Why Do Older Adults Have Sex? Approach and Avoidance Sexual Motives Among Older Women and Men

Management of HIV in the older adults: Clinical and public health challenge

As a result of significant advances in antiretroviral therapy (ART), the number of people living with human immunodeficiency virus (PLWH) who are alive well into their senior years has increased significantly in recent years. While increased life expectancy is a highly desired outcome for PLWH, it brings with it a number of challenges that are only now starting to be understood and fully appreciated. These challenges include higher rates of co-morbidities, polypharmacy, drug side effects, and cognitive deficits, as well as numerous psychosocial issues such as stigma, loneliness, and depression. Older PLWH also face challenges related to housing, health insurance, and long-term care. This review will discuss many of the challenges faced by older PLWH and present clinical and public health responses with suggested interventions that may improve outcomes for this population.

Romantic Attachment, Sex Motives and Sexual Difficulties in Emerging Adults: The Role of Childhood Interpersonal Victimization

A growing body of research has revealed that many emerging adults (i.e., aged 18 to 25) experience sexual difficulties. Past studies have emphasized the need to examine sexual difficulties by accounting for sex motives (i.e., reasons for engaging in sex) and by using a trauma-focused or attachment-based framework. This study examined the role of sex motives in the associations among attachment insecurities (anxiety, avoidance) and sexual difficulties in emerging adults, and assessed whether these links varied on the basis of low or high exposure to childhood interpersonal victimization (CIV) (i.e., 0-3 different types of CIV or 4 or more types of CIV). A sample of 437 French-Canadian emerging adults completed validated questionnaires online. Path analyses revealed that participants with higher attachment anxiety were more likely to endorse the partner approval sex motive, which was related to more sexual difficulties. Participants with higher attachment avoidance were less likely to endorse the pleasure sex motive, which was associated with more sexual difficulties. Results indicated a significant effect of CIV showing that some indirect effects were significant only in participants who reported high CIV exposure. Results suggest that addressing sex motives using an attachment- and trauma-focused framework might help understand, prevent and treat sexual difficulties among emerging adults.

Orgasm and Faking Orgasm: Heterosexual Interactions in China

This article examines the prevalence and correlates of orgasm and faking orgasm in the last year among a representative sample of Chinese men and women. Existing research on orgasm in China has largely been confined to medical research. To our knowledge, no published studies have examined faking orgasm in a Chinese context. These data come from the Chinese Health and Family Life Survey (CHFLS) conducted in 1999 and 2000. We used multivariable logistic regression to identify independent correlates of orgasm and faking orgasm among 1496 women and 1497 men, ages 20-64. In accounting for orgasm and faking orgasm in China, we found evidence that men and women are trying to manage social expectations and to act in accordance with gender expectations, consistent with research in other countries. Results provide insight into how specific sexual practices (e.g., oral sex) and interactional pressures (e.g., insecurity) are correlated with orgasm and faking orgasm. Findings pave the way for future research on the presence of gender inequality as evidenced through lower orgasm rates among women and higher rates of faking orgasm. These findings have implications for how we conceptualize and study gendered and interactional components of sex, which are often overlooked in research and programmatic efforts in China.

Mediating effects of ageism and knowledge on the relationship between contact with older adults and attitudes toward older adults' sexuality among nursing students

BACKGROUND

Healthcare professionals often ignore sexuality in aging and avoid discussing related topics, especially in China. Nursing students, as future professionals, can address the sexuality of older adults encountered in clinical practice by establishing positive attitudes toward aging sexuality. Previous studies have demonstrated that contact has positive impacts on nursing students' attitudes toward aging sexuality. However, little is known about the mechanism underlying this relationship between contact and attitudes.

OBJECTIVES

To explore the mediating effects of ageism and knowledge on the relationship between contact and nursing students' attitudes toward aging sexuality.

DESIGN

This was a cross-sectional study.

SETTINGS

The study was conducted at a nursing school in Hefei city, China.

PARTICIPANTS AND METHODS

614 nursing students completed online-administered questionnaires measuring the level of contact with older adults, ageism, knowledge, and attitudes toward aging sexuality. Data were analyzed using SPSS and AMOS.

RESULTS

The mean scores for knowledge and attitudes toward aging sexuality were 85.70 (SD = 16.39) and 104.91 (SD = 14.88), respectively. Overall, our findings confirmed that these hypotheses were accepted. Ageism (β = -0.079, P = 0.007) and knowledge (β = -0.070, P < 0.001) mediated the relationship between contact and attitude.

CONCLUSION

Given the mediating role of ageism and knowledge in the relationship between contact and attitude, reducing ageism and enhancing knowledge are vital to changing students' attitudes, including integrating ageism and aging sexuality knowledge learning into the nursing curriculum and creating opportunities for contact with older adults. The frequency and quality of contact between nursing students and older adults can be improved by rationalizing the internship duration, tasks, and assessment objectives of placements on geriatric wards and by the role of clinical faculty role models in cultivating positive attitudes toward aging sexuality.

Why Hungarians Have Sex: Development and Validation of a Brief 15-Item Instrument (YSEX?-15H)

The present study developed a brief version of the Hungarian Why Sex? questionnaire (Meskó et al., 2022). The study was in part based on previously reported data obtained from several samples (N = 6193; 1976 men, 4217 women). Using Mokken Scaling Procedure, Item Response Model and redundancy analysis indicated that retaining three summary scales comprising five items each was the optimal solution for the brief version. The validity of the brief scale was tested with the Sexual System Functioning Scale (SSFS), the Experiences in Close Relationships Scale-Short Form (ECR-S) and, the Hungarian version of the Attachment Style Questionnaire (ASQ-H; n = 297, 127 men, 170 women). In addition, correlations between the long and brief versions of YSEX? with sociosexual orientation (SOI-R) and the five-factor personality construct (BFI-S) were compared (n = 1024, 578 women, 446 men). The results suggest that the three summary scales of the Hungarian 15-item Form of the Why Sex Questionnaire (YSEX?-15H) provide reliable and valid measures of the previously affirmed three broad sexual motives (Personal Goal Attainment, Relational Reasons, Sex as Coping). The Relational Reasons summary scale was associated with secure emotional and sexual attachment. The Personal Goal Attainment and Sex as Coping summary scales showed coherent patterns of associations with the emotional and sexual aspects of secondary attachment strategies (over- and under-functioning). The YSEX?-15H offers both researchers and practitioners a concise and useful instrument for the assessment of sexual motivation.

Discomfort in Discussing Sexual Issues: Developing a New Scale for Staff at Long-Term Care Facilities for Older Adults

Interviews reveal that many health professionals working with older adults are uncomfortable discussing sexual issues with those under their care. Nevertheless, to date, discomfort in discussing sexual issues with older adults has not been empirically investigated. To facilitate exploration of this subject, the current study evaluated the psychometric properties of a new measure: The Discomfort in Discussing Sexual Issues (DDSI) with Older Adults scale. The study was conducted via online survey among 127 long-term care staff (e.g., nurses, physicians, physical therapists, social workers, speech therapists, occupational therapists) serving older adults. A confirmatory factor analysis confirmed the DDSI scale's structure as a single, four-item construct. More conservative attitudes regarding sexuality in later life were associated with higher DDSI scores. In addition, DDSI scale scores were negatively correlated with knowledge about sexuality in later life and educational level. Findings indicate that the DDSI has good psychometric properties, as reflected by its high reliability and adequate validity, making it a useful assessment tool for future research. [Journal of Gerontological Nursing, 48(9), 27-37.].

Eradicating ageism through social campaigns: An Israeli case study in the shadows of the COVID-19 pandemic

This study examined three social campaigns for the eradication of ageism that were undertaken in Israel during the COVID-19 pandemic (April, 2020-May, 2021). The documentation and analysis of the campaigns were undertaken via the lens of the Theory of Change and Five Key Principles for social campaigns: planning strategically, communicating effectively, fostering community engagement, implementing key activities, and using research. We conducted desk reviews and qualitative interviews with the campaigns' organizers. The Theory of Change implemented by the campaigns targeted self-ageism among independent older people and/or employers of older adults. All campaigns emphasized "active aging" and "successful aging," to decrease (self)-ageism. The focus on one dimension of active and positive aging may result in ageism and exclusion of older people who do not fit into the category of independent and active people. The complex timing of the campaigns had influenced the degree of implementation of the five key principles. The joining of forces of different organizations and the employment of more diverse representations of old age, may facilitate the achievement of campaign goals. Finally, an empirical evaluation of social campaigns' efforts is still necessary to gather evidence about the effectiveness of social campaigns.

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.

Perceived Changes in Sexual Interest and Distress About Discrepant Sexual Interest During the First Phase of COVID-19 Pandemic: A Multi-Country Assessment in Cohabiting Partnered Individuals

Due to COVID-19 pandemic, different restrictive measures in terms of physical distancing and lockdowns have been introduced in most European countries, affecting all facets of social life. Currently, little is known about how partnered individuals perceive changes in their sexual life during this complex emergency. This study explored retrospectively assessed changes in sexual interest for one's partner and levels of distress related to perceived sexual interest discrepancy during the first phase of the pandemic in a large-scale online sample of partnered individuals (n = 4813; M_age = 38.5 years, SD = 10.74) recruited between May and July 2020 in seven European Union countries and Turkey. We also examined the possible role of approach/avoidance motives for sex in reported changes in sexual interest and associated distress. Most participants (53%) reported no change in their sexual interest during the pandemic, followed by those who reported an increase (28.5%). The pattern was similar across the eight countries. Distress about discrepant sexual interest, which was only weakly related to changes in sexual interest, was significantly associated with relationship quality and emotional closeness with a partner, coping with and worrying about the pandemic, and specific motivation for sex. In contrast to avoidant and relationship-focused approach motivation, ego-focused approach motivation was related to stable sexual interest during the pandemic. The current study contributes to the understanding of the link between sexual interest and complex emergencies. Considering that the COVID-19 pandemic continues, the reported experiences and perceptions are prone to change.

‘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.

Factors Associated with Four Sexual Behaviors among Married/Partnered Women Ages 60 and Older in the United States

Women ages 60 and older vary in sexual behaviors. This study examined the prevalence of vaginal intercourse, outercourse, and receipt and performance of oral sex reported among 461 married/partnered women age ≥ 60 years in the United States and factors associated with these four sexual behaviors. Using data from the National Social Life, Health, and Aging Project, associations between participants’ socio-demographics, health indicators, sexual perceptions, communication, and sexual behaviors were examined. In the past year, 53.6% reported having vaginal intercourse, 56.0% outercourse, and 21.7% receiving and 20.6% performing oral sex. Women with depressive symptomology were less likely to report intercourse and outercourse (p < 0.05). Women endorsing pleasurable sex as necessary to maintain relationships were more likely to report all four behaviors (p < 0.01). Women who communicated openly with partners were more likely to report intercourse (p = 0.002), outercourse (p = 0.001), and performing oral sex (p = 0.025). Findings may inform strategies about positive sex perceptions and strengthening partner communication.

"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.

Geographical variations and factors associated with recent HIV testing prevalence in Ghana: spatial mapping and complex survey analyses of the 2014 demographic and health surveys

OBJECTIVE

To examine the factors associated with recent HIV testing and to develop an HIV testing prevalence surface map using spatial interpolation techniques to identify geographical areas with low and high HIV testing rates in Ghana.

DESIGN

Secondary analysis of Demographic and Health Survey.

SETTING

Rural and urban Ghana PARTICIPANTS: The study sample comprised 9380 women and 3854 men of 15-49 years.

RESULTS

We found that 13% of women and 6% of men of Ghana had tested for HIV in the past 12 months. For women, being within the age groups of 15-39 years, being currently married, attainment of post-secondary education, having only one sexual partner and dwelling in certain regions with reference to greater Accra (Volta, Eastern, Upper West and Upper East) were associated with a higher likelihood of HIV testing. For men, being older than 19 years, attainment of post-secondary education and dwelling in the Upper East region with reference to the greater Accra region were significantly associated with a higher likelihood of HIV testing. The surface map further revealed intra-regional level differences in HIV testing estimates.

CONCLUSION

Given the results, HIV testing must be expanded with equitable testing resource allocation that target areas within the regions in Ghana with low HIV testing prevalence. Men should be encouraged to be tested for HIV.

Sexual satisfaction of older adults: testing the Interpersonal Exchange Model of Sexual Satisfaction in the ageing population

Having a satisfying sex life is important to older adults. Thus, this study aimed to provide information about the sexual satisfaction of older adults in a relationship, using the Interpersonal Exchange Model of Sexual Satisfaction (IEMSS) as a theoretical framework. Participants were 187 sexually active individuals (98 men and 89 women) in a romantic relationship (age 65–75 years). They were recruited using Amazon's Mechanical-Turk, and completed the Interpersonal Exchange Model of Sexual Satisfaction Questionnaire and two open-ended questions asking what they enjoyed most and least about their sexual relationship. On average, participants were highly sexually satisfied. In keeping with the IEMSS, greater sexual satisfaction was predicted by a more favourable balance of sexual rewards to costs, greater equality of sexual costs and higher satisfaction with the non-sexual aspects of the relationship. Four themes emerged regarding what participants liked most and least about their sexual relationship: emotional aspects of the relationship, physical aspects of the relationship, dyadic aspects of the relationship and age-related aspects of being sexual. None of the four themes were specific to men or women, although some gender/sex differences were found. The results paint a positive picture of the sexual relationships of older adults and support the utility of the IEMSS as a framework to understand sexual satisfaction in older adults.

Sexual functioning in 4,418 postmenopausal women participating in UKCTOCS: a qualitative free-text analysis

OBJECTIVE

Sexual well-being can contribute significantly to the overall quality of women's lives. This qualitative study aimed to examine sexual activity, functioning, and satisfaction in a large sample of postmenopausal women from the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) METHODS:: Thematic analysis was used to evaluate the free-text data of the Fallowfield Sexual Activity Questionnaire (FSAQ) completed by UKCTOCS participants at baseline before annual screening.

RESULTS

A total of 24,305 women completed the baseline FSAQ and 4,525 (19%) provided free-text data, with 4,418 comments eligible for analysis. Median age was 64 years; 65% had a partner and 22.5% were sexually active. Four interrelated themes were derived: partner availability, physical and sexual health, mental well-being, and interpersonal relationships. Primary reason for absence of sexual activity was lack of a partner, mainly due to widowhood (n = 1,000). Women discussed how partner's medical condition (27%) or sexual dysfunction (13.5%), their own physical health (18%) or menopause-related symptoms (12.5%), and prescribed medication (7%) affected sexual activity. Impact of low libido in self (16%) or partner (7%), relationship problems (10.5%) or logistics (6%), and perceptions of ageing (9%) were also mentioned. Few (3%) referred to positive sexual experiences or had sought medical help for sexual problems (6%).

CONCLUSIONS

This qualitative analysis explored postmenopausal women's perspective on their sexual functioning. Having an intimate partner and good physical health are key factors for continuation of sexual activity and satisfaction. Further sexual education for healthcare professionals is needed to raise awareness about sexuality and sexual difficulties in later life. : Video Summary: Supplemental Digital Content 1, http://links.lww.com/MENO/A426.