Added: Lynise Gregoire - Date: 17.08.2021 17:00 - Views: 35623 - Clicks: 3732
Sexual desire is a major component of sexuality at any age, and inhibited desire is one of the main sexual dysfunctions reported by older women. Aging is a physiological, psychological, and social transition that typically affects sexuality. Continual sexual activity carries numerous health benefits throughout the life span: because sexual intimacy impacts sexual desire necessary for ongoing healthy sexual interactions in human relationships, problems in any area of the sexual experience should be addressed as part of a holistic health assessment as discussed by Yee and Sundquist [ 1 ].
Sexuality and older women are issues, however, that are typically dichotomized rather than considered a naturally occurring combination to be explored and nurtured in their intersection. A seemingly perpetual belief is that sexual interest wanes considerably or completely with age [ 2 ]. This was done in order to complement the knowledge of clinical practitioners who have been heavily influenced by the medicalization of sexuality in terms of physiological responses.
This overt medicalization could lead health care professionals to use an exclusively functional diagnostic approach. It could also reinforce the notion of complete sexual equivalency between men and women as well as among all women heterosexual, bisexual, lesbian, and transgender. As we have noticed in our clinical practice, women do not usually define their sexual satisfaction or loss of desire based on the functioning of their sexual organs, but mostly based on the quality of the relationship within which sexual activity ensues.
Whereas this topic has inspired some anecdotal literature by several knowledgeable professionals in the medical and psychological fields, it has received relatively little empirical attention, which, in turn, impacted our ability to locate a larger body of pertinent empirical literature for this review.
Investigating the prevalence and risk factors of sexual dysfunction in a nationally representative USA sample of individuals aged 57 to 85, Laumann and colleagues [ 5 ] reported the following prevalence rates for lack of interest in sex among older women: Another noteworthy result was the lack of ificant ethnic and racial differences for sexual interest in older age, suggesting that sexual desire and related concerns affect older women of all ages without racial exceptions.
Conversely, an active sex life appears to provide many older people with a buffer against ill health in later life [ 6 ]. Positive attitudes toward sexuality and the availability of a sensitive partner may facilitate the resumption of sexual interaction. In particular, Yee and Sundquist [ 1 ] listed five specific factors that appear to encourage sexuality thus increasing sexual desire in older women: a positive attitude towards sexuality, an active sex life in younger and middle years, good health, an interested and interesting partner, and the willingness to experiment sexually.
Additionally, Persson [ 7 ] discovered that the following factors Longing for a mature female predict engagement in sexual intercourse: a good mental health; b high levels of interest in sex among men when they were 20 years old; and c for women, having experienced premarital sex. Also important for continued sexual activity were cognitive flexibility and being able to adjust to the changes that accompany age instead of battling against the inevitableboth of which allow the likelihood of emotional and sexual satisfaction, as well as sexual enhancement [ 8 ].
Taking all the aforementioned factors intophysicians, psychologists, nurses, and other health providers Longing for a mature female not hesitate to raise the topic of sexual health and, in particular, sexual desire with older women patients. However, the assessment of the sexual concerns of older women is seldom done, for a variety of reasons succinctly covered herein. To shed some light on these neglected issues and to encourage reluctant clinicians to pay more attention to this area, we set as the main objective of this paper to inform medical professionals about biopsychosocial issues related to sexual desire among older women, with the secondary objective being to clarify reasons for the seldom assessment of sexual concerns in older female patients.
Once searches for sexual desire in particular yielded very few studies, we extended our searches to include the assessment of any sexuality issue pertinent to older female patients, thereby gathering a few additional studies. We conducted electronic searches of Medline and PsychInfo to utilizing keyword search terms for our main and secondary goals. The two criteria for review inclusion of a study were 1 being written in English and 2 being pertinent to either one of our two goals.
Selecting applicable studies that only utilized placebo or comparator control trials was not feasible, given the small body of the mostly cross-sectional literature obtained via our searches. For the same reasons, the type of literature that we were able to gather was not conducive to conducting a critical review. Given these challenging circumstances, we chose not to critique the scientific value of each study, focusing instead on offering the reader pertinent initial descriptive findings with direct clinical utility for either of our research goals.
Clinical treatment issues concerning sexuality in older age have not been covered herein, to reasonably limit the scope of this review. Sexual dysfunctions, as characterized by the Diagnostic and Statistical Manual of Mental Disorders DSM-V, American Psychiatric Association [ 9 ]reflect situational or generalized pain or disturbances in one or more psychophysiological processes that accompany the sexual response cycle and cause marked psychological and interpersonal distress.
Since the publication of the DSM-IV, research evidence has invalidated the linearity and precise division of phases in describing and treating sexual behavior for women in particular. For this reason, the publication of the DSM-V has sought to utilize an updated conceptualization of sexual behavior and to rectify and expand diagnoses and their respective criteria for sexual dysfunctions. Within this framework, drive is conceptualized as biologically based and experienced as spontaneous interest typically through genital tingling, sexual thoughts or fantasies, and increased sexual interest in others nearby.
Moreover, testosterone is known as necessary for sexual desire, which declines in both men and women with age. Occurring cognitively, expectations, beliefs, and values affect the interest in behaving sexually. Last, psychological motivation is defined as a Longing for a mature female or unwillingness to behave sexually with a partner.
Also, according to Levine, an important feature in understanding sexuality and sexual desire in particular is sexual equilibrium, which has an interpersonal nature and is characterized by a balance in sexual capacities and perceptions of those capabilities between two people. These capacities include capability for desire, arousal, and orgasm, which are highly responsive to psychosocial forces. In contrast, disequilibrium occurs when there is dissatisfaction in one or both partners with a nonsexual relationship, or when sexual relations occur less than ten times per year.
Not all women experience a negative impact on sexual health as a result of menopause; McCoy and Davidson [ 11 ] found that the older women in their samples reported no major loss of health and sexuality. For many women, however, changes in hormonal levels during and after menopause result in varied changes in the genitourinary system.
Testosterone deficiency and decreased secretion of estrogen may result in vaginal dryness and painful intercourse, atrophic skin changes, shrinkage and atrophy of the clitoris and vagina, diminished sensation, urogenital prolapse, and urinary incontinence. Researchers have reported that hormone replacement therapy HRT could improve quality of life for some women [ 13 ].
Compared to placebo administration, use of synthetic estrogen treatment may reduce some of the physical symptoms of menopause, yet it does not ificantly ameliorate depression or overall quality of life [ 14 ]. In consideration of the increased risk for cancer, stroke, and blood clots related to the use of synthetic hormones, research within the past decade has shown that long-term use of such hormones is inadvisable for some women [ 15 ].
Some scholars have reported that, although randomized control trials are lacking, the findings of several clinical outcome studies indicate that bioidentical hormones are related to lower risks of breast cancer and cardiovascular disease and are also more effective than synthetic or animal-derived hormones e. Butler and Lewis [ 18 ] noted that older women are typically viewed as inactive, unhealthy, asexual, and ineffective in society.
Older women's social contexts and sexual norms are likely to impact their sexual desire by affecting the way they feel about their bodies, appearance, and sexuality. The resulting pejorative self-views and expectations could emphasize any reduced cognitive behavior, increase depression, and reduce sexual interest and activities.
Inevitably, the human body changes in its biology and its appearance over time, but a woman who perceives the aging process as a positive reflection of her maturity and self-confidence could even experience enhancement of her desirability and sexual desire.
Such self-perceptions could result in a decrease in sexual desire, as sexual activity requires emphasis on the body, which could become a source of anxiety and depression for women who are not successful at coping with their bodily changes. Some of them choose to use cosmetic surgery and other image enhancers to preserve their youthful looks, but, at times, these attempts can result in somewhat uneven to even grotesque that are doubtfully effective at enhancing self-esteem. Within the past few years, a preoccupation with cosmetic genitoplasty has been noted, mainly to address labial reduction and vaginal tightening.
However, according to researchers such as Lih and Creighton [ 20 ], genital surgery is risky, does not empower women to resolve body image issues, and often le to a preoccupation with the next unattractive physical attribute to be altered. While menopause is undoubtedly culturally experienced and defined, Western industrialized societies continue the tradition of medicalization in the approach to this life transition for a woman.
At the same time, some research attention is being focused on multidimensional postmenopausal sexuality, with the resurgence of qualitative methods of inquiry that place priority on the context of the relationship in which sexuality occurs e. Research shows that the healthy couple is close yet has autonomous and differentiated identities [ 22 ], and the corresponding sexual-developmental task is to sustain pleasure [ 10 ]. However, the empirical literature suggests that intimacy may not promote sexual desire [ 8 ], whereas mystery, freshness, and risk are typically necessary to elevate components of passion that may be absent in these relationships.
Older couples are at a greater risk of becoming asexual; therefore, they must devote considerable energy toward keeping intimacy alive and healthy. Contrary to the misperception that women are usually in control of determining whether an older heterosexual couple ceases sexual activity, sexual desire more commonly declines among men, usually due to erectile dysfunction ED [ 23 ].
Research shows that most women and men report that ED is a major reason for decreased sexual activity [ 25 ]. Although very popular these days, Sildenafil and similar medications have side effects and do not always work for ED. Empirical evidence suggests that the most preferred intimate activity among sexually active men and women aged 80 to is mutual caressing, followed by masturbation and penetrative sex [ 3 ]. Moreover, one of the most ificant relational changes occurring in older age for many heterosexual women is that they will likely outlive their male partners.
In a study of USA women over 60 years old by Diokno and colleagues [ 26 ], Many women who would otherwise remain sexually active into older age are forced into sexual abstinence due to lack of a partner or access to an intimate companion. Back in yet still pertinent nowRubenstein [ 28 ] reported that factors affecting the sexual activities of older adults include shame, sin, and other religious and cultural aspects. While more modern interpretations of religions are not necessarily averse to a loving sexual relation outside of procreation, and shame may be more indicative of negative perceptions of sexuality, older adults and believers typically are less sexually permissive than young people and nonbelievers, regardless of educational level [ 29 ].
Concerning social context, lack of privacy, especially if the older woman lives with her family or in a geriatric facility, may further limit her opportunities to be sexual, and social pressure could steer her towards celibacy. As to social norms, Riley [ 30 ] reported that older women face more cultural obstacles related to roles prescribed by societal values and norms than older men.
Moreover, prejudice, misapprehension, and misinformation in the older population are a ificant source of intense feelings of Longing for a mature female, denial, and despair about sex [ 32 ]. Furthermore, in a literature review, Guan [ 23 ] pointed out that Masters and Johnson, back in [ 33 ], insightfully acknowledged that aging itself is Longing for a mature female what they observed to be the cause of cessation of sexual activity in older patients, but that sexual norms correlate highly with sexual activity and usually discourage sex in older age.
Typically, older men have an advantage over older women as it pertains to assessing their sexual problems. Sobecki and colleagues [ 34 ] highlighted that men are counseled more than women about the impact of medical treatment on sexual functioning as part of the decision-making process regarding their need to adhere to a particular medication regimen.
According to the aforementioned authors, health care physicians feel more comfortable talking about sex with men simply due to the availability of FDA-approved erectile dysfunction drugs deed for them. Without a magic pill to alleviate biological symptomatology, many distinguishable psychosocial sexual concerns of older woman have frequently gone undetected by physicians.
Some researchers have discovered that older women are indeed interested in discussing their sexual concerns with their physicians e. Consequently, the neglect of the assessment of sexual concerns, typically encountered in the hospital visit, virtually places diagnostic responsibility on the older patient, who is expected to raise likely embarrassing sexual questions. This is hardly an ideal situation for an older woman in need of help with her sexual problems.
Female physicians under the age of 60 are more likely to address sexual activity, orientation, or identity with female patients and gynecologists in general are more likely to screen for sexual dysfunction than other physicians. Yet, when their doctors do not ask, these patients could assume that their sexual problems are not a viable topic for discussion; as a result, they could feel anxious about initiating the conversation and, thus, their clinical needs for help in this area could go unmet. Perhaps having a same-sex provider could help reduce embarrassment on both parts.
Fifty percent of the respondents who received postresidency training in urogynecology reported that their training in female sexual dysfunction was unsatisfactory. Yet, even this one question is usually not posed in a medical setting Longing for a mature female start with.
The mission of comprehensive health treatment obliges physicians, psychologists, and other health care providers to place importance on the sexuality of their patients. Yet, the reasons for avoidance of this topic among many health care professionals are multifaceted. Researchers have pointed out that, as detrimental sexual stereotypes surrounding the older woman persist, others expect her to be incapable of having sex, to be sexually undesirable, and to not desire sex [ 40 ]. Regrettably, ageism may produce feelings of embarrassment, shame, and anxiety for older women that prevent them from discussing sexual concerns.
Ageist attitudes regarding sexuality were detected in a study by Gott and colleagues [ 42 ], who found that the general practitioners from their UK sample did not proactively address the sexual health of older people and deemed this issue an illegitimate topic for discussion likely based on stereotypic views of sexuality and aging rather than on individual patient experiences.
As reported by Gott and Hinchliff [ 37 ], older adults stated that their general practitioners did not provide information about sexual issues or discuss the risks Longing for a mature female side effects of their medical condition and its associated pharmacotherapy although the latter could directly impact their sexual functioning. Trainees who held this strong belief also had a high degree of authoritarian views and homophobia, which, in turn, could preclude assessing whether homosexuality is a life-long choice for the older female patient or is adopted as a reaction to the scarcity of male partners in older age we found no empirical evidence on this potentially controversial yet clinically relevant topic.
As gleaned from the aforementioned literature, a physician may be more inclined to address the topic of sexual health with women patients when this health care professional is a woman, a gynecologist, under the age of 60, more socially empathic, less homophobic, sufficiently trained in female sexual health and in taking a sexual history, and oriented toward a biopsychosocial conceptualization of patient complaints. Realistically, this combination of traits and training is hardly common. We believe that the use of sexual functioning questionnaires, as opposed to direct interview methods or at least in addition to those methods, may be useful in initiating discussions of sexual concerns with older women.
To say the least, just bringing up the topic of sex and asking an older woman patient whether she would like to discuss her sexual health concerns with a specialist would be helpful. Then, the underpinnings of her sexual problems could be addressed, ideally using appropriate interdisciplinary treatment plans which are outside the scope of this review.
A physician would likely benefit from Longing for a mature female the origin of his or her discomfort with the topic of sex in aging patients, as she or he could learn to overcome this difficulty, which could enhance a sense of professional competence and help older patients who could be struggling with unspoken, sensitive sexual concerns.
For instance, interested researchers should focus on the sexual health of nonmainstream groups, such as older women with nontraditional sexual orientations or those living with different kinds of physical limitations and disabilities. Also, little empirical evidence is published on the relationship between ethnicity and the sexual health of older women as pointed out by Vincent [ 6 ]. Unfortunately, diversity of any kind has been neglected in the investigation of older women's sexual desire and sexual functioning in general. Furthermore, many training questions are currently unanswered, including how to best train physicians—those who are not willing to refer older women out for the assessment and treatment of sexual problems as well as physicians who are interested in improving their clinical expertise on sexual health—for the conduction of reliable and comprehensive assessment of sexual functioning in older women.
In view of the extensive aging of the current population, this topic should be addressed more adequately as soon as possible, by interested physicians as well as by individuals in charge of medical school training and continuing education curricula. Main deterrents to initiating geriatric clinical research in this area could be the anticipated difficulties inherent in soliciting information of a very delicate sexual nature from older women. Some of the research findings summarized above, however, suggest that these women are interested in discussing their sexual concerns with their health providers.
More research on this taboo topic is definitely needed to clarify reasons for these low statistics. Low sexual desire, as elucidated in this review and emphatically pointed out by researchers such as Miner and colleagues [ 17 ], is often untreated due to the embarrassment of clinicians and their patients to introduce the topic within clinical settings.
The aforementioned authors encouraged health providers to utilize short, validated questionnaires to assess inhibited sexual desire, including the Decreased Sexual Desire Screener, which can be completed in the waiting room and has a very high reported sensitivity of 0. Using such a tool might provide an opener for the discussion of sexual concerns between patients and health care professionals.
Moreover, conducting and disseminating additional research in this area would have many benefits. This is an open access article distributed under the Creative Commons Attributionwhich permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Article of the Year Award: Outstanding research contributions ofas selected by our Chief Editors. Read the winning articles. Journal overview. Special Issues. Academic Editor: Andrea Tinelli.
Received 26 Apr Revised 24 AprLonging for a mature female
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Study Finds High Rate of Sexual Satisfaction in Women Over 80