Factors Associated With Sexual Health and Well Being in Older Adulthood

Maria Kleinstäuber

Disclosures

Curr Opin Psychiatry. 2017;30(5):358-368. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: To provide an update of recent studies on factors associated with sexual well being in older people with a special focus on sexual activity, satisfaction and function.

Recent findings: Most recent studies confirmed the relationship between mental health status, especially negative affect and depressive symptoms, and sexual health in older adulthood. However, when this relationship is investigated more deeply, it seems that in fact positive psychological well being (positive affect and quality of life) accounts for sexual activity rather than the lack of depressive symptoms. Moreover, recent studies provided more insight into the relationship between marital characteristics, religion, cognitive functioning and sleeping difficulties and different dimensions of sexual health in older adulthood.

Summary: In summary, there is substantial previous research revealing associations between various psychosocial, health-related and demographic variables and sexual health in older adulthood. Most considered variables are, for example, age, sex, general physical and mental health. For future research, it is important to consider that relationships between specific variables and sexual health in higher age are usually more complex than they are expected to be and factors differ between different dimensions of sexual health. Communication about sexuality between health-care providers and older patients still implies a lot of barriers and lack of knowledge. Therefore, the provision of communication training for health-care providers to older people in which knowledge is gained about correlates of sexual health in older adulthood should be implemented.

Introduction

According to the WHO, sexual health or well being is defined as 'a state of physical, emotional, mental and social well being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity'.[1] Sexual health refers strongly to the physical and emotional health status of people across all ages.[2] Especially in populations of higher age, previous empirical evidence has demonstrated the protective value of a healthy and enjoyable sexuality in regard to different dimensions of health, such as cardiovascular disease, all-cause mortality or cognitive performance.[3,4,5**,6–8] In contrast to negative attitudes towards sexuality in older adulthood and the myth of 'asexual elderly', especially widespread in Western cultures, epidemiological studies show that sexual activity still plays an important role in later phases of life.[9–12] Although the frequency of sexual activities implying the explicit goal of orgasm decreases with increasing age in both sexes, in the age group of 65+ at least one-third of participants indicate that they are still involved in vaginal sex.[9,13] Moreover, older men and women focus rather on other kinds of sexual behaviour implying the goal of pleasure and intimacy (e.g. foreplay activities).[9,13] Therefore, it can be assumed that in later phases of life, a broader definition of sexuality becomes important,[14,15] which, besides sexual behaviour with the explicit goal of achieving orgasm, also includes sensual activities with or without the explicit goal of sexual pleasure in the sense of experiences of pleasure from one's senses leading to an increased awareness and appreciation of one's own body (e.g. engaging in foreplay, fondling and holding hands), emotional intimacy or a sense of sexual identity.

According to this empirical evidence of how important sexual health is for general health status in older adulthood, for clinical practice as well as for future research, it is important to know more about factors associated with sexual well being in elderly people. The central aim of the current review is to summarize previous research with a focus on most recent findings with regard to the relationship between different demographic, psychosocial and health-related variables and sexual health in older adulthood. Because of limited space, studies investigating biological indicators of sexual function only, lesbian, gay, bisexual and transgender (LGBT) samples or individuals suffering from specific medical conditions have not been considered for this review. Figure 1, Figure 2 and Figure 3 [9,13,16–35] summarize findings of previous research on factors that were examined in an older adulthood sample in relation to at least one of three dimensions of sexual well being – sexual activity (behaviours aiming at sexual pleasure or orgasm), satisfaction (evaluation of an individual's sexual experiences and sexual relationship, if existing, as a whole)[36] or functioning (body's reaction in different stages of the sexual response cycle, including aspects such as sexual desire or interest, erection, orgasm and ejaculation)[37] – in at least two studies (factors for which empirical evidence is provided in only one study are summarized in Table 1).[9,13,16–35]

Figure 1.

Summary of empirical evidence (≥2 studies; for details, see: [9,13,16–35]) on factors associated with sexual activity in older adulthood (♂: association has been demonstrated for men only. ♀: association has been demonstrated for women only).

Figure 2.

Summary of empirical evidence (≥2 studies; for details, see: [9,13,16–35) on factors associated with sexual satisfaction in older adulthood (♂: association has been demonstrated for men only. ♀: association has been demonstrated for women only).

Figure 3.

Summary of empirical evidence (≥2 studies; for details, see: [9,13,16–35]) on factors associated with sexual function in older adulthood (♂: association has been demonstrated for men only. ♀: association has been demonstrated for women only).

In the following, the most important previous results from Figure 1, Figure 2 and Figure 3 are summarized. It is obvious that most of the previous research was focused on factors associated with sexual activity rather than other dimensions of sexual well being. Age seems to be the factor with the strongest empirical evidence across different dimensions of sexual well being. Although higher age is associated with increased sexual dysfunction and less sexual activity in both sexes, the relationship between older age and sexual satisfaction is rather contradictory. Sex effects differ strongly in regard to different dimensions of sexual well being. Although in regard to sexual activity men seem to be more active than women in older adulthood, there is a tendency that women are more satisfied with their sex life with increasing age. However, data have to be interpreted cautiously as results vary depending on whether a partner was present or not, and only in a small number of studies[9,18,27,30] were analyses adjusted for this variable. Although different kinds of medical conditions with an increased prevalence in older adulthood (e.g. diabetes and cardiovascular diseases), specific health-related risk behaviours (e.g. smoking and alcohol consumption), intake of specific medication (e.g. β-blocker use) and self-rated physical health were strongly correlated with sexual activity, sexual satisfaction was demonstrated to be associated rather with psychosocial variables (e.g. emotional satisfaction or self-rated mental health). Regarding sexual functioning, erectile dysfunction is one of the most common sexual dysfunction disorders in older males, whereas vaginal dryness and lack of sexual interest are the most common sexual dysfunction disorders in older women.[13] Although erectile dysfunction seems to be strongly associated with physical health status, evidence for correlates of lubrication problems in women is less clear. Previous studies showed that for some of the investigated associated factors of sexual health in older adulthood, a strong influence of cultural aspects has to be considered. For example, although in studies of Western populations there seems to be a tendency for older women to be more satisfied than men of older age,[9,24,26,28,31] in a study of a Korean sample by Kim and Jeon[23] it was shown that older men experienced more sexual satisfaction than women.

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