Sexual activities, sexual and life satisfaction, and successful aging in women

Influence Factors of Sexual Activity for Internal Migrants in China

Background

Sexual frequency is associated with the quality of life. China’s internal migrants that are sexually active are more likely to participate in sexual behavior. However, less work has been undertaken to assess the sexual frequency and its predictors in migrants.

Aim

This study seeks to explore which factors were related to sexual frequency in migrants and how the association varies with different levels of sexual frequency.

Methods

A total of 10,834 men and 4,928 women aged 20–49 years from 5 cities in China were enrolled by multi-stage sampling during August 2013–August 2015.

Outcomes

Sexual frequency among migrants was determined by asking: How many times have you had sexual intercourse with a man/woman in the past 30 days?

Results

In this study, sexual frequency with an average age of 38.28 years was 5.06 (95% CI 5.01–5.11) time per month. Negative binomial showed that male gender, younger age, earlier age of sexual debut, masturbation, more knowledge of sexual and reproductive health, longer time together with a spouse, and higher school education and incomes were predictors of increased sexual frequency in migrants. Communicating with sexual partners frequently had the largest effect on sexual frequency compared with occasional communicating (β = 0.2419, incidence rate ratio = 1.27, 95% CI 1.23–1.31). In the quantile regression, months of cohabitation (β = 0.0999, 95% CI 0.08–0.12), frequent sexual communication (β = 0.4534, 95% CI 0.39–0.52), and masturbation (β = 0.2168, 95% CI 0.14–0.30) were positively related to lower levels of sexual frequency. Interestingly, migrants who had low and high sexual frequency would be affected in opposite directions by the knowledge of sexual and reproductive health.

Clinical Translation

Clinicians can more understand the relationship between sexual frequency and its factors that can as the symptom basis of sexually-related diseases.

Conclusions

The present findings indicate that specific demographic, socioeconomic, and epidemiological characteristics influenced sexual frequency among migrants. Sexual communication as the largest effect predictor to sexual frequency should be paid more attention to, to improve sexual activity of migrants.

Zhang J, Wu J, Li Y, et al. Influence factors of sexual activity for internal migrants in China. J Sex Med 2018;6:97–107.

Sexual Quality of Life, Sexual Knowledge, and Attitudes of Older Adults on the Example of Inhabitants Over 60s of Bialystok, Poland

Introduction: Aging has a strong influence on the quality of relationships and sexual functioning, but in itself does not cause a lack of sexual desire.

Objectives: The aim of this study was to assess the quality of sexual life and define sexual knowledge and attitudes of older people on the example of residents of Bialystok, Poland at the age of 60 and over.

Methods: The study included 170 people, inhabitants of Bialystok, Poland aged over 60: 85 students of the University of Healthy Senior and the University of Psychogeriatric Prophylaxis and 85 students of the University of the Third Age. The study used three standardized psychometric scales: Sexual Quality of Life Questionnaire-Male (SQoL-M), Sexual Quality of Life Questionnaire-Female (SQoL-F), and Aging Sexual Knowledge and Attitudes Scale (ASKAS).

Results: The overall mean score for the ASKAS scale for knowledge was 65.21 ± 12.32 and for attitudes −124.65 ± 22.00. The overall mean SQOL score was 62.92 ± 18.18. Taking into account the gender of the respondents, the knowledge of men on sexuality of seniors was at the level of 63.48 ± 12.63, while in the female group −65.74 ± 12.23. The attitudes of men on sexuality of seniors was at the level of 128.80 ± 21.56, while in the female group −123.38 ± 22.05. Satisfaction with sex life among men (72.36 ± 27.49) was significantly higher than among women (60.02 ± 12.88).

Discussion: The seniors were characterized by moderate knowledge and attitudes to sexuality of older people and the average level of sexual satisfaction. There was no significant relationship between knowledge on sexuality and sexual satisfaction in the study groups, and there was a positive correlation between attitudes toward sexuality and the satisfaction of sex life outside the group of men. In addition, a significant positive relationship was found between attitudes toward sexuality and sexual satisfaction. In order to improve the knowledge of senior citizens about sexuality of old age and to overcome the taboos that are prevalent in this topic, a structured training should be provided in this field. Such training should be carried out by specialists in the field of sexology. It is desirable to conduct in-depth studies in the assessment of knowledge, attitudes, and quality of sexual life in a larger research group, in order to get results for the population of the whole country.

Prediction of Marital Satisfaction Based on Emotional Intelligence in Postmenopausal Women

Objectives

This study was coperinducted with the aim of prediction of marital satisfaction based on emotional intelligence for postmenopausal women.

Methods

This cross-sectional study was the descriptive-correlation and with a sample size of 134 people to predict marital satisfaction based on emotional intelligence for postmenopausal women was conducted in the Borujen city. The subjects were selected by convenience sampling. Data collection tools included an emotional intelligence questionnaire (Bar-on) and Enrich marital satisfaction questionnaire.

Results

The results of this study showed a significant positive relationship between marital satisfaction and emotional intelligence (P < 0.05, r = 0.25). Also, regression analysis showed that emotional intelligence (β = 0.31) can predict positively and significantly marital satisfaction.

Conclusions

Due to the positive relationship between emotional intelligence and marital satisfaction, adequacy of emotional intelligence is improved as important structural in marital satisfaction. So it seems that can with measuring emotional intelligence in reinforced marital satisfaction during menopause, done appropriate action.

Discussing sexual health with aging patients in primary care: Exploratory findings at a Canadian urban academic hospital

Sexuality is an important component of overall health and quality of life, yet evidence suggests many aging adults are not discussing sexual health with their physician. The objective of this study was to understand practices of primary care physicians in discussing sexual health with aging patients. An electronic survey was distributed to primary care physicians and family medicine residents at an urban academic hospital in Ontario, Canada. The survey captured the self-reported prevalence of discussions of sexual health with patients aged 50 and above as well as patient, physician and contextual factors influencing the likelihood of discussion. Descriptive statistics were used to summarize the results. Among the 37 physicians who responded to the survey (response rate of 24%), physicians were more likely to discuss sexual health with patients aged 50–75 years than with patient s>75 years with both males (p<0.0001) and females (p<0.0001). Most frequently discussed issues with males were erectile dysfunction and sexually transmitted infection, while atrophic vaginitis, bleeding, and pain during intercourse were most often discussed with females. Factors limiting discussion include lack of time, multiple patient comorbidities and a perceived disinterest in sexual activity. 54% of respondents report having adequate knowledge to discuss and manage later life sexual health issues. Proactively discussing sexuality with aging adults may reveal underlying illness and facilitate future help-seeking behaviours. We suggest that primary care physicians have a responsibility to routinely initiate such discussions in clinical practice.

The impact of experiences of ageism on sexual activity and interest in later life

Experiences of ageism are associated with poorer health outcomes. Sexual activity and interest are areas in life where the impact of ageism may also be evident as popular culture often depicts the older body as asexual, undesirable or sexually impotent. We explore the possible links between experiences of ageism and sexual activity/interest in later life using data from a study of Australians aged 60+. We explored characteristics of those who were more likely to have experienced ageism (measured using the Ageism Survey) and the relationships between experiences of ageism and measures of sexual interest/activity in later life (N = 1,817). Experiences of ageism were greater among those without a partner, unemployed participants, those with lower incomes and poorer self-rated health. Adjusting for these differences, experiences of ageism were more likely to be reported by those who had not had sex in the past two years and were not sure about their hopes/plans for sex in the future. Those who reported their sexual interest had increased or decreased since 60 also reported greater levels of ageism experience, as did those who wanted to have sex more frequently in the future. Ageism appears to impact sexual activity and interest in different ways. It is critical that social policy aims to reverse attitudes that reinforce the view of the ageist asexual and unattractive older body or person.

Sexual Well-Being in Older Women: The Relevance of Sexual Excitation and Sexual Inhibition

The aim of this study was to use the dual control model of sexual response (DCM) to investigate variation in sexual well-being among women 50 years of age and older. Data from 185 women 50 years of age and older (M = 59.46, SD = 6.96) were used to examine the relationships between sexual excitation (SE) and sexual inhibition (SI) and their lower-order factors to indicators of sexual well-being (i.e., sexual functioning, satisfaction, distress, frequency of sexual activity, and breadth of sexual behavior). Possible moderating factors were also explored. Independently, SE and SI were associated with the majority of the indicators of sexual well-being, and the directions of associations were consistent with the tenets of the DCM. SE and SI lower-order factors were significant predictors of sexual function, satisfaction, and frequency of sexual activity. Sexual distress was predicted more strongly by SI factors and breadth of sexual behavior by one SE lower-order factor (arousability). Partner physical and mental health and participant's own mental health were identified as moderating variables of these associations. Findings of this study are discussed considering the contribution of the DCM to understanding the role of diversity in older women's sexual well-being.

Repercussões da Menopausa para a Sexualidade de Idosas: Revisão Integrativa da Literatura

Resumo A menopausa representa transformações hormonais significativas que podem ser acompanhadas de mudanças sociais e emocionais. Além disso, a população idosa feminina tem apresentado maiores comprometimentos em relação à sexualidade do que os homens. Este estudo teve por objetivo apresentar uma revisão integrativa da literatura científica nacional e internacional sobre as possíveis repercussões da menopausa para a sexualidade de idosas. As buscas foram realizadas nas bases Lilacs, SciELO, PePSIC e PsycINFO com análise da produção científica nacional e internacional relativa ao período de janeiro de 2006 a março de 2016. Foram analisadas 36 produções na íntegra cujo perfil predominante é de estudos quantitativos, descritivos e transversais, desenvolvidos com mulheres de diferentes faixas etárias na pós-menopausa, incluindo idosas. Todavia, estudos com amostras compostas exclusivamente por idosas são minoria. Entre os resultados houve predominância de pesquisas voltadas para a avaliação e quantificação das possíveis patologias e sintomas biológicos que afetam a sexualidade (redução da libido, de lubrificação e de orgasmos, por exemplo). A maioria das pesquisas aponta para a importância da análise conjunta de aspectos biológicos, psicológicos, sociais, culturais e individuais para a compreensão das suas distintas influências na sexualidade das idosas. Destaca-se a necessidade de realização de pesquisas com abordagem mista e voltadas apenas para mulheres idosas a fim de ampliar a compreensão acerca das suas perspectivas sobre as repercussões da menopausa para a sexualidade pretendendo respaldar práticas clínicas e políticas sociais destinadas a essa população.

Factors associated with sexual quality of life among midlife women in Serbia

PURPOSE

To assess factors associated with better sexual quality of life (QOL) in midlife period among women who are and are not sexually active.

METHODS

Participants were 500 women aged 40-65 years from Belgrade, Serbia. Data were collected through general questionnaire (regarding socio-demographic characteristics, lifestyle habits, general medical, and gynecological history) in which one item investigated having partnered sexual activity (heterosexual intercourses). The sexual domain of the Utian Quality of Life Scale was used to assess the sexual QOL. The sexual QOL consisted of reflections on the satisfaction with frequency of sexual interactions, as well as sexual and romantic life in general. Higher scores indicated better sexual QOL.

RESULTS

Most women were sexually active in midlife (81.6%). The mean sexual QOL score for the overall sample was 9.99 (range 3-15). The level of sexual QOL did not differ between sexually active and non-active women. Factors associated with better sexual QOL in sexually active menopausal women were being married or coupled, being physically active, having more children, having hot flushes, and not having tachycardia. Factors associated with better sexual QOL in sexually inactive menopausal women were drinking alcohol, being physically active, not having insomnia or skin rash.

CONCLUSIONS

Sexual QOL among Serbian urban midlife women was good and did not differ between women who were sexually active and those who were not. Further studies are needed to determine in what manner women who are not sexually active in midlife achieve high level of satisfaction with their sexual QOL.

The More or the Better? How Sex Contributes to Life Satisfaction

Much cross-sectional research documented associations between sexuality and life satisfaction, but very little longitudinal research on the topic has considered whether changes in sexuality and life satisfaction unfold together over time. Using data from 5582 individuals in partnerships surveyed across 5786 intimate relationships (providing 18,712 observations for analysis) during five waves of the German Family Panel (pairfam), this study examined whether intraindividual changes in sexual frequency and satisfaction were associated with corresponding intraindividual changes in life satisfaction. Fixed effects regression modeling results showed that individuals reported a greater increase (decrease) in life satisfaction when they also experienced a more substantial increase (decrease) in sexual frequency and satisfaction. This finding was consistent for men and women. This study contributes to the literature by documenting that naturally occurring increases in sexual frequency and satisfaction over time predicted corresponding increases in life satisfaction.

Sexual Quality of Life and Aging: A Prospective Study of a Nationally Representative Sample

Unlike other life domains, sexual quality of life (SQoL) has a negative relationship with age. This study disentangled the effect of age in this relationship from confounding sociocultural influences (e.g., the period of time in which data were collected, and cohort differences) and aimed to understand the roles of other sexual domains (i.e., frequency, perceived control, thought and effort invested in sex, and number of sexual partners). We analyzed data from the longitudinal Midlife in the United States study (n = 6,278; age range 20-93), which were collected between 1995 and 2013. Repeated measures linear mixed-effects models showed that age was the most robust time-related predictor of declining SQoL. However, after the sexual domains were included in the model, age had a positive relationship with SQoL and older adults' SQoL was differentially influenced by the quality-not quantity-of sex. When partnership characteristics were included in the model, age was no longer related to SQoL. These findings suggest that aging may be associated with the acquisition of skills and strategies that can buffer age-related declines in SQoL, particularly in the context of a positive relationship. We summarize these findings as sexual wisdom.

Happiness, rather than depression, is associated with sexual behaviour in partnered older adults

Background

The relation between positive psychological well-being (PPWB) and sexual behaviour is understudied in older adult groups.

Objective

To examine the relation between PPWB (positive affect and life satisfaction) and sexual behaviour (sexual activity and physical tenderness) in older adults, and whether it is independent from depressive symptoms and uniform across older age groups.

Design

Cross-sectional.

Setting

Community-dwelling adults aged 65 years or older, Rotterdam, The Netherlands.

Methods

Sexual behaviour, the Cantril Self-Anchoring Striving Scale, the Center for Epidemiological Studies Depression (CES-D) scale and partner status were assessed in 2,373 dementia-free older adults from the Rotterdam Study.

Results

For partnered participants, greater positive affect and life satisfaction was associated with more sexual activity and physical tenderness. Although CES-D was negatively associated with sexual behaviour within partnered older adults, there was no association between the negative affect sub-scale and sexual behaviour. The relations were independent of depressive symptoms, physical health and chronic disease status and were observed for both sexes at all older ages. For unpartnered participants, greater life satisfaction and was associated with more physical tenderness. There was low prevalence of sexual behaviour in unpartnered participants, limiting further stratification.

Conclusion

Greater PPWB was associated with more sexual behaviour in partnered, community-dwelling older adults. We are the first to demonstrate that sexual behaviour is associated with PPWB, rather than lack of depressive symptoms; and that the association was present at all ages for partnered older adults. Limited conclusions can be drawn for unpartnered older adults as their sexual behaviour was infrequent.

Older Women in New Romantic Relationships

Although research has found that sexual activity declines with age, most of this literature examines people in long-term marriages. Little is known about the initiation of new sexual relationships in later life. In-depth interviews with 14 women aged 64 to 77 years were conducted to examine their personal and collective narratives regarding sexuality in later life. In contrast to common perceptions, none of the participants felt that aging had negatively impacted their own sexuality. For many, this was a time in their lives when they were experiencing renewed sexual desire and enjoyment. Even though sex might not have held the same priority as when they were younger, it held a place of importance in their romantic relationships. The discussion focuses on understanding women’s sexual relationships and behaviors within the context of their cohort and lives.

Talking about Sexuality and Intimacy with Women Spousal Caregivers: Perspectives of Service Providers

This article reports the findings of an exploratory study examining service provider perceptions and experiences of addressing sexuality and intimacy with women spousal caregivers. The caregiver-provider encounter is examined, and challenges faced by service providers in addressing sexuality are considered. Themes identified include ambivalence and discomfort, personal and institutional barriers, meanings attributed to sexuality and intimacy, and lack of opportunities to discuss experiences. Strategies to overcome silence and invisibility on the part of service providers in the health and social services system are considered.

The exercise of sexuality among the elderly and associated factors

Abstract Objective: To analyze factors that interfere with the exercise of sexuality among the elderly. Methods: A cross-sectional study of 235 elderly persons enrolled at the Open University of the Third Age of the Federal University of Pernambuco was carried out. The dependent variable was the exercise of sexuality, which was investigated in terms of perception of sexuality, thinking about sex, what the elderly person does when he or she has the desire for sex, sexual activity and auto-eroticism. The independent variables were sociodemographic data, health status and self-perception of body image. Statistical analysis involved bivariate correlation by the Kendall and Spearman coefficients. All variables with p≤0.20 in bivariate analysis were included in the generalized linear regression, with p=0.05 considered for the rejection of the null hypothesis. Result: The conception of sexuality was most closely related to genitality (67.2%), 51.5% of the sample reported thinking about sex, while 71.1% of the elderly persons said they were indifferent to sexual desire; 32.3% claimed to be sexually active; and 23% auto-eroticized. The variables age, years of education, religion, physical exercise and dissatisfaction with body image were significant in bivariate correlation analysis. The desire for sex and sexual activity were less likely to be present among elderly persons who performed exercise. Conclusion: The sexuality of the elderly is based on several factors that may interfere with their experience and should be considered in educational strategies employed by health professionals who promote actions for the sexual health of the elderly.

Obliterative Surgery for the Treatment of Pelvic Organ Prolapse: A Patient Survey on Reasons for Surgery Selection and Postoperative Decision Regret and Satisfaction

OBJECTIVES

To identify patient-reported reasons for selecting obliterative surgery for the purpose of predicting decision regret and satisfaction.

METHODS

We created a deidentified database of patients who underwent an obliterative procedure for prolapse from 2006 to 2013. Patients were excluded if they declined study participation, were deceased, or had dementia. Participants completed a survey regarding reasons for selecting obliterative surgery and a modified version of validated questionnaires on decision regret (Decision Regret Scale-Pelvic Floor Disorder) and satisfaction (Satisfaction with Decision Scale-Pelvic Floor Disorder). Parsimonious multivariate linear regression models were constructed to determine if any of the reasons given for choosing obliterative surgery were independent predictors of decision regret and satisfaction after controlling for significant sociodemographic, clinical, and surgical outcome data identified by bivariate analysis.

RESULTS

Seventy-seven women completed the surveys. "To follow my doctor's recommendations" and "no longer sexually active," and/or "did not plan to be" as reasons for selecting obliterative surgery made the most difference; however, these reasons were not identified as independent predictors of decision regret or satisfaction after controlling for confounders. The regret linear regression models identified preoperative sexual activity rather than the patient-reported reason "no longer sexually active and/or did not plan to be," as the only independent predictor of more decision regret after obliterative surgery (B coefficient 1.68, P < 0.01). The satisfaction linear regression models identified reoperation for any reason as an independent predictor of lower satisfaction (β, -0.24; P = 0.04) and the patient-reported reason for choosing obliterative surgery "not interested in pessary" as a predictor of higher satisfaction (β, 0.30, P = 0.01).

CONCLUSIONS

This study advances our knowledge about the obliterative surgical decision making process. Behavioral and educational interventions directed at improving patient and physician communications concerning the dynamics of sexual health issues in an aging population will likely decrease regret when obliterative surgery is chosen. Minimizing reoperation after obliterative surgery through increased experience, knowledge, and improved surgical skills and patient validation when pessary is declined will likely improve satisfaction when obliterative surgery is chosen.

Sexual well-being of older men and women

Most older adults experience sexual desire and engage in sexual activity, however, our knowledge about the sexual well-being (SWB) of older adults is still scarce. The present study aimed to examine the SWB of older adults as well as differences in their SWB based on gender and relationship status. The final sample consisted of 297 adults (149 men and 148 women) who ranged in age from 65 to 75 years; 63% (n=188) were currently in a romantic relationship. Participants were recruited using the crowdsourcing platform Amazon's M-Turk. Participants completed a background questionnaire, as well as measures of sexual behaviours (frequency of genital and non-genital activity and masturbation alone), sexual affect and cognitions (sexual esteem, attitudes, and satisfaction), sexual motivation (sexual interest), and sexual functioning. Our participants reported overall positive SWB; specifically, positive sexual self-esteem and attitudes toward sex as well as high sexual satisfaction and interest. Furthermore, participants who were in a relationship engaged in frequent genital and non-genital sexual activity. About two-thirds of the participants in a current relationship had experienced at least one sexual difficulty in the last three months, but only one-quarter were distressed about it. Although some gender and relationship status differences emerged, in general both the men and women and participants who were and were not in a relationship reported positive SWB. These results are discussed in terms of the ways in which they extend our knowledge on the SWB of older adults and challenge popular myths about sexuality in later life.

Midlife and older women's experiences and advice about sex with men, risk behaviors, and HIV prevention education

This article reports on older women's experiences and advice on condom use, male-female relationships, HIV risk, and prevention education. It reports on findings from five written, open-ended questions with 110 ethnically and economically diverse women, 40-80 years old. Analysis revealed four themes: (a) Gap between condom use advice and condom use behavior; (b) invisibility with age; (c) negative expectations of men; and (d) desire for education that breaks the silence on sex. The article discusses the meaning of the findings as they relate to current knowledge about HIV prevention education and midlife and older women and offers recommendations for research and education.

Gendered sexual uses of alcohol and associated risks: a qualitative study of Nigerian University students

Background

Alcohol misuse among young people is a global phenomenon. In many countries, young people engage in heavy drinking and this exacerbates risky sexual behaviour. In Nigeria, alcohol held multiple roles in the traditional era but was mainly consumed by adult males for pleasure. Adult females and young people were culturally constrained from drinking in most communities. In contemporary Nigeria, young people’s drinking is increasing, and many engage in sexual intercourse under the influence of alcohol.

Methods

This study draws on the traditional gender and social sexual scripts to explore the factors that motivate young people to use alcohol for sexual purposes. In-depth interviews were conducted with 19 to 23-year old male and female undergraduate students from a Nigerian university. Thematic analysis was conducted with the aid of NVivo 10 software.

Results

Men drink to become confident to initiate sexual relationships, stimulate sexual urges, prolong erection, increase sexual satisfaction and become more aggressive during sexual intercourse. Women also drink to be bold in initiating sexual relationships, for sexual arousal and to increase satisfaction. Relatedly, not every brand of alcohol is used for sexual purposes. For example, while men use ‘herbal’ alcoholic beverages and a mixture of locally-produced gin and marijuana, women use champagne and other flavoured alcoholic beverages. The results also revealed that young people use alcohol or salt in a bid to prevent conception after sexual intercourse.

Conclusions

Adherence to the traditional gender (masculinity) and social sexual scripts amongst men and the enactment of what appears to be a new form of femininity script amongst women contribute to a culturally specific understanding of the motivations to use alcohol for sexual purposes. Evidence-based strategies should be employed to distribute information about the consequences of sexual intercourse under the influence of alcohol.

Subjective Sexual Well-Being in Chilean Adults: Evaluation of a Predictive Model

Research on sexuality has traditionally focused on sexual satisfaction, with studies into subjective sexual well-being being a recent phenomenon. This study sought to evaluate the relationship between sexual behavior, happiness, health, and subjective sexual well-being. The data were collected from 862 people aged between 18 and 50 years in Santiago, Chile, and were analyzed by logistic regression analysis. The results showed that sexual behavioral indicators (sexual frequency, sexual caresses, and touching), happiness, and perception of health taken as a whole predicted 47.4% of subjective sexual well-being (SSWB). Analysis of the four items of subjective sexual well-being separately showed that the dimension of physical satisfaction was associated with three variables of sexual behavior indicators with a prediction percentage of 33.5%, whereas emotional satisfaction was associated with three variables of sexual behavior indicators and happiness, with a percentage of prediction of 43.3%. Satisfaction with sexual function was associated with perception of health and one sexual behavior indicator, with a prediction percentage of 29.2% of this variable. The importance of sex was associated with three sexual behavior variables that predicted 26.2% of this variable. The results confirm that subjective sexual well-being can be predicted and that its four dimensions present a different behavior compared to the study predictors.

Obesity and Sexuality Among Older Couples: Evidence From the National Social Life, Health, and Aging Project

OBJECTIVE

We investigate whether obesity is associated with sexual activity, sexual frequency, and the range of sexual behaviors in heterosexual older couples. We assess to what extent associations between obesity and sexuality are explained by physical, psychological, and sexual health, and by relationship quality.

METHOD

We use data from 1,698 older adults in 849 partnered dyads in the 2010-2011 wave of the National Social Life, Health, and Aging Project and conduct couple-level analysis featuring women's and men's characteristics.

RESULTS

Women's obesity-particularly at severe levels-is negatively associated with coupled sexual activity, but the association is not mediated by hypothesized mediators. Men's obesity did not have any association with sexual activity. There was no significant difference between overweight and normal weight adults across all three sexuality measures.

DISCUSSION

The growing number of older adults with high levels of body mass index, particularly women, may face certain difficulties in maintaining active sexual lives.

Sexual Health and Positive Subjective Well-Being in Partnered Older Men and Women

OBJECTIVES

We examine the associations between different patterns of sexual behavior and function and three indicators of subjective well-being (SWB) covering eudemonic, evaluative, and affective well-being in a representative sample of partnered older people.

METHOD

Using data from a Sexual Relationships and Activities Questionnaire (SRA-Q) in Wave 6 of the English Longitudinal Study of Ageing, latent class analysis identified groups characterized by distinctive patterns of sexual behavior and function and then examined their link to SWB. Eudemonic SWB was measured using a revised 15-item version of the CASP-19, evaluative SWB using the Satisfaction With Life Scale, and affective SWB using the 8-item version of the Centre for Epidemiologic Studies-Depression scale.

RESULTS

Sexual behavior and function was best described by six classes among men and five classes among women. These ranged from high sexual desire, frequent partnered sexual activities, and few sexual problems (Class 1) to low sexual desire, infrequent/no sexual activity, and problems with sexual function (Class 5([women])/6([men])). Men and women who reported either infrequent/no sexual activity, or were sexually active but reported sexual problems, generally had lower SWB than those individuals identified in Class 1. Poorer SWB in men was more strongly associated with sexual function difficulties, whereas in women desire and frequency of partnered activities appeared more important in relation to SWB.

DISCUSSION

Within the context of a partnered relationship continuing sexual desire, activity and functioning are associated with higher SWB, with distinctive patterns for women and men.

Sexual satisfaction in couples in the male and female climacteric stage

The objective was to describe the sexual life satisfaction of couples in the climacteric stage and determine whether there are differences between the perception of satisfaction and the sex life of each partner. We studied 142 couples obtained by stratified sampling of family health centers, Concepción, Chile. 66% of women and 84% of men reported being very or somewhat satisfied with their sex lives. Slight concordance was found between the responses of the partners in relation to satisfaction with their sexual life. Moreover, a slight degree of agreement was found between the sexual life satisfaction reported by women and their partners' perceptions of the women's sexual life satisfaction. Additionally, a slight degree of agreement was reported between the sexual life satisfaction reported by men and their partners' perceptions of the men's sexual life satisfaction. This study provides new information about Chilean couples in the climacteric stage in relation to self-reported sexual satisfaction and perceived satisfaction in couples.

Sexual Problems Among Older Women by Age and Race

BACKGROUND

The purpose of our study was to examine the prevalence of sexual problems by age and race among older women in the United States and to examine quality of life correlates to sexual dysfunction among non-Hispanic white and African American older women.

METHODS

A cross-sectional study using self-report surveys was conducted among community-dwelling U.S. women, aged 60 years and over. A total of 807 women aged 61-89 years were included. Self-administered questionnaires assessed sexual dysfunction, satisfaction with life, depressive symptomatology, and self-rated health. Analyses included multivariate logistic regression.

RESULTS

The mean age of the sample was 66 years. Two-thirds of the sample had at least one sexual dysfunction; the most common for both African American and non-Hispanic white women were lack of interest in sex and vaginal dryness. Prevalence varied by age for each of the sexual dysfunctions. The odds of experiencing sexual dysfunction varied with age and race. Compared with non-Hispanic white women, African American women had lower odds of reporting lack of interest in sex or vaginal dryness. Poor self-rated health, depressive symptomatology, and lower satisfaction with life were associated with higher odds of having some sexual dysfunction.

CONCLUSIONS

Improved understanding of how sexual dysfunction affects women across multiple age ranges and racial/ethnic groups can assist providers in making recommendations for care that are patient centered. The associations that we identified with quality of life factors highlight the need to assess sexual health care in the aging female population.

Physical activity and sexual function in middle-aged women

OBJECTIVE

To investigate the relationship between physical activity level and sexual function in middle-aged women.

METHODS

A cross-sectional study with a sample of 370 middle-aged women (40-65 years old), treated at public health care facilities in a Brazilian city. A questionnaire was used containing enquiries on sociodemographic, clinical and behavioral characteristics: the International Physical Activity Questionnaire (IPAQ), short form, and the Female Sexual Function Index (FSFI).

RESULTS

The average age of the women studied was 49.8 years (± 8.1), 67% of whom exhibited sexual dysfunction (FSFI ≤ 26.55). Sedentary women had a higher prevalence (78.9%) of sexual dysfunction when compared to active (57.6%) and moderately active (66.7%) females (p = 0.002). Physically active women obtained higher score in all FSFI domains (desire, arousal, lubrication, orgasm, satisfaction and pain) and total FSFI score (20.9), indicating better sexual function than their moderately active (18.8) and sedentary (15.6) counterparts (p <0.05).

CONCLUSION

Physical activity appears to influence sexual function positively in middle-aged women.

Facilitating communication about sexual health between aging women and their health care providers

Many women experience changes in sexual health as they age, and discussing these changes with health care providers is an essential component of optimal health management. The purpose of this study was to understand aging women's perspectives about communicating with providers about sexual health. We used the integrative model of behavioral prediction as a theoretical lens to explore women's attitudes, perceived norms, and perceived self-efficacy that promote or inhibit the likelihood of communicating about sexual health. In this theory-based qualitative study, we interviewed 28 community-dwelling older women in the Midwestern United States. Through thematic analysis, we identified both positive and negative attitudes about communicating with providers. Women seemed most inclined to discuss sexual health if they perceived that important patient-provider conditions, such as trust and rapport, were in place. Despite situational obstacles and perceived norms, these women held strong beliefs about their abilities to discuss sexual health topics with providers.

Relationship Power, Sexual Decision Making, and HIV Risk Among Midlife and Older Women

The number of midlife and older women with HIV/AIDS is high and increasing, especially among women of color. This article addresses these demographic realities by reporting on findings about self-esteem, relationship power, and HIV risk from a pilot study of midlife and older women. A purposive sample (N = 110) of ethnically, economically, and educationally diverse women 40 years and older from the Greater Los Angeles Area was surveyed to determine their levels of self-esteem, general relationship power, sexual decision-making power, safer sex behaviors, and HIV knowledge. Women with higher levels of self-esteem exercised greater power in their relationships with their partner. Women with higher levels of general relationship power and self-esteem tend to exercise greater power in sexual decision making, such as having sex and choosing sexual acts. Income and sexual decision-making power were statistically significant in predicting the use of condoms. Implications and recommendations for future HIV/AIDS research and intervention targeting midlife and older women are presented.

The conditional importance of sex: exploring the association between sexual well-being and life satisfaction

Leaders in the field of sexuality have called for additional research examining the link between sexual well-being and life satisfaction in women in order to expand knowledge regarding the important consequences of a satisfying sex life. Participants in the present study were sexually active women reporting a wide range of sexual difficulties who completed an in-person interview, validated self-report measures, and daily online assessments for 4 weeks. Sexual well-being was related to life satisfaction both cross-sectionally and within individuals over time. In addition, high relational satisfaction and low attachment anxiety served as protective factors, decreasing the degree to which unsatisfying sexual experiences were associated with decreases in life satisfaction. These results extend previous findings by confirming a strong association between sexual well-being and overall life satisfaction within individuals over time. The strength of this association is moderated by a number of intra- and interpersonal factors. Implications for healthcare providers are discussed.

Sexual function after fractional microablative CO₂ laser in women with vulvovaginal atrophy

OBJECTIVE

To investigate the effects of fractional microablative CO2 laser on sexual function and overall satisfaction with sexual life in postmenopausal women with vulvovaginal atrophy (VVA).

METHOD

This prospective study included 77 postmenopausal women (mean age 60.6 ± 6.2 years) treated for VVA symptoms with the fractional microablative CO2 laser system (SmartXide(2) V(2)LR, Monalisa Touch, DEKA, Florence, Italy). Sexual function and quality of life were evaluated with the Female Sexual Function Index (FSFI) and the Short Form 12 (SF-12), respectively, both at baseline and at 12-week follow-up. A 10-mm visual analog scale was used to measure the overall satisfaction with sexual life and the intensity of VVA symptoms (vaginal burning, vaginal itching, vaginal dryness, dyspareunia and dysuria) before and after the study period.

RESULTS

We observed a significant improvement in the total score and the scores in each specific domain of the FSFI at 12-week follow-up compared to baseline (p < 0.001). After concluding the laser treatment, the overall satisfaction with sexual life significantly improved (p < 0.001). Seventeen (85%) out of 20 (26%) women, not sexually active because of VVA severity at baseline, regained a normal sexual life at the 12-week follow-up. Finally, we also found a significant improvement in each VVA symptom (p < 0.001) and in quality-of-life evaluation, both for the scores in the physical (p = 0.013) and mental (p = 0.002) domains.

CONCLUSIONS

Fractional microablative CO2 laser treatment is associated with a significant improvement of sexual function and satisfaction with sexual life in postmenopausal women with VVA symptoms.

Sexuality and affection among elderly German men and women in long-term relationships: results of a prospective population-based study

Satisfaction with sexual activity i.e. sexual satisfaction and the importance of sexuality and affection were analysed using data from the German “Interdisciplinary Longitudinal Study of Adult Development” (ILSE). At three measurement points, 1993–1995, 1997–1998, and 2004–2006 i.e. subjects' ages of 63, 67, and 74 years, participants' reports about their affection and sexual activity were collected. The sample of completed records used for this study consisted of 194 urban non-institutionalised participants, 68% male, all living with partners. Median levels of sexual satisfaction were reported, fluctuating between the measurement points of ages 63 to 74. Between baseline, first and second follow-up no differences were found in levels of sexual satisfaction, though at measurement points age 63 and 67 women were more satisfied than men. When measured at age 74, affection was given a higher priority than sexual activity. Although men and women reported similar priorities, sexual activity and affection were more important for men than for women. Satisfaction within the relationship can be predicted by the importance of affection, but not by that of sexual activity. Our results confirm the thesis of the ‘second language of sexuality’: for humans in their later years affection seems to be more important than for younger individuals.

The Influence of Sexual Attitudes on Mid-to Late-Life Sexual Well-Being: Age, Not Gender, as a Salient Factor

The influence of sexual attitudes on sexual activity and expression has been relatively understudied in older populations. In the current study, we sought to understand the role sexual attitudes have on sexual well-being among middle-aged and young-old adults. Using a diverse sample of participants over the age of 45 ( N = 384), a path model was analyzed to determine whether sexual attitudes contributed to sexual well-being. The model was then compared by gender. Results indicated: a) only age-relative sexual attitudes significantly contributed to sexual well-being; and b) the model was equally robust for both men and women, even though women held slightly more positive age-relative sexual attitudes than men. Therefore, among middle-aged and young-old adults, sexual well-being may be reduced by harboring negative ageist sexual attitudes. Efforts should be made to reduce stigma surrounding continued sexual activity and expression among the aged.

Improving sexual health communication between older women and their providers: how the integrative model of behavioral prediction can help

Talking about sexual health can be a challenge for some older women. This project was initiated to identify key factors that improve communication between aging women and their primary care providers. A sample of women (aged 60+) completed an online survey regarding their intent to communicate with a provider about sexual health. Using the integrative model of behavioral prediction as a guide, the survey instrument captured data on attitudes, perceived norms, self-efficacy, and intent to communicate with a provider about sexual health. Data were analyzed using structural equation modeling. Self-efficacy and perceived norms were the most important factors predicting intent to communicate for this sample of women. Intent did not vary with race, but mean scores of the predictors of intent varied for African American and White women. Results can guide practice and intervention with ethnically diverse older women who may be struggling to communicate about their sexual health concerns.

Maintaining sexuality in menopause

Sexual health in the menopause is a medical challenge because the progressive decline of sexual hormones interacts with the aging process and many psychosocial stressors modulate vulnerability for sexual symptoms (low sexual desire, poor arousal and lubrication, dyspareunia, orgasmic dysfunction and lack of satisfaction). In clinical practice, a coordinated approach is needed to optimally manage the risk for developing female sexual dysfunction (FSD), especially when chronic conditions are present. Biomedical and psychosocial interventions include general education, recognition of signs and symptoms, promotion of health, attention to the partner and individualization of treatment. Counselling to overcome personal and relational difficulties should be always combined with hormonal and non-hormonal strategies to maximize biological signals driving the sexual response. By enhancing women's abilities to cope with sexual changes at midlife, health care providers may significantly optimize healthy aging and partnership.

Long-term follow-up after colpocleisis: regret, bowel, and bladder function

INTRODUCTION AND HYPOTHESIS

Colpocleisis is not a popular option amongst surgeons, possibly due to concern about long-term regret. This study assessed a cohort of women who underwent colpocleisis 2-5 years previously to determine the regret rate, the effect on quality of life (QOL) and bladder and bowel function.

METHODS

This was a longitudinal study of patients who underwent colpocleisis at least 2 years previously. Participants were asked to complete the Prolapse QOL (P-QOL), International Consultation on Incontinence-Urinary Incontinence (ICIQ-UI Short Form) and Colorectal Anal Distress Inventory questionnaires (CRADI). Two additional questions were asked: (1) Do you regret having vaginal closure surgery for prolapse? (never, sometimes, often, all the time), and (2) Would you recommend this surgery to a relative or friend who is not sexually active? (yes, no.)

RESULTS

Thirty-four women were identified. Six had died by the time of follow-up, and five declined to answer the questionnaires because of ill health. Twenty-three women responded (67 %). Mean age was 78.68 years. One woman regretted having had the surgery, as the colpocleisis had failed. Twenty-one women (91.3 %) would recommend this surgery; one would not (4.3 %), and another was not sure (4.5 %). Low P-QOL [8 (0-37) ± 9.41), ICIQ-UI (7 (0-17) ± 5.44) and CRADI (10; 0-28 ± 8.13] scores suggest a positive impact on QOL, bladder and bowel function.

CONCLUSION

In this cohort, colpocleisis produced a good outcome with low regret rate (4.3 %), good QOL and minimal effect on bladder and bowel function at 2-5 years.

Positive sexuality and its impact on overall well-being

Historically, the issue of sexual health has been largely considered with respect to the associated negative health outcomes. The dangers of sexual activity such as sexually transmitted infections (STIs), HIV/AIDS, unintended pregnancy, sexual coercion, and sexual violence have dominated the attention of those working in the field. Over the last 20 years, and particularly in the last decade, an increasing number of people from a variety disciplines that address issues of sexual health have developed a new discourse concerning the positive aspects of sexuality. This review of the literature explores this emerging discourse. The results indicate that sexual health, physical health, mental health, and overall well-being are all positively associated with sexual satisfaction, sexual self-esteem, and sexual pleasure. The beneficial effects of sexual satisfaction should be integrated into programs that seek to improve these diverse health outcomes through service delivery, prevention, and sexuality education.

Sexual Health for Older Women: Implications for nurses and other healthcare providers

This article presents findings from a review of the evidence regarding sexual health for older women from MEDLINE, SCOPUS and the Cumulative Index to Nursing and Allied Health (CINHAL) databases. A total of 10 articles based on primary studies, reporting about the sexuality or sexual health of older women (and older people), and published between 2002-2012, were deemed suitable. The major themes that emerged from the available literature suggest that the sexual health of older people is affected by factors such as physical changes, mental health, changes to their relationship with their husband, chronic ill health and other psychosocial situations. It is concluded that nurses and other healthcare providers have a range of interventions that can be adopted to promote sexual health among older women. These interventions may focus on improving the older woman's sexual health assessment; increasing awareness and knowledge about sexuality in later life; pharmacological and psychotherapeutic therapies; using alternative techniques to achieve better sexual functioning; addressing partner and relationship issues, and advocating the importance of sexual health through media and policy development.

Longitudinal trajectory of sexual functioning after hematopoietic cell transplantation: impact of chronic graft-versus-host disease and total body irradiation

This prospective study described the trajectory of sexual well-being from before hematopoietic cell transplantation (HCT) to 3 years after in 131 allogeneic and 146 autologous HCT recipients using Derogatis Interview for Sexual Function and Derogatis Global Sexual Satisfaction Index. Sixty-one percent of men and 37% of women were sexually active pre-HCT; the prevalence declined to 51% (P = .01) in men and increased to 48% (P = .02) in women at 3 years post-HCT. After HCT, sexual satisfaction declined in both sexes (P < .001). All sexual function domains were worse in women compared with men (P ≤ .001). Orgasm (P = .002) and drive/relationship (P < .001) declined in men, but sexual cognition/fantasy (P = .01) and sexual behavior/experience (P = .01) improved in women. Older age negatively impacted sexual function post-HCT in both sexes (P < .01). Chronic graft-versus-host disease was associated with lower sexual cognition/fantasy (P = .003) and orgasm (P = .006) in men and sexual arousal (P = .05) and sexual satisfaction (P = .005) in women. All male sexual function domains declined after total body irradiation (P < .05). This study identifies vulnerable subpopulations that could benefit from interventional strategies to improve sexual well-being.

Sexual desire, erectile dysfunction and the biomedicalization of sex in older heterosexual men

AIM

To examine sexual desire in older age and the use of pharmaceuticals for sexual enhancement in the context of erectile dysfunction.

BACKGROUND

The ability of the older person to fulfil sexual desire has not been well supported in Western society.

DESIGN

The paper draws on themes that emerged during a phenomenological study of sexual desire in older age.

METHOD

Narratives were collected between 2008-2010 from in-depth interviews with six men and two women aged 65-84 years who were part of a larger Australian study of sexual desire in older age.

FINDINGS

Emergent themes reveal that for some older people, the biomedicalization of sex can be a disappointing experience.

CONCLUSION

The findings illuminate the need for nurses who are at the front line of health care, health policy makers and educators, to consider sexual desire experienced in older age in the context of sexual health and healthy ageing. This study will contribute to a growing body of knowledge about sexual desire in older age.

Sexual Health and Overall Wellness (SHOW) survey in men and women in selected European and Middle Eastern countries

Objective

To investigate whether better sexual health is associated with improvements in overall health and wellness, a more loving and intimate relationship, and a more positive outlook on life.

Methods

The Sexual Health and Overall Wellness survey used self-administered questionnaires to collect data from men and women aged 25–74 years who had had sexual intercourse at least once within the previous 12 months.

Results

Across nine countries, 3780 self-administered questionnaires were completed: 1893 from men (mean age, 44.6 years); 1887 from women (mean age, 44.2 years). The majority of men and women were satisfied with the frequency of sexual intercourse over the previous 4 weeks (59% and 66%, respectively); the majority (67% and 55%, respectively) reported that having sex was ‘very important’ or ‘absolutely essential’. For men and women, there was a strong association between satisfaction with sex and overall health, and between satisfaction with sex and an overall positive outlook on life.

Conclusion

For men and women, satisfaction with different aspects of sex was important, and was strongly associated with satisfaction with general health, relationships and other aspects of wellbeing.