what are the most common sexual problems cited by women in middle to late adulthood?
Indian J Psychiatry. 2011 Oct-Dec; 53(4): 300–306.
Sexuality: Want, activity and intimacy in the elderly
Gurvinder Kalra
Section of Psychiatry, Lokmanya Tilak Municipal Medical College and Sion General Hospital, Sion, Mumbai, Republic of india
Alka Subramanyam
oneSection of Psychiatry, T. Due north. M. C. & B. Y. L. Nair Charitable Infirmary, Bombay Central, Mumbai, Maharashtra, Bharat
Charles Pinto
iDepartment of Psychiatry, T. N. M. C. & B. Y. L. Nair Charitable Infirmary, Mumbai Cardinal, Mumbai, Maharashtra, Bharat
Abstract
Groundwork:
Sexual office and activity in former historic period accept been inadequately studied earth over. It is important to know that aging processes are not confined to persons beyond the age of 60 years; many changes in elderly have their antecedents in the center age.
Aims:
This written report sought to determine the patterns of sex activity and role in individuals over l years of age. It also sought to discuss barriers such as chronic illness that may interfere with sexual part.
Materials and Methods:
Nosotros conducted a study of subjects above the historic period of 50 years in diverse outpatient departments (OPDs) of a teaching municipal hospital in Mumbai, by interviewing 60 individuals who attended the OPDs, after taking their informed consent. Socio-demographic and other information on their sexual function and activities were obtained. Data was analyzed using statistical package for social sciences v15.
Results:
72% individuals beneath 60 were sexually agile, while only 57% higher up 60 were active. Others had get completely abstinent at some time in their lives. Statistical analysis revealed significant gender, health and educational status based differences in the sample.
Conclusion:
Our study showed meaning presence of sexual desire, activity and office even after the historic period of 50 years; a decline by the age of sixty and above was a finding that reflected more in women. Chronic illness did affect sexual function and want.
Keywords: Elderly, illness, sexual activity, sexual want, sexual function, sexuality
INTRODUCTION
Although recognized as a fundamental driving force, human sexuality is ofttimes misunderstood and particularly in the elders, neglected.[1] Human beings are actually never also quondam to bask a happy and salubrious sex activity life. Despite this, many people, young and old alike, are astounded at the idea of people remaining sexually active in their sixties and beyond. It is frequently assumed that elder persons lose their sexual desires or that they are physically unable to perform. For the elders, the ability to remain sexually active is a major concern in their lives. Fright about the loss of sexual prowess in older males is common. Older women also express sexual desire, only may fear their involvement is undignified and disgraceful. Some elder persons may fifty-fifty freely accept their interests in sexual practice, but their children or grandchildren may disapprove, making them experience guilty. The elder often view sexuality as an expression of passion, affection, admiration, and loyalty, a renewal of romance, a general affirmation of life, especially the expression of joy and a continuing opportunity for growth and feel. In improver, sexual practice is a means for the elderberry to affirm physical functioning, to maintain a strong sense of identity and institute self-conviction, and to forbid anxiety. It remains a manner of pure concrete pleasure as well. However, not all elder persons take positive attitudes nearly sexuality. Similar all persons, elders may experience sexual dysfunction due to boredom, fear, fatigue, grief, or other factors (e.thousand., intrinsically depression sexual desire, physical disability). Sexuality in the elderberry is peculiarly afflicted by problems that are common in this historic period group, for instance, depression, medical disorders, or incapacitation or death of a partner.[2]
Aging is characterized past physiological, pathological, behavioral, and psychosocial changes that can all affect sexual operation, and information technology is hard to disentangle their individual furnishings. Clinicians tend to ignore this aspect of the lives of elders, who themselves can find sexual bug very difficult to talk about. In psychiatric interview of elders, sexual history and details are often omitted. Homo sexuality and particularly sexuality in the elderly is an surface area that requires more attention in psychiatric grooming.[3] A marked increase in life expectancy over the past century has meant that individuals over the age of 65 years form an increasingly large proportion of our population. Yet, very little attending has been paid until recently to the treatment of sexual dysfunction in older adults. Older individuals are more often than not erroneously viewed as asexual people who take lost both their involvement in sex and their capacity for sexual behavior.[4]
MATERIALS AND METHODS
The study was a cross-sectional, single interview report that was approved by the Institutional Review Board. We interviewed sixty consecutive elder individuals (30 men and 30 women) above the historic period of fifty years from the Geriatric, Hypertension, Rheumatology and Diabetes outpatient departments (OPDs) of a third hospital in Mumbai after obtaining their informed consent. Individuals with any previously diagnosed psychiatric disorders or dementia or HIV-positive individuals were excluded from the study. Subjects were briefed about the study and were interviewed to answer a self-prepared questionnaire probing into diverse areas of sexuality. Data was pooled and statistical assay was washed using statistical package for social sciences (v15); chi-square test was applied wherever necessary.
RESULTS
The population characteristics were equally follows:
Individuals in the age group betwixt fifty and 60 years comprised 41.vii% of our report population (group I), while the balance (58.3%) consisted of those aged lx years and above (grouping II). Around 88.3% had their spouses alive at the fourth dimension of the interview; 83.three% were staying with their spouses, 53.three% were working and 76.eight% were educated, ranging from primary level to postgraduate level.
36.7% subjects did non accept any diagnosed major illness. 18.three% were hypertensive, xv% were diabetic, 10% had arthritis, and 8.3% had experienced an episode of stroke in the by, while xi.vii% were patients with diagnosed cardiac illness. Of those who were ill (63.3%), approximately 28.3% had an illness of more than than v years elapsing.
The findings in unlike areas of sexuality in the subjects were as follows:
Factors affecting sexual desire and sexuality
The term sexuality for this report meant the sexual experiences and expressions of subjects' in-totality, and included their sexual part, fantasy, orientation, beliefs, and various other aspects. As high as 70% subjects perceived that their age negatively affected their sexuality (P=0.05; likelihood ratio=0.02). In every decade of life after 50, more number of subjects said that their age had affected their sexual desires "very much"; almost 42.9% subjects in group II attributed age to be responsible for their diminishing desires compared to 28% in group I [Figure one]. Subjects in grouping I attributed their reduced sexual desires to loss of partner as a pregnant cistron (24%).
Factors affecting sexual desire
Approximately 43% women reported that their sexuality was afflicted past increasing age, while 56.7% men reported their sexuality beingness affected past their deteriorating health [Table i]. It was interesting to know that twenty% of women subjects were affected sexually due to loss of partner or other family member as compared to 3.three% men. These findings were statistically significant (P=0.008).
Table one
Gender and factors affecting sexual want
A greater number of women subjects at all age groups in our sample reported "very much" decrease in their sexual desire (66.vii%). Although this was not statistically significant (P=0.3), such change in sexual desires and beliefs over the life wheel is normal.[5]
A greater number of nonworking elderly subjects (75%) showed "very much" subtract in their sexual desires, as compared to the working subjects (37.five%), which was statistically significant (P=0.004), thus proving the fact that an active and working lifestyle may assistance to keep one sexually agile for a longer time. Presence of any affliction caused "very much" or "quite a lot" reduction (89.v%) in the sexual desires in all subjects (non meaning).
Sexual involvement, activity and function
Nigh 52% subjects in grouping I all the same wanted to experience sexual intercourse or in other words were interested in sexual activity at to the lowest degree once per week or daily; however, only 40% actually experienced information technology in the past ane year at that frequency. A similar blueprint was also seen in group II, wherein 25.seven% individuals were still interested in continuing their sex, while only 14.3% were actually experiencing it at least once per week or daily. Withal, this pattern was not found in "in one case per month" frequency for either groups. 72% subjects in grouping I were still sexually agile, equally compared to only 57.1% in grouping II [Figure 2]. In total, 83.four% men in our sample were even so sexually agile after the age of 50.
Across both groups I and II, women in our sample showed less interest in non-sexual activities similar property hands, kissing, hugging [Table 2] (P=0.03), and besides masturbating or sexual activity [Tabular array 3]. While simply 43.iv% women reported some interest in non-coital activeness, almost double, that is, 83.3% men in both the groups, showed this interest. Similarly, they engaged less in such activities [Tables 4 and 5]. This was found to be statistically significant. While 43.4% women in our study were still sexually active, older men of almost double that number (83.4%) were sexually active, which was meaning (P=0.005). Thus, it was seen that men, fifty-fifty in old historic period, were more interested and participating in both not-coital likewise as coital activities with their spouse [Tables 2–five].
Tabular array 2
Gender and interest in non-sexual activeness
Table 3
Gender and interest in sexual activity
Table iv
Gender and involvement in non-sexual activity
Table 5
Gender and involvement in sex
Above l years, more women (56.6%) had stopped sexual practice at some time due to varied reasons than men (16.vi%) (P=0.012). 30 per centum women in our report reported loss of sexual involvement in self every bit the cause of stopping their activity, as compared to vi.7% men who reported a loss of interest to be the cause. This was also reflected the other mode circular. Of the men who had stopped sexual action, 3.3% attributed it to the loss of partner'south interest in sexual practice. Women, on the other mitt, did non report anything like this. Overall, nosotros found sexual activity in elder men to be more than in elderberry women. As pointed out earlier, men reported sexual inactivity because of lack of desire, ill health, or erectile dysfunction in their former age, whereas women reported sexual inactivity due to loss of partner.
Near 100% individuals of group II agreed that they took significantly (P=0.002) more time for sexual arousal compared to earlier. Age besides afflicted the erection obtained. Overall, 31.four% men in a higher place the age of 50 reported erection stiffness "just sufficient for intercourse". Around 28.7% men in group 2 reported poor quality of erection for intercourse equally compared to eight% men in group I (P=0.04). Poor quality of erection was defined every bit insufficient erection for intercourse. Erection was assessed by request the subjects about frequency of sexually stimulated erections, morning erections and spontaneous erections, and the stiffness of erection was compared to erections in the youth. Twenty-vi percent subjects with illness reported some or the other course of erectile dysfunction as compared to but 9% of salubrious subjects. Men in grouping Two (45.7%) too perceived a significant decrease in the corporeality of ejaculatory volume (P=0.04) every bit compared to those in group I; nonetheless, this change did non distress most of the subjects in the report.
All women in our written report reported a departure in vaginal lubrication as compared to that in young age. Xx pct women in grouping I reported poor quality of lubrication, as opposed to 40% women from group 2 who reported poor quality of lubrication, insufficient for intercourse (P=0.4).
Nosotros asked the subjects to compare their electric current sexual chapters with their capacity 1 year after their marriage. Sex now was worse than earlier for 75% of them (76% for women, 73% for men). Subjects with any affliction (84%) reported greater worsening of sexual pleasure equally compared to those without illness (59%) (P=0.07; likelihood=0.05). Although this was not statistically significant (P=0.06), more than number of subjects in grouping II (83%) reported worse orgasm at this age than when they were young (likelihood ratio=0.04). Similarly, subjects with illness reported higher reduction (81%) in the intensity of orgasm as compared to those who were salubrious (54%) (P=0.07; likelihood=0.05). A larger per centum (71.4%) of subjects in group II did non become distressed by this decrease in orgasmic intensity. This difference in perception of orgasm with age was statistically significant (P=0.04). Working subjects with no illness adapted all-time and expected this age-related change in orgasmic intensity (P=0.03). On the other paw, people who were not working or people with illness were less adjusted to this modify. Both these findings were statistically significant.
Approximately 78% subjects reported no sexual dreams of any type. Of the other 22% who reported dreams, majority had dreams at a frequency of around three–4 times/month, irrespective of gender. It was interesting that ane of these women, who reported very frequent sexual dreams, was in fact separated from her married man and dreamt of having intercourse with him frequently. Thirty percent men reported having dreams of a sexual nature equally opposed to 13.3% women in a higher place the age of 50.
96.vii% subjects in our sample did non masturbate at all. At that place was no gender divergence noted. Only 6.half dozen% men above the historic period of 50 masturbated.
All study subjects were asked well-nigh their preferred role in sex (i.e. agile or passive). We found a pregnant departure (P=0.00) in this; about all men preferred to be active partners while all women preferred to be passive partners.
Love and intimacy
Around 48% subjects in our study did not perceive whatever alter in the areas of dearest and intimacy in their relationship over the years, while these areas had improved in 25% of the subjects' lives and worsened for xiii.3% of them. The subjects were asked how much role, sex had played in their relationships over the years. But 26.7% subjects in our study thought that sex had played 100% role in their marital relationship over the years, while 41.7% felt it had only played 50% part. A small percentage (13.3%) felt that sex was only a minor role player in their relationships. Educated elderly subjects attributed a greater role played by sex in their relationship with their spouses (P=0.002; likelihood ratio=0.004).
Give-and-take
This study was washed in a sample of 60 individuals above the age of 50 years, and three wide areas related to sexuality in the elder were studied, including factors affecting sexual want, sex activity and function, and love and intimacy.
The results of this written report leave footling incertitude that intact sexual function is common among elder people, even among those above 60 years (group 2). But definitely there was a declining course of sexual functions including a decrease in sexual want with increasing age, with a steep course in grouping II. This finding is like to that of Pfeiffer et al.[6] Subjects in grouping I being young, did not look loss of partner at their age, and so this was the main factor worrying them for their decreasing sexual desires every bit opposed to those in group II, who did not attribute loss of partner as an important factor in affecting their sexual desires as this was something that was more common in their age group and something which they may take been ready for.
Changes brought on by age can often make a person'southward sexual practice life more difficult,[7] simply there is still an internal drive or need for sexual fulfilment. Continuation of sexual activeness for elder persons in many societies indicates that cultural factors may be key determinants in their sexual behavior.[8] Our society has more often than not been viewed equally restricting the sexuality of older adults. Although many old people experience sexual difficulties, traditionally they have presented for treatment relatively infrequently, being more prepared to live with the problem than younger adults.[9,10] However, this picture seems to be changing recently with an increase in the number of elder persons seeking treatment for sexual difficulties,[xi] even in the Indian setup.
Deacon et al.[12] suggest that a pass up in sexual activity for men is less probable to be due to the lack of a partner, while in women information technology is more likely to exist due to this reason and that too at any age. George and Weiler[13] similarly reported affliction and deteriorating health as the major reason for reduced sexual desires and activity in men in their study, while women reported loss of partner equally the major gene. Loss of partner is both commoner and more of a handicap for women in that they survive longer than men and tend to exist younger than their husbands.[fourteen] The greater decrease in sexual desire in women at all age groups in our study may reflect the influence of socio-cultural factors in determining the libido of elderly women.[8]
There are many causes for women'south sexual bug, especially in old historic period, including shame and guilt, sexual abuse, interpersonal conflicts, depression and religious and cultural prohibitions.[15] Some women employ changes at midlife as a reason to cease existence sexual. Earlier unhappy and unsatisfying sexual experiences may lead some women to observe relief in their loss of sexual feelings and capacities at midlife and encourage them to hibernate behind the belief that they are "also sometime for sex".[16] Older adults feel sexual problems and concerns which are not that different from those of immature people; withal, biological and psychological factors may need to be looked at more closely with an aging population.[17]
Even though it was not studied in detail, disease did have a negative effect on sexual desires in our subjects. The incidence of sexual dysfunction and decreased sexual desires increases in old age, but it is possible that this is primarily related to the increased rate of health issues, rather than old historic period per se.[18] Still, it is non right to presume that concrete changes associated with advancing historic period reduce the opportunity to enjoy sex.[12]
Numerous endocrine, vascular and neurological disorders may interfere with sexual part, but as many forms of medications and surgeries. These health factors are more prevalent in older people, and hence information technology is peradventure not surprising to find an increase in biologically acquired sexual problems in the elderly.[eighteen] Deacon et al.[12] indicate that the pathological factors that affect sexual office include cardiovascular disease, diabetes mellitus, dementia, arthritis, and surgery. They too indicate that pharmacological factors play a role in sexual bug.[12,16,19] There is a possibility that some of these issues might have interfered with sexual operation in our subjects. We need to put it across to the elderly individuals that some illnesses and disabilities require that the couple experiment with new positions for intercourse or they could experiment with "outercourse"[20] which refers to the non-sexual activities like kissing, hugging, caressing, etc.
Although the subjects in our study maintained a definite interest in sexual action, their action itself had declined substantially for both the groups. This concept has been called the 'interest-activity gap', wherein older adults accept an involvement in maintaining their sexual activeness; however, the sexual activity per se decreases.[ii,vi,21]
A larger percentage of men (83.4%) were maintaining their sexual activity even after the age of fifty years. All others had stopped their sexual activity at some time or the other. This was slightly more than that reported past Helgason et al.[22] and Antonovsky et al.[23] wherein approximately 71% men in their sample were having sexual intercourse after the age of l.
The involvement as well every bit interest in both sexual and non-sexual activities was reported to be significantly less past women in our written report, which reflected the findings of Lindau et al.[24] who reported that women were less probable than men at all ages to written report sexual activity. Men in our sample were more interested too as involved in both these activities, as was seen by Pfeiffer et al.[2] In an earlier Indian study, Sanger et al.[25] had reported a rate of 63.2% non-coital activity in their sample of 120 elderly men. Changes in sexual expression and preferred sexual activeness may exist common with advancing historic period,[26] and one tin see a shift from sexual activity to not-sexual petting and caressing or touching.
Even when it comes to sex activity, the time taken for sexual arousal is increased. The bio-physiological changes in erstwhile age predispose to increased fourth dimension for arousal that has been well reported in literature.[27] The quality of erection was poor in men of grouping II. It is seen that after the age of 35 or 40 years, most men may have erectile difficulties and may need direct penile stimulation to go an erection.[19] In a study by Helgason et al.[22] on men aged fifty–eighty years, 68% men reported erection stiffness just sufficient for intercourse, which was reported by only 31.four% men in our report. Men in group 2 who reported a significant decrease in ejaculatory volume did not get distressed past it. Information technology is known that changes occurring in the sexual physiology of an aging male can touch both erectile function and ejaculation. These changes demand non have whatever functional touch on on the subjective enjoyment of the sexual encounter. Yet, knowledge that these changes are not dysfunctional and assistance with the adjustment of sexual practices may be crucial in preventing dysfunction in them.[12]
Corresponding to this finding, women in our report reported decreased vaginal lubrication which pointed to an of import age-related change in the physiology in women,[28] that may exist responsible for painful intercourse, if the vaginal walls become excessively thin.[18]
As would be expected, the quality of sex had worsened for most of our subjects, and more and then for those with any of the chronic disease. Chronic affliction can accept profound negative furnishings on relationship and sexual satisfaction of both patients and their partners.[29] This could be due to impaired sexual fulfilment equally a result of anxiety, loss of self-esteem, grief and low associated with chronic illnesses.[30] Orgasms were similarly of poor quality for more subjects in group II and those with illness as compared to those in group I or the healthy subjects. In one-time age, orgasms may be less intense than in the youth, which is an expected physiological change. Sexual and orgasmic dysfunction may often be related more to chronic disease than to crumbling alone,[31] which is why chronically ill individuals perceive greater deterioration in sexual and orgasmic quality at whatsoever age. Equally the subjects grew older (group II), they did not get distressed by the subtract in orgasmic intensity since they knew it was inevitable and had adjusted to information technology accepting the physiological changes.
On similar lines, very less percentage of men in our sample masturbated, which was reverse to the findings of Bergstrom-Walan and Nielsen,[32] where 51% men between the ages 60 and 80 reported masturbation at to the lowest degree one time a month, but and then that was a Western sample. A number of myths nowadays at that age group could accept been the principal reason behind it,[33] ane of which was that masturbation "ruins" a person for partner sex. Masturbation is a natural supplementary activity inside a human relationship,[nineteen] but was very less practised in our sample of individuals (3.4%). Even today, many people exercise not treat masturbation as a normal and enjoyable activity.[19]
In a sexual encounter, the subjects in our sample stuck to the conventional sexual roles, with men preferring to perform as active partners and women as passive. In nigh sexual encounters, there has to be one active (masculine) and 1 passive (feminine) partner.[27] Men and women tend to conform to their gender roles and acquit as active or passive in their sexual encounters, which probably continues in old age.
The areas of dear and intimacy remained same every bit they were in their youth for a large percentage of our subjects. Cultural factors probably reflect in the solidarity of relationships till old age.[8] In men, whether or not erectile capacity is retained, the decision to go along intimacy is often socio-cultural.[8] The quality and frequency of intimacy and intercourse may decline with age; however, satisfaction with sexuality may not be affected.[34]
It was the educated subjects who attributed a greater importance to sex activity in their relationship with their spouses, which shows that didactics does play a vital role in sexuality and intimacy. Noesis of sexuality and its importance may perhaps enhance its role in an educated individual's human relationship. This finding definitely opens up new areas in research on the role of education in sexual attitudes. Pfeiffer and Davis[35] had pointed out that educational level is an important predictor of sexual interest, frequency and enjoyment for women.
Agism, or the credence by us and club at big that old age is associated with loss and decline, is all the more marked in the field of sexuality. Our study on sexual desire, sexual interest, activity and function, and love and intimacy in the Indian elderly people was an eye opener even for us.
Limitations
The sample size of the written report was very pocket-sized. We had used an interviewer-based questionnaire that was not cocky-administered which might have been more forthcoming. The effect of disease like diabetes, hypertension and their medications and its impact on sexual functioning of the subject was not a part of the study.
CONCLUSION
To conclude, our study found that overall sex showed a declining class with increasing age merely still continued in individuals above 50 years of age. The increasing 'interest-activity gap' was very well demonstrated in our study in both group I (50–threescore years) and grouping Ii (>threescore years) subjects. Significant gender differences were establish in that women were less interested and as well less involved in both coital too as non-coital activities. A better sexual function was seen with an active and working lifestyle in old historic period in our sample. The study showed meaning reduction in the post-obit parameters with increasing age: Quality of erection, ejaculate volume, vaginal lubrication, orgasmic pleasure and overall sexual functioning. Nevertheless, the subjects did not seem to be distressed with these changes. Further, presence of co-morbid affliction worsened sexual office and sexual activeness.
Both sexes reported a significant increment in the time required for sexual arousal. The reasons for stopping sex differed significantly in case of either gender, with loss of a partner in women and deteriorating health in men existence the most important ones. Honey and intimacy stayed the same for majority of our subjects.
These findings warrant because sexual function in clinical decision making and the blueprint of clinical trials in elder men and women. Information technology too opens doors to a new area for research into geriatric sexuality, much of which lies neglected till now.
Footnotes
This paper won Bombay Psychiatric Society Silver Jubilee National Award at the lxth Annual National Briefing of Indian Psychiatric Guild, in Kolkata on ivth Jan 2008.
Source of Support: Nil
Conflict of Interest: None declared
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