From the desk of Jon Amesbury – dealing with sexuality…

Hello and welcome back to my monthly Eldernet blog. This month we are moving away from the dementia’s and will focus on the not so commonly discussed issue of sexuality and intimacy within the over 65 age group.

Sexuality and sexual intimacy, particularly when relating to the elderly, is possibly one of the last taboos in today’s society. This unfortunately means that it is often difficult for aging individuals to seek advice and help for sexual problems due to social stigma and embarrassment. Sexual expression is however, one of the fundamental human driving forces. Intimacy is a basic need for all humans and an outlet for the expression of the self, a vehicle for both physical and psychological connection and, in a lot of ways, an affirmation of life, belonging and identity.  As in all generations, sexual intimacycan remain an experience of basic psychological and physical pleasure. For some older people sexual expression is openly accepted, particularly within long standing relationships, however, for many, sexual feelings are accompanied by feelings of guilt and self-disapproval. These feelings can be compounded by disapproving views and not so positive stereotypes expressed by children or grandchildren. These negative influences, accompanied by physical illness, the individual’s self-perception around body image and the loss of a spouse can present hurdles in maintaining a fulfilling sexual relationship.

For males, the most common form of sexual problem would be erectile dysfunction (ED) or, in more basic terms, problems in achieving or maintaining and erection.  It is important to stress that ED can affect any male, at any age and indeed, many younger men will experience problems in this area. There are many causes for erectile dysfunction and not all of them are physical. Psychological states such as depression, anxiety, fatigue and stress can lead to erectile difficulties as well as ‘performance anxiety’. Usually, this is nothing to worry about and tend to dissipate after a short while. However, illness and factors such as alcohol intake, diabetes, cardiovascular (heart) conditions, high blood pressure, strokes, obesity and smoking can be contributing factors in a male being unable to achieve a full erection. Some medications can also have a direct impact on a male’s ability to achieve a strong penile erection. If this is the case, medical review and lifestyle changes can dramatically assist by losing weight if obese, stopping smoking, cutting down on alcohol and the maintenance of a gentle exercise regime will usually see some improvement in the situation. There is a range of medications now available that can effectively treat ED, and you would be encouraged to make an appointment with you GP to discuss the options. Remember, you are not the only person to have a problem in this area and, although you may be embarrassed, your GP has dealt with numerous patients who are going through exactly the same thing as yourself.

For females, decreased vaginal lubrication is an age related physical change. This can make penetrative intercourse uncomfortable and painful.This is due, primarily to the menopause and a decrease in the hormone Oestrogen. As part of the natural aging process, an older woman will experience her vagina becoming shorter and narrower, the walls of the vagina also become thinner and a little harder. Most women will have less vaginal lubrication as they get older because the amount Oestrogen produced post-menopause starts to decrease. It is Oestrogenthat helps to keep a woman’s vagina moist. In addition to this the decreased hormone levels also may affect a woman’s libido. As with the males, it is vital that you remember that you are not alone with this issue and going off the idea of sex or not being ‘in the mood’, the inability to reach orgasm and pain during intercourse are very common problems.  Again, you are encouraged to consult your doctor who can prescribe medications to help with these problems. Over the counter lubrication is also available, remembering that water based lubrication is preferable to oil based, particularly if using condoms.

As with any issue within a relationship, communication is the key. Talk to your partner about any emotional or physical changes that are interfering with the intimacy that you share. Openness and honesty about how you are feeling or the worries you may have is important. Discuss plans for your intimate times, as feeling pressured to make love at bedtime can produce stress and anxiety, and often tiredness and a good night’s sleep can seem a much more desirable proposition. Take things slowly to increase arousal time and use gentle touch or massage as a precursor to intimacy.  Consider that penetration is not the only medium leading to sexual fulfillment and that holding, kissing and cuddling give the pure and simple joy of being touched by another person.

For older people venturing into a new relationship, it is important to remember that sexually transmitted diseases are not restricted to the young. Indeed, in some countries, there is a growing number of over 50’s (particularly women) who are contracting HIV. If you are starting out on the adventure of getting to know another person, do not be embarrassed to ask a male partner to use a latex condom, at least until you have ensured that you both remain safe and healthy.

Until next month, you all, as usual, remain in my thoughts.

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About Jon. M. Amesbury. R.N.