• What people learn about physical closeness and touching, and how they come to feel about themselves and others are major determinants of adult sexuality.

• Sexuality encompasses the biologic, psychologic, social, cultural, and spiritual aspects of sexual feelings and expression.

• It includes the needs for love, warmth, sharing, closeness, intimacy, sensuality, touching and being touched.

• Sexual Integrity- are healthy expression of sexuality promoted by the person’s acceptance and comfortable recognition of himself or herself as a sexual being.

• Sexual Expression- includes both genital and nongenital activities, with verbal and nonverbal expression of sexuality. It is essential to the human experience; for some people, age may alter certain aspects of sexual expression, but age does not affect the personal enrichment that comes from the affirmation of a sense of self as a sexual and vital person.

• there are no known age limit on sexual function and healthy older adults who want to have sexual activity are likely to be sexually active into late adulthood.

• Climacteric- is a period when reproductive function undergoes significant change.

• excitement: longer time period required to attain full penile erection, penis less firm

• plateau: scrotal wall vasocongestion reduced, testicular elevation diminished

• orgasm: ejaculatory strength decreased, # of penile contractions decreased, sensation of ejaculatory inevitability diminished, psychosexual pleasure of orgasm with ejaculation diminished

• resolution: rapid penile detumescence, prolonged refractory period.

• excitement: decreased vaginal lubrication, time required for vaginal lubrication lengthened, vaginal ballooning delayed, vasocongestion of breast diminish.

• plateau: elevation of labia majora decreased, no sex flush present, levels of muscle tension decreased, no elongation or widening of vaginal barrel

• orgasm: vasocongestion of orgasmic platform decreased, # of vaginal contractions decrease, # of vaginal contractions decreased, intense or painful uterine contractions possible.

• resolution: delayed areola detumescence, rapid shrinking of vaginal balloon, possible urinary urgency immediately after coitus, increased complaints of dysuria.

• could happen because of the aging process, loss of partners, the onset of chronic illnesses, and the concomitant treatments.

• Sexual dysfunction- disturbances in the sexual desire and in the psychologic changes that characterize the sexual response cycle, and these disturbances cause marked distress and interpersonal difficulty. (unsatisfying, unrewarding, or inadequate)

• Myriad of factors can lead to the development of sexual dysfunction:

Organic: physical or medical factors such as illness, injury, or drug effects

Psychosocial: psychologic, interpersonal, environmental, situational or cultural

• medications may adversely affect sexual function through interference with the CNS and through hormonal release systems.

• alcohol may lead to sexual dysfunction, the tolerance for alcohol decreases with age, and alcohol can act like other drugs in that it may produce negative effects on sexual function.

• the primary reason given for cessation of sexual intercourse in older adults is the physical illness of one or both partners.

• chronic illnesses tend to develop slowly over a period of years; resultant changes in sexual functioning may develop slowly and may be mistakenly attributed to the aging process rather than to the chronic disease.

• depression can also affect sexual desires.

• Illness affecting sexual function in direct and indirect ways:

• Illness can disrupt the human sexual response cycle.

• The general effects of the illness (such as weakness, fatigue, immobility, pain, and depression) can affect sexual function.

• The treatment for an illness (such as medication) can create a sexual problem.

• If the condition is life threatening (such as stroke or CVD), anxiety and fear about death may affect sexual function.

• Illness may cause changes in the sense of self. Disease and illness that disfigure the body can alter the affected person’s body image and affect sexual function.

• ARTHRITIS: people who take steroids to help control arthritis process may find that The drug decreases their interest in sexual activity. It does not appear to directly affect the individual’s physiologic sexual response. The Assault on body image by the progressive disfiguring elements of the Disease may lead to feelings of unattractiveness.

• CVA (STROKE): after strokes, erectile difficulties are common, a decrease in Frequency of intercourse and in sexual relating (mutual verbal and Nonverbal responsiveness, caressing, and touching). Some believe Sex will cause another stroke, so they will not have sex. Antihypertensive drugs contribute to erectile dysfunction.

• CVD: most common barrier is fear and avoidance. Fear experiencing another MI or Death. The strain of intercourse and orgasm is equivalent to the exertion of Two flights of steps. Sex needs to gradually resumed after three months. Side Lying position should be encourage not on top. Fatigue also can effect it. The pt. needs to be taught what S/S to look for before and after sex. Hypertension drugs can cause deceased libido, arousal, and erectile dysfunciton

• PROSTATECTOMY: Effects after surgery are usually psycholigic rather than Physiological. 3 reasons why: the surgery may provide an excuse for some men to terminate intercourse in the face of previously decreasing desire and performance; erectile dysfunction may be in response to the Drs. attitude that suggests it is a frequent sequela; or the man may be concerned that intercourse will in some way endanger his health.

• GYNECOLOGIC CONDITIONS AFFECTING WOMEN: decreased estrogen levels. Thinning of the vaginal wall may cause infection, bleeding, and itching. UTI is common. Adequate fluid intake and voiding before and after intercourse Can help alleviate the problems.

• CHRONIC OBSTRUCTIVE PULMONARY DISEASE: problems with activity Intolerance related to exertional dyspnea and anxiety related to frequent Coughing spells. Anxiety and fear r/t exertional dyspnea can lead to fear of Suffocation and make sexual activity stressful instead of enjoyable.

• DIABETES: Men have erectile dysfunciton, retrograde ejaculation.Women Experience orgasmic dysfunction and reduced sexual desire and/or Decreased vaginal lubrication. Neuropathy is a cause.

• MALIGNANCIES: diagnosis and treatment of cancer may have adverse effects on Body image, sexual response, and sex roles.Alteration or removal of body Parts, changes in their function, and psychologic responses to these changes Such as anxiety, depression, or guilt may result in sexual dysfunction.When Cancer is far advanced, a person’s needs for affection, sharing of feelings, and Touch may be heightened.

• PENILE IMPLANTS: when illness causes complete inability to have erections, Sexual function by use of a mechanical device surgically implanted in the Penis can partially restore function. They cannot restore sensation or cause Ejaculation. It can restore masculinity, restoration of sexual function. It can Cause infection, if so they have to be removed.

• The surviving man has the opportunity to expand his sexual choices, whereas the older woman is restricted by the male-female imbalance.

• Most men spend their older years married and in family settings, whereas most older women spend their later years as widows outside of family settings

• Men who lose a spouse through divorce or death are more likely to remarry than are women in the same situation.

• More often than not, older men marry or remarry women younger than themselves.

• Men remarry sooner whereas those widows who remarry do so in about 7 years.

• men are more sexually active than women throughout life, with the exception of the very old age groups, in which there is no difference.

• women report lower orgasmic frequency than men throughout the life span.

• for both sexes, the greater the interest in sexual activity when young, the greater the interest and activity when old.

• unavailability of a partner is the primary reason in both sexes for discontinuation of sexual expression.

• the most frequently reported sexual activity was touching and caressing without sex.

• people use their sense of touch to communicate with others.

• to say that one is touched by a warm thought or touched by a beautiful painting or the sound of a familiar melody is an example of the use of the word touch to connote positive emotions.

• Intimacy needs persist to the end of life no matter what a person’s physical or cognitive abilities are.

• Important are the needs for closeness, touch, and being valued as a man or a woman.

• Touch had the potential to be a therapeutic tool to maintain contact and reduce anxiety for many older adults.

• expression of sexual feelings by older adults may add pleasure to their lives and provide relief from anxiety.

• frail older adults in institutions such as hospitals or nsg. Homes have a capacity for sexual pleasure, which includes the need to touch and be touched and to feel warmth and caring.

• Sexual behaviors may be perceived by staff as harmful and disruptive when in fact the behavior is normal and harmless and is an expression of the older person’s need for intimacy or closeness.

• Older adults may resort to clinging to possessions that can be handled or that evoke memories of lost contact with loved ones as spouse and friends die and children move away.

• they may use sexual jokes as a way of drawing attention to themselves as sexual beings.

• Conduct a sexual assessment to determine the individual’s degree of satisfaction or dissatisfaction in fulfilling sexual needs.

• Some older people are willing to talk about sexuality with a nurse if she projects ease and openness. Others will be reluctant to initiate discussion about a sexual concern with a nurse or health professional.

• Sexual difficulties can be concerns that lead to physical depletion and emotional pain.

• Assessments should include a description of the older person’s past patterns of sexual expression, recent changes in the pattern of sexual activity, knowledge of age-related changes in sexual functions, knowledge of illness-related changes in sexual functions, and beliefs about sexual expression.

• the nurse should be alert for covert signs of unmet sexual needs such as repeated references to sex, repeated inappropriate attempts to touch staff members, or reports of sexually inappropriate behavior from friends or family members.

• The single most important factor in helping people with sexual concerns and questions is the ease and comfort with which the clinician handles sensitive and value-laden sexual topics.

• to be effective, nurses must first achieve a healthy attitude toward their own sexuality.

• The diagnoses of sexual dysfunction and altered sexuality patterns encompass all situations in which an individual expresses concern regarding sexuality because of actual or perceived difficulties, limitations, or changes in sexual behavior.

• Knowledge deficit
• Self-esteem disturbance
• Body image disturbance

• Alteration in sexual patterns related to loss of husband

• Knowledge deficit related to physical changes of the aging process or medical treatment.

• many sexual problems can be managed by using educational methods that do not require intensive therapy.

• sexual counseling and therapy depend almost entirely on permission giving and correction of false attitudes toward sexuality and aging.

In the Acute Care Setting:

• previously held attitudes, beliefs, and religious mores regarding sexual behavior need to be explored before specific suggestions regarding sexual activities can be addressed.

In the Nursing Home:

• respect for the dignity and sexual identity of nursing home residents is the primary task of the professional nurse.

• it is crucial to the wellbeing of the nursing home resident that staff members realize that sexuality is a lifelong need and it does not cease to exist because a person becomes a resident of a nursing home.

• no one should demean an older nursing home resident for any form of masturbation, but if public masturbation offends other residents, the staff can assist the resident to a private space, their room.

In the Private or Family Home:

• A major issue to consider when assessing sexual health is the availability of privacy, as well as the availability of a partner.

• the nurse needs to use interpersonal skills to show sensitivity to the older person’s need for sexual expression, find opportunities to affirm the older person’s attractiveness, encourage the person’s expression of femininity or masculinity, and promote social interactions with age peers.

• the nurse should treat all sexual concerns of the older person with the utmost respect for the person’s dignity.

• the nurse must continually evaluate the many relationships that are established with the patient and the patients caregivers.

• nurses must promote sexual integrity – educate the patients, families, and staff regarding the impact of normal aging and chronic illness on sexual function

• advocate for sensitivity to older adults’ needs for closeness, touch, warmth, and meaningful relationships; and competence and comfort in conducting a sexual health assessment.

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