clocks change with age, it is not necessarily for the better or worse in terms of either or frequency of activity or the nature of the sexual experience. So, our biological clocks change with age, it is not necessarily for the better or worse in terms of either or frequency of activity or the nature of the sexual experience. People who have been responsive all their lives will still be responsive and enjoy sex when they are older. People who have been responsive all their lives will still be responsive and enjoy sex when they are older. Some say it is even better than when they were younger. Some say it is even better than when they were younger. Actual level of activity may be less important than one’s satisfaction with the activity. Actual level of activity may be less important than one’s satisfaction with the activity.

19. Women and Age-Related Physiological Changes Climacteric or loss of reproductive ability takes place in 3 phases: premenopause, menopause, and postmenopause and may extend over many years. Climacteric or loss of reproductive ability takes place in 3 phases: premenopause, menopause, and postmenopause and may extend over many years. Pre is marked by decline in ovarian function (stop producing eggs and decrease in production of estrogen). Pre is marked by decline in ovarian function (stop producing eggs and decrease in production of estrogen). Menopause is gradual cessation of cycle from loss of ovarian function - 1 year of no cycle with average age at 50 or 51. Menopause is gradual cessation of cycle from loss of ovarian function - 1 year of no cycle with average age at 50 or 51. Postmenopausal women experience hot flashes, urogenital atrophy, urinary tract changes and bone changes. Postmenopausal women experience hot flashes, urogenital atrophy, urinary tract changes and bone changes.

20. Men and Age-Related Physiological Changes

21. Age-Related Physiological Changes in Genital Function Normal changes in women that do not interfere with full sexual activity: Normal changes in women that do not interfere with full sexual activity: –Reduction in vaginal elasticity and lubrication –Thinning of vaginal walls –Slower response to sexual stimulation –Preorgasmic plateau phase is longer –Fewer and less intense orgasmic contractions –After orgasm, rapid return to pre-arousal state

22. Age-Related Physiological Changes in Genital Function Normal changes in men that alter the nature of sexual response, but do not interfere with performance: Normal changes in men that alter the nature of sexual response, but do not interfere with performance: –Erection may require more direct stimulation –Erection is slower, less full, disappears quickly after orgasm –Orgasm is experienced more rapidly, less intensely, with decreased volume and force of ejaculation –Increased length of time between orgasm and next erections (longer refractory period) –Occasional lack of orgasm during intercourse –More seepage

23. Disease and Sexual Activity Physical health problems, of one’s own and/or one’s partner, are frequently the reason for refraining from sexual activity; even if disease does not affect sexual organs themselves Physical health problems, of one’s own and/or one’s partner, are frequently the reason for refraining from sexual activity; even if disease does not affect sexual organs themselves Sexual response depends on the cooperation of multiple systems of body – hormonal, circulatory, and nervous system. Sexual response depends on the cooperation of multiple systems of body – hormonal, circulatory, and nervous system. If any systems are disrupted, sexual functioning can be affected. If any systems are disrupted, sexual functioning can be affected.

24. Benign Prostatic Hypertrophy More than 50% of men have some prostate enlargement and 1 out of 3 over age 65 have prostate problems, usually inflammation or enlargement of prostate, pain in uro/genital area and urinary flow dysfunction. More than 50% of men have some prostate enlargement and 1 out of 3 over age 65 have prostate problems, usually inflammation or enlargement of prostate, pain in uro/genital area and urinary flow dysfunction. Infections are treated and drugs will shrink prostate. Infections are treated and drugs will shrink prostate. Some problems are treated through warm baths and gentle massage. Some problems are treated through warm baths and gentle massage. When urination is restricted or painful, surgery is necessary. When urination is restricted or painful, surgery is necessary. With surgery, semen is no longer ejaculated through penis, but is pushed back into bladder and later discharged in urine. With surgery, semen is no longer ejaculated through penis, but is pushed back into bladder and later discharged in urine. When healing occurs, ejaculate and fertility return for some. When healing occurs, ejaculate and fertility return for some. Feeling of orgasm can still be present, and sexual pleasure is not inevitably lessened. Feeling of orgasm can still be present, and sexual pleasure is not inevitably lessened.

25. Hysterectomy Surgical removal of uterus or ovariectomy (surgical removal of ovaries) or a mastectomy (surgical removal of one or both breasts) Surgical removal of uterus or ovariectomy (surgical removal of ovaries) or a mastectomy (surgical removal of one or both breasts) Most women worry about these surgeries interfering with their sex lives. Most women worry about these surgeries interfering with their sex lives. Most sexual satisfaction and long term functioning are not affected. Most sexual satisfaction and long term functioning are not affected.

26. Other Reasons for Sexual Dysfunctioning in Men Arteriosclerosis Arteriosclerosis Diabetes Diabetes Smoking Smoking Inactivity Inactivity Poor diet Poor diet Circulation problems Circulation problems Kidney diseases Kidney diseases Neurological lesions in brain or spinal cord. Neurological lesions in brain or spinal cord. Arthritis makes it painful often Arthritis makes it painful often Depression Depression Drug use Drug use Alcohol use Alcohol use

27. Gay and Lesbian Partners in Old Age Varieties of bonding are similar to those in heterosexual community: Varieties of bonding are similar to those in heterosexual community: –Ranging from monogamous life partners and non- monogamous primary relationships to serial monogamy and episodic liasions. –Gay and lesbian life partners face same issues that long term hetero couples face as they age. –While these couples face many other issues, there seems to be a consistent pattern of relatively high life satisfaction with being gay, good adjustment to old age, and on-going sexual interest and activity.

28. Psychosocial Factors and Late Life Affection, Love & Intimacy Things that affect the ways in which older people express their sexuality: Things that affect the ways in which older people express their sexuality: –Past history of sexual activity –Negative attitudes toward sexual activities other than intercourse such as kissing, masturbation, etc. interfere with openness to try new ways of expressing intimacy. –Reactions to physiological changes and to illness- induced or doctor-induced changes such as the importance of performance, etc. –Reactions to attitudes of other –Living arrangements

29. Widower’s Syndrome Man that has not had sexual intercourse for a long time following the loss or illness of a partner may have the desire and new opportunities for activity, but his physiological system may not respond and he cannot maintain an erection. Man that has not had sexual intercourse for a long time following the loss or illness of a partner may have the desire and new opportunities for activity, but his physiological system may not respond and he cannot maintain an erection.

30. Widow’s Syndrome After a year or more of sexual inactivity, women are likely to experience a reduction in the elasticity of vaginal walls. After a year or more of sexual inactivity, women are likely to experience a reduction in the elasticity of vaginal walls. Also caused by estrogen deficiencies and become more severe with no sexual contact. Also caused by estrogen deficiencies and become more severe with no sexual contact.