Seniors and sexuality study by NEJM

Survey: Seniors Have Sex Into 70s, 80s
from The Associated Press

NPR.org, August 23, 2007 · An unprecedented study of sex and seniors finds that many older people are surprisingly frisky — willing to do, and talk about, intimate acts that would make their grandchildren blush. That may be too much information for some folks, but it comes from the most comprehensive sex survey ever done among 57- to 85-year-olds in the United States.

Sex and interest in it do fall off when people are in their 70s, but more than a quarter of those up to age 85 reported having sex in the previous year. And the drop-off has a lot to do with health or lack of a partner, especially for women, the survey found.

The federally funded study, done by respected scientists and published in Thursday's New England Journal of Medicine, overturns some stereotypical notions that physical pleasure is just a young person's game.

"Most people assume that people stop doing it after some vague age," said sex researcher Edward Laumann of the University of Chicago.

However, more than half of those aged 57 to 75 said they gave or received oral sex, as did about a third of 75- to 85-year-olds.

"Bravo that the New England Journal of Medicine is publishing something like that. It's about time," said Ruth Westheimer, better known as sexpert Dr. Ruth, who has long counseled seniors on sex.

The survey involved two-hour face-to-face interviews with 3,005 men and women around the country. Researchers also took blood, saliva and other samples that will tell about hormone levels, sex-related infections and other health issues in future reports. They even tested how well seniors could see, taste, hear and smell — things that affect being able to have and enjoy sex.

Some results:

—Sex with a partner in the previous year was reported by 73 percent of people ages 57 to 64; 53 percent of those ages 64 to 75, and 26 percent of people 75 to 85. Of those who were active, most said they did it two to three times a month or more.

—Women at all ages were less likely to be sexually active than men. But they also lacked partners; far more were widowed.

—People whose health was excellent or very good were nearly twice as likely to be sexually active as those in poor or fair health.

—Half of people having sex reported at least one related problem. Most common in men was erection trouble (37 percent); in women, low desire (43 percent), vaginal dryness (39 percent) and inability to have an orgasm (34 percent).

—One out of seven men used Viagra or other substances to improve sex.

—Only 22 percent of women and 38 percent of men had discussed sex with a doctor since age 50.

The survey had a remarkable 75 percent response rate. Only 2 percent to 7 percent did not answer questions about sexual activities or problems, although a higher percentage declined to reveal how often they masturbate.

Why do this research? Sex is an important indicator of health, said Georgeanne Patmios of the National Institute on Aging, the study's main funder.

Sexual problems can be a warning sign of diabetes, infections, cancer or other health woes. Untreated sex issues can lead to depression and social withdrawal, and people may even stop taking needed medications because of sexual side effects, the researchers wrote.

Some of them did a landmark study of sexual habits in younger people a decade ago, but little is known about X-rated behaviors beyond Generation X.

"This subject has been taboo for so long that many older people haven't even talked to their spouses about their sexual problems, let alone a physician," said the lead author, Dr. Stacy Tesser Lindau, a University of Chicago gynecologist.

Many doctors are embarrassed to bring it up, and some may not know how to treat sexual dysfunction, said Dr. Alison Moore, a geriatrics specialist at the University of California, Los Angeles, who had no role in the study.

"Even among geriatricians, there can be an age bias that this is not as big a deal as some of the other things they come into us for," like heart problems or dementia, Moore said. "It gets lost in the shuffle."

The National Opinion Research Center, a university-affiliated private research firm, did the surveys in people's homes. Laumann, its chairman, has received research support from Pfizer Inc., the maker of Viagra.

Hundreds of questions were asked face to face; others, like the number of lifetime sex partners and frequency of masturbation, were asked in a questionnaire, and 84 percent of those were completed.

Most participants were married. But by the time they were 75 to 85, only 37 percent of women had spouses compared to 71 percent of men. Roughly 10 percent of those in the survey were black and more than 6 percent were Hispanic.

The proportion of each gender reporting giving and receiving oral sex "matched up perfectly," Lindau said. "This gives us pretty good reassurance that men and women are telling the same story."

Older people were generally sexually conservative. A small minority had more than one partner, and very few said they paid for sex.

Researchers also used state-of-the-art technology and products donated by several companies to test people's senses. Taste strips were used to see if people could distinguish between various tastes (sour, salty). Special devices were used to test the ability to smell certain scents, including a suspected pheromone — a smell thought to evoke sexual responses.

Scents and tastes "get under the skin to influence biology," and scientists wanted to know whether these senses diminish as people age, Lindau explained.

Niels Teunis, an anthropologist and researcher at the Institute of Sexuality, Social Inequality, and Health at San Francisco State University, said the survey bolsters the "use it or lose it" factor seen in previous studies.

"If you are doing it, you keep doing it. If you slack off in marriage like when you're in your 40s, it's hard to pick it up when you are older," he said.

Jack Menager, 83, and his wife, Elizabeth, 84, agree. The suburban Los Angeles couple say they have had a good sex life for nearly 60 years.

"It gives a person relief on any burdens or problems. It makes us forget everything — escape," he said, admitting that as physical endurance wanes "you have to work at it harder."

The couple takes twice daily walks, drinks wine in moderation and talks a lot, said his wife.

"I think it's important," she said of sex. "It just makes you feel close."

More men than women felt that way. Only 13 percent of men but 35 percent of women said sex was "not at all important."

Menopause has a big effect on women, and the drop-off of estrogen makes many of them less interested in sex, Dr. John Bancroft of the Kinsey Institute for Research in Sex, Gender and Reproduction at Indiana University wrote in an accompanying editorial.

But menopause also means women no longer have to worry about getting pregnant, and many have more time and feel freer after children are gone, notes Westheimer, the sex adviser.

At age 79, she said, "I don't ever answer personal questions" about sex. But she added, "I certainly have a zest for life."

————

Associated Press Science Writer Alicia Chang in Los Angeles contributed to this report.

Sex Education as a Noble Vocation

By MCauch
SageHealth Network

Shortly after my commentary on seniors and sexually transmitted infections was printed in the Toronto Star (http://www.thestar.com/printArticle/247081), many older adults expressed their views to me in very supportive and approving ways. Many told me they were very pleased by shedding light on the subject. One comment was especially meaningful to me. It came from a 70 year old man from India who told me after reading the article, “what you’re doing is very noble work.”

I was flattered that my message about sexual education for seniors crossed a cultural divide and was seen by both this gentleman and his wife as a worthy cause. If noble work is to raise a warning flag to danger and facilitate access to information that prevents illness and saves lives, so be it.

However, this aspect of raising awareness of sexually transmitted infections among older adults is only one small piece of a much larger picture. It’s all part of a larger, invisible and ignored area of older adulthood--- advocacy for seniors’ sexuality and sexual rights.

Last week, the New England Journal of Medicine released a new study on seniors and sexuality confirming once again that older adults are indeed sexually active.


The latest findings:
• 73% reported being sexually active
• 2/3 had sex at least twice a month
• More than half had sex at least twice a month into their 80s
• People in good physical health were 2x as likely to be sexually active than those in poor or fair health.
• 50% of men and a quarter of the women reported that they engage in self pleasuring
• More than half of those aged 57 to 75 and 1/3 or 75-85 year olds said they gave or received oral sex

People are always so shocked at the thought of seniors having sex. Seniors having sex? This doesn’t happen. They’re too old for such nonsense. They can’t possibly have sex at THAT age! Every time a story comes out reporting the sexuality of seniors, shock and disgust are usually the first reactions that welcome the news. There has been, and will continue to be negativity towards senior sexuality.

The good news is that we won’t have to wait too long for a change in our disbelieving, youth-skewed psyches. In the somewhat near future, seniors and sex will become a practically commonplace notion. The clout of the aging baby boomers will slowly but surely begin to change societal perspectives on everything from architectural design to sex. The boomers will have such a profound influence on aging and sex that the only reaction to greet the subject will be run of the mill, “so-what” shrugs.

But why do we need to wait that long to begin to change societal attitudes? We need to advocate for senior sexuality now. Intimacy, physical connection, the ability to feel emotion, these are all part of being human. Why should these rewards be regarded as the domain of the young? Senior sexuality should be celebrated as a life force of physical and emotional expression. An energy that keeps us healthy, vibrant, and content.

Time will turn the tide of perceptions of senior sexuality but we still need to advocate for senior sexuality. We need to talk about it and bring it out of the shadow of being shameful or taboo.

The New England Journal of Medicine put senior sexuality back in the spotlight. Hopefully, it will stay there for a little while longer before it fades from public consciousness again.

Birds, bees and HIV- for Seniors

Birds, bees and HIV – for seniors
TheStar.com - comment - Birds, bees and HIV – for seniors

August 17, 2007
Michele Cauch

(Original link http://www.thestar.com/printArticle/247081)

Recently, the Department of Aging in New York City has initiated sex education for seniors. The program gives away free condoms and offers free HIV testing in efforts to raise awareness of sexually transmitted infections among older adults.

Case in point, HIV was diagnosed in an 82-year-old in Washington, D.C. NYC has the most HIV cases of any U.S. city, nearly 100,000, and the city council has earmarked $1 million toward HIV education for older adults.

In contrast, Ontario has been lax in taking on a leadership role in educating older adults about HIV/AIDS. Seniors and HIV is an invisible danger no one wants to talk about or give any credence to.

Yet the threat is very real. Public Health Canada data show approximately 10 per cent of the positive HIV test reports in Canada each year since the beginning of the epidemic have been among those aged 50 years or older.

Compounding the danger of unchecked HIV/AIDS infection rates is the statistical proof of a major demographic shift. According to census results from Statistics Canada, seniors total 4.3 million, or 13.7 per cent of Canada's 31 million population, a huge cross-section.

In response to this future health risk, seniors and care providers need information now on the subject of sexuality. This is not the same old "birds and the bees" topic that used to make parents blush, but rather the unpleasant, cold, hard facts on sexually transmitted infections such as HIV, HPV, gonorrhea, chlamydia, and herpes, to name a few.

However, it's been an uphill battle to raise awareness in this population and their care providers. The biggest stumbling block is individuals who have the means to prevent access to information. Subjective announcements of "that doesn't happen here," or "that's not our concern" resound in nursing homes and retirement communities.

With respect to government agencies, no one wants to take ownership of this sensitive issue. The mandate of the government is young adults, who receive the bulk of sex education funding. While it would be unconscionable to downgrade the importance of such educational initiatives, we need to advocate and educate on senior sexual health also.

Education and prevention efforts must be aimed at three groups: First, older adults who are at risk of acquiring sexually transmitted infections in later life; second, older adults who acquired a sexually transmitted infection earlier in life and are aging with it; and third, senior care providers who must acknowledge the existence of senior sexuality and risk of unsafe sexual practices.

Seniors are not immune to sexually transmitted infections because of their age.

However minor an increase in HIV infection in older adults is, it will be compounded by the natural aging process of the baby boomers. We need strong government leadership that will acknowledge, support and implement programs for seniors, care providers and family members.

We need to create an environment in which we can openly discuss senior sexual health, disease prevention and management in a constructive and non-judgmental manner.

Otherwise, the health, dignity and well-being of our seniors will be at risk.



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Michele Cauch is executive director of SageHealth Network Canada, which offers health promotion workshops focusing on older adults and care providers. sagehealthnetwork.com

Condoms Can Be Fun, Too

Condoms Can Be Fun, Too
Promoting Condoms as Pleasurable Boosts Contraceptive Use, New Research Suggests
By DAN CHILDS
ABC News Medical Unit

Dec. 1, 2006 —

When it comes to setting the mood for safe sex, pleasure seems to be more of a motivation than fear of pregnancy or disease.

Authors of "Viewpoint" in this week's issue of leading U.K. medical journal The Lancet say campaigns promoting condom use should emphasize how they can enhance the "fun factor" of sex.

Touting the pleasure-enhancing benefits of certain condoms -- whether they be ribbed, textured or twisted -- would represent a divergence from conventional safe-sex promotion efforts, which usually focus on the adverse consequences of unprotected sex.

"Since pursuit of pleasure is one of the main reasons that people have sex, this factor must be addressed when motivating people to use condoms and participate in safer sexual behavior," the authors say in the "Viewpoint."

"Although enjoyment -- and even sex itself -- has been noticeably absent from much of the dialogue surrounding STI [sexually transmitted infections] and the spread of HIV, increasing evidence shows the importance of condom promotion that includes a combination of pleasure-based and safer sex messages."

Most experts told ABC News that they agreed that a new approach was needed to promote safer sex.

"Sole emphasis on disease prevention is no longer working," said Eli Coleman, professor and director of the Program in Human Sexuality at the University of Minnesota Medical School in Minneapolis. "The authors accurately point out the obvious -- that one of the main goals of having sex for humans is pleasure. It is important that we recognize that sexual health is more than the absence of disease."

Fear-promotion has not stopped the spread of sexually transmitted diseases.

"Fear tactics have famously not worked. The spread of STIs is epidemic and devastating," said Gina Ogden, sex therapist and researcher and author of "The Heart and Soul of Sex: Making the ISIS Connection." "Since sex is about pleasure and fun, it makes sense that providing pleasurable, fun materials to make sex safer is a way to help stem STIs."

And condoms need all the public relations they can get.

It turns out the perception that condoms decrease sexual sensation is the key reason more people don't use them.

This finding comes from a study led by The Global Programme on AIDS, which looked at sexual behaviors in 14 countries.

Changing this perception, experts say, is crucial in appealing to those who value pleasure over prudence.

"People do have lots of negative connotations around condom use," said David Greenfield of the Healing Center, LLC, in West Hartford, Conn. "The reality is that people mostly have sex because it's fun and feels good. So why not just deal with that reality and stop pretending it's all about abstinence and reproduction?"

Some doctors have already started adapting a more pleasure-oriented approach to condoms.

"This is an approach that I have used in my practice when teaching women how to convince men to use condoms," said Dr. Hilda Hutcherson, assistant professor of obstetrics and gynecology at Columbia University in New York. "I recommend that they tell their partners that the condoms that they have chosen will increase their pleasure and make sex more fun."

Not everyone is sold on the approach, however.

"I am very skeptical that this will be effective in the long term, but it would certainly encourage men, including teenagers, to be more willing to try them and perhaps accept them," said Dr. Martin Kafka, associate clinical professor of psychiatry at Harvard University in Boston.

Though shifting condom messages into more pleasurable territory may not be a silver bullet, Kafka says it may be worthwhile to try this approach.

"Any method or marketing strategy that encourages safer sex practices and reduces the risk of pregnancy or sexually transmitted diseases is worthy of investigation," he said.


Could the Pleasure Message Appeal to Teens?
Though the study examined in "Viewpoint" dealt largely with HIV-prone populations in Africa, experts say the findings could also help tailor more effective safe sex messages directed at teens in the United States.

"Safer sex messages have been mired by a hesitation or fear that if we even promote condoms we might promote more sexual behavior, particularly among youth," Coleman said.

"However, there are a myriad of other factors that are influencing sexual behaviors and practices. Condom promotion has only helped increase responsible sexual behavior rather than encourage greater sexual activity," Coleman said.

Ogden says there is no basis for the idea that teaching teens about the pleasurable aspects of sex leads to promiscuity.

"In fact, when teens are taught responsible sex -- along with any other kind of responsibility, like wearing a seat belt and using directional signals when driving a car -- they tend to become safer, happier, more confident human beings," he said.

Such promotion efforts could resonate with teens, a demographic not typically known for its attention to messages on safety.

"Teens feel they are invincible," Coleman said. "They are not focused on reproduction or worried about getting old or sick. For those that are sexually active -- and most of them are -- they are looking for ways to enhance pleasure, develop relationships, and enhance their self esteem."


"Many adolescents and young adults are far more interested in being adventurous than practical or prudent, whether it's how they drive, how they snowboard, or how they act on their sexual urges," said Linda De Villers, licensed psychologist and author of "Love Skills: A Fun, Upbeat Guide to Sex-cessful Relationships."


Marketing the 'Sex Toys of the Future'
According to the "Viewpoint," condom brands that emphasize a ribbed or studded design to increase pleasure have sold well in Uganda, where HIV/AIDS remains a problem.

Thus, the authors write, adding pleasure into the equation has the potential to boost condom use even further, reducing the spread of disease.

Now, some say, the onus is on manufacturers to develop and promote new product lines -- ones that enhance stimulation for parties on both sides of the latex.

"It blows my mind that the condom companies themselves are so lacking in unique designs and interesting advertising plans," said Suzie Heumann, president of Tantra.com, Inc. and author of "The Everything Great Sex Book."

"Condoms could actually be the new sex toys of the future -- and without batteries -- with design changes, additions, and a new advert campaign," she said.

And shifting the focus to pleasure, Hutcherson says, makes condoms no less effective in preventing disease and pregnancy.

"All of this puts the focus on increased pleasure during sex, and the protection against STIs is a wonderful 'side effect' or bonus," Hutcherson said. "It seems to work better than the typical 'protection against STIs' message."


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