1 / 49

Geriatric Sexuality

Geriatric Sexuality. Older people were young once too! C. Frank CCFP Oct ‘02. Outline. Myths and expectations research- old and new what changes as we age Talking to older patients about sexuality some specific topics. The writer’s view.

shay
Télécharger la présentation

Geriatric Sexuality

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Geriatric Sexuality Older people were young once too! C. Frank CCFP Oct ‘02

  2. Outline • Myths and expectations • research- old and new • what changes as we age • Talking to older patients about sexuality • some specific topics

  3. The writer’s view • “Wives are young men’s mistresses, companions for middle age and old men’s nurses.” Francis Bacon • “Sexuality in the elderly is a ‘dark continent’ that most people, including physicians, prefer not to think about.” J. LoPiccolo

  4. The writer’s view... • “Forty years of romance makes a woman look like a ruin, 40 years of marriage makes a woman look like a public building.” Oscar Wilde • “These people are just happy to be alive.” Anon

  5. The media’s view...

  6. What is sexuality? • “too often sexuality is equated with the ability to have or the frequency of intercourse” • “sexuality encompasses self, interactions with others, and many levels of expression and affection”

  7. What do you think of when you think of elderly & sex? • ???

  8. Beliefs about sex & aging • Current elderly were ‘Victorians’ when young • sexual desire goes with age • older women who enjoy sex were ‘nymphomaniacs’ when younger • the ‘dirty old man’ • elderly are not “desirable, desirous, capable”

  9. More mythology & viewpoints... • Physiological changes = sexual dysfunction • “cute”, “disgusting”, “troublesome” • physical illness obviates sex & sexuality • Viagra leads to divorces!

  10. How do older people view sexuality? • “I was told nothing until my wedding night and my husband explained it.. For two solid weeks I was in a state of shock.” • despite initial naivete women describe good early attitudes towards sex • minimal change in attitude with aging

  11. Talking with older women... • “The longer you live you start to realize …life is too short… and sex is probably one of the last things to go.” • “You are always a sexual being, until you die.” • “You know, just because we are old doesn’t mean that when I see a nice grey-haired older man.. I take another look.”

  12. Apart from myths, what are other barriers • Physiological changes • lack of privacy • illness & impotence • lack of a partner • negative attitudes from staff & physicians • feeling of unattractiveness • guilt & “widow’s syndrome

  13. Thinking about barriers • “My husband got used to me after 50 years… if I was to start up with a new man now…if we could do it in the dark with our clothes on…” • “There are no single guys out there…not at our age.”

  14. Why do older people stop having sex? • For the same reasons they stop riding a bicycle • fear of falling off (ill health) • afraid of looking ridiculous • lack of a bicycle

  15. What research tells us... • The Kinsey report: general decline interest & activity • M&J: “sharp decline in interest after age 60” • other generally gloomy results

  16. Newer results... • The Starr-Weiner report: • 97% liked sex • 91% approved of unmarried/widowed aged having sex • quality more important than frequency! • Women in survey had intercourse 1.4/week

  17. Even educated fleas do it... • Large proportion of seniors sexually active: • 54% of married men & women • 65% of women over age 70 • Netherlands: 34 % of women surveyed enjoy sexual activity most of time • Vs. 70% of premenopausal women

  18. Defining sexuality more clearly than Clinton • Women age 80-102: • 25% had regular partner • touching and caressing 64% • masturbation 40% • intercourse 30% • activities often dependent on older partner

  19. Physiology & the pleasure principle • Women: • reduced size of vagina & vulva • decreased vascularity & secretions • thinner, more lax vaginal walls • atrophic vaginitis common • libido declines but rarely disappears

  20. What problems may women report • 43% of older Swedes reported vaginal dryness • 10% vaginal burning • urinary incontinence may occur • dyspareunia • decreased orgasm (30%)

  21. How does the sexual cycle change? • Excitement! • Decreased vasocongestion, lubrication, delayed arousal • Plateau: • expansion of vaginal ‘barrel’, orgasmic platform, clitoral retraction

  22. Cycle changes... • Orgasm: • shorter & fewer contractions • may be painful • Resolution: • more rapid reversion to pre-arousal state

  23. What changes for men? • Changed libido • erectile function • increased need for stimulation • inadequate rigidity associated with risk factors • decreased ejaculatory demand • decreased ejaculatory power • prolonged refractory stage (up to one week)

  24. Talking to your granny about SEX! • Important indicator of comorbidities • if done appropriately, not offensive • 91% over age 65 felt history-taking was appropriate • remember that identification & education very successful • sexual abuse can still occur

  25. Hearing from the AARP’s • Health-providers should help us feel comfortable talking about sex: • don’t be afraid or embarrassed • help us “break the ice” • offer permission to express feelings & needs

  26. Suggestions to help talking about it • … be open-minded and concerned: • don’t assume there are no concerns • ask direct questions about activity & attitudes • answer honestly • don’t evade sexual concerns

  27. More from the AARP... • …should treat older adults with respectful & non-judgemental attitude • see us as individuals with sexual needs • accept us: gay, straight, bisexual • …can provide advice & suggestions:

  28. What did Kingston women have to say? • “So, how’s your sex life?” not a great line • valid question if an explanation is given • would talk to their MD if something specifically wrong • layman’s terms, avoid making patient feel complaint insignificant

  29. Getting better informed about specific topics • Menopause • “ED” • dementia • sexual abuse • chronic illnesses

  30. Menopause: just a few controversies • Treatments: • HRT (local and oral) • education of woman & partner • ?testosterone ?Viagra • lubricants • education about male partner’s aging changes

  31. The myth of male menopause? • Controversial! • ?aging associated with lower sex steroid levels • levels of binding globulin increases • pituitary, adrenal and testicular causes • less dramatic & less rapid than with women

  32. What might it mean? • testosterone likely plays smaller role in ED • many men try androgens to help erectile dysfunction • frailty: osteoporosis, decreased muscle mass

  33. How to look for it?

  34. Viagra: an interesting sociological study • Pfizer stock is a star! • US army spending $$$ on it

  35. Listening to Viagra • “Dr. Ian Osterloh may be one of the most important men in American history, if not world history”

  36. Viagra:the first of many • inhibits phosphodiesterase • elevates serum levels of cyclic guanosine monophosphate • effect is on erectile dysfunction not libido

  37. Viagra:the first of many

  38. How to use it? • taken orally 50 mg 1 hour before planned intercourse • achieve erections in up to 85% of men • be aware of safety concerns- good assessment of comorbidities

  39. Who to be cautious with • Active coronary ischemia • active CHF • hypotension/hypertension • liver/renal failure • interacts with cimetidine, erythromycin • frequent users!!!

  40. New kids on the block? • Vardenefil - can be taken with food! • tadalafil • apomorphine- ??2003

  41. Dementia & Sexuality • Barriers to intimacy: • agnosia • social cues • sexual disinhibition • caregiver stress • depression (s)

  42. Sexual abuse and older people • Fits definition of “Elder Abuse” • remote history of abuse • depression • anxiety • adjustment disorders • resource limitations

  43. Sexuality and medical conditions • Cardiac disease • stroke • COPD • Diabetes

  44. Ae’ fond kiss and then we sever

  45. Sexuality and the older adult • Be aware of the issue • knowledge of aging changes important • comfort in communication • expertise in specific topics helpful

  46. If it’s not too effective, is it safe? • Weight gain, gynecomastia, sleep apnea • MI, stroke • altered lipids, ? Polycythemia • prostate cancer?

  47. How to answer patients’ questions? • Consider screen for testosterone,highest level in AM • if low, check FSH, LH, prolactin • could consider Tx for libido problems • not likely great for lost vigor and soft body!

  48. If it works for young men can it work for older men? • Testosterone given IM to 13 men 57-76 years old with low serum testosterone • increased lean body mass but no change in % body fat, grip strength, bone parameters • increased PSA • less clear benefit than in younger men

  49. Tx options they might read about on the Internet? • Oral testosterone- serious hepatotoxicity • parenteral- may cause fluctuation in levels • transdermal- scrotal or non-scrotal • more physiological levels • scrotal patch causes high DHT

More Related