Academic journal article Indian Journal of Psychiatry

Clinical Practice Guidelines for Management of Sexual Disorders in Elderly

Academic journal article Indian Journal of Psychiatry

Clinical Practice Guidelines for Management of Sexual Disorders in Elderly

Article excerpt

Byline: T. Sathyanarayana Rao, Abhinav. Tandon, Shivanand. Manohar, Supriya. Mathur

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Introduction

Sexuality is an important component of emotional and physical intimacythat most men and women desire to experience throughout their lives. Although it is a fundamental driving force, human sexuality is frequently misunderstood. Even among clinicians who acknowledge the relevance of addressing sexual issues in their patients, there is a general lack of understanding of the optimal approach for sexual problem identification and evaluation.

In line with the worldwide trend the number of older adults is notable and is growing in India. The latest data by the Ministry of Statistics and programme implementation in 2016 shows that India has a total of 103.6 million elderly and their population has risen from 5.6% to 8.6% in the last 5 decades, thus this topic which is frequently neglected in the elderly takes on particular importance.

Sexual life continues to be important in later life and the elder often view sexuality as an expression of passion, affection, admiration and loyalty. Sexual activity is a means for elder to affirm physical functioning, to maintain a strong sense of identity and establish self-confidence. Studies show that sexual desire does not change with older age and it is important for both men and women. Even in elderly women after menopause, the sexual ability does not completely disappear but it is affected by sexual dysfunction, either in oneself or in the partner.

Sexual functioning is a complex combination of bio-psycho-social process which is coordinated by neurological, vascular and endocrine systems and any approach to the study of human sexuality that stresses only in one dimension is counter-productive. Recent studies suggest sexual functioning are influenced by factors representing three domains: biologic (the drive), psychological (the will), social context (the wish), and interactions between them.

Sexual function and activity are closely linked with physical health, hence understanding sexual function in the later life course is important from a medical standpoint. Poor sexual function can be due to an underlying serious health condition. For example, it has been found that erectile dysfunction in men may be a marker for asymptomatic coronary artery disease. Diabetes mellitus, which has vascular effects on blood vessels, is one of the most frequent systemic disorders associated with low sexual desire and other sexual problems in aging men whereas diabetic neuropathy can cause impaired sexual desire in women. Understanding the sexual behaviour may uncover protective health effects. Laumann and colleagues discovered an association between sexual well-being and happiness.

Numerous prescription drugs have adverse effects on sexual functioning including antidepressants especially SSRI's (causing anorgasmia, erectile dysfunction, decreased libido) and antihypertensives (Diuretics, calcium channel blockers). Moreover adverse drug effects are reported much more frequently in the aging population than in the general population. The use of prescribed medications and the rate of adverse effects of drug therapy are consistently higher in female than male elderly populations and they influence sexual responses including desire by non-specific effects on general well-being, energy levels and mood.

Psychological factors (the will) are major determinants of intensity of sexual desire. Psychological factors are independently related to sexual functioning. In addition emotional and interpersonal motivation mediates the effect of sexual drive which is characterized by willingness of person to behave sexually with a given partner and can compensate for diminished physiologic desire of sexual activity (eg as result of declining testosterone levels). Psychological condition such as depression is a risk factor for sexual dysfunction along with the medications associated with treating it. …

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