Added: Delaine Delee - Date: 09.05.2022 10:24 - Views: 11256 - Clicks: 5587
Try out PMC Labs and tell us what you think. Learn More. Although sexuality remains an important component of emotional and physical intimacy that most men and women desire to experience throughout their lives, sexual dysfunction in women is a problem that is not well studied. Increasing recognition of this common problem and future research in this field may alter perceptions about sexuality, dismiss taboo and incorrect thoughts on sexual dysfunction, and spark better management for patients, allowing them to live more enjoyable lives. This need is especially acute for physicians who will increasingly encounter patients trying to maintain a high quality of life as their bodies and life circumstances change, and as advances in nutrition, health maintenance, and technology allow many to extend the time midlife activities are maintained.
One quality-of-life issue affected by these changes, for both men and women, is sexuality. Although studies agree that the majority of women consider sexuality a very important determinant of quality of life, the literature on the subject of sexual function in elderly women is not extensive. Although sexuality remains an important component of emotional and physical intimacy that most men and women desire to experience throughout their lives, it is unfortunately a topic many health care professionals have difficulty raising with their patients.
Thus, it is not surprising that sexual dysfunction is a problem that is not well studied or discussed. Sexual dysfunction in the elderly population has often focused on the lack of estrogen as a main cause. The most common sexual concerns of women of all ages include loss of sexual desire, problems with arousal, inability to achieve orgasm, painful intercourse, negative body image, and diminished sexual desirability and attractiveness.
Common disorders related to sexual dysfunction and increasing age include cardiovascular disease, diabetes, lower urinary tract symptoms, and depression. Treating those disorders or modifying lifestyle-related risk factors eg, obesity may help prevent or diminish sexual dysfunction in the elderly. The biologic processes involved in sexual responses and initiation are thought by many to center around estrogen and testosterone as the key hormones for sexual function.
Estrogen plays an essential role in female sexuality. One role of estrogen is to promote pelvic tissue resiliency for comfortable intercourse. When estrogen is not produced at a level sufficient to maintain premenopausal levels, vaginal dryness may occur. Furthermore, inspection of the vaginal tissues in postmenopausal or otherwise estrogen-deficient women reveals the mucosa to be dry and thin.
A reduction in the amount of pubic hair and loss of subcutaneous fat and elastic tissue causes the labia majora and minora to appear wrinkled. Additionally, chronic estrogen deprivation causes the labia to become less sensitive to tactile stimulation. Discomfort during intercourse is a common problem of postmenopausal women. Heightened anxiety can cause dyspareunia by decreasing blood flow to the vaginal area. Pelvic atrophy, bony pelvis, decreased vaginal lubrication, greater irritation, tissue friability, and anxiety may result in pain or abdominal discomfort with both insertion and deep penetration.
Changes in libido may result if arousal becomes more difficult because of the longer time needed for lubrication or anticipation of discomfort during coitus. There is a lack of elasticity and tone of these tissues. Such changes can lead to urinary incontinence, urinary frequency, dysuria, and cystitis after intercourse.
These problems for substantial morbidity among post-menopausal women. Menopause occurs because the ovaries gradually cease to respond to the stimulation from the gonadotropin-releasing hormones GnRH —follicle-stimulating hormone FSH and luteinizing hormone LH —released by the anterior pituitary gland.
In response, the levels of gonadotropins rise between 5- and fold. Hormone-related libido changes in menopause may be attributed more to falling testosterone levels than to reduced estrogen concentrations. When SHBG production increases the level of free testosterone decreases; this is commonly seen in aging women. Treatment with transdermal testosterone combined with an oral conjugated equine estrogen improved sexual function and psychologic well-being substantially more than placebo treatment. The traditional linear cycle of female sexual response was first constructed by Masters and Johnson.
It is composed of four phases: excitement or arousal, plateau, orgasm, and resolution. Kaplan proposed an alternate model in and introduced the concept of desire into normal sexual responses. In this model, desire le to arousal then to plateau, which is followed by orgasm and resolution. This model was intended to reflect sexual response for men and women; however, researchers recognized that some women did not experience all four phases of the cycle. The woman assesses her subjective arousal by how sexually exciting she finds the stimulus and by concurrent emotions and cognitions generated by the arousal.
This modulation of her subjective arousal appears to be more consistent than the variable modulation by feedback from the genital vasocongestion. Sexual satisfaction may occur without orgasms. Alternatively, orgasms may be experienced before the maximum arousal, and further orgasms may occur at peak arousal and during its very gradual resolution. Thus, for women, orgasm and arousal are not particularly distinct entities. FSD is a multicausal and multidimensional problem combining biologic, psychologic, and interpersonal determinants. It has a major impact on quality of life and interpersonal relationships.
Despite the widespread interest in research and treatment of male sexual dysfunction, less attention has been paid to the sexual problems of women. Selection of medications should take into sexual dysfunction and patient desire to improve sexual activity. These disorders are subclassified as hypoactive sexual desire disorder HSDDsexual aversion, female sexual arousal disorder, female orgasmic disorder, and sexual pain disorder, encompassing dyspareunia and vaginismus.
When a woman describing lack of libido has really never had much interest in sexual activity, treatment is less likely to be successful. The cause is not considered to be hormonal because libido was lacking in these women even when estrogen and testosterone were at premenopausal levels. Some postulated theories are early abuse, relationship difficulties, or psychologic factors such as depression.
Sexual aversion disorder is the persistent or recurrent phobic aversion to and avoidance of sexual contact with a sexual partner that causes personal distress. Sexual arousal disorder is the persistent or recurrent inability to attain or maintain sufficient sexual excitement that causes personal distress, which may be expressed as a lack of subjective excitement, lack of genital lubrication, or some other somatic response. Orgasmic disorder is the persistent or recurrent difficulty, delay in, or absence of attaining orgasm following sufficient sexual stimulation and arousal that also causes personal distress.
Psychologic issues, antidepressants, alcohol use, and drugs have all been responsible in causing anorgasmia. Sexual pain disorders, such as dyspareunia, are described as recurrent or persistent genital pain associated with sexual intercourse. The most common causes are infection, surgery, medications, endometriosis, and interstitial cystitis. Vaginismus is the recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with vaginal penetration that causes personal distress.
Noncoital sexual pain disorder is recurrent or persistent genital pain induced by noncoital sexual stimulation. Multiple factors determine female sexuality and libido. These include the health of the individual, her physical and social environment, education, past experiences, cultural background, and her relationship with her partner. Sex and sexuality after the age of 60 years may be affected by both individual physical changes of aging as well as the physical changes of aging in her partner.
Aged women may be more concerned about problems related to intimacy, 16 dyspareunia, decreased arousal and response, decreased frequency of sex, and loss of sexual desire. Initial studies report a decline in sexual activity in women as they age that is associated with a decline in subjective and objective health ratings, with an added incremental decline associated with the menopausal transition.
There are eight assessments using a self-reported questionnaire based on the McCoy Female Sexuality Questionnaire and blood samples for hormone levels. By the postmenopausal phase there was a ificant decline in sexual arousal, interest in, and frequency of sexual activities. Participants were aged 42 to 52 years, pre- or early perimenopausal, and not using hormonal therapies.
Early perimenopausal women reported greater pain with intercourse than premenopausal women, but the two groups did not differ in frequency of sexual intercourse, desire, arousal, or physical or emotional satisfaction. Variables having the greatest association across all outcomes of sexual function were relationship factors, the perceived importance of sex, attitudes toward aging, and vaginal dryness.
The were similar, illustrating that pain during sexual intercourse increased and sexual desire decreased over the menopausal transition. Masturbation increased during the early transition, but then declined in postmenopausal women.
The menopausal transition was not independently associated with reports of the importance of sex, sexual arousal, frequency of sexual intercourse, emotional satisfaction with partner, or physical pleasure.
The from SWAN highlight the importance of including social, health, and relationship factors in the context of menopause and sexual functioning. Therapies to prevent menopausal transition-associated vaginal pain may help slow or prevent subsequent declines in sexual desire. The very strong association of the importance of sex with all domains of sexual function suggests that asking women about the importance of sex may be the cornerstone in the management of sexual concerns of aging women. A study of Sexuality and Health among older adults in the United States sampled US adults, women and men, aged 57 to 85 years, and described the association of sexual activity, behaviors, and problems with age and health status.
All agree that elderly women engage in, or wish to engage in, sexual activity. Some studies cite a decrease in sexual behavior and interest with age, 1926 whereas others find no decrease. Sexual satisfaction among postmenopausal women has been inadequately described. All members of the WHI observational study, aged 50 to 79 years—excluding women who did not respond to the sexual satisfaction question or reported no partnered sexual activity in the past year—were included. SWAN reported substantial ethnic differences in sexual domains in women of all ages. After controlling for a wide range of variables, black women reported a higher frequency of sexual intercourse than white women; Hispanic women reported lower physical pleasure and arousal; Chinese and Japanese women reported more pain and less desire and arousal than white women, although the only ificant difference was for arousal.
Many common general medical disorders negatively impact sexual function, causing decreased interest in sex Table 1. Negative effects on desire, arousal, orgasm, ejaculation, and freedom from pain during sex can occur. Chronic disease also interferes indirectly with sexual function by altering relationships and self-image and causing fatigue, pain, disfigurement, and dependency. Risk factors other than age are strongly associated with FSD. In terms of specific conditions, cardiovascular disease, diabetes, lower urinary tract problems, breast cancer, hysterectomy, oophorectomy, endocrinopathies, bariatric surgery, osteoarthritis, clinical depression, smoking, and natural menopause have all been consistently found to show ificant associations with female sexual dysfunction.
Body image and perceived attractiveness are modified by aging and disease with a concomitant reduced desire for sexual relationships. Cardiovascular disease is a leading cause of morbidity in the elderly and is frequently associated with sexual dysfunction. Advanced age in itself constitutes a risk factor for vascular dysfunction even when other known risk factors are absent. Intact neurologic and vascular systems are necessary for normal arousal in women. The prevalence of sexual dysfunction is also high in women with diabetes. Lower urinary tract symptoms are common in older women and frequently associated with FSD.
They may represent specific age-related pathology, be it a manifestation of a systemic illness or a result of medications used for comorbid conditions. Sen and colleagues recently investigated the effects of different types of urinary incontinence on female sexual function using the Female Sexual Function Index Questionnaire FSFI.
They reported that mixed urinary incontinence, compared with stress urinary incontinence, had the most ificant impact on sexual function. Urogynecological surgery, such as sling procedures or vaginal surgeries, do not seem to affect overall sexual satisfaction, based on several prospective and retrospective studies on sexual function after tension-free vaginal tape procedure and vaginal hysterectomy. Surgery can play a role in sexual function due to organic, emotional, and psychologic factors.
Sexual life after surgery can be unchanged, worsened, or improved. Their responses suggested that neither self-image nor sexuality diminishes after hysterectomy. The type of hysterectomy that was performed also did not appear to affect the attitudes of the respondents. Coital frequency was increased, cyclicity of arousability was reduced, and frequency of desire, frequency of orgasm, and multiplicity of orgasm were unchanged.
Obesity is associated with lack of enjoyment of sexual activity, lack of sexual desire, difficulties with sexual performance, and avoidance of sexual encounters. Consistent with these benefits, studies have shown that bariatric surgery in the morbidly obese can improve sexual dysfunction. Hyperprolactinemia has been described as a potential factor in sexual dysfunction; however, women more commonly present with menstrual irregularities, infertility, and galactorrhea, rather than with sexual dysfunction.
Excessive prolactin lowers free testosterone through its inhibitory effects on hypothalamic GnRH secretion and pituitary gonadotropin FSH and LH secretion. When hyperprolactinemia is associated with panhypopituitarism, a reduction in androgens, estrogens, glucocorticoids, and thyroxine can compound sexual dysfunction.
The incidence of sexual dysfunction in women with hypothyroidism is unknown. Because the incidence of hypothyroidism peaks at the age of menopause and perimenopausal symptoms could overlap with symptoms of hypothyroidism, screening for hypothyroidism in women at this age is generally recommended. All organ systems have decreased homeostatic reserve with aging, which in decreased clearance and enhanced toxicity of many drugs. Undesired effects of medications are for these reasons quite prevalent in the elderly. The odds of being polymedicated also increase with advanced age, and common medication interactions tend to occur more often in the elderly population.
New symptoms such as decreased libido, lack of lubrication, inability to reach orgasm, and lack of interest in sexual encounters may also result. Patients may believe new symptoms are a result of aging and may not report these occurrences to their physician unless the practitioner gives them an opportunity by asking questions about their sexual health, for example, about sexual activity, frequency of sexual activity, or reasoning for no sexual activity.Sex with the older women
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Older Women More Likely to Lose Interest in Sex