Sexual life of the elderly: the importance of breaking stereotypes and providing better guidance to patients with dysfunctions
A recent study showed that many men and women with dementia living in their homes are sexually active and, although sexual dysfunction was frequent, they rarely talked about sex with a sexologist in Delhi.
These surveys, as well as older ones, break stereotypes about the sexual life of the elderly and highlight the need for more people to talk to their sexologists in Delhi about sexual issues.
Causes of sexual dysfunction in the elderly
Aging promotes anatomical, physiological (mainly hormonal) and psychological changes that influence sexuality at the end of life. Changes that accompany sexual function include decreased libido, sexual responsiveness, comfort level and frequency of sexual activity.
On the other hand, the sexual dysfunctions of the elderly are influenced by factors that include physical effects of diseases, medications, psychiatric disorders, and psychosocial stress, related to the loss of close people or hospitalizations due to acute illnesses.
A cardiac or cerebral vascular event can raise fears about performance or even death during sex. It is worth mentioning that data have indicated that the probability of sudden death after sex is low.
Main sexual disorders in the elderly
Sexual disorders in elderly men are erectile dysfunction and delayed ejaculation, while in elderly women there is little sexual interest, orgasmic disorder and genital-pelvic pain.
The main predictors of sexual interest and activity at the end of life are: previous level of sexual activity, physical and psychological health, as well as availability, level of interest and integrity of the partner. For men, the main factor for sexual activity seems to be physical health and for women, it seems to be the quality of the relationship.
Residents in long-term environments are significantly less likely to be sexually active, as they face barriers such as difficulty finding partners, lack of privacy and, of course, physical, and mental health problems.
How to assess sexual status and conduct to be adopted in dysfunctions
Examination of sexual status asks about current sexual functioning, past sexual experiences, and attitudes towards sexuality.
The assessment and treatment of sexual dysfunction requires a relationship of trust between the sexologist doctor in Delhi and the patient. The physician’s attitude and language must be appropriate and convey security.
The clinical evaluation must be complete and include mental and psychological status, such as marital stress and grief, for example; urological and/or gynecological function and laboratory tests, especially of the metabolic and hormonal profile, such as testosterone, thyroid and prolactin.
An important point is the detailed knowledge of the medications in use, as several can cause sexual dysfunction.
Anti-hypertensive drugs, especially beta-blockers and diuretics, antiandrogens, used in the control of prostate tumors, and several psychotropic drugs, particularly selective serotonin reuptake inhibitor antidepressants, venlafaxine, and mirtazapine, especially in men, stand out.
Sex doctor in Delhi mentions that sexual dysfunction can be caused by both the antidepressant and the depression that recommends the use of the medication.
Role of education and referral indication
In the management of cases of sexual dysfunction in the elderly, education has an important role. Patients should be informed about factors and causes and possible treatments for dysfunctions. Education about sexually transmitted diseases and safe sexual practices should not be neglected.
Long-term care facilities should train their staff to respect the privacy of residents and assess their ability to avoid possible risks associated with sexual intercourse.
Patients who suffer cardio or cerebrovascular events or interventions should receive advice from doctors or rehabilitation programs on how to gradually resume habitual sexual activity.
The basic psychotherapeutic approach is similar to that of younger individuals, although it must take into account long-standing bad relationships, as well as deficiencies in general and cognitive health.
The specific treatments for sexual disorders are not different from those used for young adults, but some specific recommendations for the elderly should be remembered. Among them, the adoption of measures that minimize pain or discomfort, such as the use of analgesics, oxygen, inhalations, lubricants, and comfortable positions for the sexual act.
Of course, drugs that can cause sexual dysfunction (mentioned above) should be replaced, if possible. Metabolic and hormonal disorders should be investigated and corrected.
Testosterone replacement to treat the decline in serum testosterone concentration, which occurs with advancing age in men in the absence of identifiable pituitary, hypothalamic or testicular disease, is questioned.
For men who show signs or symptoms that could be caused by testosterone deficiency, such as changes in energy, mood and libido, replacement can be considered, but only if the concentration is unambiguously low in three dosages of samples collected in different times, between 8 and 10 am. For replacement, special attention should be paid to the risks of coronary events, prostate and breast cancer, sleep apnea and erythrocytosis.
The use of testosterone to increase libido in women lacks robust evidence and can pose risks.
Phosphodiesterase 5 (PDE, Phosphodiesterase) inhibitors, used to treat erectile dysfunction are effective for older men, although with less response. For some older men with no ideal response to use on demand, daily administration of low doses may be more effective.
Side effects seen in the elderly are headache, flushing of the skin, dizziness, gastrointestinal discomfort, back pain, and blurred vision.
Any changes in visual acuity when taking a phosphodiesterase 5 inhibitor require immediate evaluation, due to reports of cases of non-arteritic anterior ischemic optic neuropathy, characterized by the rapid onset of visual loss
Erectile dysfunction occurs frequently in coronary patients and is even considered a predictor of coronary artery disease. The coronary patient usually gives up sexual activity but can restart it when using phosphodiesterase inhibitors 5.
However, top sexologist in Delhi instructed to avoid the use of these drugs concomitantly with nitrates, as they can suffer severe hypotension, worsening myocardial ischemia, which can even trigger a serious event.
The best sexologist in Delhi should deepen their knowledge of the sexual life of the elderly. It is necessary to know how to approach the topic in an appropriate way, without omission, in order to enable the realization of possible diagnoses, the identification of the causative factors and the correct orientation.