Sexuality and Relationships

Aromantic

little to no romantic attraction to other people

Asexual

lacking a sexual attraction to or disinterest in being sexual with other people

Celibacy

choice to abstain from sexual activity

Dyspareunia

pain in the genital area with sexual intercourse

Ethnogeriatrics

health care for older adults from diverse ethnic backgrounds; intersection of the studies of aging, ethnicity and health

Inappropriate Sexual Behavior

unwelcome sexual advances, requests for sexual favors or other verbal or physical harassment of a sexual nature

subjectively defined

can interfere with client care/intervention

understanding WHY the behavior happen does NOT mean accepting it, but it can help determine how we RESPOND

Menopause

cessation of menstruation

defined as 12 months without a period

Refractory Period

recovery phase after orgasm during which it is physiologically impossible for a male to have additional orgasm

Sexual Health

state of physical, emotional, mental and social well being in relation to sexuality

not merely absence of disease, dysfunction or infirmity

Sexuality

ability to be intimate with another person in a mutually satisfying manner

Sexual Identity

a person’s understanding of self as a sexual being

includes a person’s values, beliefs, self esteem and self image

Sexual Expression

communicating and acting on sexual desire and needs

includes verbal and nonverbal communication appearance and behaviors

Sexual Function

physical, cognitive, physiological

Benefits of Safe Sexual Expression

self esteem

cognitive function

social

mood

independence

reduced risk of disease

connected to: reduced sensitivity to pain, improved cardiovascular health, reduced depression and loneliness, improved overall wellbeing

sex is an important need according to older adults

Physiological Changes for Male (XY)

low testosterone

low sperm production

amount and consistency changes in seminal ejaculate

low ejaculation force

low likelihood of premature ejaculation

low frequency of ejaculation with high refractory period

possible high prostate size

high duration to stimulate sexual excitement

high lasting erection

Physiological Changes for Female (XX)

menopause

low estrogen and progesterone

external genitalia shrinkage

low pubic hair growth

vaginal wall shrinkage and thinning

low vaginal secretions

high duration to stimulate sexual excitement and lubrication

Perimenopause

around menopause when menstruating people will state to transition to menopause

ovaries being producing less hormones

body is moving towards end of reproductive years

irregular periods, changes in mood, low libido, hot flashes, night sweats, sleep problems, vaginal dryness, urinary urgency

Intimacy and Sexuality Considerations

stage of life

family and relationships

attitudes and norms

communication

health and disability

culture, race, ethnicity

settings and environments

LGBTQ+ and intersectionality

Barriers to Sexual Expression

physiological changes

disability and disease

attitudes

settings/environment

communication

Ageist Erotophobia

a particular form of ageism

failure or refusal to see older people as sexual beings

Intersectionality

multigroup model of risk and protective health factors for older individuals with racial/ethnic as well as sexual gender minority identities

Sexual Consent

knowledge

intelligence

voluntariness

Knowledge

recognition of the other person in the relationship (safety, ability to identify body parts)

Intelligence

rationality or understanding (potential risks, appropriateness, consequences, ability to discriminate between fantasy, reality, lies, truth)

Voluntariness

decisional capacity to engage or refrain, and ability to protect the self from abuse, exploitation and unwanted advances

Continuum (Range of Behaviors)

offensive jokes

flattering comments

asking for a date

deliberate touching

exposure

fondling

Responding to Inappropriate Sexual Behavior

ignoring the patient rarely accomplishes anything

redirection may be helpful

be assertive and provide nonthreatening feedback

be honest and clear

reporting of repeated behavior must offer and an inter professional behavior plan may be warranted

Ex-PLISSIT Model

helps navigate sexual expression in any age

4 levels of involvement that can be sed to help healthcare practitioners identify their role in the assessment and addressing an individual’s sexual well being needs

reflection and self awareness of the practitioner

encourages review at the end of the session and beginning of a future one by referring to periods session

extended permission giving (core of all stages)

limited information

specific suggestion

intensive therapy

Occupation Performance Inventory of Sexuality and Intimacy (OPISI)

a screening tool and in-depth self assessment of ability, satisfaction, understanding, and confidence in skills and ability to improve occupational performance associated with sexuality and intimacy over time

not older adult specific

Long Term Care Interventions

education of staff/providers/families on geriatric sexuality

reflection on attitudes

sexual history and assessment in care plans

privacy

pets of soft objects to hold

meet n’ mingles

alternate forms of sexual expression

salmon/barber services

cultivation of friendships

sexual health education

addressing sexual concern and complaints

Responsible Sexual Behavior

STI is increasing

due to shame, no one is asking, no intervention offered, chronic illness masks issues

Responsible Sexual Behavior Interventions

talk about it

educate

do not assume

skills training