By APRIL BOYKIN, MSW, LCSW, and RENEE TAYLOR, MSW, LCSW, Certified Sex Therapist
If you’ve made it past the title, then you’re ahead of the game. Research tells us that medical providers (and everyone else) have great difficulty raising questions about sexuality with our older patients. Instead, we focus on medical problems or ask physiological questions. Always staying in the safe zone: side effects of medications, pain, exercise or diet, bowel movements, and maybe even emotions. But never SEX.
Sexuality is central to being human. We are living longer and sexual functioning among older adults is more important than ever for leading a healthy and fulfilling life. According to Indiana University’s Center for Sexual Health, in the 1970s only 10 percent of men and women reported being sexually active into their 70’s. Today, 60 percent of men and 34 percent of women are reporting being sexually active into their 80s. That change is something to celebrate. Sex has so many benefits, including improving the immune system, lessening pain, improving sleep, managing stress, boosting self-esteem, improving connections and quality of life, and so much more. So, let’s encourage their oxytocin to start flowing.
What gets in the way of SEX talk? Time constraints, discomfort, not enough privacy, insufficient training in sexual function in old age, and even socio-cultural factors. Most of us are uncomfortable with conducting a sexual history with our older patients. But it’s not just us, it's them too. Older adults usually have greater difficulty talking about sex in general. They are reluctant because they buy into myths about sex and aging. They think they shouldn’t be interested, or it’s undignified, worry they will be judged, or have a lifetime of being reserved about this topic. For many, sex-ed was a one-time event and they never think of talking about the changes that are happening to their bodies sexually because they are assumed to be normal and unavoidable. But we can fix that.
Ways to Start the Conversation:
- Your Comfort-Check if your discomfort is getting in the way. If so, then get the information you need and practice, it will feel normal before long. The more comfortable you are in discussing sex the more comfortable patients will be.
- Patient Comfort - Acknowledge the discomfort patients may experience at the start of the conversation, “this may be difficult to talk about…” This gives permission and opens the door for a great conversation.
- Props - Not what you think! Use posters on the wall, rack cards, a flyer, or something that promotes talking about sex. This is a non-threatening way to let patients know you are comfortable with this topic and encourages the conversation.
- Annual Wellness Visit - Make sexuality a part of the annual health questionnaire.
- Open-Ended Questions - Or just “go for it” with questions that get them talking such as, “In what ways has your sexual relationship changed with your partner as you have aged?” or “Tell me about how you are expressing your sexuality now?” or “Is there anything getting in the way of a fulfilling sex life?”
What older patients would benefit from knowing:
- Sex is Good for You: Older patients need to know that they are entitled to a healthy and happy sex life at any age, and that sex and intimacy play a vital role in overall health and well-being. For some older patients, the physician’s office might be the only opportunity to discuss their current sexual experiences.
- Sexual Cycle: If a patient reports sexual issues, a physician can help them identify which area of the sexual cycle they are experiencing distress; desire, arousal, orgasm, or resolution. When we are young desire happens before we become aroused, but as we age and hormones change, often desire happens after arousal. Helping patients understand this shift can help them stay engaged.
- Disruptions due to Body Changes: It is not uncommon for men to have erectile issues or women to have vaginal dryness, these changes occur due to natural hormonal changes. But bodies also change because parts are removed, prolapsing, thinning, or changing in other ways. It is important to include in sexual information when you educate patients about dealing with these changes.
- Disruptions due to Medication Side Effects/Health Conditions: Sexual issues can also be a symptom of a health issue or side effect of a medication. Some sexual issues can be remedied by changes to medication, suggesting using lubricants, prescribing an erectile enhancer, or hormone therapy. It is important to include information related to sexual disruptions when prescribing a new mediation or addressing a new diagnosis.
- Outercourse or intercourse: For patients not able to have penetrative sex, you can let them know that they can still have an enjoyable sex life without penetration. Penetration or intercourse is only a part of sexual activity, outercourse can also provide pleasure and enhance intimacy. Outercourse can include, massage, sensual touching, kissing, hugging, oral stimulation, and masturbation. Two great techniques that patients can use to guide them in outercourse is Sensate Focus and Tantric Sex.
- STIs and Aging: Another reason to talk to older patients about sex is that they might not think about using protection as pregnancy is no longer an issue. According to the CDC in 2018, 17 percent of new HIV diagnoses were people 50 and older; and Athenahealth reported between 2014 and 2017, STIs rose 23 percent amongst patients 60 and older.
The physician’s office can be a great space to normalize sex and sexuality for older patients, as well as provide education, resources, and guidance on having healthy sexual relations with themselves or with a partner. Counselors are great partners in this discussion. We are skilled at addressing all aspects of a persons’ physical, behavior, or emotional functioning, including sex.
April Boykin is a Licensed Clinical Social Worker and cofounder of Counseling Resource Services (CRS). Established in 2013, CRS is a community-based in-home integrated behavioral health agency serving the aged and disabled population in Central Florida. As a mental health counselor, she has provided individual, family and caregiver counseling to children, teens and adults. She can be reached at firstname.lastname@example.org