Sexuality is an integral part of life, especially for older adults. With a country that boasts a melting pot of cultures and ethnicities, the expansion and normalization of sexual health within the context of aging is very vital. The World Health Organization defined sexual health as “the integration of the somatic, emotional, intellectual and social aspects of sexual beings in ways that are positively enriching and that enhance personality, communication and love.”
Their definition embraces the healthy liberation of sexual behavior and the prevention of interferences with sexual functions. In Margaret Nusbaum and Jo Ann Rosenfeld’s Sexual Health across the Lifecycle: A Practical Guide for Clinicians, the Cambridge University Press listed the benefits of a healthy sense of sexuality among older adults as: “(1) a link with the future through procreation; (2) a means of pleasure and physical release; (3) a sense of connection with others; (4) a form of gentle, subtle, or intense communication; (5) enhanced feelings of self-worth; and (6) a contribution to self-identity.” Every older adult should have the opportunity to experience these benefits, armed with the confident attitude needed.
This applies especially to older adults who may not feel comfortable enough to communicate or explore their lack of desire, diminished, or absent capacity for sexual fulfillment due to physiological, mental, or cultural barriers. Although they are well past their reproductive years, older adults often still have the desire and the capacity to lead full sexual lives as well as grasping the conduct within sexual actions. A 2008 NIH study on sexuality and health among older adults in the United Sates indicated that despite the high prevalence of bothersome sexual problems, the frequency of sexual activity did not actually decrease substantially with increasing age.
Data from the study also approximated that one quarter of sexually active older adults with a sexual dysfunction reported avoiding sex as a consequence. They as well, deserve the opportunity to achieve that even through addressing the implications for mental health and the health of relationships. In order to produce awareness on the matter, communication and dialogue throughout the older adult community is imperative.
In working to encourage the communication of sexual health, it is important to consider the traditional communities where there is an encumbrance in openly expressing themselves. For example, NHCOA’s extensive work with Hispanic older adults across the nation in the area of health-related topics reveals that Hispanic older adults are hesitant to talk about socially sensitive subjects even with healthcare providers. Along with that, there is a stigma constantly attached to older age and sexual activity that does not encourage a healthy discussion on the topic. The prior NIH study also concluded that reasons for the poor communication on the topic include the unwillingness of patients and physicians to initiate such discussions, along with gender, age, and cultural differences between patients and their physicians. Negative societal attitudes about women’s sexuality along with their age also inhibits such discussions.
Data from NHCOA’s HIV education and awareness program has illustrated the rise of the percentage of sexually transmitted infections among seniors over fifty years old. Now more than ever, it is important that we encourage physicians as well to advance their knowledge on sexuality at older ages in order to improve their skills in boarding the topic on patient sex education and counseling. This also means incorporating a more open understanding from physicians on cultural consciousness as a means to encourage a diligent and gentle approach in initiating the patient’s comfortable communication. This would assist in bridging the disconnect that is present due to cultural norms that are applicable with respect to some older ethnic adults.
If older adults do not confront the plethora of concerns, lack of information, and myths regarding sexuality, it can cause undue denial of what is a normal and important aspect of the quality of life and fulfillment as an older adult. The Institute of Medicine report No Time to Lose elaborates on the potential negative effects; they range from impeding the development and implementation of effective sexual health and educational programs, to impacting the level of counseling training given to health care providers to assess sexual histories as well as comfort levels of providers conducting risk-behavior discussions with clients.
In the former Surgeon General Dr. Satcher’s call for action, he challenged the country in: gaining an understanding on the importance of sexual health in everyday lives, being aware of sexual health care needs for patients, training professionals to manage these needs and, generally promoting an open and honest national dialogue about sexuality and sexual health.