1. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 12 Sexuality and Intimacy

2. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins TERMS TO KNOW Andropause: a decline in testosterone levels with aging Dyspareunia: painful intercourse Erectile dysfunction: the inability to attain and maintain an erection of the penis sufficient to engage in sexual intercourse Hormone replacement therapy (HRT): replacement of estrogen and/or progestin hormone that is no longer being made by the body Menopause: the permanent cessation of menses for at least 1 year Perimenopause: the several years prior to the onset of menopause Postmenopause: time beginning 12 months after the last menstrual cycle

3. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Introduction Sex controversial subject In the past, limited information on sexuality Changes in attitudes over the years Education on sexuality increasing Ignorance and prejudice related to sex and older adults

4. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement True or False? Myths, ignorance, and the vulgar status previously associated with sex in general have been conferred on the sexuality of the older adult population and these attitudes reinforce fear and aversion to growing old.

5. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Myths about older adults and sexuality are prevalent in our society. These misconceptions and prejudices are an injustice to persons of all ages and may repress meaningful sexual activity, and lead to feelings of guilt and inferiority for an older adult and a fear of aging for younger generations.

6. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Attitudes Toward Sex and Older Adults Myths, ignorance, misconceptions, and prejudice are injustices toward older adults Subtle or blatant violations of respect to older adults’ sexual identity are common Older adults are entitled to same dignity and respect as sexual beings that are afforded to persons of other ages Stereotypical views toward sex in late life lead to safe sex issues being ignored

7. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement True or False? Older adults who may be infected with HIV are usually diagnosed in a later stage of the disease process as they are embarrassed to seek attention and if they do present symptoms to a health care provider the symptoms are not associated with HIV.

8. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True If older adults learn that a sexual partner is HIV- positive they may be embarrassed to seek medical attention and when they do present with symptoms to a health care provider, the symptoms are not associated with HIV simply because the person is old.

9. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Menopause as a Journey to Inner Connection Menopause: permanent cessation of menses Important transition in a woman’s life –More than a physiological experience –Awakening of body, mind, and spirit –Physical beauty of youth versus inner beauty of age

10. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Symptom Management and Patient Education Need for effective management of physical aspects –Leads to positive passage rather than distressing detour Nursing knowledge related to menopause is essential –Symptoms related to estrogen loss and menopause

11. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Menopause and Hormone Therapy Risks and benefits of hormone therapy Women’s Health Initiative –Estrogen and progestin increased heart risks –Estrogen alone less risk Age at the start of hormone replacement therapy alters risk Individual decision for treatment Managing symptoms

12. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Self-Acceptance Nurses play key roles in guiding women through changes with menopause –Emotions and symptoms used for expression –Realize significance of caring for and nurturing self –Self-acceptance: broadening perspectives, purpose, and connections

13. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Andropause Testosterone levels decline in men Does not occur in all men Low testosterone levels in older men can result in reduced muscle mass, energy, strength, and stamina Other changes: erectile dysfunction, breast enlargement, osteopenia, osteoporosis, and shrinkage of testes

14. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Realities of Sex in Older Adulthood Misconception by health professionals: older adults not interested in nor capable of sex Health professionals lack experience in discussing sex with any age group Medical and nursing assessments lack inquiry of sexual history and activity Need to promote understanding of older adults’ sexuality

15. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Sexual Behavior and Roles Older adults can and do enjoy sex General pattern of sexual behavior remains consistent throughout life Sexuality must be viewed in the context of individuals’ total life experience Nurses need to recognize and respect sex- specific roles of older adults identity

16. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Intimacy Sexuality encompasses more than just physical acts –Love, warmth, caring, and sharing –Intimate exchange of words and touch –Feeling important and wanted by another person –Multiple losses have significant effect on intimacy

17. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Age-Related Changes and Sexual Response Older adults physically able to be sexually active Age-related changes have impact on sexual function Regular sexual expression for both sexes is important in promoting sexual capacity and function

18. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following statements is TRUE related to age-related changes and sexual response? a.Older men get erect and ejaculate more quickly b.Older women lose interest in sex c.There is a decrease in sexual responsiveness in both genders d.Sexual activity declines after the fifth decade

19. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer c.There is a decrease in sexual responsiveness in both genders Despite the physical ability to remain sexually active in old age, there is a decrease in sexual responsiveness and a reduction in the frequency of orgasm.

20. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Identifying Barriers to Sexual Activity Physical, emotional, and social variables have impact on older adults’ ability to remain sexually active Comprehensive nursing assessment includes sexual history Sensitivity to sexual function and identity promotes wellness

21. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Unavailability of a Partner Lack of partner, particularly for older women By age 65, 7 men to every 10 women; by age 85, 1 man to every 5 women Tendency for men to marry younger women Most older men are married, most older women are widowed

22. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychological Barriers Negative attitudes from society Fear of losing sexual abilities Concerns about body image Relationship issues Misconceptions by older adults

23. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Medical Conditions Physical conditions can affect sexual function Evaluation is critical in determining a realistic approach to helping Interventions include medications, penile prostheses, lubricants, surgery, and counseling Nurses need to communicate and advocate for preserving sexual capabilities

24. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Erectile Dysfunction Impotence or erectile dysfunction: unable to attain or maintain erection of penis for sexual intercourse Multiple causes: atherosclerosis, diabetes, hypertension, multiple sclerosis, thyroid dysfunction, alcoholism, renal failure, structure abnormalities, medications, and psychological factors Physical exam essential Medical treatments and other options available

25. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following diseases most commonly causes erectile dysfunction in the older adult population? a. Measles b. Acromegaly c. Diabetes d. Benign prostatic hyperplasia

26. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer c.Diabetes A chronic complication of diabetes is neuropathy, which can cause a decrease in innervation and thus erectile dysfunction.

27. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Medication Adverse Effects Medications can affect potency, libido, orgasm, and ejaculation Various medications can affect sexual function –Educate regarding medications affecting sexual function –Evaluate medications when new sexual dysfunction occurs Nondrug treatment modalities for managing problems

28. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Cognitive Impairment Dementia affects sexual behavior Inappropriate behaviors can occur Touching and endearing statements may be misinterpreted by cognitive impaired person as an invitation to become sexual Educate family members and caregivers in understanding features of dementia and sexual issues

29. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Promoting Healthy Sexual Function Basic education in understanding effects of aging process on sexuality Realistic framework for sexual functioning Nurses preparedness to openly discuss sex Sexual history part of nursing assessment Identification of problems and potential solutions for problems

30. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Promoting Healthy Sexual Function Special consideration for institutionalized older adults Masturbation beneficial Holding, caressing, and exchanging loving words as means for sexual satisfaction Nurses foster positive attitudes