This presentation was done for World Mental Health 2013 @IMH when the theme was Geriatric mental Health

1. SEXUAL LIFE IN
OLD AGE
DR.V.JAIKUMAR
IMH
9.10.2013

2. ATTITUDES

Idea of sexuality in late life has been

1.denied

2.regarded with humour

3.disgust

3. ATTITUDES

Denial of sexuality in parents and grand parents becomes denial of
sexuality in all older individuals

4. REVOLUTIONS

1.Hormone replacement Therapy

2.treatment of ED

5. SEXUAL BEHAVIOURS IN LATE LIFE

Middle aged/older individuals continue to be sexually active

Modest decrease in sexual activity

Older men are sexually more active than older women

Individuals with steady partners are more active than single
individuals

6. American Association of Retired
Persons

1999.

45+

45-59 84% M 78% F

75+ 58% M 21 %F
¾ remained sexually active

7. Frequency
45-59 50% once a week
60-74 30% once a week
Masturbation:
Men majority +
Female 77% Is it Imporant? 60 M 35% F -Yes

8. AARP 2004

5% homosexuals

African Americans& Hispanics-more satisfied

Regular physical exercise more satisfied

1999-2004

Men using erectogenic agents increased from 10 to 22%

Females using HRT dropped by 50 % due to cancer warnings

Lindau et al 2007

National council of Aging 1998

9. Sexual response cycle

I stage desire

II stage excitement arousal

III stage plateau

IV Orgasm

V resolution

10. Physiological changes in
menopause(Women)

Atrophy of urogenital tissue

Decreased vaginal size

Decreased vaginal lubrication

Decreased erotic sensitivity of nipple,clitoral,vulvar tissue

Decreased sexual desire

Increased time to sexual arousal

11. Menopausal symptoms

Hot flashes

Head/neck aches

Mood changes

Excess fatigue

Decreased libido

12. Men

Decreased anticipatory arousal

More physical stimulation
ERECTION
Less frequent
Less durable
Less reliable
Volume of ejaculate-decreased

13. Men

Refractory period in older men varies from hours to days

Young people -minutes

14. Attitudes

Over reaction to normal changes

Decreased sexual activity

Lose self confidence

Feels less sexy

Feel it is inappropriate /harmful

15. + side

Decreased responsibility to wards children

Empty nest syndrome

Decreased anxiety – no pregnancy

16. SEXUALITY IN LONG TERM CARE

Privacy for couples

Facilitate conjugal/home visit

DO NOT DISTURB signs

Knock before enter

Hair styling/manicuring facilities

17. SEXUAL DYSFUNCTION IN LATE LIFE

Men-ED ,50 %, 40-70 years

Women-

Hypoactive sexual desire

Inhibited orgasm

Dyspareunia

Physician-fail to ask about sexual function-remains untreated

18. Sexual dysfunction in Late Life

Psychiatric problems:

Anxiety,Depression,psychosis

Substance abuse

Fear of death- H/o MI,dyspnea

Sensitivity to loss of physical appearance

Control of bodily functions(continence)

19. Sexual dysfunction in late life
Life stressors


Loss of loved one,

Divorce

Financial/Occupational stressors

Major Health scare

20. Sexual dysfunction

Major risk factors

DM,Peripheral vascular disease

CA,pulmonary diseases,stroke,dementia,

Parkinson’s disease

Primary effects:

DM,PVD

Secondary effects:

Fatigue, pain,disability

Medications:beta blockers ,diuretics

21. Assessment

Comprehensive medical,psychiatric& sexual history

Sexual History:

Prior sexual experiences

Current sexual functioning

Attitude towards sexuality

Attitude towards any partner

22. ASSESMENT

Doctor –patient relationship

Partner involvement

Medical work up incl phy.exam

Routine invs:Bld count,sugar,electrolytes,urea

Special diagnostic tests:

Nocturnal Penile tumescence(NPT)

Penile duplex USG

23. Treatment

1.Education-Reassurance

2.Shift focus from intercourse to foreplay

3.Maximize rehabilitation and palliative treatment

Analgesics-pain

Inhalers-shortness of breath

Physiotherapy- joints, muscles

4.treat depression anxiety/psychosis

24. Treatment

Medication side effects

Wait for tolerance

Decrease dose

Alternative regimen

Drug holidays

25. Antidepressant induced ED

1.Antidotes:
yohimbine,amantadine,cyproheparidine,bethanecol,methylphenid
ate, buspirone,bromocriptine

Other antidepressants:

1.Bupropion,nefazodone,mirtazapine,trazodone

Erectogenic agents:

Sildenafil,vardenafil,tadalaifil

Stop medications

26. Sex Therapy

Both partners

Brief educational/supportive counselling

Intensive couples therapy

Cognitive therapy

Sensate focus

27. Cognitive Therapy

Distorted attitude  practical attitude

Catastrophic Thinking:

“If I don’t achieve erection I will be rejected by partner”

All or Nothing Thinking:

I must achieve instant erection or the whole thing is pointless

Replace negative thoughts with realistic/hopeful statements,
affirmations of success

28. Sensate Focus

Relaxation techniques with non pressured sensual touching

Gradual progression to genital stimulation/intercourse

29. ED
1.testosterone
2.Penile intacavernosal injection-alprosatidal
3.Urethral suppository
4.PDE-5 inhibitors
5.Vaccum constriction device
6.Penile implants

30. Premature Ejaculation

Squeeze, Start-Stop techniques

Dapoxetine with or without sildenafil

31. Hypoactive sexual desire disorder

Poor self image/negative societal attitudes-sex education&
counselling

Estrogen replacement therapy

Testosterone replacement therapy

Siledenafil

32. Female orgasmic disorder

Individual sex therapy:
-Relaxation techniques+sensual self stimulation/masturbation with
vibrator
-Increase clitoral stimulation

33. Dyspareunia

Treat medical condition:

Vulvitis

OG opinion

Estrogent replacement therapy

Sex therapy

Sensual excess;massage,foreplay,oral sex

34. Ways to enhance sexual function in
late life

1.+attitude

2optimal Health No tobacco, alcohol

3.communication with partner

4.foreplay

5.treat medical problems

35. Ways to enhance sexual function in
late life

6.Before sex take pain killers or inhalers

7Females-Estrogens,cream

8Identify problematic medication

9.Avoid unrealistic expectations

10.Explore positions

36. THANK YOU