Follow TIMEHealth For more than a decade, doctors have cautioned women about the risks associated with hormone-replacement therapy.
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Abstract Sexual desire is a major component of sexuality at any age, and inhibited desire is one of the main sexual dysfunctions reported by older women.
Introduction Aging is a physiological, psychological, and social transition that typically affects sexuality. Continual sexual activity carries numerous health benefits throughout the life span: Sexuality and older women are issues, however, that are typically dichotomized rather than considered a naturally occurring combination to be explored and nurtured in their intersection.
A seemingly perpetual belief is that sexual interest wanes considerably or completely with age [ 2 ]. This was done in order to complement the knowledge of clinical practitioners who have been heavily influenced by the medicalization of sexuality in terms of physiological responses.
This overt medicalization could lead health care professionals to use an exclusively functional diagnostic approach.
It could also reinforce the notion of complete sexual equivalency between men and women as well as among all women heterosexual, bisexual, lesbian, and transgender.
As we have noticed in our clinical practice, women do not usually define their sexual satisfaction or loss of desire based on the functioning of their sexual organs, but mostly based on the quality of the relationship within which sexual activity ensues.
Whereas this topic has inspired some anecdotal literature by several knowledgeable professionals in the medical and psychological fields, it has received relatively little empirical attention, which, in turn, impacted our ability to locate a larger body of pertinent empirical literature for this review.
Investigating the prevalence and risk factors of sexual dysfunction in a nationally representative USA sample of individuals aged 57 to 85, Laumann and colleagues [ 5 ] reported the following prevalence rates for lack of interest in sex among older women: Another noteworthy result was the lack of significant ethnic and racial differences for sexual interest in older age, suggesting that sexual desire and related concerns affect older women of all ages without racial exceptions.
Conversely, an active sex life appears to provide many older people with a buffer against ill health in later life [ 6 ]. Positive attitudes toward sexuality and the availability of a sensitive partner may facilitate the resumption of sexual interaction. In particular, Yee and Sundquist [ 1 ] listed five specific factors that appear to encourage sexuality thus increasing sexual desire in older women: Additionally, Persson [ 7 ] discovered that the following factors best predict engagement in sexual intercourse: Also important for continued sexual activity were cognitive flexibility and being able to adjust to the changes that accompany age instead of battling against the inevitableboth of which allow the likelihood of emotional and sexual satisfaction, as well as sexual enhancement [ 8 ].
Objectives of this Review Taking all the aforementioned factors into account, physicians, psychologists, nurses, and other health providers should not hesitate to raise the topic of sexual health and, in particular, sexual desire with older women patients.
However, the assessment of the sexual concerns of older women is seldom done, for a variety of reasons succinctly covered herein.
To shed some light on these neglected issues and to encourage reluctant clinicians to pay more attention to this area, we set as the main objective of this paper to inform medical professionals about biopsychosocial issues related to sexual desire among older women, with the secondary objective being to clarify reasons for the seldom assessment of sexual concerns in older female patients.
Once searches for sexual desire in particular yielded very few studies, we extended our searches to include the assessment of any sexuality issue pertinent to older female patients, thereby gathering a few additional studies. Search Methods for Identification of Relevant Studies and Eligibility Criteria for Inclusion We conducted electronic searches of Medline and PsychInfo to utilizing keyword search terms for our main and secondary goals.
The two criteria for review inclusion of a study were 1 being written in English and 2 being pertinent to either one of our two goals. Selecting applicable studies that only utilized placebo or comparator control trials was not feasible, given the small body of the mostly cross-sectional literature obtained via our searches.
For the same reasons, the type of literature that we were able to gather was not conducive to conducting a critical review. Given these challenging circumstances, we chose not to critique the scientific value of each study, focusing instead on offering the reader pertinent initial descriptive findings with direct clinical utility for either of our research goals.
Clinical treatment issues concerning sexuality in older age have not been covered herein, to reasonably limit the scope of this review. Until now, primary reliance has been afforded to the DSM-IV diagnostic criteria for sexual dysfunctions of the sexual response cycle, which encompasses the following four phases during which disorders may occur at one or more of these phases: Since the publication of the DSM-IV, research evidence has invalidated the linearity and precise division of phases in describing and treating sexual behavior for women in particular.
For this reason, the publication of the DSM-V has sought to utilize an updated conceptualization of sexual behavior and to rectify and expand diagnoses and their respective criteria for sexual dysfunctions. Within this framework, drive is conceptualized as biologically based and experienced as spontaneous interest typically through genital tingling, sexual thoughts or fantasies, and increased sexual interest in others nearby.
Moreover, testosterone is known as necessary for sexual desire, which declines in both men and women with age. Occurring cognitively, expectations, beliefs, and values affect the interest in behaving sexually.
Last, psychological motivation is defined as a willingness or unwillingness to behave sexually with a partner. Also, according to Levine, an important feature in understanding sexuality and sexual desire in particular is sexual equilibrium, which has an interpersonal nature and is characterized by a balance in sexual capacities and perceptions of those capabilities between two people.
These capacities include capability for desire, arousal, and orgasm, which are highly responsive to psychosocial forces. In contrast, disequilibrium occurs when there is dissatisfaction in one or both partners with a nonsexual relationship, or when sexual relations occur less than ten times per year.Discussion and Conclusion The review of the literature related to TC application in different countries shows a significant variation in practice.
Case studies conducted outside of Japan have revealed that different steps are followed and various participants are involved in implementing TC. This Postpartum Depression Literature Review of Risk Factors and Interventions, commissioned by Toronto Public Health, is a comprehensive review of the literature from in .
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