Sexual functioning of people with rheumatoid arthritis: a multicenter study

The objective of this study is to compare men and women with rheumatoid arthritis (RA) to controls regarding sexual motivation, activity, satisfaction, and specific sexual problems, and to determine the correlation of physical aspects of the disease with sexual functioning. Questionnaire for screening sexual dysfunctions (QSD), self-constructed questionnaire on experienced distress with joints during sexual activities, arthritis impact measurements scales 2 (AIMS2), and the modified disease activity score 28 (DAS 28) were the methods used. RA patients were recruited from a registration base in three Dutch hospitals. Controls were age and sex matched healthy volunteers. A completed questionnaire was sent back by 271 patients (response 23%). Forty-seven men and 93 women were clinically examined to obtain the DAS 28. Male patients felt less sexual desire, and female patients masturbated and fantasized less than controls. Differences in satisfaction were not found. Male and female patients did not experience more sexual problems than controls. Among the women, correlations were predominantly found between age and sexual motivation and activities, among the men between physical health and sexual problems. Up to 41% of the men (4–41 depending on the joints), and up to 51% of the women (10–51 depending on the joints) have troubles with several joints during sexual activities. Medications influencing ejaculation in men correlated with distress with orgasm. Conclusions are that patients are less sexually active than controls and a considerable number of both male and female patients have trouble with their joints during sexual activities. However, patients do not differ from controls regarding sexual satisfaction. Physiological changes due to RA are apparently independent from those on psychological level. It is argued that sexual satisfaction also depends on personal and social factors. In men, physical health and disease activity are more related with sexual problems than in women.     

Patterns and Correlates of Sexual Activity and Condom Use Behavior in Persons 50-Plus Years of Age Living with HIV/AIDS

This study characterized rates of sexual activity and identified psychosocial and behavioral correlates of sexual activity and condom use in a metropolitan sample of 290 HIV-infected adults 50-plus years of age. Thirty-eight percent of participants were sexually active in the past three months, 33% of whom had at least one occasion of anal or vaginal intercourse that was not condom protected. Rates and correlates of sexual activity and condom use differed between gay/bisexual men, heterosexual men, and heterosexual women. In the past three months, 72% of heterosexual men were sexually active compared to only 36% of gay/bisexual men and 21% of heterosexual women. However, among sexually active persons, only 27% of heterosexual men reported inconsistent condom use compared to 37% of gay/bisexual men and 35% of heterosexual women. As the number of older adults living with HIV/AIDS in the U.S. continues to increase, age-appropriate secondary risk-reduction interventions are urgently needed.     

Sexual behavior in later life

OBJECTIVE: This research tests the influences of age, biological, and psychosocial factors on sexual expression in later life. METHOD: The American Association of Retired Persons Modern Maturity Sexuality Survey collected data on diagnosed illnesses, treated illnesses, sexual desire, sexual attitudes, partner circumstances, and sexual behavior from 1,384 persons ages 45 and older. Ordered logistic regression models estimate the associations of age, biological, and psychosocial factors with the frequency of five sexual behaviors. RESULTS: Diagnosed illnesses and treatments are generally unrelated to frequency of sexual activity. Sexual attitudes are related to frequency of partnered behavior and sexual desire is related to frequency of masturbation among both women and men. Satisfaction with the physical relationship with a partner is strongly related to behavior. Age remains significant after all other factors are controlled. DISCUSSION: The authors conclude that the nature of sexual expression in later life reflects the interplay of body, mind, and social context.     

Metabolic Syndrome and Sexual Function in Postmenopausal Women

Background

Limited literature suggests that sexual dysfunction in women covaries with the metabolic syndrome. This study examined the association of sexual function with metabolic syndrome and cardiovascular disease in healthy older women.

Methods

There were 376 postmenopausal, community-dwelling women from the Rancho Bernardo Study (mean baseline age = 73 years) that completed a clinic visit during 1999-2002 and returned the Female Sexual Function Index (FSFI) questionnaire mailed in 2002.

Results

Thirty-nine percent reported being sexually active; 41.5% met a diagnosis of metabolic syndrome. The number of metabolic syndrome components was strongly associated with decreased sexual activity, desire, and low sexual satisfaction. Waist girth, diabetes, and hypertension were associated with decreased sexual activity. Elevated triglycerides were associated with low desire. Among the cardiovascular endpoints, heart attack, coronary artery bypass, and angina were associated with decreased sexual activity, but not with sexual desire or satisfaction. Past diagnosis of heart failure, poor circulation, and stroke were not associated with sexual function. Sexually active women with metabolic syndrome met criteria for sexual dysfunction in desire, arousal, orgasm, and satisfaction domains. The FSFI Total Score did not differ significantly between sexually active and inactive women.

Conclusions

Metabolic syndrome was associated with decreased sexual activity, desire, and satisfaction in all women and with sexual dysfunction in most domains in sexually active women. Coronary artery disease was more prevalent in women with low sexual activity.     

Women's Sexual Health and Aging

Older women are often sexually active, but physicians caring for older women rarely address sexual concerns. Although women's desire for sex declines with age, a majority of older women rate sex as having importance in their lives. Women identify emotional intimacy as an important reason for engaging in sexual relationships. Women are less likely than men to have an available spousal or intimate partner and more likely to have a partner with sexual difficulties of their own. Up to half of sexually active older women report a distressing sexual problem, with low desire and problems related to genitourinary syndrome (vulvovaginal atrophy) being most common. Difficulty with orgasm in older women is often associated with a partner's erectile dysfunction. Sexually transmitted infections (STIs) are increasingly prevalent in older women. A minority of older women report discussing sexual issues with a physician. Most commonly, the patient initiates discussions. Physicians should ask regularly and proactively about sexual activity and function. Important interventions include offering practical advice to common chronic medical conditions and sexual problems that confront older women; treating vulvovaginal atrophy; and providing STI screening, prevention strategies, and treatment when appropriate.     

Sexual function in the elderly

Little is known about sexual behavior among the elderly living in the community. Questions about sexual activity and its correlates were included in a clinic examination whose participants were identified by a household survey of a probability of Washtenaw County, Michigan, elderly, aged 60 years and over, on the medical, epidemiological, and social aspects of aging. Estimates of proportions based on responses at the clinic examination were also projected to the demographics of the household survey. The estimated proportions of individuals who are sexually active are 73.8% for married men and 55.8% for married women; among unmarried men and women the proportions are 31.1% and 5.3%, respectively. The levels decrease significantly with age in both genders. The estimated proportion of married men with erectile impotence is 35.3%. Significant associations were observed between having problems with mobility and the lack of sexual activity in both genders. The prevalence of impotency was significantly associated with a history of heart attack, urinary incontinence, and the use of sedatives. The consumption of at least one cup of coffee per day was significantly associated with a higher prevalence of sexual activity in women and with a higher potency rate in men.     

Sexuality and Sense of Self in Later Life: Japanese Men’s and Women’s Reflections on Sex and Aging

The aim of this article is to provide a nuanced analysis of the transformation of sexuality that occurs with age. Drawing on several ethnographic narratives of married men and women over the age of 60 in Japan, this article provides insight into gender-specific experiences of marital sexuality, the impact of extra-marital sexual activity on marital relationships, and the development of “sibling-like” relationships as couples grow older. It also highlights the continuing importance of sexual desire in later life, especially to men’s sense of self. This article contributes to the growing scholarship on the sexuality of older persons around the world and makes a case for the importance of the life history interview as a methodology for illuminating the complex relationship between gender, sexuality, and aging.     

Racial and socioeconomic disparities in sexual activity among older married Malaysians

Sexuality as an important part of life has not been well studied in Malaysia, particularly among older adults. The main aim of this study was to investigate the racial and socioeconomic differences in sexual activity among older married Malaysians. Data for this study consisting of 1036 older married adults aged 60 years and older were obtained from the nationwide community-based cross-sectional survey entitled “Determinants of Wellness among Older Malaysian: A Health Promotion Perspective”, conducted in 2010. Data were analyzed using SPSS version 21 for Windows. The results showed that 57.3% (95% CI: 54.3–60.3) of the respondents (61.6% of men and 50.6% of women) had engaged in sexual intercourse during the last 12 months. The adjusted multivariate logistic regression analysis revealed that ethnicity and educational attainment were independently and significantly associated with sexual activity, after controlling for the possible confounding effects of chronic medical conditions and demographic characteristics. The findings from this study do support the notion that sexuality is a lifelong need and cultural teachings and formal education may have important role in maintaining the quality of sexuality in later life.     

Sexual Function and Aging in Racially and Ethnically Diverse Women

OBJECTIVES: To examine factors influencing sexual activity and functioning in racially and ethnically diverse middle-aged and older women.
DESIGN: Cross-sectional cohort study.
SETTING: Integrated healthcare delivery system.
PARTICIPANTS: One thousand nine hundred seventy-seven women aged 45 to 80.
MEASUREMENTS: Self-administered questionnaires assessed sexual desire, activity, satisfaction, and problems.
RESULTS: Of the 1,977 participants (876 white, 388 African American, 347 Latina, and 351 Asian women), 43% reported at least moderate sexual desire, and 60% had been sexually active in the previous 3 months. Half of sexually active participants (n=969) described their overall sexual satisfaction as moderate to high. Among sexually inactive women, the most common reason for inactivity was lack of interest in sex (39%), followed by lack of a partner (36%), physical problem of partner (23%), and lack of interest by partner (11%); only 9% were inactive because of personal physical problems. In multivariable analysis, African-American women were more likely than white women to report at least moderate desire (odds ratio (OR)=1.65, 95% confidence interval (CI)=1.25–2.17) but less likely to report weekly sexual activity (OR=0.68, 95% CI=0.48–0.96); sexually active Latina women were more likely than white women to report at least moderate sexual satisfaction (OR=1.75, 95% CI=1.20–2.55).
CONCLUSION: A substantial proportion of community-dwelling women remain interested and engaged in sexual activity into older age. Lack of a partner capable of or interested in sex may contribute more to sexual inactivity than personal health problems in this population. Racial and ethnic differences in self-reported sexual desire, activity, and satisfaction may influence discussions about sexual difficulties in middle-aged and older women.     

Sex and the Single (Older) Guy: Sexual Lives of Older Unmarried Thai Men During the AIDS Era

In Thailand and elsewhere, some older persons remain sexually active well into late middle and old age. Very little research, program, or advocacy effort has targeted this group with respect to HIV and their susceptibility to it. We explore these issues using qualitative data from two sets of semi-structured, in-depth interviews of unmarried older Thai men, most of whom were in their 50's. Opportunities exist for several of the men we interviewed to engage in a fairly wide range of sexual relationships. Some do, but others choose celibacy because of declining interest; a wish to avoid financial hardships thought to be inextricably linked with sexual relationships; a wish to avoid social sanctions; and desires to pursue interests thought to be more appropriate for their age group.     

Factors associated with sexuality in later life: An exploratory study in a group of Greek married older adults

The present study aimed to investigate factors associated with sexual interest and behaviors in married older adults. The study recruited older adults from the Open Protection Centers for Elderly. A 30-items questionnaire addressing sexuality, emotional and physical intimacy, demographics, and background data was constructed. Dichotomous responses were used for intimacy and sexuality items. Data were analyzed using Chi-square tests, Pearson's correlation coefficient and Independent samples t-test. The sample consisted of 454 married participants (age range: 60-90, mean: 69.0+/-6.5). More than 50% reported having sexual desire and intercourse's average frequency of 4/month. Increasing age and marriage's years related significantly to decreased frequency of sexual intercourse (p<0.001). Participants married out of love reported higher frequency of intercourse p.a. compared with those in arranged marriages (p=0.031). Gender, age, income, married out of love and being still in love with the partner were all significantly associated with sexual interest and behaviors (p<0.05). This study demonstrates that older adults remain sexually active and a range of personal, socio-economic and interpersonal factors are associated with sexual interest. Therefore, sexual expression should be a well-informed individual's choice and not the result of societal myths or health professionals' misconceptions.     

Processes and Outcomes of HIV Serostatus Disclosure to Sexual Partners among People Living with HIV in Uganda

Disclosure of HIV serostatus to sexual partners supports risk reduction and facilitates access to prevention and care services for people living with HIV/AIDS. To assess health and social predictors of disclosure as well as to explore and describe the process, experiences and outcomes related to disclosure of HIV-infected men and women in Eastern Uganda, we conducted a study among HIV-infected men and women who were clients of The AIDS Support Organization (TASO) in Jinja, Uganda. We enrolled TASO clients in a cross-sectional study on transmission risk behavior. Demographic and behavioral data and CD4 cell count measurements were collected. Among 1,092 participants, 42% were currently sexually active and 69% had disclosed their HIV serostatus to their most recent sexual partner. Multivariate logistic regression analysis showed that disclosure of HIV-status was associated with being married, having attended TASO for more than 2 years, increased condom use, and knowledge of partner’s serostatus. From these clients, 45 men and women were purposefully selected and interviewed in-depth on disclosure issues. Positive outcomes included risk reduction behavior, partner testing, increased care-seeking behavior, anxiety relief, increased sexual communication, and motivation to plan for the future. The findings and conclusions in this report are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention.     

Sleep quality,sleep duration and sexual health among older people: Findings from the English Longitudinal Study of Ageing

ContextHow sleep quality and sexual health are associated among community-dwelling individuals remains largely unknown.ObjectiveWe examined the association of sleep disturbance and sleep duration with a range of measures assessing sexual activities, functioning and concerns in a representative sample of older people.MethodsParticipants were community-dwelling adults aged 50-90+ years from wave 6 (2012/2013) of the English Longitudinal Study of Ageing (ELSA) who reported any sexual activity in the last year. Sleep disturbance, sleep duration and sexual health were measured by self-report at wave 6. Retrospective reports of restless sleep (waves 1–6 [2002–2013]) were also examined. The association between sleep measures and sexual health was assessed using logistic regressions stratified by gender and adjusted for demographic, health and lifestyle factors with results expressed as odds ratios (OR) and 95% confidence intervals (CI).ResultsAmong both men and women disturbed sleep was associated with reported declines in sexual activity and function over the last year, and increased concern about their sexual desire, frequency of sexual activity and sexual functioning. Robust associations between high sleep disturbance and vaginal pain (OR = 1.67, 95% CI = 1.21, 2.31) and vaginal dryness (OR = 1.69, 95% CI = 1.24, 2.30) were also observed among women. Retrospective reports of restless sleep showed a dose-response relationship with reported declines in sexual health over the last year, and increased concerns about sexual expression and functioning.ConclusionsSelf-reported sleep disturbance and retrospective restless sleep were mainly associated with subjective assessments of recent declines in sexual activity and functioning, and higher levels of sexual concerns.     

Older widows and married women: their intimates and confidants

Interview data obtained from 132 women sixty-five and older reveals that the widows and married women have a comparable number of primary friends. Being over age seventy-four influences the size of the friendship network for widows but not married women. The primary friendships of widows and married women parallel each other in terms of endurance and stability. Primary ties with men are the exception rather than the norm, for both widows and married women. Widows do differ from married women in that the former rely on confidant friends to a greater extent. Ties between older women and their confidants are characterized by norms of reciprocity.     

Childhood Trauma and Adult Prostitution Behavior in a Multiethnic Heterosexual Drug‐Using Population

A cross-sectional study of the association between severity of childhood trauma and adult prostitution behaviors was conducted among 676 heterosexual drug addicts in San Antonio, Texas. Three hundred and fifty eight women and 338 men taking part in a national multisite program for AIDS prevention research completed the Childhood Trauma Questionnaire as part of a comprehensive risk behavior assessment. Women addicts in the sample were less educated, more likely to be in a common-law relationship, living with someone of the opposite sex or separated, and had lower incomes in comparison to men addicts. Among male subjects, higher educational levels and older age were positively associated with prostitution activities. Single female subjects were three times more likely to engage in selling sex than married subjects. Single women with higher incomes were more likely to be prostituting than single women with lower incomes. Black women reporting severe degrees of emotional abuse, emotional neglect, or physical neglect were more likely to engage in prostitution behavior than Hispanic or white women with similar levels of trauma. Black men with a history of childhood physical abuse were more likely to use prostitutes than Hispanic or white men.     

Childhood trauma and adult prostitution behavior in a multiethnic heterosexual drug-using population

A cross-sectional study of the association between severity of childhood trauma and adult prostitution behaviors was conducted among 676 heterosexual drug addicts in San Antonio, Texas. Three hundred and fifty eight women and 338 men taking part in a national multisite program for AIDS prevention research completed the Childhood Trauma Questionnaire as part of a comprehensive risk behavior assessment. Women addicts in the sample were less educated, more likely to be in a common-law relationship, living with someone of the opposite sex or separated, and had lower incomes in comparison to men addicts. Among male subjects,higher educational levels and older age were positively associated with prostitution activities. Single female subjects were three times more likely to engage in selling sex than married subjects. Single women with higher incomes were more likely to be prostituting than single women with lower incomes. Black women reporting severe degrees of emotional abuse, emotional neglect, or physical neglect were more likely to engage in prostitution behavior than Hispanic or white women with similar levels of trauma. Black men with a history of childhood physical abuse were more likely to use prostitutes than Hispanic or white men.     

Sexual relations in later life: a national study of married persons

Sexual behavior among married persons 60 years of age and older was examined using data from the National Survey of Families and Households. About 53 percent of the entire sample, and 24 percent of those 76 years of age and older, report having had sexual relations at least once within the past month. Persons who have been sexually active within the past month report having sex about four times during the month. While respondent's age is significantly related to sexual behavior, the monthly incidence and overall sexual frequency variables are not influenced by gender, race, or a Gender by Spouse's Health Status interaction term. While the NSFH variables included in our model are poor predictors of elderly persons' sexual behavior, analyses reveal that a person's sense of self-worth/competence and his/her partner's health status are significantly and positively related to the incidence of sex within the past month.     

Sexual transmission of human T-lymphotropic virus type I (HTLV-I)

STUDY OBJECTIVE: To study the seroprevalence of human T-lymphotropic virus type I (HTLV-I) in a sexually active population and to determine sexual behavior risk factors for infection. DESIGN: Cross-sectional seroprevalence study using enzyme-linked immunosorbent assay (ELISA) and Western blot. Risk-factor data were gathered by administered questionnaire and chart review. SETTING: Two urban, primary care clinics for persons with sexually transmitted diseases run by the Jamaican Ministry of Health. PATIENTS: Of the 2050 consecutive patients presenting with new episodes of sexually transmitted disease, 1977 patients were eligible for analysis. MEASUREMENTS AND RESULTS: Overall HTLV-I seroprevalence was 5.7%; prevalence increased with age from 1.6% (age, 14 to 19 years) to 5.1% (age, 30 years and older) in men and from 5.3% (age, 14 to 19 years) to 14.1% (age, 30 years and older) in women. Compared with a reference cohort of food service employees, age-adjusted HTLV-I seroprevalence was increased in female patients with sexually transmitted disease (odds ratio = 1.83; CI, 1.41 to 2.83) but not in male patients with sexually transmitted disease. Independent risk factors for HTLV-I infection in women included having had more than ten lifetime sexual partners (odds ratio = 3.52, CI, 1.28 to 9.69) and a current diagnosis of syphilis (odds ratio = 2.12; CI, 1.12 to 3.99). In men, a history of penile sores or ulcers (odds ratio = 2.13; CI, 1.05 to 4.33) and a current diagnosis of syphilis (odds ratio = 3.56; CI, 1.24 to 10.22) were independent risk factors for HTLV-I infection. Of 1977 patients, 5 (0.3%) had antibodies to human immunodeficiency virus type 1 (HIV-1), including 2 with HTLV-I and HIV-1 coinfection. CONCLUSIONS: We conclude that HTLV-I is transmitted from infected men to women during sexual intercourse. Our data are consistent with the lower efficiency of female-to-male sexual transmission of HTLV-I, but penile ulcers or concurrent syphilis may increase a man's risk of infection.     

Aging and attractiveness: marriage makes a difference

In order to explore women's agreement with the double standard of aging, thirty-two women ranging in age from twenty-eight to sixty-three were asked to share their definitions of attractiveness, femininity, and sexual appeal. They were then asked if they had changed these definitions over time and if they perceived themselves as growing more or less attractive, feminine, and sexually appealing as they grew older. The findings showed that attractiveness was defined primarily by appearance, femininity by behavior and inferred traits, and sexual appeal by both. More single than married women had changed definitions of these terms, and more single women perceived themselves as having grown more attractive, feminine, and sexually appealing as they grew older. Age differences in these evaluations were found among the group of married women, but few age differences were found among single women. The findings suggest there may be qualitatively differing experiences between single and married women that are reflected in their evaluations of attractiveness and sexual appeal.