Academic literature on the topic 'Elderly sexuality sexual health quality of life'

This chapter starts by defining different aspects of sexuality and sexual health, and exploring the biopsychosocial model of sexual function. Male and female physiologies are illustrated, and the psychology of sexuality is described in the context of rehabilitation post disability. The PLISSIT model for managing and exploring sexual problems is described, with examples of how to manage conversations with patients. Both male and female fertility and sexual function are described, including methods of overcoming erectile dysfunction and problems with ejaculation. Hyper- and hyposexuality and the promotion of a good quality of life in sexual rehabilitation are discussed.

Sexuality is defined as the dynamic outcome of physical capacity, motivation, attitudes, opportunity for partnership, and sexual conduct. Sexual health in older persons is a topic deserving increasing interest and attention for both a public audience and physicians. Over half of people over 65 years of age, report sexual dysfunction, women more so than men. Since sexual health is dependent on general health and can be considered a mirror of general health, its assessment should be part of the routine clinical assessment, even in older subjects. However, asking about sexual health especially in older persons is often a difficult or embarrassing task for many primary care physicians. In addition, many patients find difficult to raise sexual issues with their doctor. Early recognition of sexual symptoms is the first step to starting multimodal treatments aimed at improving sexual health and related quality of life in older persons.

Sexuality is unique to each person and includes physical, psychological, social, and cultural factors that influence sexual values, beliefs,, and behaviour. Cancer and its treatments can disrupt many aspects of the sexual lives of patients. Lesbian, gay, bisexual or transgender people (LGBT) may have particular needs as a result of cancer and its treatment. Cancer causes changes to body image through amputation, scarring, hair loss, drug side effects, and weight changes. Patients can be prepared in advance by providing images of how appearance may change. After treatment, the partner of the patient, support groups, or professionals, including sexual counsellors, may help them through a period of adjustment. Sexual problems, like changes to physical sensation, pain, loss of sexual response and impotence, infertility, and loss of confidence and intimacy, may be associated with cancer treatments. There is a range of resources available to individuals and couples, including written and Internet-based information. Despite the effects of cancer and its treatment, many couples adjust by re-evaluating the place of sexual activity in their lives, and some couples report becoming closer as a result. Patients report that they want nurses to provide information and initiate conversations about sexuality. However, many nurses find this difficult. Important principles of working with a patient’s sexuality include: letting them know it is acceptable to talk about sexuality, treating it as an element of health and quality of life, providing information about the sexual problems associated with cancer, addressing problems that are raised, and finding sources of additional support.

According to the World Health Organization, sexual health as a state of physical, emotional, mental, and social well-being in the context of sexuality, excludes the mere absence of disease, dysfunction, or infirmity. Thus a woman’s sexual function encompasses many areas; the construct of a normal function as a quality of life indicator often but not always conforms to the sexual response cycle, which is an endogenous process contributed by hormonal, vascular, neuronal, and psycho-emotional factors. Clinical and scientific evidence abounds about the physiological role of sex steroids viz. oestrogen, testosterone, and also progesterone in facilitating and maintaining the woman’s sexual parameters. The neurophysiology extends from the central and peripheral nervous systems to the targeted genital structures resulting in coordinated vascular and non-vascular smooth muscle relaxation, to be accompanied by pelvic vasocongestion, vaginal lubrication, and labial and clitoral engorgement. Any detrimental impact on this normal cycle of concerted responses can result in a functional impairment or ‘female sexual dysfunction’ (FSD). Sexual changes, psychogenic or organic, are common in women at any age; such complaints are frequently accompanied by quality-of-life concerns, varying levels of personal distress, anxiety, depression, and also fertility concerns in younger women. With FSD as a medically diagnosable entity, fewer drugs have met the safety and efficacy criteria for global approval and clinical utility. In order to appreciate the diverse range of FSD and the extent of its physical, physiological, and psychological implications, it is important to understand the fundamentals as well as the changing paradigms in a woman’s sexual functioning.