Chapter 16: Sexuality and Aging

While the specific forms and frequency of sexual activity may change, the need for affection, connection, and emotional bonding remains vital to psychological and social health. Normal physiological changes impact both genders; older men typically experience a delayed reaction to sexual stimuli, less firm erections, and a longer time and reduced force during orgasm, with Erectile Dysfunction (ED) being a common concern often exacerbated by chronic conditions like diabetes and cardiovascular disease. Older women encounter changes related to decreased estrogen and progesterone, which can result in vaginal dryness, thinning vaginal walls (atrophic vaginitis), and pain during intercourse (dyspareunia), although localized topical treatments or low-dose estrogen preparations may alleviate discomfort. Sexual health is also significantly affected by various external factors, including physical illnesses like arthritis or cardiac problems, the use of many therapeutic medications (such as antihypertensives or antidepressants), and excessive alcohol consumption. The most frequent cause of decreased sexual activity is the loss of a partner, and social or financial concerns may influence whether older adults choose to remarry or cohabitate. Furthermore, health care providers must recognize the unique challenges faced by the growing LGBTQ+ older adult population, who frequently encounter discrimination, feel reluctant to disclose their orientation to health systems, and require specific advocacy, particularly regarding advance directives and relationship recognition. Nurses are tasked with promoting sexual well-being by conducting sensitive, nonjudgmental assessments using open-ended questions to identify potential barriers—such as lack of privacy, illness, or medication side effects—and implementing interventions like protecting the sexual rights of all older adults and ensuring dignity for confused residents who display inappropriate sexual behaviors. Given that Sexually Transmitted Infection (STI) rates are rising among those over 55, comprehensive safer sex education must be available to this age group.