Older widows' perspectives on sexuality: A life course perspective

Effect of Sexual Knowledge, Attitude and Quality of Life on Marital Satisfaction of Aged Couples in South Iran: APIM-SEM Analysis

Marital satisfaction is important for health and well-being among aged couples. The aim of this study is to explore the relationship between knowledge, sexual attitude, and quality of life with marital satisfaction of aged couples of over 60 years in southern Iran. This APIM analytical study was performed on 510 aged couples in southern Iran in 2020. Proportionate stratified sampling was randomly performed in three stages relative to the aging population in main cities in the south Iran. Data collection tools included demographic information (age, education, occupation, living alone, type of disability, etc.), sexual knowledge and attitude scale (SKAS-10), quality of life scale (SF-12), and marital satisfaction questionnaire. Mean score of marital satisfaction, sexual attitude, sexual knowledge, and QoL (SF-12) was 49.71 (SD = 14.8), 27.5 (SD = 7.3), 24.7 (SD = 8.5), and 31.49 (SD = 3.2), respectively. The present study showed that sexual knowledge and attitude, quality of life, are among the estimators of marital satisfaction in aged couples.

Reasons people refrain from sex in later life

There has been an increase in research on sexual activity in later life, yet far less is known about the actual perceptions and experiences of older adults who refrain from sexual activity. In the current study, a thematic analysis was conducted to identify patterns in semi-structured interviews with 47 older adults, aged 60-91. The analysis yielded seven themes that describe why older adults refrain from sex: 1) avoiding confronting sexual dysfunctions, 2) avoiding confronting the aging body, 3) avoiding performance anxiety, 4) being uninterested in sexual activity, 5) taking time to grieve the loss of a partner, 6) avoiding judgment, and 7) seeing sexuality as evolving and changing. Themes were organized according to the bio-psycho-social perspective and based on the axis of personal (self-focused) and interpersonal (partner-focused) motives. It is perfectly acceptable for people to refrain from sexual activity for their own reasons. However, if older adults want to remain sexually active, they should receive complete information about the many possibilities of treating different sexual problems in later life and about the many ways, beyond sexual penetration, one can enjoy sexual activity even in old age.

Dating Behaviors of Older Black Women

The complexities of older Black women's dating behaviors and preferences were uncovered in this phenomenology study with 14 older Black single and/or widowed women. The participants recognized that, as older Black women, their sexuality did not simply pertain to whether they were dating, it encompassed various factors that influenced their decisions about whether to date. These factors were categorized into three major themes: pursuing intimacy, dating preferences, and barriers to dating. The adoption of the Black feminist standpoint theory helped to understand their dating experiences in the context of the participants' Blackness. The women's subjective experiences with dating and the challenges that they face as older Black women demonstrated the complexities and intersections of race, gender, class, and age within this contextual analysis. These findings hold important practical implications for understanding the influence of the older women's Blackness on their experiences and how it shapes their dating behavior. These understandings will help social workers and gerontologists better appreciate and validate older Black women's self-determination in their dating choices and the need to support them.

The prevalence of sexual compulsivity and its correlates among adults living with HIV/AIDS attending antiretroviral therapy clinic in Gambella town, Southwest Ethiopia, 2020

INTRODUCTION

Sexual compulsivity is a concealed psychiatric disease marked by intrusive thoughts followed by ritualized sexual acts. In Ethiopia, the prevalence of HIV/AIDS has recently increased. Furthermore, sexual compulsivity among adults living with HIV/AIDS receives less attention, particularly in Ethiopia. Therefore, this study aimed to assess the prevalence of sexual compulsivity and its correlates among adults living with HIV/AIDS attending ART clinic in Gambella town, Southwest Ethiopia, 2020.

METHOD

A hospital-based study employing cross-sectional design and simple random sampling technique was used to select the study participants. Data were collected by using interview technique. A 10 item Sexual Compulsivity Scale (SCS) questionnaire was used to assess sexual compulsivity. The translated version of the questionnaire was used for data collection. Bivariate and multivariable logistic regression was conducted to determine factors associated with the outcome variable at p-value < 0.05 with a 95% confidence interval.

RESULT

Out of 300 respondents, 27% (24.3, 29.2) of them were scored above the mean score of the Sexual Compulsivity Scale. Age less than 31 years old, widowed, involving in risky sexual behaviors, current substance use, not received any skill training about safer sex behaviors, and not attending support group discussion on HIV prevention were significantly associated with sexual compulsivity.

CONCLUSION

Almost one fourth of the respondents have high score for Sexual Compulsivity Scale score. Therefore, there is a need of routine sexual behavior screening program and collaboration with mental health workers for addressing the problem. Furthermore, the emphasis should be given on the identified high-risk categories.

‘Why would I want sex now?’ A qualitative study on older women's affirmative narratives on sexual inactivity in later life

The existing research tries to understand the reasons for discontinuing sex in later life with the assumption that people want to be sexual. Although the growing body of literature informs that sex remains an integral part of older adults’ lives, a substantial number of older adults declare not being sexually active. This study aimed at exploring motives for deliberately choosing sexual inactivity among older women. Semi-structured interviews with 16 Polish women (aged 65–82) were thematically analysed in relation to the sexual scripts theory and the participants’ specific socio-cultural background. Three main themes regarding the reasons for cessation of their sex life were identified: ‘I am glad that sex does not concern me anymore’, ‘I am satisfied with my memories’ and ‘The right one’ or no one. The results indicate that some women give up sex for good, with no regrets or feeling of a loss; for others, it may be a temporary decision, its duration dependent on meeting the right partner. Developing sexual agency may encourage discontinuing their sex life – a choice perceived as optimal and liberating. Personal factors and the memories of marital relationships seem to shape older women's (a)sexual expectations. Acknowledging these nuances may contribute to a better understanding of older women's sexual functioning; implications for consideration in further research and practice are also discussed.

"What Do You Mean by Sex?" A Qualitative Analysis of Traditional versus Evolved Meanings of Sexual Activity among Older Women and Men

ABSTRACTOlder adults remain sexually active well into later life; yet, there is no consistency in the literature about what sex means to them. The study described in this paper investigated the understanding of sexual activity as reported by 30 women and men from Poland, aged 65 to 82 (M = 71, SD = 5,24). Semi-structured interviews were thematically analyzed in relation to sexual scripts theory and the participants' specific sociocultural background. The results demonstrate the diversity of opinions on what sex is: from penetrative intercourse, through various expressions of physical intimacy, to emotional intimacy as a central concept. The dominant perception of sex as intercourse among some study participants evolved into an intimacy-oriented and partner-focused activity, with the discovery of fondling and female sexual pleasure as components of sex. Certain life events - such as ending a long-term marriage or engaging in a new romantic relationship - were identified as facilitating this change. Notable similarities in older women's and men's perceptions of satisfying sex in later life were observed. Acknowledging the nuanced meaning of sex for this population can contribute to a better understanding of the specificity of older adults' sexuality.

Communicating with older adults about sexual issues: How are these issues handled by physicians with and without training in human sexuality?

Although sexuality is an important part of health and emotional well-being throughout the entire life cycle, including during old age, little is known about how physicians discuss or approach the topic of sexuality during later life. The present study examined the perspectives of two groups of physicians toward discussing sexuality with older patients: 17 physicians who did not have any training in human sexuality and 21 physicians who were certified as sex therapists. The interviews underwent thematic content analysis to identify and code major themes and patterns. Qualitative analysis of the interviews yielded three main themes: (a) discourse between physicians and older adults regarding sexuality, (b) diagnosing sexual dysfunction among older adults, and (c) treating sexual dysfunction among older adults. Physicians who were not trained in sex therapy did not regularly ask their older patients about sexual functioning and/or problems with sex, tended to diagnose sexual problems from a medical perspective, and offered medication as the main treatment for sexual problems. Physicians trained as sex therapists felt more comfortable discussing sex-related issues with their older patients and diagnosed sexual problems from a medical, social, dyadic and psychological perspective. Although they offered their older patients a greater variety of medication-oriented interventions than those without training in sexuality, they did not rush into such interventions and instead emphasised the importance of the psychological and relational aspects of sex. The present study highlights the importance of human sexuality training for physicians and points out the effects of such training on the discourse, diagnosis and treatment of sexual concerns in later life.

Factors Conditioning Sexual Behavior in Older Adults: A Systematic Review of Qualitative Studies

The sexual behavior of older adults, especially women, has undergone changes in recent years, though there are still certain stereotypes today related to pathophysiology, beliefs, culture and tradition that negatively affect older adults’ sexual activity. The aim of our review is to present the main qualitative studies analyzing how physiological and psychosocial factors affect sexual behavior in older adults. A systematic review of these qualitative studies was carried out. All stages of this review were carried out peer-to-peer in order to guarantee minimized bias. A bibliographical search was completed between February and April 2019, in Web of Science, Scopus, PubMed Medline, PsycINFO ProQuest and CINAHL. To analyze the findings of the selected qualitative studies, a “Thematic Synthesis Analysis” was performed, using Eppi-Reviewer 4 software (UCL Institute of Education, University of London, UK). The quality of the studies was assessed with a CASP-Qualitative-Checklist. A total of 16,608 references were screened and 18 qualitative studies were included in this review. The studies involved 2603 participants across seven countries, most being women (approximately 80%). We identified a wide variety of physiological and psychological factors that can influence the sexual behavior of older adults, such as the presence of pathologies (erectile dysfunction and menopause), the strength of spiritual beliefs, and patriarchal roles upheld by upbringings conveying that women’s role is to provide men with sexual pleasure. Biological age in relation to stereotypical models of sexual behavior, emphasized as a risk factor in the contraction of sexual diseases, seems to play a relevant role as a factor limiting sexual behavior in older adults.

The Role of Sexual Activity from the Perspective of Older Adults: A Qualitative Study

Despite a growing amount of literature on aging and sexual activity, there are still a limited number of studies that capture older people's understanding of sexuality in later life. This study explored the meanings that older people ascribe to sexual activity and how these meanings relate to the continuation, the decline, and the complete cessation of sexual activity. Thirty in-depth semi-structured interviews were conducted with Czechs aged 50-75 years (13 men) who were recruited through a preventive cognitive health program offered at a hospital. The analysis was carried out with a grounded theory approach and the principles of consensual qualitative research. The study identified three dominant understandings of sexual activity in later life that emerged as a reflection of the aging process. The first was sexual activity within a relationship that represented proof of being with someone and where sexual inactivity was linked to the threat of loneliness. The second concerned sexual pleasure and its continuity in later life, while its loss gave room for affliction and the emergence of ageist beliefs. The third linked sexual activity with the connotations of self-identifying as young versus being self-perceived as really old. The study findings suggest that the understanding of sexual activity in later life is ambivalent. Its continuity is viewed as an instrument for mitigating the markers of getting old, while the threat of its decline may activate older people's desire for asexual aging and negative views on aging.

Influence of Sexuality on the Health of the Elderly in Process of Dementia: Integrative Review

Objective: this work sought to inquire on the influence of sexuality on the health of the elderly during dementia. Materials and Methods: this was an integrative review. A careful search was conducted in nine databases; however, only five databases provided articles fulfilling the scope of the study: Medline, Lilacs, BDENF, Scopus, and Web of Science (WoS). The health science descriptors (DeCS) were adopted: “sexualidad”, “demencia” and “anciano”, and the descriptors cataloged in the Medical Subject Headings (MeSH): “sexuality”, “dementia” and “aged”. After applying the inclusion criteria, eight articles were selected to comprise the study sample. Results: the practice of sexuality influences upon the health of the elderly with dementia with some beneficial effects, given that it provides, especially, better perception of quality of life and wellbeing. Nevertheless, it cannot be generalized due to methodological insufficiency evidenced in the studies found to construct this review. Conclusions: due to the limitation of studies addressing the theme and the methodological insufficiency of those included in this review, it is necessary to conduct research that shows in depth the influence of sexuality on this population, given that it can be constituted as another approach for the promotion and protection of health in the elderly with dementia.

When sex meets age: Family physicians' perspectives about sexual dysfunction among older men and women: A qualitative study from Israel

BACKGROUND

Gender differences in relation to sexual functioning among older adults have received very little research attention, although the ageing process is likely to be characterized by difficulties in sexual functioning among both women and men.

OBJECTIVES

The purpose of this qualitative research is to examine and understand the perceptions of family physicians, and the differences in their attitudes regarding male and female patients.

METHOD

Qualitative interviews with family physicians were conducted between August 2017 and December 2017. Sixteen family physicians participated in the study, aged 36-64; most were born in Israel and half of them were women. Twelve physicians were Jewish, two were Christian and two were Muslim. Nine work in rural practices and seven work in urban practices. We used in-depth, semi-structured, face-to-face interviews. The interviews were recorded, transcribed and analysed by three researchers using content analysis.

RESULTS

The analysis of the interviews revealed two main themes: (1) Differences as perceived by family physicians: men are perceived as being interested in engaging in full sexual relations, including penetration, while among women, the main need is focused on the relationship and intimacy. (2) Gender differences regarding seeking a solution through the family physician. Family physicians reported that most of the patients who seek solutions regarding sexual dysfunction in old age are men with impotence problems. Family physicians perceived that women seek out solutions less frequently, some because they are afraid their relationship will suffer if they do not continue having sex with their partners.

CONCLUSION

Men and women were seen as having different motivations for engaging in sex and different needs from physicians.

Views of family physicians on heterosexual sexual function in older adults

Background

Sexual functioning among older adults has received little attention in research and clinical practice, although it is an integral part of old age. As older adults tend to consume health services and to visit family physicians more frequently, these care-providers serve as gatekeepers in the case of sexual concerns. The present study evaluated the perceptions of family physicians regarding sexuality in older adults.

Method

Qualitative interviews with 16 family physicians were conducted. We used in-depth, semi-structured interviews.

Results

Three main themes emerged: 1. Family physicians described having difficulty in raising questions about sexuality to older patients. 2. Family physicians tended towards the biological side of the spectrum, focusing on the patient’s medical problem and asking physiological questions. 3. Family physicians mainly related to medication administered to their male patients, whereas a minority also described the guidance they provided to older individuals and couples.

Conclusions

The study shows that family physicians tend not to initiate discourse with older patients on sexuality, but rather discuss sexuality mostly in conjunction with other medical conditions. Implications for research and practice are discussed.