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Authors
Masters & Johnsons
D.N Mishra (From Book of Sexual Medicine).
INTRODUCTION AND OBJECTIVES
BIOLOGICAL CONSIDERATIONS
1. Aging alone does not diminish female sexual interest or the potential of the woman to be sexually responsive if her general health is good.
2. Specific physiological changes do occur, however, in the sexual response cycle of postmenopausal women.
3. These changes do not appear abruptly or in exactly the same fashion in each woman.
4. Typically, there is little or no increase in breast size accompanying sexual arousal. Although breast sensitivity to stimulation continues.
5. The sex flush occurs less often and extensively than at younger ages. But this change has absolutely no effect on sexual feeling or functioning.
6. Less muscle tension develops during sexual arousal, particularly in the plateau phase, which is not surprising since this corresponds to the usual decrease in muscle size and strength that occurs with aging.
7.This reduced muscular tension may account for the reduced intensity of orgasm that is sometimes experienced by women in late adulthood.
8. While clitoral response is not affected by aging, vaginal function changes in two different ways. First, reduced elasticity in the wall of the vagina leads to less expansion during sexual arousal.
9. Second, vaginal lubrication generally begins more slowly than at younger ages and vaginal dryness may create some problems as the quantities of lubrication are somewhat reduced.
10.This condition can be overcome if it causes discomfort either by estrogen replacement therapy or by the use of an artificial lubricant such as K - Y jelly
METHODS
1. Recent research has shown that the decrease in vaginal lubrication in postmenopausal women is the direct result of diminished vaginal blood flow that, in turn, is caused by low estrogen.
2. Recent investigation, Leiblum and co-workers found that sexually active postmenopausal women had less shrinkage of the vagina and higher levels of androgens and pituitary gonadotropins (LH and FSH) than sexually inactive women.
3. This Suggests that regular sexual activity may provide at least some protection against the physiologic changes of aging in relation to female sexual anatomy.
SEX AND AGED MAN
1. The normal pattern of reproductive aging in men is quite different from women because there is no definite end to male fertility.
2. Although Sperm production slows down after age forty, it continues into the eighties and nineties. Similarly, while testosterone production declines gradually from age fifty-five or sixty on, there is usually no major drop in sex hormone levels in men as there is in women.
3. About 5 percent of men over sixty experiences a condition call the male climacteric which resembles the female menopause in some ways. (Using the term "male menopause" to describe the male climacteric is incorrect since men do not have menstrual periods.)
4. This condition is marked by some or all of the following features: Weakness, tiredness, poor appetite, decreased sexual desire reduction or loss of potency, irritability, and impaired ability to concentrate.
5. These changes occur because of low testosterone production, and they can be reversed or improved by testosterone injections or capsules.(Nuvir) or testosterone gel.
6. It should be stressed that most men do not have a recognizable climacteric as they age.
RESULTS
The physiology of male sexual response is affected by aging in a number of ways. The following changes have been noted in men over fifty-five:
1. It usually takes a longer time—and more direct stimulation for the penis to become erect.
2. Erections tend to be less firm, on average, than at earlier ages.
3. The testes elevate only partway up to the perineum, and do so more than in younger men.
4. The amount of semen is reduced, and the intensity of ejaculation is lessened.
5. There is usually less physical need to ejaculate.
6. The refractory period — the time interval after ejaculation when the mate is unable to ejaculate again - becomes longer.
PSYCHOLOGICAL ASPECTS OF SEXUALITY IN AGED
1. Aged persons show great variability to sexual values and interest.
2. Sexuality may be altered with ageing because of varied reasons.
3. Such alterations may be in the form of :
4. In general, sexual disinterest may arise because sex may be considered as an unnecessary, aesthetically unappealing and a meaningless activity with loss of reproductive potential. Loss of enthusiasm could also be due to the fear of sexual inadequacy, declining interest or dysfunction of the partner.
5. Sexual boredom may be due to lack of novelty, innovation and exploration in sexual practices, cultural inhibitions and declining health of couples.
6. Physical impairment of sexuality may be due to alteration in blood flow to the genitals or defective innervations of the pelvis.
7. Chronic illness resulting in early fatigue and physical disabilities may also interfere.
8. Cultural attitudes that glamorize vitality and youth and denigrate the aged may make the aged feel that sex is mainly for the young.
9. They may feel embarrassed and guilty on getting sexually excited.
10. They may abstain to express their emotional and sexual needs and may even avoid sexual contact.
11. This will have a negative effect on exchange of emotions and continued intimacy.
12. Disuse attrition is a common problem in the aged. There is diminished lubrication of the vagina and actual shrinkage of the vaginal barrel in sexually inactive women, resulting in dyspareunia.
13. Similarly, a male after prolonged abstinence may find that he is unable to have erection on reversion to sexual activity. CONCLUSION
It may thus be concluded that there is sufficient evidence to show that both in men and women, sexuality declines with advancing age.
Several factors are involved and hormonal changes may be responsible to some extent. Sexual responses are also altered probably due to physiological changes of ageing. The society’s attitudes towards the aged in India need to be changed in general and to their sexual and emotional needs in particular. This will help the older people to live happily and enjoy life fully — physically, emotionally and sexually.
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