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Sexual life in old age

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

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Sexual life in old age

  1. 1. SEXUAL LIFE IN OLD AGE DR.V.JAIKUMAR IMH 9.10.2013
  2. 2. ATTITUDES  Idea of sexuality in late life has been  1.denied  2.regarded with humour  3.disgust
  3. 3. ATTITUDES  Denial of sexuality in parents and grand parents becomes denial of sexuality in all older individuals
  4. 4. REVOLUTIONS  1.Hormone replacement Therapy  2.treatment of ED
  5. 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. 6. American Association of Retired Persons  1999.  45+  45-59 84% M 78% F  75+ 58% M 21 %F ¾ remained sexually active
  7. 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. 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. 9. Sexual response cycle  I stage desire  II stage excitement arousal  III stage plateau  IV Orgasm  V resolution
  10. 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. 11. Menopausal symptoms  Hot flashes  Head/neck aches  Mood changes  Excess fatigue  Decreased libido
  12. 12. Men  Decreased anticipatory arousal  More physical stimulation ERECTION Less frequent Less durable Less reliable Volume of ejaculate-decreased
  13. 13. Men  Refractory period in older men varies from hours to days  Young people -minutes
  14. 14. Attitudes  Over reaction to normal changes  Decreased sexual activity  Lose self confidence  Feels less sexy  Feel it is inappropriate /harmful
  15. 15. + side  Decreased responsibility to wards children  Empty nest syndrome  Decreased anxiety – no pregnancy
  16. 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. 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. 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. 19. Sexual dysfunction in late life Life stressors   Loss of loved one,  Divorce  Financial/Occupational stressors  Major Health scare
  20. 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. 21. Assessment  Comprehensive medical,psychiatric& sexual history  Sexual History:  Prior sexual experiences  Current sexual functioning  Attitude towards sexuality  Attitude towards any partner
  22. 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. 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. 24. Treatment  Medication side effects  Wait for tolerance  Decrease dose  Alternative regimen  Drug holidays
  25. 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. 26. Sex Therapy  Both partners  Brief educational/supportive counselling  Intensive couples therapy  Cognitive therapy  Sensate focus
  27. 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. 28. Sensate Focus  Relaxation techniques with non pressured sensual touching  Gradual progression to genital stimulation/intercourse
  29. 29. ED 1.testosterone 2.Penile intacavernosal injection-alprosatidal 3.Urethral suppository 4.PDE-5 inhibitors 5.Vaccum constriction device 6.Penile implants
  30. 30. Premature Ejaculation  Squeeze, Start-Stop techniques  Dapoxetine with or without sildenafil
  31. 31. Hypoactive sexual desire disorder  Poor self image/negative societal attitudes-sex education& counselling  Estrogen replacement therapy  Testosterone replacement therapy  Siledenafil
  32. 32. Female orgasmic disorder  Individual sex therapy: -Relaxation techniques+sensual self stimulation/masturbation with vibrator -Increase clitoral stimulation
  33. 33. Dyspareunia  Treat medical condition:  Vulvitis  OG opinion  Estrogent replacement therapy  Sex therapy  Sensual excess;massage,foreplay,oral sex
  34. 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. 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. 36. THANK YOU

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