Sexuality as we Age
DeniseKoehnRN,BSN,WHNP-BC
Sexuality as we Age
DeniseKoehnRN,BSN,WHNP-BC
The Circles of Sexuality and Aging
•  Sexualitybeginsinuteroaswearedevelopingashumanbeingsandendswithourdeath.“”fromthewombtothetomb”
•  “Closeness,inFmacyandtoucharelifelongneedsthatdonotgetold,evenwhenwedo.Wemaybegrayingbutour
rainbowsaresFllflickering,asoursexualityevolvesandchangesoverourlifecycle.Itissimplynottruethatwhenweare
lighFngdozensofcandlesonourbirthdaycakethatweloseinterestinsexorthatourlivesassexualbeingsareover.
Sexualityevolvesandchangesasweage,butissFllverymuchapartofwhoweareunFlthedaywedie”.
•  ToooMenthewordssexandsexualityareusedinterchangeably,andthatmayleadtodiminishingthevalueofsexualityas
weage.
•  Onecanthinkofsexaswhathappensbelowthewaist,andinbetweenthelegs(behaviors)vs.sexuality.
•  Sexualityisthetotalexpressionofwhoweareashumanbeings.ItisthemostcomplexhumanaQributeand
encompassesourwholepsychosocialdevelopment–ourvalues,aStudes,physicalappearance,beliefs,emoFons,
aQracFons,likes/dislikes,ourspiritualselves.Thisisallinfluencedbyourvalues,culture,socializaFon,poliFcs,andlaws.
TerriClark,TheCirclesofSexualityandAging,AmericanSocietyonAging
Benefits of good Sexual Health
•  Thebenefitsofsexextendbeyondthebedroom.
CanImprovePhysicalHealth–seximprovesphysicalstamina,burnsfatandcalories,boosts
immunity
CanimproveMentalHealth–sexcausesthebraintoreleaseofendorphins,drasFcally
reducesanxiety
Increaseslifespan–throughit’shealthimprovingbenefits,agoodsexlifecanaddyearsto
yourlife
SolidifyrelaFonships–sexisachancetoexpresstheclosenessofyourdeepest
relaFonship
Giverefuge–sexgivescouplesachancetoescapefromthesomeFmesharshrealiFesof
theworld
BeQerSexasYouAge,HelpGuide.0rg
Importance of Discussing Sexual Health
Wehavelearnedalotaboutwomen’spercepFonsregardingtheirsexualhealthinthe2008
PrevalenceoffemalesexualProblemsAssociatedwithDistressandDeterminantsofTreatment
SeekingStudy(PRESIDE).
-43%of31,581respondentsreportedfemalesexualdysfuncFon(FSD)insexualdesire,
arousal,ororgasm
-11.5%oftheserespondentsweredistressedaboutit
-14.8%ofwomenaged45-64reportedthehighestrateofdistress
-10.8%ofwomenaged18-44
-8.9%ofwomen65andover
-mostprevalentdysfuncFonreportedwashypoacFvesexualdesiredisorder(in
2013actuallygivennameintheDiagnosFcandStaFsFcalManualofMental
Disorders,FiMhEdiFon)Again,midlifewomen(45-64)reporFngthemost
distress.
-OBGManagement
“Whensexisbadornonexistent,itplaysaninordinatelynegaFverole,reducingthequalityofa
relaFonshipby50-70%insomestudies.”(Dr.SusanKelloggSpadt)
Sexuality in the younger genera@on
•  Concernsforpregnancy
•  ConcernsforsexuallytransmiQeddiseases
•  Physical/MentalHealthIssues
•  Busyworklives
•  Busyfamilylives
•  SexualdysfuncFons(10.8%women)
-lowlibido
-inabilitytoachieveorgasm
-dyspareunia(painwithintercourse)
Sexuality from midlife and Beyond
•  EmoFonalobstacles:lifestressaschildrenleavehome,anxiety,anddepressioncan
affectinterestinsexandtheabilitytobecomearoused.Thismayinterferewiththe
abilitytoconnectemoFonallywithyourpartner.
•  BodyImage:Asmorewrinkles,grayhair,lovehandlesorcelluliteappear,youmayfeel
lessaQracFvetoyourpartner.Thesefeelingscanmakesexlessappealingandcauseless
interest.
•  Lowself-esteem:changesatwork,loomingreFrementandothermajorlifechangessuch
asagingparentsrequiringFmeandaQenFon,mayleaveyoufeelingtemporarily
uncertainaboutyoursenseofpurpose.Thiscanundermineyourselfesteem,create
stressandfaFguemakingonefeellessaQracFveandsexuallyinterested.
•  Worryoverperformance:worryingabouthowyouwillperform,orwhetheryouare
worthyofsexualaQenFonfromyourpartner,canleadtoimpotenceinmenandlackof
arousalororgasminwomen
BeQerSexasyouAge,HELPGUIDE.ORG
Why do sexual desire and behavior change?
•  Changesinsexualdesireandbehaviorthroughoutthelifecyclearenormal,thoughinFmacyand
connecFonremainimportantintolaterlife.
•  ThebestpredictorofsexualinterestandacFvityinlateryearsmaybethefrequencyofsexual
acFvitywhenyou’reyounger.Ifsexiscentraltoyourlifestyleandhappinessatage30,itwill
probablysFllbeimportantatage60andbeyond.
•  WhensexualacFvitydecreasesorceases:commoncauses
ForMen
-lackofdesire,usuallyresulFngfrommedicaFons
-difficulFesmaintaininganerecFon
-poorgeneralhealth
ForWomen
-hormonalchangeslinkedtomenopause(naturalandsurgical)
-lackofdesire,someFmesrelatedtomedicaFons
-lossofpartner
SexandAging,PamelaRogers,MS,PhDHealthLine Physical Effects of Menopause
Reducedlevelsofthehormonesestrogenandprogesterone:
-lessnaturalvaginallubricaFon
-Fghteningofthevaginalopening
-thinningofvulvar/vaginalFssues
-narrowingandshorteningofthevagina
-loworabsentsexualdesire
-urinaryinconFnence
-weightgain
-risksforosteoporosis
-vasomotorsymptoms(hotflushes)
-forgeoulness(menopausalbrain)
Effects of Menopause that can effect
Sexuality
•  VaginalDryness-byfarthemostcommonproblemthatwomen
report.
•  PainwithintercourseandvaginalbleedingduetoatrophyofFssues
•  Slowerresponsetomentaland/orphysicalsexualsFmulaFon
•  Totallackofinterestoranaversiontosex
•  Leakingofurineduringsex
•  HotflushesoccurringwithsexualacFvity
•  Difficulty/discomfortwithsexposiFons
Medical interven@ons
•  DiscusscurrentmedicaFonsyouaretakingwithyourclinicianthat
maybeaffecFngsexuality
•  Hormonereplacementtherapy
•  PhysicalTherapy
•  SurgicalintervenFon
•  MedicaFonsforlowlibido,dyspareuniaandvasomotorsymptoms.
Addyi-forpremenopausalwomen.RestricteddistribuFonintheUS
Brisdelle-forpostmenopausalhotflushes
Osphena–forpostmenopausaldyspareunia(painwithintercourse)
Non medical strategies for staying sexual aJer
menopause
•  Manywoman,cliniciansandsextherapistsreporttherealityoftheuse-it-or-loseitfactor.Regularsex,eitherwithapartnerand/ormasturbaFondefinitelyhelps
keepvaginalFssuesmoresuppleandmoist.
•  LiberaluseofawaterbasedbioadhesivelubricantisoMenenoughtomake
intercoursemorecomfortable.
•  DailyuseofanonprescripFvevaginalmoisturizersuchas“Replens”and/or
coconutoilonadailybasismaybehelpful.
•  Healthydiet.DRINKWATER!Limiteduseofalcohol.
•  Don’tsmoke.
•  DailyphysicalacFvity(aerobicandstrengtheningexercise)
•  Yoga,relaxaFon,meditaFonandmindfulnessexercises
•  Overthecountersupplementsandherbaltherapies(soyisoflavones,black
cohosh)
More Strategies:
•  Talkwithyourpartner;thismaybedifficultaswhensexualproblemsoccur,
feelingsofhurt,shame,guiltandresentmentcanoccuraswell;findtheright
Fme,avoidcriFcizing,letyourpartnerknowthechangesyouareexperiencing
inyourbody.Behonestaboutwhatyouareexperiencingphysicallyand
emoFonally.Thisshowscommitment,careandconcernfortherelaFonship.
•  SetasideFmetobesensualandsexualtogether,shareyourthoughtsabout
lovemaking.Letyourpartnerknowwhatisgoodforyou.Asksameforyour
partner.
•  ReadingorwatchingeroFca,beingmindfuloferoFcthoughtsastheyoccur,use
imagery,fantasy,focusonsensaFonduringarousalavoidingdistracFons.Be
present.
•  TakeFmeforforeplay,usevibratorsorFiera*(devicethatprovidesalowlevel
ofvibraFontotheclitorisandanteriorvulvatoincreasesFmulaFon)
•  PracFce“KegelExercises”–doingtheseseveralFmesadaymaybeallthatis
neededtochecksurpriseleaks.Welltonedgenitalmusclesmayalsoenhance
moreintensiveorgasmsforbothwomenandmen.
The Takeaway
Sexualityevolvesandchangesasweage,butissFllverymuchapartofwhoweareunFlthedaywe
die.
Yoursexualwell-beinggoeshandinhandwithyouroverallmental,physicalandemoFonalhealth.
Itisnormalforsexualdesiresandbehaviorstochangeasweage,butsexandphysicalinFmacy
remainimportanttomanyolderadults.
DealingwithsexissuescanbeadaunFngproposiFonandmanyofusmightprefertosweepthem
underthecarpet,readabook,finishareport,orpaintthebathroom,anythingthatdoesn’tcause
suchanxietyandfrustraFon.ButtherearemanysoluFonsavailabletotry.SobeproacFve!
“Whensexisgood,itaddsaliQlebit-likeicingonthecupcake-toagoodrelaFonship”(Dr.Susan
KelloggSpadt)
“Sexualityandsexualexpressionareamonglife’sgreatestgiMs,andourstoexplore,tweak,
enhanceandenjoyonanylevelthatispossibleandcomfortableforallofourlives”(Rebecca
Chalker,www.clitoraltruth.com.)
Ques@ons,
Comments,
Thoughts?
References
hQp://www.helpguide.org/arFcles/aging-well/beQer-sex-as-youage.htm*
hQp://www.helpguide.org/Harvard/Fps-to-improve-your-sex-life-.htm*
hQp://www.asaging.org/blog/circles-sexuality-and-aging
hQp://www.mayoclinic.org/healthylifestyle/sexual-health/in-depth/sexualhealth/art-20046698?
p=1
•  hQp://www.healthline.com/health/healthy-sex-ans-aging?print=true
•  StrategiesforStayingSexualaMerMenopause,RebeccaChalker,TheWomen’sHealthAcFvist,
March/AprilNewsleQer2009
•  hQp://www.everydayhealth.com/sexual-health/things-women-need-happy-healthy-sex-life/
•  hQp://www.obgynnews.com/news/print-friendly/ask-listen-help-pearls-to-treat-sexualdysfuncFon-in-menopause/f3e2327e7389c4ea87952v9166dad52.html?ty*
•  hQp://www.everydayhealth.com/sexual-health/sex-and-aging/aging-and-sexuality.aspx
•  HowdoyoubreaktheicewithpaFentstoaskabouttheirsexualhealth?,OBG
Management,July2016,Vol.28No.7
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