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Sexual function and activity in old age have been inadequately studied world 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 middle age. This study sought to determine the patterns of sexual activity and function in individuals over 50 years of age. It also sought to discuss barriers such as chronic illness that may interfere with sexual function. We conducted a study of subjects above the age of 50 years in various 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 v Others had become completely abstinent at some time in their lives. Statistical analysis revealed significant gender, health and educational status based differences in the sample. Our study showed significant presence of sexual desire, activity and function even after the age of 50 years; a decline by the age of 60 and above was a finding that reflected more in women.
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INTRODUCTION

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Sexual function and activity in old age have been inadequately studied world 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 middle age. This study sought to determine the patterns of sexual activity and function in individuals over 50 years of age. It also sought to discuss barriers such as chronic illness that may interfere with sexual function. We conducted a study of subjects above the age of 50 years in various 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 v Others had become completely abstinent at some time in their lives. Statistical analysis revealed significant gender, health and educational status based differences in the sample. Our study showed significant presence of sexual desire, activity and function even after the age of 50 years; a decline by the age of 60 and above was a finding that reflected more in women.

Chronic illness did affect sexual function and desire. Although recognized as a fundamental driving force, human sexuality is frequently misunderstood and particularly in the elders, neglected. 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.

Fear about the loss of sexual prowess in older males is common. Older women also express sexual desire, but may fear their interest is undignified and disgraceful. Some elder persons may even freely accept their interests in sex, but their children or grandchildren may disapprove, making them feel 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 experience. In addition, sexual activity is a means for the elder to affirm physical functioning, to maintain a strong sense of identity and establish self-confidence, and to prevent anxiety. It remains a mode of pure physical pleasure as well. However, not all elder persons have positive attitudes about sexuality.

Like all persons, elders may experience sexual dysfunction due to boredom, fear, fatigue, grief, or other factors e. Sexuality in the elder is particularly affected by problems that are common in this age group, for example, depression, medical disorders, or incapacitation or death of a partner.

Aging is characterized by physiological, pathological, behavioral, and psychosocial changes that can all affect sexual functioning, and it is difficult to disentangle their individual effects. Clinicians tend to ignore this aspect of the lives of elders, who themselves can find sexual problems very difficult to talk about. In psychiatric interview of elders, sexual history and details are often omitted. Human sexuality and particularly sexuality in the elderly is an area that requires more attention in psychiatric training.

Yet, very little attention has been paid until recently to the treatment of sexual dysfunction in older adults. Older individuals are generally erroneously viewed as asexual people who have lost both their interest in sex and their capacity for sexual behavior. The study was a cross-sectional, single interview study that was approved by the Institutional Review Board. We interviewed 60 consecutive elder individuals 30 men and 30 women above the age of 50 years from the Geriatric, Hypertension, Rheumatology and Diabetes outpatient departments OPDs of a tertiary 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 various areas of sexuality. Data was pooled and statistical analysis was done using statistical package for social sciences v15 ; chi-square test was applied wherever necessary.

Individuals in the age group between 50 and 60 years comprised Around Of those who were ill The findings in different areas of sexuality in the subjects were as follows:. A similar pattern was also seen in group II, wherein In total, While only This was found to be statistically significant. While Above 50 years, more women Thirty percent women in our study reported loss of sexual interest in self as the cause of stopping their activity, as compared to 6.

This was also reflected the other way round. Of the men who had stopped sexual activity, 3. Women, on the other hand, did not report anything like this. Overall, we found sexual activity in elder men to be more than in elder women. As pointed out earlier, men reported sexual inactivity because of lack of desire, ill health, or erectile dysfunction in their old age, whereas women reported sexual inactivity due to loss of partner.

Age also affected the erection obtained. Overall, Poor quality of erection was defined as insufficient erection for intercourse. Erection was assessed by asking 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. Men in group II All women in our study reported a difference in vaginal lubrication as compared to that in young age.

We asked the subjects to compare their current sexual capacity with their capacity 1 year after their marriage. A larger percentage On the other hand, people who were not working or people with illness were less adjusted to this change. Both these findings were statistically significant. It was interesting that one of these women, who reported very frequent sexual dreams, was in fact separated from her husband and dreamt of having intercourse with him frequently.

Thirty percent men reported having dreams of a sexual nature as opposed to There was no gender difference noted. Only 6. All study subjects were asked about their preferred role in sex i. The subjects were asked how much role, sex had played in their relationships over the years. Only A small percentage This study was done in a sample of 60 individuals above the age of 50 years, and three broad areas related to sexuality in the elder were studied, including factors affecting sexual desire, sexual activity and function, and love and intimacy.

The results of this study leave little doubt that intact sexual function is common among elder people, even among those above 60 years group II. But definitely there was a declining course of sexual functions including a decrease in sexual desire with increasing age, with a steep course in group II. This finding is similar to that of Pfeiffer et al. Changes brought on by age can often make a person's sex life more difficult,[ 7 ] but there is still an internal drive or need for sexual fulfilment.

Continuation of sexual activity for elder persons in many societies indicates that cultural factors may be key determinants in their sexual behavior. 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. Deacon et al. George and Weiler[ 13 ] similarly reported illness and deteriorating health as the major reason for reduced sexual desires and activity in men in their study, while women reported loss of partner as the major factor.

Loss of partner is both commoner and more of a handicap for women in that they survive longer than men and tend to be younger than their husbands. There are many causes for women's sexual problems, especially in old age, including shame and guilt, sexual abuse, interpersonal conflicts, depression and religious and cultural prohibitions.

Even though it was not studied in detail, illness 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 problems, rather than old age per se. Numerous endocrine, vascular and neurological disorders may interfere with sexual function, just as many forms of medications and surgeries. These health factors are more prevalent in older people, and hence it is perhaps not surprising to find an increase in biologically caused sexual problems in the elderly.

They also indicate that pharmacological factors play a role in sexual problems. Although the subjects in our study maintained a definite interest in sexual activity, their activity itself had declined substantially for both the groups. A larger percentage of men All others had stopped their sexual activity at some time or the other.

This was slightly more than that reported by Helgason et al. The interest as well as involvement in both sexual and non-sexual activities was reported to be significantly less by women in our study, which reflected the findings of Lindau et al.

Men in our sample were more interested as well as involved in both these activities, as was seen by Pfeiffer et al. Changes in sexual expression and preferred sexual activity may be common with advancing age,[ 26 ] and one can see a shift from sexual activity to non-sexual petting and caressing or touching. Even when it comes to sexual activity, the time taken for sexual arousal is increased. The bio-physiological changes in old age predispose to increased time for arousal that has been well reported in literature. 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 get an erection.

Men in group II who reported a significant decrease in ejaculatory volume did not get distressed by it. It is known that changes occurring in the sexual physiology of an aging male can affect both erectile function and ejaculation. These changes need not have any functional impact on the subjective enjoyment of the sexual encounter. However, knowledge that these changes are not dysfunctional and assistance with the adjustment of sexual practices may be crucial in preventing dysfunction in them.



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