Medicalization and the refashioning of age-related limits on sexuality

Love (and) ageing well: A qualitative study of sexual health in the context of ageing well among women aged 50 and over

BACKGROUND

The United Nations has declared 2021-2030 the 'Decade of Healthy Ageing' and identified the need to strengthen the evidence base on interpretations and determinants of healthy ageing to inform policy.

OBJECTIVES

This study sought to interrogate a 'policy blind spot' and examine interpretations and experiences of sexuality and sexual health within the context of ageing well among women aged 50+.

DESIGN

The qualitative study design was underpinned by an interpretivist epistemology. Research was guided by principles of feminist scholarship and located in an affirmative ageing framework.

METHODS

Semi-structured individual interviews were conducted between April-June 2019 with 21 English-speaking women aged 52-76. Women were recruited through community organizations in North West England. Transcripts were analysed using a framework approach to thematic analysis, applying an inductive approach to theme generation.

RESULTS

Narratives encompassed six broad themes: reflections on 'ageing well'; age alone does not define sexuality and sexual health; interpretations of sexual health and sexuality; vulnerability and resistance in later-life sexual health; narratives of (in)visibility; and reimagining services to promote sexual health in later life. There was a dominant belief that sexual health represents a component of ageing well, despite a broad spectrum of sexual expression and health challenges. Sexual expression was diversely shaped by conflicting societal expectations within an evolving digitized environment. In clinical settings, however, sexual health discussions were often muted or framed from a disease-focussed lens. Women expressed a preference for holistic, person-centred sexual health provision from an orientation of wellness to support varied sexual expression, sensitive to wider health, life and relationship realities.

CONCLUSION

This work strengthens calls to disentangle sexual health from disease-centred narratives and legitimize sexual health as part of the healthy ageing agenda.

Sex and Relationships in Later Life: Older Adults' Experiences and Perceptions of Sexual Changes

The aim of this study was to explore the sexual lives of older adults in the UK to elucidate their experiences of sexual changes and problems, and the role of intimacy and interpersonal support in coping with these changes. We conducted in-depth semi-structured interviews with 31 participants (aged 66-92, mean = 74, 16 women and 15 men), analyzed using reflexive thematic analysis. Our analysis generated three themes: Sexual Changes are "Natural," Sex is the Icing on the Cake, and Maintaining Sexual Connection and Relationship Satisfaction. The participants often rationalized and accepted sexual changes and problems as part of the natural aging process, or as a consequence of other age-related health issues. Sexual activity was seen by many as the "icing on the cake" of a satisfying romantic relationship, built on strong foundations of intimacy, connection, and companionship. Relationship satisfaction and sexual wellbeing can be maintained despite changes to sexual function by retaining a sexual connection through shared experiences, emotional closeness, and support. The findings have important implications for researchers and health providers, and suggest that adopting an "affirmative older age" perspective would be useful for not only future research but also when providing support for older adults with sexual difficulties.

The Role of Information in Later-Life Sexuality: An Invitation for Further Exploration

Despite the key role of information in realizing, questioning, or respecting one's sexual health, individuals' engagement with information about sex and sexuality remains understudied, particularly in older adult populations. Beginning with current understandings of later-life sexuality to contextualize how older adults may need, use, and manage information about their sexual lives and practices, this forum article follows with what is currently known about older adults' sexuality-related information needs and practices. We conclude with an invitation for collaboration between gerontologists and Library and Information Science scholars and professionals as a means to step outside the medicalization of older adults' sexuality and bolster our understandings of how information and later-life sexuality are mututally shaping.

Spotlight on Age: An Overlooked Construct in Medical Sociology

Medical sociology gives limited attention to age-a surprising observation given the aging of the population and the fact that age is among the strongest determinants of health. We examine this issue through an analysis of articles published in Journal of Health and Social Behavior (JHSB) and Sociology of Health & Illness (SHI) between 2000 and 2019. One in 10 articles focused on age or aging, with attention increasing over the period. However, the journals differed. More JHSB than SHI articles addressed it, but fewer focused on the latest life stages when frailty often appears. We discuss three dimensions of age that would enrich medical sociology: as a dimension of inequality akin to race and gender with similar health effects, as an institution interacting with the medical one, and as an identity-again, akin to race and gender-through which people process their experiences in ways that affect health.

Regulating, fostering and preserving: the production of sexual normates through cognitive ableism and cognitive othering

People with cognitive disabilities are commonly positioned as risky sexual subjects. This article discusses the discursive production of sexual normates in the form of desirable and normative able-minded sexual subjects, in scientific research on the sexuality and cognitive disabilities of younger and older individuals (in particular those with dementia). We identify three interrelated discourses: regulating sexuality; fostering sexuality; and preserving sexuality. The first of these, regulation, pathologises sexuality of people with cognitive disabilities as faulty and in need of restriction. The second discourse, fostering, is more affirmative and argues for educating for a 'healthy' sexuality of people with cognitive disabilities, to mitigate risks of abuse. This discourse is more salient with younger people. The third discourse, preservation, in contrast, is more visible with older people with dementia and affirms sexuality so long as it is consistent with a 'genuine' or 'authentic' sexuality of the past. In conclusion, scientific research reinforces the cultural ideal of the rational and autonomous individual (and as such the mature/adult) capable of making independent decisions and engaging in healthy, good sex, based on stable sexual identities. Findings demonstrate how age intersects with cognitive ableism to intensify the cultural anxiety that exists around the sexualities of people with cognitive disabilities.

Older adults' embodied experiences of aging and their perceptions of societal stigmas toward sexuality in later life

RATIONALE

Sexuality is an important part of life for many older adults, and research is beginning to demonstrate the diversity of sexual agency and sexual expression in middle and later life. There is a lack of qualitative research, however, on the lived experiences of older adults concerning this topic.

OBJECTIVE

The aim of this study was to explore older adults' embodied experiences and perceptions of aging in relation to sexuality, and whether differences based on gender and/or sexual orientation exist amongst this participant group.

METHODS

Thirty-one United Kingdom adults aged 66-92 years (M age 74; 16 women and 15 men) completed in-depth semi-structured interviews; these were analysed using reflexive thematic analysis.

RESULTS

Three themes were generated. Changing Body; Media and Society; and "I still feel the same inside." Older adults reported being seen as "past it" and irrelevant, but some saw this as freedom from societal expectations. Health and functional aspects of their bodies were prioritised over aesthetics and "overly glamourous" older celebrities were rejected as appropriate role models. Aging "well" meant resisting decline, but outward appearances did not always align with internal perceptions and experience. Many of our participants had internalised narratives of "successful aging" that centred around retaining youth.

CONCLUSIONS

Findings support affirmative aging narratives. Aging as a time of difference without a sense of loss or decline. Implications for how later life is presented in advertising and service provision are discussed.

Aging sexual stereotypes and sexual expression in mid- and later life: examining the stereotype matching effect

OBJECTIVES

Ageist sexual stereotypes may prohibit midlife and older adults from achieving sexual wellness when stereotypical beliefs about aging, sex, and intimacy become internalized over the life course (i.e. stereotype embodiment). Though there are several studies examining the application of stereotype embodiment theory to various health behaviors, it has not been applied to sexual and intimate health across the life course. The current study examined sexual stereotype embodiment by assessing the impact of aging-sexual-stigma on sexual and intimate activity among midlife and older adults.

METHOD

In this cross sectional study, a convenience sample of 972 adults aged 50 and older was recruited via a crowdsourcing platform. Participants completed an online survey assessing attitudes about aging sexuality and their participation in a spectrum of sexual and intimate behaviors. Hierarchical linear regression was used to examine the study hypotheses related to sexual and intimate behaviors among middle age and older adults.

RESULTS

Results of this exploratory study suggest that embodiment of sexual stereotypes effects both midlife and older adults, with endorsement of aging sexual stigma predicting lower engagement in both sexual and intimate activities. Sexual embodiment had similar effects across age cohort and gender.

CONCLUSION

In addition to pervasive societal impact, ageist sexual stereotypes appear to affect individual sexual health and wellness via internalized beliefs. This provides preliminary evidence for stereotype embodiment in a novel domain, sexual health. Future research should explore potential age and cohort effects across the life course in longitudinal studies with robust measures of aging sexual stigma.

Older Iranian Muslim women's experiences of sex and sexuality: A biographical approach

Muslim women in Iran live in a patriarchal society which significantly restricts their freedom and agency. While there is a growing understanding of social change as it relates to younger Muslim women in Iran, the perspectives and experiences of older women are marginalized; mirroring problems with the intersections of age, gender, and sexuality in the West. In order to address this occlusion, this article draws on life history interviews with 30 older Muslim women living in Tehran and Karaj. Adopting a biographical life course approach, and examining pivotal moments related to sexuality in their lives, we discuss how cultural meanings and symbols of sexuality have emerged and been negotiated by these women at the life stages of puberty, first sex at marriage, and menopause. The patriarchal and religious gender order of Iran transgresses these women's human rights so that sexuality is experienced as a source of shame, stigma, and pollution, yet the women also exert forms of agency in their lives as they adopt and challenge these norms.

"Why not ask the doctor?" Barriers in help-seeking for sexual problems among older adults in Poland

OBJECTIVES

Existing data show that older adults rarely seek medical or psychological help for their sexual problems. The current study explores the barriers in help-seeking faced by older adults from a conservative Central European country.

METHODS

Thirty semi-structured interviews were conducted among Polish residents (16 women, 14 men) aged 65-82. The data were analysed thematically, with coding validity and analytical rigour ensured throughout the process.

RESULTS

Three main barriers in seeking help were identified: not recognising sexual problems; fear for the doctors' disapproval; lack of knowledge how to access appropriate services. The data reveal that the participants' main concern is that health providers would dismiss their problems as trivial. Older adults from Poland suffer from the lack of fundamental knowledge about their sexual functioning.

CONCLUSIONS

Employing qualitative methodology to understand why older adults from conservative cultures do not seek help for their sexual problems might contribute to existing literature by providing evidence from different cultural settings, and help to develop and implement appropriate interventions. Implications related to health providers' attitude towards older patients' concerns are further discussed.

Sex for seniors: how physicians discuss older adult's sexuality

Background

This study examined physicians’ perspectives on sexuality in later life.

Methods

In-depth interviews were conducted among 38 physicians with various specialties and they were asked to discuss sexuality in later life within the medical context.

Results

Perceptions on older adult’s sexuality emerged from the interviews were organized into three themes: What, why and how. What, referred to physician’s definition to what role sexuality plays in later life and what is considered sex. Why, referred to the reasons why physicians assumed older adults experience sexual difficulties, and how these assumptions effect the diagnostic process. How, referred to how sexual difficulties were treated by physicians. Physicians employed a bio-medical approach when treating older, as compared to young adults with sexual dysfunction.

Conclusions

The findings highlight a potential for differential treatment of older adults, based on age, rather than on other objective reasons.

"Femme ain't frail": (re)considering femininity, aging, and gender theory

We analyze the intersection of femme, aging, and later-in-life disability by using the popular, contemporary slogan "femme ain't frail" to explore who is erased, excluded, and overlooked when fem(me)ininity is conceptualized as strong, fierce, and chosen. Building from Lisa Walker's position that dominant femme discourse marginalizes the experiences of aging femmes, we analyze the narratives of Amber Hollibaugh, Joan Nestle, Mary Frances Platt and Sharon Wachsler to explore femme experiences of later-in-life disability and aging, and to further trouble existing, popular constructions of femme identity that are predicated upon youth and able-bodiedness. We elaborate on discourses of femme and frailty, bringing them together to explore the ways femme is or, can be, frail. Insofar as femme is located in vulnerability, and vulnerability is associated with frailty, we see how femme might, indeed, be frail, and why this relationship is important to explore, not disavow. We contend that considerations of the frailty of fem(me)ininity can challenge the ageist and ableist orientation of contemporary femme politics and the broader cultural devaluation of fem(me)ininity.

Mapping the Perceived Sexuality of Heterosexual Men and Women in Mid- and Later Life: A Mixed-Methods Study

Introduction

There is currently limited research that examines the meaning of sexuality at midlife and later life.

Aim

This study investigates how heterosexual men and women in mid- and later life perceive their sexuality and the factors that influence it.

Methods

Group concept mapping was used to produce a conceptual map of the experience of sexuality for heterosexual adults ages 45 years and above. Group concept mapping data were collected using 6 open-ended survey questions that asked about sexuality, intimacy, and desire. Thematic analysis was used to examine how participants perceived their sexuality to have changed as they aged. Thematic analysis data were collected using a single open-ended survey question.

Main Outcome Measure

Statements generated from 6 of the open-ended survey questions were rated by participants using a 5-point Likert scale for how important participants felt that each statement was to themselves personally. Participants responses to the seventh open-ended survey question were examined using thematic analysis to understand whether participants felt that their sexual experiences had changed over time and, if so, how they had changed.

Results

Eight themes were identified across the different phases of group concept mapping. These were, in order of importance, partner compatibility, intimacy and pleasure, determinants of sexual desire, sexual expression, determinants of sexual expression, barriers to intimacy, sexual urges, and barriers to sexual expression. Seven areas of change were identified in terms of perceived changes to sexuality with age. These included changes to perspective, relationship dynamics, environment, behavior, body/function, sexual interest/desire, and sexual enjoyment.

Conclusion

The results highlight the prioritization of interrelationship dynamics in mid- and later life sexuality over sexual functioning and sexual urges. These findings may facilitate the development of new perspectives on how sexuality is experienced in the later years and provide new avenues for intervention in situations where sexual problems arise.

Macleod A, Busija L, McCabe M. Mapping the Perceived Sexuality of Heterosexual Men and Women in Mid- and Later Life: A Mixed-Methods Study. Sex Med 2019; 8:84–99.

"At My Age … ": Defining Sexual Wellness in Mid- and Later Life

Sexual wellness is integral to quality of life across the life span, despite ageist stereotypes suggesting sexual expression ends at midlife. However, conceptualizing sexual wellness in mid- and later life is complicated by a dysfunction-based narrative, lack of a sex-positive aging framework, and existing measures that are age irrelevant and limited in scope. This study aimed to address these limitations by providing a conceptualization of sexual wellness grounded in definitions from midlife and older adults. A sample of 373 midlife and older adults (M = 60, SD = 5.84) in the United States provided a definition of sexual wellness. Using thematic analysis, multiple researchers coded qualitative responses, and results suggested a biopsychosocial-cultural framework. Findings reflect that midlife and older adults provide multifaceted definitions inclusive of various behavioral experiences, including disengaging from sex. They are also keenly aware of physical and psychological limitations and strengths, and emphasize mutual experiences and synchronicity. Midlife and older adults also reflect on age, drawing comparisons to different phases of life and often displaying adaptability in adjusting expectations. When conceptualizing sexual wellness in this population it is imperative to capture this multidimensionality, include those who are not actively engaging in sex, and be aware of the influence of ageist and dys/function narratives.

How do older people discuss their own sexuality? A systematic review of qualitative research studies

This study captured older people's attitudes and concerns about sex and sexuality in later life by synthesising qualitative research published on this issue. The systematic review was conducted between November 2015 and June 2016 based on a pre-determined protocol. Key words were used to ensure a precise search strategy. Empirically based, qualitative literature from 18 databases was found. Twenty studies met the inclusion criteria. Thomas and Harden's thematic synthesis was used to generate 'analytical themes' which summarise this body of literature. Three main themes were identified: (a) social legitimacy for sexuality in later life; (b) health, not age, is what truly impacts sexuality, and (c) the hegemony of penetrative sex. The themes illustrate the complex and delicate relation between ageing and sexuality. Older adults facing health issues that affect sexual function adopt broader definitions of sexuality and sexual activity.

Sexual dysfunction or sexual discipline? Sexuopharmaceutical use by men as prevention and proficiency

In the first decade following Viagra’s appearance, feminist and critical scholars documented the sexuopharmaceutical expansion of definitions of erectile dysfunction and its target consumer. As we approach Viagra’s 30th anniversary, while feminist scholarship on the medicalization of sexuality flourishes, the impact of erectile medication has received much less attention. This paper (re)casts a critical lens on popularized erectile medication sexual health messages in the context of current pharmaceutical marketing targeting users as neoliberal aspirational sexual subjects. Discourse analysis reveals that online advice about erectile medication use leverages the increased preoccupation with health risk assessment and prevention technologies to normalize erectile dysfunction as a risk for all men, irrespective of age and health status. Erectile dysfunction is presented as inevitable, pathological, and requiring vigilance and expert consultation; penile performance acts as a predictive health gauge. Erectile medication users are situated as model masculine subjects, (medically) augmenting sexual proficiency in romantic or sexually experimental contexts.

Physicians' response to sexual dysfunction presented by a younger vs. An older adult

AIM

The aim of this study is to determine whether physicians have an age bias regarding sexual dysfunction presented by older vs. younger patients in terms of attributed diagnosis, etiology, proposed treatment and perceived prognosis.

METHOD

An on-line survey consisting of one of two, randomly administered, case vignettes, which differed only by the age of the patient (28 or 78). In both cases, the patient was described as suffering from occasional erectile dysfunction with a clear psychosocial indication. A total of 236 physicians responded to the survey. Overall, 110 physicians received an "old" vignette and 126 physicians received a "young" vignette.

RESULTS

Even though both cases presented with a clear psychosocial etiology, the "older" vignette was more likely to be diagnosed with erectile dysfunction whereas the "younger" vignette was more likely to be diagnosed with performance anxiety. The "older" vignette's dysfunction was more likely to be attributed to hormonal changes, health problems and decreased sexual desire. Physicians were more likely to recommend testosterone replacement therapy (TRT) and PDE5 inhibitors (PDE5i; such as Sildenafil; Vardenafil; Tadalafil) as well as a referral to urology to the "older" vignette. In contrast, the "younger" vignette was more often referred to a sexologist and received a more positive prognosis than the older patient.

CONCLUSIONS

This study demonstrates an age bias among physicians regarding sexuality in later life. Of particular note is the tendency to prescribe PDE5i to the older patient, despite the clear psychosocial indication presented in the case vignette. Copyright © 2016 John Wiley & Sons, Ltd.

Sexual Assault and Justice for Older Women: A Critical Review of the Literature

This article provides a critical review of current literature on the sexual assault of older women-including an exploration of the specific features and emotional and physical impacts of older women's experiences-and highlights current gaps and future directions for research, practice, and theory. A review of the literature indicates that older women constitute only a small proportion of victim/survivors. However, there is evidence to suggest that existing research underestimates the extent of this issue. Older women face particular barriers to disclosure and accessing the justice system, resulting in their experiences remaining hidden. Many of these barriers also contribute toward older women's experiences being ignored, dismissed, or downplayed by potential bystanders. These barriers are explored in depth in this article and include cultural context, ageism, cognitive and health impairments, and living in a residential care setting. Responding to, and preventing, the sexual assault of older women requires a tailored approach-and we currently lack sufficient insight to develop appropriate responses. In closing, this article considers how we might work toward achieving "justice" for older women victim/survivors.

The Importance of Sex and the Meaning of Sex and Sexual Pleasure for Men Aged 60 and Older Who Engage in Heterosexual Relationships: Findings from a Qualitative Interview Study

That many older individuals continue to engage in various forms of sexual expression well into later life is now well established in the literature. To date, however, only a small body of qualitative research has examined older men's experiences and understandings of sex in later life. Likewise, the ways in which older men's discussions on sex may be used as an avenue for "doing" masculinity remain underexplored. Older men are particularly interesting in this regard, as they inhabit an increasingly subordinated position in relation to hegemonic masculine ideals because of their age. To what extent might this limit or, alternatively, open up the possibilities for sexual expression and subjectivity in later life? Drawing on a subset of findings from Sex, Age, and Me: A National Study with Australian Women and Men Aged 60 and Older, data from qualitative interviews with 27 Australian men were explored in this article. The first Australian study of its kind, we argue that older men who engage in heterosexual relationships draw on a diverse and complex array of discursive positions regarding sex, relationships, and masculinity in making sense of their experiences of sex in later life. Older men are a heterogeneous group, and their experiences and understandings of sex do not simplistically follow "decline" or "success" narratives of aging. The findings of this research build upon and extend emerging research illustrating the centrality of intimacy to older men's sexual lives, while simultaneously highlighting the ways in which the body and discursive constructions of sex intersect to shape older men's sexual subjectivities.

'Basically, it's sorcery for your vagina': unpacking Western representations of vaginal steaming

Vaginal steaming made global headlines in 2015 after its promotion by celebrity Gwyneth Paltrow. One of many female genital modification practices currently on offer in Anglo-Western nations - practices both heavily promoted and critiqued - vaginal steaming is claimed to offer benefits for fertility and overall reproductive, sexual or even general health and wellbeing. We analysed a selection of online accounts of vaginal steaming to determine the sociocultural assumptions and logics within such discourse, including ideas about women, women's bodies and women's engagement with such 'modificatory' practices. Ninety items were carefully selected from the main types of website discussing vaginal steaming: news/magazines; health/lifestyle; spa/service providers; and personal blogs. Data were analysed using thematic analysis, within a constructionist framework that saw us focus on the constructions and rationalities that underpin the explicit content of the texts. Within an overarching theme of 'the self-improving woman' we identified four themes: (1) the naturally deteriorating, dirty female body; (2) contemporary life as harmful; (3) physical optimisation and the enhancement of health; and (4) vaginal steaming for life optimisation. Online accounts of vaginal steaming appear both to fit within historico-contemporary constructions of women's bodies as deficient and disgusting, and contemporary neoliberal and healthist discourse around the constantly improving subject.

Sex, desire and pleasure: considering the experiences of older Australian women

Older age is often associated with asexuality. That is, older individuals are not viewed as desiring of sex, nor as sexually desirable to others. Broader social and cultural norms that downplay women's sexual desire and agency further compound these phenomena. Whether this popular image accurately reflects older women's sexual desires, behaviour and capacity to experience pleasure is unclear. Drawing on semi-structured interviews with 43 partnered Australian women aged 55–81, this article considers women's sexual experiences and desires in older age. The findings of our research confirm that older women's experiences of sex and sexual desire are diverse and fluid. Some of the factors that influenced participants’ sexual behaviour and desire will be considered in this article, as will their understandings of what “counts” as sexual satisfaction and “successful sex”. The factors affecting sexual behaviour and desire also influence the way in which women are able to negotiate sexual interaction with their partners. Participants expressed a need for education and resources in order to gain greater control and to make autonomous choices over their sexual experiences, desire and ability to give and receive pleasure. The implications of these findings for practitioners are also considered.

Are "anti-aging medicine" and "successful aging" two sides of the same coin? Views of anti-aging practitioners

OBJECTIVES

This article analyzes data from interviews with anti-aging practitioners to evaluate how their descriptions of the work they do, their definitions of aging, and their goals for their patients intersect with gerontological views of "successful aging."

METHOD

Semistructured interviews were conducted with a sample of 31 anti-aging practitioners drawn from the directory of the American Academy for Anti-Aging Medicine.

RESULTS

Qualitative analysis of the transcripts demonstrate that practitioners' descriptions of their goals, intentionally or unintentionally, mimic the dominant models of "successful aging." These include lowered risk of disease and disability, maintenance of high levels of mental and physical function, and continuing social engagement. Yet, the means and modes of achieving these goals differ markedly between the two groups, as do the messages that each group puts forth in defending their positions.

DISCUSSION

Anti-aging practitioners' adoption of the rhetoric of successful aging reflects the success of successful aging models in shaping popular conceptions of what aging is and an ethos of management and control over the aging process. The overlap between anti-aging and successful aging rhetoric also highlights some of the most problematic social, cultural, and economic consequences of efforts made to reconceptualize old age.

Sexual improvement as if your health depends on it: An analysis of contemporary sex manuals

Adding to a small but growing feminist literature, this article critically examines popular, contemporary American sex manuals from a feminist social constructionist perspective, focusing specifically on how these manuals construct gender and sexual norms. With notable exceptions, the majority of these manuals are geared toward white, heterosexual, middle-class, able-bodied, and cisgendered audiences. We argue that in addition to positioning sexual activity as a biological, essential (albeit gendered) human need, and as the ultimate path to individual fulfillment and empowerment, a new rationale for the importance of sex (and working on sexual improvement) is now prominent in contemporary sex manuals. Reflecting the “healthicization” of sex in the post-Viagra era, authors frame frequent pleasurable sexual activity as an important factor in the maintenance of health and wellness, an argument that gives further weight to the importance of “sex work” as a fundamental aspect of particularly women’s work in heterosexual relationships. These findings are in keeping with a growing body of literature that highlights the rise of the “sex as health” discourse as well as literature examining the growing pressure to master, improve, and work on sex.