Download Female sexuality and changes with age

Female sexuality and
changes with age
http://womenshealth.med.monash.edu.au
Sexuality is an integral part of the human psyche and is present
from birth to death in everyone. Sexuality is expressed throughout
life in all people both consciously and unconsciously in body
movements and body language, speech, appearance and in
every imaginable way people interact with each other. The way
people demonstrate their innate sexuality varies according to their
stage of life. It is expressed in family intimacy and as part of play
in childhood, more overtly in adolescence and in physical sexual
activity throughout adult life. The importance of sexual health to
overall health is often overlooked by health care professionals and
society in general to the detriment of all. One cannot dismiss the
impact that sexual health has on a woman’s general wellbeing.
It’s as important as diet and exercise.
According to the World Health Organisation:
‘Sexual health is a state of physical, emotional, mental
and social well-being related to sexuality; it is not merely
the absence of disease, dysfunction or infirmity. Sexuality
is experienced and expressed in thoughts, fantasies,
desires, beliefs, attitudes, values, behaviors, practices,
roles and relationships. While sexuality can include all of
these dimensions, not all of them are always experienced
or expressed.’
Individual expression of sexuality is influenced by cultural and social
environment, personal knowledge, past experiences and current
expectations, physical and psychological well being and most
importantly the availability of a partner.
Sexual difficulties are common in women of all ages with
reported prevalences ranging from 10 – 50 per cent.
The diagnostic classifications of female sexual dysfunctions
according to the Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition, revised are:
• Hypoactive sexual desire disorder
• Sexual arousal disorder
• Orgasmic disorder
• Dyspareunia (pain)
• Other (eg. aversion)
Hypoactive Sexual Desire Disorder (HSDD) is defined as
the persistent or recurrent deficiency (or absence) of sexual
fantasies/thoughts and/or desire for, or receptivity to, sexual
activity, which causes personal distress (Diagnostic and Statistical
Manual of Mental Disorders, Fourth Edition, revised). This is
believed to be intimately linked to low arousal and sexual
responsiveness in women.
Sexual function and ageing
Although ageing per se interferes with the level of sexual
performance, the improved health of older people and possibly
altered expectations appear to have impacted on the sexual lives
of older people over the last few decades. A Swedish study
reported that sexual activity of 70 year-old women increased
between 1971 and 2000 (Beckman 2008). The proportion of
70 year-olds reporting sexual intercourse increased in married
women from 38 – 56 per cent (p=0.001) and in married men from
52 – 68 per cent (p=0.002). These data confirm that sexual activity
remains an important part of life for many older women.
Older women experience fewer sexual thoughts and fantasies,
lessened vaginal lubrication with intercourse and less sexual
satisfaction. For many women these changes are subtle and
do not interfere with their overall sexual relationships. One of
the greatest predictors of a woman having a satisfying sexual
relationship or experiences after menopause is the quality of
the sexual aspects of her life before menopause, with those most
satisfied with this aspect of their life in the late premenopausal
years least likely to report problems. The availability of an
interested partner appears to be a critical factor for older
women, who often attribute lessened sexual activity to
impotence or illness in their partner.
The physical changes resultant from both ageing and declining
oestrogen levels affect female sexuality. In addition to circulating
oestrogen levels falling at menopause, the nervous system and
vascular system also decline with age. Loss of fat and glandular
tissue combined with lessened muscle tone and tissue elasticity
makes the breasts and other body regions more drooping and
flabby. The cervix, uterus and ovaries shrink, the vagina becomes
dry and the lining tissue thinner, and the clitoris, which retains
its sensitivity, decreases in size. Oestrogen loss causes much
of the discomfort of intercourse that may occur with ageing,
and oestrogen therapy as vaginal oestrogen creams or pessaries
will successfully reverse symptoms such as vaginal dryness and
the contact bleeding with intercourse.
The duration of orgasm is reduced in women over 50 years of
age. In some women, uterine contractions during orgasm may
become spasmodic and painful instead of being rhythmic and
pleasurable. Alternatively, the contractions may become so mild
in older women that they are not sure whether they have achieved
orgasm. Resolution to an unstimulated state is more rapid in
older women however women of all ages are able to experience
multiple orgasms.
Sexual arousal is achieved through touching, kissing, clitoral
stimulation and erotic fantasies. In older women touch sensation
is diminished as is vascular responsiveness, therefore nipple
erection and genital response and congestion is lessened. Vaginal
secretions are reduced and a longer time is required for adequate
lubrication to occur. Although the clitoris becomes smaller with
age, the response to stimulation remains intact, but it usually takes
longer to achieve a sexual plateau.
Female sexual dysfunction impacts adversely on self-esteem,
quality of life, mood and relationships with sexual partners. It is
associated with significantly lower health-related quality of life in
women in general. Furthermore, sexual desire within a relationship
is a key determinant of the quality of the nonsexual aspects of
the relationship. Both men and women reporting a discrepancy
between their own and their partner’s sexual desire have lower
relationship satisfaction and individuals in sexually inactive
marriages report less marital happiness.
Fundamentally age is no deterrent to good sex. The changes of
ageing may require some adjustments, but these can always be
made to permit ongoing sexual activity.
The impact of illness
on sexual activity in women:
Physically coitus is about as strenuous as a vigorous walk.
For a woman with heart disease sexual activity is usually safe
if she is able to climb a flight of stairs or walk briskly for 10–15
minutes without any distress.
Diabetes is a common cause of loss of ability to sustain an
erection in men, but does not appear to affect either sexual
desire or performance in women. Urinary tract and vaginal
infections such as thrush are more common in diabetics so
practices such as emptying the bladder before and soon after
intercourse are worthwhile.
Anti-depressants are the most likely medications to suppress
sexual function. Female sexual dysfunction is an established
side-effect of antidepressant therapy, and is most frequently
reported by women using selective serotonin reuptake inhibitor
(SSRI) therapy. SSRIs are the most commonly used antidepressant
by Australian women. An overall incidence of antidepressantrelated sexual dysfunction of 56.9 per cent has been reported in
women, with SSRIs and venlafaxine (a serotonin and norepinephrine
reuptake inhibitor; SNRI) having the most adverse effects. Sexual
dysfunction in women being treated for depression is not only a
recognised cause of cessation of therapy, but adversely affects
personal wellbeing and relationship health, and is likely to contribute
to treatment failure and consequent persistence of depression.
Women on anti-depressants who experience diminished sexual
desire or responsiveness should discuss this issue with their doctor.
Sexual health after gynaecological and other cancers. This is
an increasingly common problem which fortunately is being more
openly discussed. The Cancer Council of Victoria has produced an
excellent book for patients and their partners that comprehensively
address this issue. Other cancer resource groups are also likely to
have patient support information available.
Partner health
Many older women do not have a partner or are in a relationship
with a person who suffers ill health or sexual dysfunction.
Masturbation is less well accepted by women than men, but is an
important sexual outlet for many women. Early research suggests
that up to 25 per cent of women over the age of 70 masturbate.
Mutual masturbation is a common healthy sexual practice for many
couples that have ill health preventing vaginal intercourse.
Summary
The low level of sexual desire unfortunately expressed by so many
older women often strongly reflects negative societal feedback on
aging in general and sexual repression of older women specifically.
Improving our attitudes towards ageing, increasing respect for
older women in the community and liberalising our views regarding
sexual expression in older people will hopefully enable older women
to experience better sexual wellbeing.
Women with concerns about their sexual life should find a doctor
or counsellor with whom they feel comfortable discussing this very
personal but important aspect of their life.
Medications prescribed for various diseases can potentially
affect female sexual function, but unfortunately have been little
studied in women, as opposed to the vast literature on drug
induced impotence in men.
The information in this flyer was correct at the time of publication. Monash University reserves the right to alter this information should the need arise.
Produced by the Women’s Health Program, Monash University © October 2010. CRICOS provider: Monash University 00008C MMS287303