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
ATTITUDES
Denial of sexuality in parents and grand parents becomes denial of sexuality in all older individuals
REVOLUTIONS
1.Hormone replacement Therapy 2.treatment of ED
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
Statistics
75+ 6% M 4 %F
2024
45+ ¾ remained sexually active
45-59 24% M 18% F
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:
Sexual response cycle
IV Orgasm V resolution
I stage desire II stage excitement arousal
III stage plateau
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
Men
Less frequent Less durable
Less reliable Volume of ejaculate-decreased
Decreased anticipatory arousal More physical stimulation
ERECTION
Men
Refractory period in older men varies from hours to days Young people -minutes
Attitudes
Feels less sexy Feel it is inappropriate /harmful
Over reaction to normal changes Decreased sexual activity
Lose self confidence
+ side
Decreased responsibility to wards children Empty nest syndrome
Decreased anxiety –no pregnancy
SEXUALITY IN LONG TERM CARE
Knock before enter Hair styling/manicuring facilities
Privacy for couples Facilitate conjugal/home visit
DO NOT DISTURB signs
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
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)
Sexual dysfunction in late life
Life stressors
Loss of loved one,
Divorce Financial/Occupational stressors Major Health scare
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,
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
Treatment
Alternative regimen Drug holidays
Medication side effects Wait for tolerance
Decrease dose
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
Sex Therapy
Cognitive therapy Sensate focus
Both partners Brief educational/supportive counselling
Intensive couples therapy
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”
Sensate Focus
Relaxation techniques with non pressured sensual touching Gradual progression to genital stimulation/intercourse
ED
6.Penile implants
4.PDE-5 inhibitors 5.Vaccum constriction device
1.testosterone 2.Penile intacavernosalinjection-alprosatidal
3.Urethral suppository
Premature Ejaculation
Squeeze, Start-Stop techniques Dapoxetine with or without sildenafil
Hypoactive sexual desire disorder
Poor self image/negative societal attitudes-sex education& counselling
Estrogen replacement therapy
Testosterone replacement therapy
Siledenafil
Female orgasmic disorder
Individual sex therapy:
-Relaxation techniques+sensualself stimulation/masturbation with
vibrator
-Increase clitoral stimulation
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1000 SLIDES
INCLUDING KAMASUTRA AND TANTRA SEX
SEX COACH CERTIFICATE
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TILL 03-01-2025
Dyspareunia
Treat medical condition: Vulvitis
OG opinion Estrogentreplacement therapy Sex therapy Sensual excess;massage,foreplay,oralsex
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
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
THANK YOU
GET 19 RECORDINGS ON SEX THERAPY
1000 SLIDES
INCLUDING KAMASUTRA AND TANTRA SEX
SEX COACH CERTIFICATE
JUST RS.3,999.00
TILL 03-01-2025
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