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SEXUAL LIFE IN OLD AGE

PRESENTED BY SIVA KUMAR

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ATTITUDES

 

2.regarded with humour 3.disgust

Idea of sexuality in late life has been

1.denied

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ATTITUDES

Denial of sexuality in parents and grand parents becomes denial of sexuality in all older individuals

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REVOLUTIONS

 

1.Hormone replacement Therapy 2.treatment of ED

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SEXUAL BEHAVIOURS IN LATE LIFE

   

Middle aged/older individuals continue to be sexually active

Modest decrease in sexual activity

Older men are sexually more active than older women

Individuals with steady partners are more active than single

individuals

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Statistics

   

75+ 6% M 4 %F

2024

45+ ¾ remained sexually active

45-59 24% M 18% F

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Frequency

Men majority + Female 77% - Is it Imporant? 60 M 35% F -Yes

45-59 50% once a week 60-74 10% once a week

Masturbation:

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Sexual response cycle

   

IV Orgasm V resolution

I stage desire II stage excitement arousal

III stage plateau

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Physiological changes in menopause(Women)

   

 

Atrophy of urogenital tissue Decreased vaginal size

Decreased vaginal lubrication Decreased erotic sensitivity of nipple,clitoral,vulvartissue Decreased sexual desire Increased time to sexual arousal

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Menopausal symptoms

   

Excess fatigue Decreased libido

Hot flashes Head/neck aches

Mood changes

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Men

 

Less frequent Less durable

Less reliable Volume of ejaculate-decreased

Decreased anticipatory arousal More physical stimulation

ERECTION

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Men

 

Refractory period in older men varies from hours to days Young people -minutes

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Attitudes

   

Feels less sexy Feel it is inappropriate /harmful

Over reaction to normal changes Decreased sexual activity

Lose self confidence

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+ side

  

Decreased responsibility to wards children Empty nest syndrome

Decreased anxiety –no pregnancy

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SEXUALITY IN LONG TERM CARE

   

Knock before enter Hair styling/manicuring facilities

Privacy for couples Facilitate conjugal/home visit

DO NOT DISTURB signs

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SEXUAL DYSFUNCTION IN LATE LIFE

   

 

Inhibited orgasm

Dyspareunia

Physician-fail to ask about sexual function-remains untreated

Men-ED ,50 %, 40-70 years Women-

Hypoactive sexual desire

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Sexual dysfunction in Late Life

   

 

Psychiatric problems: Anxiety,Depression,psychosis

Substance abuse Fear of death-H/o MI,dyspnea Sensitivity to loss of physical appearance Control of bodily functions(continence)

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Sexual dysfunction in late life

   

Life stressors

Loss of loved one,

Divorce Financial/Occupational stressors Major Health scare

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Sexual dysfunction

   

 

 

DM,PVD Secondary effects:

Fatigue, pain,disability Medications:betablockers ,diuretics

Parkinson’s disease Primary effects:

Major risk factors DM,Peripheralvascular disease

CA,pulmonary diseases,stroke,dementia,

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Assessment

   

 

Current sexual functioning Attitude towards sexuality Attitude towards any partner

Comprehensive medical,psychiatric& sexual history Sexual History:

Prior sexual experiences

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Treatment

   

 

Analgesics-pain Inhalers-shortness of breath

Physiotherapy-joints, muscles 4.treat depression anxiety/psychosis

1.Education-Reassurance 2.Shift focus from intercourse to foreplay

3.Maximize rehabilitation and palliative treatment

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Treatment

   

Alternative regimen Drug holidays

Medication side effects Wait for tolerance

Decrease dose

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Antidepressant induced ED

 

 

Stop medications

1.Antidotes:

yohimbine,amantadine,cyproheparidine,bethanecol,methylphenid ate, buspirone,bromocriptine

Other antidepressants:

1.Bupropion,nefazodone,mirtazapine,trazodone

Erectogenic agents:

Sildenafil,vardenafil,tadalaifil

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Sex Therapy

   

Cognitive therapy Sensate focus

Both partners Brief educational/supportive counselling

Intensive couples therapy

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Cognitive Therapy

   

 

All or Nothing Thinking: I must achieve instant erection or the whole thing is pointless

Replace negative thoughts with realistic/hopeful statements, affirmations of success

Distorted attitude practical attitude Catastrophic Thinking:

“If I don’t achieve erection I will be rejected by partner”

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Sensate Focus

 

Relaxation techniques with non pressured sensual touching Gradual progression to genital stimulation/intercourse

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ED

6.Penile implants

4.PDE-5 inhibitors 5.Vaccum constriction device

1.testosterone 2.Penile intacavernosalinjection-alprosatidal

3.Urethral suppository

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Premature Ejaculation

 

Squeeze, Start-Stop techniques Dapoxetine with or without sildenafil

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Hypoactive sexual desire disorder

 

Poor self image/negative societal attitudes-sex education& counselling

Estrogen replacement therapy

Testosterone replacement therapy

Siledenafil

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Female orgasmic disorder

Individual sex therapy:

-Relaxation techniques+sensualself stimulation/masturbation with

vibrator

-Increase clitoral stimulation

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Dyspareunia

   

 

Treat medical condition: Vulvitis

OG opinion Estrogentreplacement therapy Sex therapy Sensual excess;massage,foreplay,oralsex

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Ways to enhance sexual function in late life

   

4.foreplay 5.treat medical problems

1.+attitude 2optimal Health No tobacco, alcohol

3.communication with partner

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Ways to enhance sexual function in late life

   

9.Avoid unrealistic expectations 10.Explore positions

6.Before sex take pain killers or inhalers 7Females-Estrogens,cream

8Identify problematic medication

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THANK YOU

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