From the Editor: ‘I’d Rather Not Talk About It’
When older adults were adolescents, they may have dreaded the talk—you know, the embarrassing talk about sex. When they became parents and had to give the talk, they may have been equally reluctant. And in late life, many still don’t want to talk about it. Sex, that is. Worse, many clinicians don’t want to start the discussion either.
When it comes to sex, age truly is just a number. Many older adults—even the oldest old—retain a healthy interest in sex. Yet while the spirit may be willing, the body often may be less than accommodating. Their bodies aren’t as flexible, and their stamina may be diminished. Joint pain from arthritis and other types of chronic pain may interfere with sexual pleasure, and dyspareunia caused by postmenopausal vaginal atrophy may keep women from wanting to have intercourse. Common conditions and diseases such as diabetes, incontinence, and cardiovascular disease can have a range of negative effects on sexual expression, as can medications for these and a host of other conditions such as depression, Parkinson’s disease, and high blood pressure.
Many, such as those who had been in monogamous relationships for decades and are now widowed, may have little awareness about their risk for HIV and other sexually transmitted diseases. Individuals older than 50 represent one-half of all diagnoses of HIV, yet older adults are less likely than others to be tested for HIV or other sexually transmitted diseases.
Emotional issues also contribute to sexual difficulties. Erectile dysfunction in men, loss of libido in men and women, and body image disturbances may cause embarrassment and distress. Men who have had prostate surgery or who have an enlarged prostate and women who have had mastectomies, for example, may be inhibited about engaging in sexual activity and uncomfortable expressing their feelings. Many older adults are single or have been widowed and are uncertain about how to develop new relationships. Some may have absorbed cultural messages that suggest that there’s something unseemly or inappropriate about being sexually active in old age.
And dementia adds another level of concern. Not only may patients have a desire for intimacy, but they also may have increased desire and exhibit inappropriate behaviors, which can be difficult not only for them but also for their families and institutional caregivers.
In this issue’s cover story, Jamie Santa Cruz looks at the obstacles to conversations about sex between older adults and their clinicians and explores the ways of overcoming the barriers, concluding that “regardless of the specifics of how and when to raise sexual health conversations, the bottom line is simply to make the conversation a priority.”