di Emine Meral Inelmen
Dipartimento di Medicina -DIMED
Cattedra di Geriatria -Direttore Prof. Enzo Manzato
Università di Padova
According to the Declaration of Sexual Rights (1) , sexuality
is an integral part of the personality of every human being,
and sexual rights are universal human rights based on the
inherent freedom, dignity, and equality of all human beings.
Unfortunately, although being aged is not sufficient reason
for being denied the joys of affection and sexuality, stereotypes
and myths still prevail that older adults are or should be
sexless and loveless. Many people assume that older adults
do not have sexual desires; are unable to make love even if
they want to; are physically unattractive, and therefore sexually
undesirable; are fragile physically and might harm themselves;
or that sexual activity in old age is perverse (!) (2) . The
perceived asexual status of later life is also known to influence
clinical practice (3): in fact, growing research literature
suggests that discussing later life sexual health issues within
medical consultations both for patients and for professionals
are embarrassing. Particularly general practitioners (GP)
are likely to have the most opportunity to initiate discussions
in this area. Another important figure who can discuss about
sexuality with the older patient is, obviously, the geriatrician
(Gr). Unfortunately GP and geriatricians (Gr) are reluctant
to take sexual histories of their senior patients, in part
for fear of embarrassing the patient, or more likely because
it is more embarrassing for the GP - Gr. Besides, GP -Gr may
not feel that the sexual issues in later age are important,
although- as for example- HIV/AIDS are becoming a severe topic
also in seniors (4).
There are currently no clear guidelines for GP - Gr on how
to approach to the sexual activity in this period of life,
and sexuality and old age are still seen by most of them as
incompatible. Hence, the aim of this article is: 1) to assess
the problems with regard to aging sexuality taking a glance
to the literature findings; 2) to explore barriers and taboos
to sexual expression in seniors; 3) to propose strategies
to foster and help GP-Gr on getting a sexual history in later
Before the 20th century, individuals often did not live beyond
the reproductive years, and sexuality of the older adults
was not an issue (5). The cultural taboo was on believing
that sex is for reproduction. Nowadays, aging baby boomers
are progressing into their 60s and 70s with a life expectancy
of an additional 16 to 20 years; however, increased longevity
without quality of life is an unpleasant burden rather than
a prize (6) (7). Thus, the hope is not only to live as long
as possible, but to improve the quality of life. Sexuality
has important implications for overall quality of life and
remains extremely important throughout the life cycle. Nonetheless,
health care providers are still biased by our ageist and sexist
society; thus they are not aware or sensitive to the sexuality
needs of older people.
Unfortunately, epidemiologic data about sexual activity in
seniors are scarce, because research in this area has typically
been youth focused (3), and it is unclear what changes can
expected as part of the aging process (8) .This leaves health
care professionals somewhat in the dark about what older adults
want and need to satisfy their sexual interests (9). Research
into such deeply personal area is fraught with difficulties
including embarrassment in one-to-one interviews, self-reporting
biases and poor response rates to postal questionnaires (10).
In fact, in the study of Nicolosi et al, 2004 (11) in 29 countries,
the percentages of response rates were very low (19%), although
the authors did not use face-to-face interviews. Nonetheless,
from the literature findings emerge that age per se does not
led to a decrease in the importance placed on sex (3), and
there is a greater desire among older individuals to love
and enjoy sexual activity, although especially psychosocial
factors, such as depression, anxiety, low self-esteem, and
problems in relationships, are responsible for sexual dysfunction
by various mechanisms in many cases in the development of
erectile dysfunction (12). Thus, contrary to the stereotypes,
myths, and societal ignorance, in the absence of social isolation
and health issues, older adults remain sexual beings with
desires, fantasies, and active sex lives: in 1382 older adults
there was found that 67% of men and 57% of women indicated
that satisfying sex is an important part of their lives (13)
. Lindau et al, 2007 (14) found that in a sample of 3005 adults
57 to 85 years of age, the majority of the subjects were engaged
in a spousal or other intimate relationships and regard sexuality
as an important part of life. Hence, although older men are
less likely than their younger counterparts to be sexually
active, sex remains important to many older men, even in the
10th decade of life; in fact, 70% of healthy 70-year-olds
continue to have regular sexual intercourse (15), although
the prevalence of sexual dysfunctions is quite high and tends
to increase with age, especially in men (11) , as confirmed
by Albersen et al, 2012 (5). In a study by Hyde et al, 2010
(8) on men aged 75-95 years, a substantial proportion were
sexually active and considered sex to be an important part
of their life; sex remained at least somewhat important to
one fifth of men aged 90 to 95 years, and of those who were
sexually active, more than 40% were dissatisfied with the
frequency of sexual activity, preferring sex more frequently.
A recent review has confirmed the studies done in the past,
suggesting that men and women remain sexually active into
their 70s and 80s (16). In this study (16) the authors suggested
that aging-related physical changes do not necessary lead
to decline in sexual functioning, and that good physical and
mental health, positive attitudes toward sex in later life,
and access to a healthy partner are associated with continued
sexual activity, in turn, regular sexual expression is associated
with good physical and mental health. Sexuality seems to stop
in the "very oldest old": an interesting study shows
that centenarians are no longer interested in sex, in contrast
to those aged 86-99 years (17), even if centenarians live
in excellent health and remain functionally independent for
most of their lives (6). However, research suggests that interest
in sex among older men has increased over the last 10 years,
possibly due to the effective and well-publicized drugs starting
with sildenafil (Viagra) in 1998 (10) , the clinically effective
oral medication for erectile dysfunction, so that a massive
and growing market for drugs and devices to treat sexual problems
targets older adults (14) . Thus it is important to focus
that -from the research findings - seems not to be a "sexual
retirement"; therefore sexual awareness among this age
group may be promoted (3).
Barriers and Taboos
There are multiple causes which create barriers and taboos
in aging sexuality. These include general physical health,
psychological causes, sexual dysfunction, and social problems.
With regard to social problems, loss of a partner through
death or incapacity of a spouse is a common scenario in the
lives of older adults. In fact, Gray and Garcia, 2012 (18)
highlight the importance of the sociocultural context within
which aging individuals express their sexuality. In reality,
sexual life in older people is affected by a complex interaction
between psycho-social factors and physiological functioning.
Barriers in aging sexuality divided by gender are summarized
in the following paragraph.
Barriers in men
Aging: Although men surviving into their 80s and 90s, continued
sexual activity is no great rarity (19) , many of them believe
that impotency is a natural consequence of the passage of
time, have fear of poor performance and of confiding it to
her spouse. Particularly those men who have had unsatisfactory
sexual relationship, age per se may be an important barrier
and taboo as it may offer an acceptable excuse to end their
sex lives (19).
Depression: When an old man cannot discuss sex with her wife,
a dysfunction is often the result; he loses self-esteem which
can lead him to depression. Depression also reduces sex drive,
sexual interest, and sexual function (20) (21).
Monotony of a repetitious sexual relationship: Another barrier
for the aging men may be a routine, stereotyped approach to
Physical unattractiveness of the spouse: an older man may
see her spouse "old and unattractive", convinced
that the reason of his is impotence is to have sex with an
old lady but forgetting that he also is "old and unattractive"(!).
At this several of the aging men who concern low sexual drive
have expressed the belief that if they were in a relationship
with a young woman, their sex drive would be intact (20).
That is why after a midlife divorce, men tend to marry women
considerable younger than themselves (20).
Hormone variables: The decline of total and free plasma testosterone
levels with advancing age roughly parallels a decline in sexual
function, affecting the level of sexual activity, libido and
potency measures. In contrast, some studies found that sexual
enjoyment was not correlated with any hormone variables (19).Thus
some authors (22) suggest that the question of "andropause"
remains controversial, and that the term should not be used,
in contrast with Werner AW, 1939 (23), who was the first author
who believed in the development of a typical climaterium syndrome
at about the age of 50, similar to that of women, usually
in less severe but perhaps more prolonged form.
Illness: Illness steals the sex lives of many of the seniors.
Fatigue reduces the enthusiasm for sex. Pain and deformity
can interfere with the ability to have sexual intercourse.
Concurrent medical illness is commonly a cause of sexual dysfunction
for aging patients (15) , altering body image and decreasing
attractiveness (12). Older men reported that elevated blood
pressure, diabetes, prostate enlargement, and cancer inhibited
their sexual activity and interest; according to these self-reports,
impotency increases with each decade, starting at age 60 (9).
Iatrogenic factors: Older people are more sensitive to side
effects of medications, in part due to underlying comorbid
disease (12).The most common iatrogenic cause of sexual dysfunction
is medications: sexual dysfunction caused by drug side effects
increases as exponential function of the number of medications
a patient is taking (15). Anti-psychotic medications, SSRI
anti-depressants, monoamine oxidase (MAO) inhibiters, and
sedative drugs may contribute to decreasing levels of sexual
Low income: the preoccupation with economic pursuits may
be a barrier: many of the adulterous or unmarried aging men
are economically deprived and cannot afford sexual relationships
(for example with sex workers).
Barriers in women
Lack of a healthy sexual partner: the greatest barrier to
being sexual in aging woman is lack of a healthy sexual partner;
in fact, the long expectancy of women have produced three
times more widows than widowers, making it almost impossible
for older woman to find another husband or a societally sanctioned
partner (25) .Thus the sexual activity of aging women is determined
to a large extent by the availability of a husband or sexual
partner and his sexual capacity (19). Most healthy women older
than 80 have no partner, and 30 % of those that do, have impotent
partners (15) . Then there is the group of unmarried women
who report a negligible amount of heterosexual intercourse,
which does not necessary imply -however- an absence of other
types of sexual behavior (19).
Self physical unattractiveness: many women look to their postmenopausal
years as a time of forced asexuality, she no longer thinks
of herself as sexually desirable, and she may lose all sexual
desire and interest. Besides, a woman may misinterpret the
normal male changes in arousal response as proof that her
male partner does not find her desirable anymore (20). To
confirm this hypothesis is the finding of a study : the 78
% of women felt they are unattractive versus the 58 % of men
Hormone variables: there is a common that women lose their
sexual desire during the climacteric; however the role of
hormones and its effects of aging on women's sexuality remain
less clear. The effect of menopause is complex, involving
not only physiological changes, but also psychological, and
interpersonal aspects of a woman's life and therefore could
have profound effects, both positive and negative, on her
sexuality (26). During the climacteric, women are more likely
to present sexual dysfunction but there is insufficient evidence
to determinate whether the sexual dysfunction occurring during
this phase is due to the decrease in estrogen levels or to
the effect of aging (27).
Illness : analysis based on 235 patients aged 60 years or
less indicated sexual difficulties due to arthritis in two-thirds
of the patients, these difficulties were relatively more common
in women, and were usually due to hip pain and stiffness;
one-quarter of these patients recognized this as a definite
cause of marital unhappiness (28).
Communication with physicians: in the study of Nusbaum et
al, 2004 (30), older women reported that it was easier to
discuss sexual concerns if the physician raised the topic
and to be interested in a follow-up appointment to specifically
address sexual concerns. The 60% stated that they would feel
more comfortable with a female physician, and 45% reported
that having a younger-appearing physician hindered this discussion.
The participants reported to have tried to raise the topic
themselves but the physician did not seem to understand. They
also reported that not having enough time and the physician
appearing rushed and embarrassed hindered discussion.
Age of the physician: older women seem to find the perceived
age of the physician (specifically, a young appearance) to
be hindrance (29).
Barriers in both genders
Nursing homes: it is worth noting that institutionalized seniors
are at risk of being stigmatized with regard to their sex
life. The most pressing of the sexual needs of the older people
in institutional settings is the right to privacy; in fact
they are segregated, double beds are rare and few institutions
provide bedrooms with locked doors (19).
Barriers and taboos in aging sexuality, divided by gender,
are summarized in Table 1.
SEXUAL HISTORY: GETTING TO THE PROBLEM
General patients group
Taking a sexual history in older people is a subject which
has received little attention in the literature. Bouman &
Arcelus, 2001 (21) indicate that taking a sexual history is
often omitted also in the psychiatric assessment of older
men. Particularly, a significant number of GP identifies that
they feel uncomfortable discussing sexual health issues with
non-heterosexual patients, as many of them believe that non-heterosexual
relationships are not "normal" or "clean",
indicating an underlying, perhaps subconscious prejudice (30).
On the other hand, to admit to problems with sexual functioning
may be humiliating for the old patients that see themselves
too old for sex, even if 91 % of them thought taking a sexual
history is an appropriate part of a medical examination (15).
Hence, a sexual history has to be achieved keeping in mind
the following barriers :
Time: time constraints are critical: for doctors, limited
time available within consultations may be the key barrier
to initiating discussions of sexual health issues (30).The
time pressures they work within meant that their priority
had to be diagnosing health conditions and prescribing medication,
meaning little, if any, time available to discuss the impact
condition upon the patient's life, including their sex life
Language: particular concerns are expressed about choosing
the language to use to address sexual issues and being up
to date with the latest developments in the field (30).
Privacy: an old patient is often accompanied by their relatives
(spouse, sons, daughters), so may be difficult to initiate
such a hot topic in front of a "third person".
Embarrass: when the topic involves sexuality, doctor-patient
"open" communication is embarrassing. Sexuality
is a sensitive topic for many and is subject to various social,
religious, and legal norms. Participants may therefore be
reluctant to report "socially censured" behaviors
Sexuality viewed not as a medical issue: sexual activity
and function are often considered by either the GP-Gr or the
patient as non-vital functions. Sexuality may be viewed not
as an issue of health and illness but as an embellishment
affecting the enjoyment of life and therefore not pertinent
to discuss in the medical office.
Younger doctor: the problem also is that the geriatric patient
is queried by a much younger physician, this can be a barrier
to communicate his sexual dysfunction.
Gender of the doctor: a preference for same-gender consultations
about sexual health issues have been identified; some GPs
reported that their preference stemmed from feeling more comfortable
discussing sexual issues with same - gender patients and concerns
that patients of the opposite gender may sexualize the consultation
Lack accurate information about sexuality by the seniors:
many older people are not receiving information about sexual
issues from their GPs-who refer that discussing with patients
about sexual issues is as opening a "can of worms"
or "Pandora box" (30).
Barriers in particular
Senior patient groups
There are specific concerns about addressing sexual issues
with particular senior patient groups: these include homosexual,
transgender and lesbian senior patients. One manifestation
of the lack of knowledge or willingness to discuss sexual
matters is the rising rates of HIV/AIDS diagnosis in older
adults, so that the diagnosis of HIV/AIDS tends to be made
later, the disease's course is faster, and prognosis is poorer.
Older adults are less likely to reveal their HIV status than
younger adults. In our case, not the patient but the social
assistant reveals that he was homosexual (4).Then they do
not perceive themselves to be at risk for HIV, and are reluctant
to take preventive measures even after an HIV diagnosis; in
fact, in our case-report the patient refused the therapy after
the delivery of the diagnosis (4). In addition, older adults
are not interesting in learning about HIV risk: late diagnosis
as in our case (4), is thought to account for much of the
initial excess morbidity and mortality of older adults. This
delay may be partially due to stereotypes held by health professionals
that led them to forgo testing their older patients for HIV
and, possibly, to under-treat them once diagnosed (4), in
according with Gott and al, 2004 (30), who identified specific
concerns about addressing such issues with particular groups
as the non-heterosexual patients.
Barriers to get a sexual history in later life are summarized
in table 2.
STRATEGIES TO GET THE SEXUAL HISTORY
Several recommendations on how to get the sexual history extend
from this paper. Questions about sexual issues are more comfortable
for both doctor and patient when the patient understands the
relevance of such questions to his/her situation; once the
subject of sex has been broached, a sexual history can be
taken, focusing on the areas of patient concern (33). In the
questionnaire the interviewer can break the ice starting with
the health problems of the patient such as depression, diabetes,
infection, urogenital tract conditions, or cancer: sexual
problems may be a warning sign or consequence of a serious
underlying illness. Then the interviewer can continue asking
about the side effects of some medications which can lead
to sexual problems, bearing in mind that patients may discontinue
needed medications because of side effects that affect their
sex lives (14).
However it is worth noting that privacy is important condition
for obtaining an accurate and honest sexual history. It should
be done routinely as part of the normal office visit, without
intrusiveness or excessive zeal. To be alone at the visit
may help the patient to open more comfortable his/her sexual
issues. Each patient should be evaluated as their individual
lifestyle, intellectual background, emotionality, sexual orientation,
environment, and religious and cultural viewpoints (29).
At this point we can design a roadmap on how to approach
to a sexual history of a senior patient.
The first goal is to build up openness, knowledge and frankness
which can encourage the patient to discuss their sexual problems.
Many aging men fear the loss of their sexual powers, but are
reluctant to express their fear. GP-Gr can encourage older
patients in the continued expression of sexuality if they
committed to the care of the entire patient and, as such,
deal with his/her sexual needs as effectively as they deal
with other medical needs. If the GP-Gr are frank, open, and
knowledgeable about both sex and aging, most older people
are willing to discuss their sexual activity. Bauer and Geront,
1999 (34) suggest that humor is an integral part of our social
system and it is notable that it is also a well-recognized
phenomenon in the caregiving relationship; humorous conversation
can, therefore, be a useful strategy to help reduce tension
arising out of social conflicts and to galvanize relationships
and manage "delicate" topics such as sex.
The second goal is to obtain important information about
the physical health of the patient. In fact, sexual problems
may be the result of the physical effects of the illness itself
or may be secondary (19), as sexual problems may be a warning
sign or consequence of a serious underlying illness such as
diabetes, an infection, urogenital conditions, or cancer (14).
The third goal is the discovery of sexual misconceptions,
concerns, or dysfunctions, which may then be directly addressed;
may be that the real reason that the patient has come to seek
medical care is his or her sexual dysfunction, but that the
patient is reticent to volunteer spontaneously.
The fourth goal is to counsel and reassure the patients and
spouses after dramatic events like myocardial infraction,
stroke: studies have shown that sexual intercourse is roughly
equivalent to climbing a flight of stairs, walking briskly
or performing ordinary daily tasks; with this information
at hand the GP-Gr can enhance them to go on with their sex
Finally, physicians should not expect full disclosure, even
if these strategies have been applied, but the benefits for
both patient and physician far exceed the costs in timed and
effort when a screening sexual history is obtained from a
geriatric patient (36).
The four strategies to get a sexual history in later life
are summarized in Tab. 3
The first lesson is that all of us -clinicians- tend to underestimate
sexuality in our senior patients. Despite studies reporting
that older people can be potentially sexually active in later
life, the youth -oriented Western culture continues to devalue
older people's sexuality. Stereotypical thinking and prejudice
ignore the elders' need for sex, and inhibit discussion on
The second and very important lesson is that older people
often mistake HIV/AIDS symptoms for the aches and pains of
normal aging so, they are less likely than younger people
to get tested for HIV/AIDS. They may be embarrassed, ashamed,
and fearful of communicating their risky sexual behaviors
to the physicians.
The third lesson is that, with the growth of the older adult
population, physicians must become familiar with the multifaceted
issues of aging sexuality. Physicians and society need to
support, investigate, and encourage the sexuality of the old.
The fourth and final lesson is that, because many older people
hesitate to initiate conversations with health care providers
about sexual topics, a sensitive but proactive approach is
warranted. An inability to interact with the patient will
result in poor outcomes.
Caveat :A WORD OF CAUTION
Nowadays, with respect to the past century, the emphasis
is increasingly on the sexuality of older adults (37). The
older adults of tomorrow, perhaps after having breaking taboos
and prejudices, will request more knowledge and information
for their sex lives. Internet makes scientific knowledge available
to everyone, and transforms the traditional ways of teaching
and learning about sexuality (38). Communications technologies
and commercialization of the Internet bring about a new digital
"sexual revolution" (38), which will influence people
of all ages. There is no doubt that there are many problems
and challenges that lie ahead, but GP-Gr cannot exclude this
area from their visits anymore, and they have to prepare themselves
not only professionally but also psychologically to this "new
scenario"(!). Perhaps they should consider raising the
topic of sexual health at the routine wellness examination
and offer a follow-up appointment to discuss these concerns
in greater detail (29).
The purpose of this paper was to explore why sexuality in
older adults is often misunderstood, misrepresented, or simply
invisible, although seniors must be considered as individuals
who have desires and sexual needs. There are many barriers
in the aging sexuality but adaptive coping strategies can
mitigate their impact considerably. Information can play a
vital role in dispelling the many myths that surround sexuality
in old age, in order to foster and help the older individual
in maintaining his/her sexuality, and also the GP-Gr in understanding
the importance of sexual health in this vulnerable group.
Much can be done by GP - Gr in cooperation, by showing sensitivity
and by breaking down the taboos. However, why GP - Gr working
with older people do not routinely discuss sexual problems
still remains unclear. A check list developed on the basis
of table 1 and 2 is relevant.
(1) Declaration of Sexual Rights. Promulgated
to the World Congress of Sexology. Valencia, Spain (1997).
Approved by the WAS (World Association of Sexology) to the
World Congress of Sexology. Hong Kong (1999).
(2) Byers JP. Sexuality and the elderly 1983; 4: 293-297.
(3) Gott M & Hindchliff S. Barriers to seeking treatment
for sexual problems in primary care: a qualitative study with
older people. Fam Pract 2003; 20: 690-695.
(4) Inelmen EM, Gasparini G, Enzi G. HIV/AIDS in older adults:
a case report and literature review. Geriatrics 2005; 60:
(5) Albersen M, Orabi H, Lue TF. Evaluation and Treatment
of Erectile Dysfunction in the Aging Male: A Mini-Review.
Gerontology 2012; 58: 3-14.
(6) Inelmen EM, Sergi G, Enzi G, Toffanello ED; Coin A, Inelmen
E. New approach to gerontology: building up "successful
aging" conditions. Aging Clin Exp Res 2007; 19: 160-
(7) Inelmen EM & Inelmen E. Aging without becoming old:
myth or reality? Aging Health 2007; 3: 575-580.
(8) Hyde Z, Flicker L, Hankey GJ, Almeida OP, McCaul KA, Chubb
SAP, Yeap BB. Prevalence of Sexual Activity and Associated
Factors in Men Aged 75 to 95 Years. Ann Intern Med 2010; 153:
(9) Rheaume C & Mitty E. Sexuality and Intimacy in Older
Adults. Geriatr Nurs 2008; 29: 342-349.
(10) Taylor A & Gosney MA. Sexuality in older age: essential
considerations for healthcare professionals. Age and Aging
2011; 40: 538-543.
(11) Nicolosi A, Laumann EO, Glasser DB, Moreira ED, Paik
A, Gingell C. Sexual behavior and sexual dysfunctions after
age 40: the global study of sexual attitudes and behaviors.
Urology 2004; 64: 991-997.
(12) Camacho ME & Reyes -Ortiz CA. Sexual dysfunction
in the elderly: age or disease? Int J Impot Res 2005; 17:
(13) Szwabo PA. Counseling about sexuality in the older person.
Clin Geriatr Med 2003; 19: 595-604.
(14) Lindau ST, Schumm LP, Laumann EO, Levinson W, O'Muircheartaigh
CA, Waite LJ. A study of Sexuality and Health among Older
Adults in the United States. N Engl J Med 2007; 357: 762-774.
(15) Holzapfel S. Aging and sexuality. Can Fam Physician 1994;
(16) Delamater J. Sexual expression in later life: a review
and synthesis. J Sex Res 2012; 49: 125-141.
(17) Dello Buono M, Urciuou O, de Leo D. Quality of life and
longevity: a study of centenarians: Age and Aging 1998; 27:
(18) Gray PB, Garcia JR. Aging and Human Sexual Behavior:
Biocultural Perspectives-A Mini-Review. Gerontology 2012;
(19) Cohen M. Sex after Sixty. Can Fam Physician 1984; 30:
(20) LoPiccolo J. Counseling and Therapy for Sexual Problems
in the Elderly. Clin Geriatr Med 1991; 7:161-179.
(21) Bouman WP, Arcelus J. Are psychiatrists guilty of "ageism"
when it comes to taking a sexual history? Int J Geriatr Psychiatry
2001; 16: 27-31.
(22) Wespes E, Schulman CC. Male andropause: myth, reality,
and treatment. Int J Impot Res
2002; 14 (Suppl 1): S93-S98.
(23) Werner A A. The male climacteric. JAMA 1939; 112: 1441-1443.
(24) DeLamater J, Hyde JS, Fong MC. Sexual satisfaction in
the seventh decade of life. J Sex Marital Ther 2008; 34 :
(25) Shomaker DM. Integration of physiological and sociocultural
factors as a basis for sex education to the elderly. J Gerontol
Nurs 1980; 6: 311-318.
(26) Basson R. The complexities of women's sexuality and the
menopause transition Menopause 2006; 13: 853-855.
(27) Lara LA, Useche B, Rosa e Silva JC, Ferriani RA; Reis
RA, Silva de Sa MF, Ramalho de Carvalho B, Cury Ramos Carvalho
MA, Japur de Sa Rosa e Silva AC. Sexuality during the climateric
period. Maturitas 2009; 62 : 127-133.
(28) Currey HLF. Osteoarthrosis of the hip joint and sexual
activity. Ann Rheum Dis 1970; 29: 488-493.
(29) Nusbaum MRH, Singh AR, Pyles AA: Sexual Healthcare Needs
of Women aged 65 and Older.
JAGS 2004; 52: 117-122.
(30) Gott M, Galena E, Hinchliff S, Elford H. "Opening
a can of worms": GP and practice nurse barriers to talking
about sexual health in primary care. Fam Pract 2004; 21. 528-536.
(31) Mitty E, Flores S. Sexuality and intimacy in older adults.
Geriatr Nurs 2008; 29: 342-349.
(32) Sankar A, Nevedal A, Neufeold S, Berry R, Luborsky M.
what do we know about older adults and HIV? A review of social
and behavioral literature. AIDS Care 2001; 23: 1187-1207.
(33) McInnes R. Chronic illness and sexuality. MJA 2003;179:
(34) Bauer M, Geront RNM. The use of Humor in Addressing the
Sexuality of Elderly Nursing Home Residents. Sexuality and
Disability 1999; 17: 147-155.
(35) Still HC. Helping The Middle Aged Couple With Sexual
Problems. Can Fam Physician 1977; 23: 96-98.
(36) Cheadle MJ. The Screening Sexual History. Getting the
Problem. Clin Geriatr Med 1991; 7: 9-13.
(37) Bancroft JHJ. Sex and Aging. N Engl J Med 2007; 357:
(38) Dupras A. The future of sexology. Sexologies 2010;19:
Tab 1. Barriers and taboos in aging sexuality, divided by
Tab 1. Barriers and taboos in aging sexuality, divided
LACK OF A HEALTHY SEXUAL PARTNER
MONOTONY OF REPETITIOUS SEXUAL
PHYSICAL UNATTRACTIVENESS OF
SELF PHYSICAL UNATTRACTIVENESS
COMMUNICATION WITH PHYSICIANS
AGE OF THE PHYSICIAN
Tab 2. Barriers to get a sexual history in later life
SEXUALITY VIEWED NOT AS A MEDICAL ISSUE
GENDER OF THE DOCTOR
LACK ACCURATE INFORMATION ABOUT SEXUALITY BY THE SENIORS
Tab 3. The four strategies to get a sexual history in
TO BUILD UP OPENNESS, KNOWLEDGE AND FRANKNESS WITH
TO OBTAIN IMPORTANT INFORMATION ABOUT THE PHYSICAL
TO DISCOVER SEXUAL MISCONCEPTIONS, CONCERNS, OR DYSFUNCTIONS
TO COUNSEL AND REASSURE THE PATIENTS AND SPOUSES
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