A more satisfying sex life may be only a good night’s sleep away for women over 50, new research finds.
Researchers led by Dr. Juliana Kling of the Mayo Clinic in Scottsdale, Ariz., tracked data from nearly 94,000 women aged 50 to 79.
The investigators found that 31 percent had insomnia, and a little more than half (56 percent) said they were somewhat or very satisfied with their sex life.
But too little sleep — fewer than seven to eight hours a night — was linked with a lower likelihood of sexual satisfaction, the findings showed.
“This is a very important study since it examines a question which has tremendous potential impact on women’s lives,” said Dr. Jill Rabin, who reviewed the findings. She’s co-chief of the Women’s Health Program at Northwell Health in New Hyde Park, N.Y.
Age played a key role in outcomes. For example, the study found that older women were less likely than younger women to be sexually active if they slept fewer than seven to eight hours per night.
Among women older than 70, those who slept fewer than five hours a night were 30 percent less likely to be sexually active than women sleeping seven to eight hours, Kling’s team found.
The findings highlight how crucial sleep is to many aspects of women’s health, medical experts said.
“Seven hours of sleep per night will improve sexual satisfaction and has been shown to increase sexual responsiveness,” said Dr. JoAnn Pinkerton, executive director of The North American Menopause Society.
Besides putting a damper on sex lives, she said, poor sleep is also tied to an array of health issues, such as “sleep apnea, restless legs syndrome, stress and anxiety.” Other health problems linked to insomnia include “heart disease, hypertension [high blood pressure], arthritis, fibromyalgia, diabetes, depression and neurological disorders,” Pinkerton added.
Dr. Steven Feinsilver directs sleep medicine at Lenox Hill Hospital in New York City. He reviewed the new findings and stressed that they can’t prove cause and effect. “It certainly could be possible that many underlying problems — for example, illness, depression — could be causing both worsened sleep and worsened sex,” he noted.
Rabin agreed, but said there’s been “a paucity of studies” looking into links between sleep and sexual health, especially during menopause.
“We know that obstructive sleep apnea and sexual dysfunction are positively correlated,” she said. “Other factors which may lead to a decreased sleep quality include: a woman’s general health; various life events, which may contribute to her stress; chronic disease; medication; and degree and presence of social supports, just to name a few,” Rabin explained.
And, “in menopause, and due to the hormonal transition, women may experience various symptoms which may impact the duration and quality of their sleep patterns,” Rabin added.
We and our patients need to know that quality sleep is necessary for overall optimum functioning and health, including sexual satisfaction, and that there are effective treatment options — including hormone therapy — which are available for symptomatic women,” she said.
The study was published online Feb. 1 in the journal Menopause.
[S]exuality encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction and what we think, feel and believe about them. It has been a research focus for over a hundred years, and highlighted as an important part of the human experience. Since the first studies on human sexuality in the 1940s, research has consistently demonstrated that sexual interest and activity are sustained well into old age. However, only a fraction of the research has explored sexuality in the later years of life.
Most of the early research on sexuality and ageing looked at the sexual behaviours and biology of older adults, generally ignoring the wider concept of sexuality. When researchers did discuss sexuality more broadly, many referred to sexuality as the domain of the young, and emphasised this was a major barrier to the study of sexuality in older adults.
Sexuality in later life ignored
Towards the end of the 20th century, research expanded to include attitudes towards sexual expression in older adults, and the biological aspects of sexuality and ageing. Consistently, the research showed sexual expression is possible for older adults, and sustained sexual activity into old age is more likely for those who had active sex lives earlier in life.
By the late 1980s, there was a strong focus on the biological aspects of ageing. This expanded to include the reasons behind sexual decline. The research found these were highly varied and many older adults remain sexually active well into later life.
But despite evidence adults continue to desire and pursue sexual expression well into later life, both society in general and many health professionals have inadvertently helped perpetuate the myth of the asexual older person. This can happen through an unintentional lack of recognition, or an avoidance of a topic that makes some people uncomfortable.
Why does this matter?
These ageist attitudes can have an impact on older adults not only in their personal lives, but also in relation to their health needs. Examples include the failure of medical personnel to test for sexually transmissible infections in older populations, or the refusal of patients to take prescribed medications because of adverse impacts on erection rigidity. We need more health practitioners to be conscious of and incorporate later life sexuality into the regular health care of older adults. We still have a long way to go.
By ignoring the importance of sexuality for many older adults, we fail to acknowledge the role that sexuality plays in many people’s relationships, health, well-being and quality of life. Failure to address sexual issues with older patients may lead to or exacerbate marital problems and result in the withdrawal of one or both partners from other forms of intimacy. Failure to discuss sexual health needs with patients can also lead to incorrect medical diagnoses, such as the misdiagnosis of dementia in an older patient with HIV.
It’s not about ‘the deed’ itself
In a recent survey examining sexuality in older people, adults aged between 51 and 89 were asked a series of open-ended questions about sexuality, intimacy and desire, and changes to their experiences in mid-life and later life. This information was then used to create a series of statements that participants were asked to group together in ways they felt made sense, and to rank the importance of each statement.
The most important themes that emerged from the research encompassed things such as partner compatibility, intimacy and pleasure, and factors that influence the experience of desire or the way people express themselves sexually. Although people still considered sexual expression and sexual urges to be important, they were not the focus for many people over 45.
Affectionate and intimate behaviours, trust, respect and compatibility were more important aspects of sexuality than intercourse for most people. Overall, the message was one about the quality of the experience and the desire for connection with a partner, and not about the frequency of sexual activities.
People did discuss barriers to sexual expression and intimacy such as illness, mood or lack of opportunity or a suitable partner, but many felt these were not something they focused on in their own lives. This is in line with the data that shows participants place a greater importance on intimacy and affectionate behaviours such as touching, hugging and kissing, rather than intercourse.
These results help us challenge the existing stereotype of the “asexual older person” and the idea intercourse is necessary to be considered sexually active. They also make it clear researchers and health practitioners need to focus on a greater variety of ways we can improve the experience and expressions of sexuality and intimacy for adults from mid-life onwards beyond medical interventions (like Viagra) that focus on prolonging or enhancing intercourse.
More people are dating in middle age, but are they looking after their sexual health?
A regular, happy sex life can benefit our physical, mental, emotional and social wellbeing, improving health and prolonging life
By Alana Kirk
[W]ith more middle-aged people dating, or starting new relationships than ever before, are we taking enough care and consideration of our sexual health?
When we think of the faces behind recent statistics that are showing a rise in sexually transmitted diseases (STDs), we probably picture someone young. Those irresponsible students and twentysomethings playing around and not thinking through the consequences of their actions. But not so much. It is becoming clear that a large proportion of people contributing to those statistics are in fact, middle-aged. The Irish Family Planning Association (IFPA) annual report highlighted an increase in women aged over 50 coming to the clinics for sexual health services, including sexually transmitted infection screening and menopause check-ups.
The association said there was a perception that once women reached menopause, that they no long needed sexual health services. But that’s not the case. Minding our sexual health all through our life is as important as looking after our physical and mental health.
Unplanned pregnancies
For many women, perhaps coming out of a long marriage or relationship, they perhaps don’t seem to think they have to go back to the good old days of contraception and protection. Yet there are more unplanned pregnancies in the 40-plus age group than the younger ages.
“We definitely see an innocence and a lack of knowledge in middle-aged women seeking our services,” says Caitriona Henchion, medical director of the IFPA. “We see women not knowing if they need emergency contraception or whether they are experiencing menopausal symptoms. They’re not sure even in their late 40s and early 50s whether they still need contraception.”
The recommendation for contraception is very simple, yet perhaps not widely known. Until you have not experienced periods for two full years and you are under the age of 50, or one full year without periods after the age of 50, you need to still consider contraception. Amid constant talk of falling fertility as we age, many women are confused about their contraception needs.
This lack of knowledge about sexual health needs is apparent not just in the number of unplanned pregnancies in older women, but the rise of STDs in that age group as well. According to Henchion, advice from GPs can sometimes vary in quality and quantity, and so any sexually active woman over the age of 40 needs to seriously consider both her health risks and contraception needs.
Regular screening
The recommendation is that anyone who is sexually active needs regular screening. This seems to be something that many women feel unable to do. But emerging from a marriage or long-term relationship where the partner may have had other sexual partners means that STD screening is imperative.
“Discovering an unfaithful partner is a really common reason that we see older women coming to our clinics for screening,” says Henchion. “Our advice would be that the first thing to consider when starting with new partners is to ensure you have safer sex with condoms.”
But condoms don’t protect against everything, so the recommendation from the IFPA would be that if in sexual relationships you need to have testing twice a year.
“Obviously the people I see are a self-selecting group who are sexually active and attending our services, but certainly I would see a lot more people in the 50-plus [group] who are openly talking about their wants and needs and their problems with it, which is great,” explains Henchion. Who they do not see are the men and women not seeking sexual health services, or asking openly about their needs
One of the reasons there is a rise in general of STDs is because far more tests are being carried out, and therefore, more positive results. The tests are better now for chlamydia and gonorrhoea, so whereas a few years ago tests had less than 75 per cent detection rate, today it is 99 per cent. The tests themselves are simple. For men with no symptoms it is a straightforward urine sample and blood test, and for a woman, a vaginal swab and blood test in a nurse-led clinic.
Simple rule
According to Henchion, “the simple rule would be if you have a new partner for a few weeks, get tested.” But for many people, we perhaps don’t even know what to look for.
The top three STDs in terms of prevalence would be chlamydia, warts and herpes, and although many of the symptoms are obvious such as bleeding or physical warts, in more than 50 per cent of cases there are no symptoms. How many cases are picked up is through automatic testing when going for certain contraception options such as the coil.
Henchion believes we need better sex education and awareness for all generations. “I see 21-year-olds coming in with no understanding of how STDs such as herpes and warts can still be spread even though they are using condoms. And for sexually active people in middle age, there is often a significant lack of knowledge.”
For now, until sexual health education is more widely available, there are plenty of support services including GPs, well woman/well man sexual health clinics and the Guide Clinic at St James’s Hospital. The IFPA offers free advice, and there are plenty of online services such as HealthyIreland.ie.
“The key message is that early detection makes a huge difference in reducing risk of pelvic infection and obviously reducing the risk of passing it on,” warns Henchion. “Anyone, whatever age, who is sexually active needs to mind their sexual health.”
Middle-aged, single and on fire – or talking ourselves celibate?
For many women who have reached the supposed sexual prime of their 40s and 50s, their body image is shattered along with their energy. A recent survey suggested some women in this age bracket have the lowest confidence of any other age group regarding body image, and it’s affecting their sex lives. Yet another survey highlighted the fact that some women in middle age are having the best sex of their lives. If both surveys are right, is it all just down to attitude, and can changing your attitude change your sexual mojo?
In the two decades since the iconic shenanigans of the “man-eater” Samantha shocked a nation in Sex and the City (while women everywhere sniggered at the delight of it), middle-age sex is becoming mainstream. The BBC were at it with Happy Valley, and even Cold Feet caught up. First time round, Adam and co were in their youth, but now that they are heading towards 50, who is the one having all the sex? Karen. Middle-aged, single and on fire. Now that ordinary middle-aged women are being shown to be – gasp! – sexual, it begs the question: what does this mean for us? Is this liberating or intimidating?
It seems your answer to that question is the difference between having an active sex life in and beyond middle age and putting away the sexy knickers and taking out the comfy slippers.
Like tight skin and fashionable clothes, sex used to be the domain of the young. But now middle-aged women can have tight skin, fashionable clothes and sex as well. It all depends on your attitude. If you think your sex life is over at 50, it will be.
“Attitude is so important,” says sex therapist Kate McCabe. “I see women challenging traditional values and beliefs that you are past it sexually after a certain age. Women are having babies later, new relationships later, are mentally and physically healthier and anxious to be active and participate fully in every aspect of their lives.”
In fact, a regular, happy sex life can benefit our physical, mental, emotional and social wellbeing, improving health and prolonging life. This generation of middle-aged women have opportunities to redefine what stereotype they fit into, experiencing greater sexual, financial, social and intellectual freedom than at any previous time. Contraception has meant we are not overburdened with childbearing, and openness about sex means that issues which might have caused discomfort and difficulty can be addressed. The increase in divorce and separation now means that middle-aged dating is an acceptable social norm.
So why are all middle-aged women not taking advantage of the chance to flirt their 50s away and sex up their 60s
“Sex must be worth it,” explains McCabe. “I see women who come into therapy to see how they can best improve their sex life, even to the extent that they’ll bring in their partners and manage to engage in that conversation.
And it’s women of all ages. McCabe has clients in their 60s and 70s. “They are definitely getting out there, and they want really good, honest information on how to make the most of their sexual potential.”
But what about those women who are talking themselves celibate because of lack of confidence? Media plays a huge part in how women can often rate themselves. According to McCabe, feeling sensual has nothing to do with how you look.
“Finding intimacy is a brave step. Overcoming hang-ups to really explore our own sensuality is vital. And much of it relies on getting the right attitude.”
[Z]hang Guowei, a 76-year-old bisexual veteran, is relishing his twilight years. “I couldn’t be happier with my life post-retirement,” says Zhang, who was a doctor in the army until 1994.
As a former military officer, Zhang’s monthly pension is 10,000 yuan ($1,440) — five times the average pension in Changde, the small city in central China’s Hunan province where he lives with his boyfriend. Zhang divorced his wife in 2003 and met the love of his life — Wu, who is 40 years younger — a year later on the internet. “I expect him to accompany me through the remainder of my life,” Zhang tells Sixth Tone after finishing his daily exercise routine.
Zhang says he is bisexual but prefers men. He gained support and understanding from his ex-wife and two daughters when he came out to them in 2003. When he passes on, his assets will be divided equally among his daughters and his boyfriend. “My kids have no problem sharing with Wu because they know he is the one taking care of me in my final years,” he says.
The May-December couple have been living together since 2005 in an apartment provided by the government for retired army cadres and their families. The 10-story building houses a dozen veterans in their 60s through 90s, some living alone and others with their spouses.
When Wu first moved in, Zhang told his neighbors that Wu was his gan erzi, or adopted son, whom he met online. (The Chinese concept of gan erzi allows for a sort of informal adoption of adults, with no legal or religious implications.) “I had this vague idea that they might be gay,” says 74-year-old Lu Shize, who lives downstairs. “But it’s none of my business to ask about his private life,” Lu adds.
Last year, following in other veterans’ footsteps, Zhang wrote a 218-page autobiography — including his experiences of recognizing his sexuality — and shared it with his fellow cadres. His neighbors were very understanding. “Everyone knows about us, and no one gossips or gives us a hard time,” Zhang says.
Lu, who had never before met any out gay or bisexual men, says he admires Zhang’s courage. “Being gay or not, it doesn’t change the way I see him,” Lu says. “We are in our 70s; what’s more important than being happy and healthy?”
China’s population is rapidly aging. The proportion of the population aged 60 or older was more than 16 percent at the end of 2015, according to the Ministry of Civil Affairs, and that number is only set to increase. The nation’s changing demography brings with it challenges for managing welfare and health care, especially as fewer seniors are able to count on their families for support.
Two older men hold a symbolic wedding ceremony in Beijing, Jan. 30, 2013.
Decades of family-planning restrictions mean that even seniors who have children often must become self-reliant, as children born during the one-child policy can’t afford to support two parents and four grandparents. As a result, for many elders, being childless is no longer a major concern or an unusual occurrence.
Wen Xiaojun, 56, is single and childless. Immediately after he retired in November from working as a civil servant, he rented an apartment in Sanya, on the southern island of Hainan, where he is spending six months avoiding the cold of his hometown in the eastern province of Zhejiang. “I still feel young and restless,” Wen tells Sixth Tone. “Being childless makes it easy for me to travel after retirement.”
Like other older people, LGBT seniors want to have rich, fulfilling, and independent lives. They hope that retirement will give them the opportunity to focus on what they truly love.
Wen enjoys his slow-paced life in Sanya. He goes to exhibitions, takes walks along the beach, plays volleyball with locals, and sometimes meets up with men he contacts through Blued — a popular gay social app, on which he hopes to find a long-term boyfriend.
But dating isn’t easy for older gay men. “Younger generations can build a relationship quickly by kissing or having sex soon after they meet offline,” Wen explains. “But we want something more spiritual and stable.”
Similarly, 62-year-old Ah Shan, as he’s called within the gay community, says that finding a partner is his biggest problem these days. His finances are secure, as he owns his apartment in Guangzhou — capital of southern China’s Guangdong province — and receives a monthly pension of about 5,000 yuan, but he has been single for four years and is ready for that to change. In the meantime, he is renting out one of his bedrooms to gay friends so he has some company at home.
Ah Shan poses for a picture in Guangzhou, Guangdong province, 2013.
Most gays, lesbians, and bisexuals of Ah Shan’s generation knew little about their sexual orientation until internet access became available at the turn of the millennium. Even when Ah Shan was working in the U.S. in the late 1980s, he refused to consider himself gay because the only information he’d heard about gay topics in China was AIDS-related or implied that homosexuality was shameful or immoral. “I think I was brainwashed,” Ah Shan laughs.
Over the last two years, Ah Shan has been working on a gay oral history project, recording the stories of older gay men in Guangzhou. He has talked to more than 60 gay men aged from 60 to 90, who have experienced some of China’s most critical historic moments, from the Cultural Revolution to the nation’s opening-up era. “If we don’t record them now, part of the important history of LGBT in China will be gone,” he says.
Many of the men are married and choose not to come out to their families. “They go to this particular park to chat with other gay men in the daytime to release their emotions, but when the sun goes down, they have to return home to bear their family responsibilities,” Ah Shan says with a sigh.
Ah Shan’s own parents passed away before he was brave enough to tell them the truth. His mother died in 2000, a year before homosexuality was declassified as a mental illness in China.
Compared with gay and bisexual men, older women find it even more difficult to disclose or discuss their sexual orientation. Since 2010, 45-year-old Yu Shi from Chengdu, the capital of Sichuan province, has been working on an oral history project for older same-sex-attracted women across China, but she says the process of locating participants and persuading them to share their stories is tough.
“Chinese women are in a weak position in the family, which doesn’t allow them to speak out for themselves,” Yu says, adding that of the 30 or so lesbians who have taken part in the project over the last six years, only one has come out to her family. Many won’t divorce their husbands even if they have female partners. “Chinese people are very concerned with saving face, and they think it’s a loss of face to get a divorce if you’re already a grandparent,” she says.
Yu and her 40-year-old girlfriend have lived together for over a decade, but despite their enduring, loving relationship, they can’t enjoy the security of a formal union, as same-sex marriage is not yet legal in China. Some issues can be resolved by making a will, but others — like legal or medical power of attorney — remain a problem.
According to Yu, some LGBT seniors who are single and childless have considered building their own retirement estate where they can live together and take care of one another. Although they aren’t opposed to regular nursing homes, Yu says “they prefer to live in a place where they can open their hearts and share their experiences with others in the same circumstances.”
A lesbian couple kiss each other during an event in Shanghai, Dec. 22, 2013.
As more and more seniors live separately from their children, retirement facilities in China have struggled to meet growing demand. The government encourages investment in privately owned nursing homes, but so far none have been established exclusively for members of sexual minority groups.
Little public attention is given to the needs of older LGBT people, but to Wang Anke, a 50-year-old bisexual woman from Beijing, these individuals don’t do enough to stand up for themselves, either. “We are almost invisible,” she says.
Wang married her husband in 1990 and plans to spend the rest of her life with him. Though Wang considers herself happy and fortunate, she says that most older lesbian and bisexual women she knows are pessimistic about their senior years. “They’re lonely and lack emotional care,” Wang says, adding that many would rather live alone than move into a nursing home where they fear they can’t be themselves. “Loneliness will go to the grave with them.”
But while some LGBT seniors advocate dedicated nursing homes, Ah Shan opposes the idea of separate services. “In the long run, LGBT people shouldn’t lock ourselves in a so-called safe place,” he says. “What we really need is for the overall environment to allow us to live comfortably in the community.”
Older people’s sexual activity problems and desires are being dismissed by health practitioners due to their age, a new study has suggested.
Research by The University of Manchester’s MICRA (Manchester Institute for Collaborative Research on Ageing) and Manchester Metropolitan University highlighted the obstacles some older couples face in maintaining fulfilling sexual lives, and how they adapt to these barriers.
The study analysed written comments from over a thousand adults aged 50 to 90 who responded to the English Longitudinal Study of Ageing Sexual Health and Relationships questionnaire. Respondents of both sexes emphasised their anxiety at not being taken seriously by health practitioners as they sought to overcome issues affecting their sexual activity, such as a drop in sexual desire or physical difficulties. One man in his eighties reported being refused Viagra for erectile dysfunction on the grounds of cost.
Participants in the study, published in Ageing and Society, cited other elements influencing sexual activity, including health conditions and physical impairment, the evolving status of sex in relationships and mental wellbeing. It was also found that men were more likely to talk about the impact of health conditions on sexual activities, but women were more likely to talk about health-related sexual difficulties in the context of a relationship.
The study recommends that health care practice should positively engage with issues of sexual function and sexual activity to improve the health and wellbeing of older people, particularly in the context of long-term health problems.
“This research further improves our understanding of love and intimacy in later life”, said study co-author David Lee, Research Fellow from The University of Manchester. “It builds upon empirical findings published in our earlier paper (Sexual health and wellbeing among older men and women in England; Archives of Sexual Behaviour) which described a detailed picture of the sex lives of older men and women. However, this new research uses narrative data to better understand how changing age, health and relationships interrelate to impact sexual health and satisfaction.”
“Appreciating individual and personal perspectives around sexuality and sexual health is of paramount importance if we are to improve sexual health services for older people.”
[J]ust because social attitudes toward sex at older ages are more positive than in the past doesn’t mean all older women have positive feelings about sex, according to a new Australian study.
Researchers found that nearly 90 percent of women over 70 in the study had low sexual desire and a much smaller proportion were distressed about it. The combination of low desire and related distress is known as hypoactive sexual desire dysfunction (HSDD) and nearly 14 percent of women had it.
Older people are increasingly remaining sexually active and sexual wellbeing is important to them, said senior author Susan R. Davis of Monash University in Melbourne.
“This is probably because people for this age are healthier now than people of this age in past decades,” Davis told Reuters Health by email.
A random national sample of women ages 65 to 79 was contacted by phone and invited to take part in a women’s health study. Those who agreed received questionnaires asking about demographic data, partner status and health history, including menopausal symptoms, vaginal dryness, pelvic floor dysfunction, depression symptoms, sexual activity and sexual distress.
Of the 1,548 women who completed and returned the questionnaires, about half were married or partnered, 43 percent had pelvic surgery and 26 percent had cancer of some kind. About a third had menopausal symptoms and one in five had vaginal dryness during intercourse.
In the entire sample, 88 percent reported having low sexual desire, 15.5 percent had sex-related personal distress, and women with both, who qualified for HSDD, made up 13.6 percent of the group, as reported in Menopause.
That’s lower than has been reported for this age group in the past, and similar to how many women report HSDD at midlife, Davis noted.
“Considering how conservative women of this age are, we were surprised that over 85 percent of the women completed all the questions on desire and sexual distress so we could actually assess this on most of the study participants,” Davis said.
Vaginal dryness, pelvic floor dysfunction, moderate to severe depressive symptoms and having a partner were all associated with a higher likelihood of HSDD. Sexually active women, partnered or not, more often had HSDD than others.
“We would never label women with low/diminished sex drive as having HSDD,” Davis said. “In our study 88 percent had low desire and only 13.6 percent had HSDD, this is because low desire is not an issue if you are not bothered by it.”
Vaginal dryness, associated with HSDD in this study, can easily treated by low dose vaginal estrogen which is effective and safe, she said.
HSDD was also associated with urinary incontinence, depressive symptoms and hot flashes and sweats, she said.
“Even talking about the problem with a health care professional who is interested and sympathetic is a good start,” Davis said. “Conversely health care professionals need to realize that many older women remain sexually active and do care about this issue.”
Sex remains important for many people living in aged care, but a challenge for staff and residents’ family members, writes Michael Bauer, who introduces a new guide to assist.
Sexuality is linked to wellbeing and quality of life and the need for affection, looking and feeling attractive, as well as intimacy, and sex can remain important for many people living in aged care facilities.
Growing old is not a limitation on the expression of sexuality or sexual desire and the above needs do not necessarily change because someone has dementia.
Residents’ sexuality can nevertheless often be a challenge for aged care facilities and staff as well as residents’ family members who may find it an awkward and difficult topic to openly discuss.
It can come as a surprise to some family and staff members alike, to learn that a resident still has sexual needs and this can evoke a range of responses from acceptance through to disbelief, or even disgust.
Children can find it difficult to understand and accept that their parent living in an aged care facility still has sexual desires and furthermore wants to fulfil them, particularly if they have dementia.
It can be equally upsetting for families and partners to learn that their loved one wants to spend time with someone else living in the facility. Families may struggle to understand and make sense of what is happening and why, particularly if the person is unable to verbally express their needs.
Sometimes behaviour may seem very out of character for the person. There may be a changed interest in sex, or a change in sexual inhibitions, all of which can cause concern or embarrassment for the family or partner.
The guide has undergone extensive consumer consultation and aims to assist family members and partners of people living in aged care facilities understand about sexuality, including for people living with dementia.
Issues covered include:
the importance of sexuality in old age
sexuality and living in an aged care facility
sexuality and dementia
sexual behaviours and their impact
how a facility can be supportive of the expression of sexuality
The guide can also be a useful resource for facility staff who need information on this topic. Initially developed in English this resource is soon to be translated into other languages.
A copy will soon be sent to all Australian residential care facilities, and it can be downloaded for free from the DementiaKT hub or here.
Funding for the project was obtained from the Dementia Collaborative Research Centres (DCRC) 3 – Carers and Consumers as part of the Australian Government’s Dementia Initiative.
Despite the fondness certain corners of the internetandcable television have for mocking sexually vital women of a certain age, new research suggests that those who embrace their sexuality may be laughing all the way to longer, healthier lives—though older men aren’t as lucky.
A study out of Michigan State University (MSU) published this month in the Journal of Health and Social Behavior has found that frequent sex (defined as once or more per week) for women age 57 and older—especially if it’s “extremely pleasurable or satisfying”—resulted in a lower risk of hypertension and protected against cardiovascular disease.
Unfortunately for men, frequent sex in the 57 and older range is actually dangerous, increasing their risk of cardiovascular events such as heart attacks and stroke. The risk is compounded by the use of medications such as Cialis and Viagra.
The study—an analysis of survey data of 2,204 people collected by the National Social Life, Health and Aging Project in 2005-6 and again five years later—isn’t just good news for older women, and should offer hope for younger women as they look to the future of their own sexuality.
Dr. Nancy Sutton Pierce, a nurse and clinical sexologist, suggests the best thing a young woman can do for her continued sexual health is to cultivate an attitude of optimism about it as she ages. “Younger women think sexy has an expiration date. Older women know it doesn’t,” she says.
The study is a stride toward busting the cultural myths that older women are supposedly non-sexual beings, which Sutton Pierce says “absolutely does them a disservice.” Sutton Pierce, who is almost 60, happily defies sexual stereotypes of older women. Married for thirty years to the same man, she says, “My sex life is better than ever, much better than my twenties.” In her work she says she sees women after forty “blossoming,” adding, “As women mature, we mature on all levels, which means we start to own our sexuality and sexual power. We don’t need someone else to tell us we’re hot, we can feel it.”
Study author Hiu Liu, an associate professor of sociology at MSU, also finds that for women, quality of sexual experience is a key contributing factor to the health benefits, not just quantity. “As a sociologist, I don’t see sex as just a physical exercise, as medical doctors do. It’s a social behavior, and has emotional meaning,” she says.
For older women experiencing other kinds of physical declines related to illness, staying sexually active may bring other benefits. Irwin H., who asked to remain anonymous, of San Francisco found that for his 70-year-old wife, who has multiple sclerosis, increasingly limited mobility, and walks with a cane, “Sex gives her back her former sense of her physical self.” He even waxes a little poetic: “Sexuality for her is like an unexpected warm day in the middle of winter. It doesn’t end winter, but it makes it bearable.”
Some older women may believe they’ve lost their sexual selves when they experience the often dramatic physical changes at and after menopause, such as vaginal dryness and reduced libido. They need not despair, says Celeste Holbrook, PhD, a sexual health consultant and sexologist. “Sex, and fulfilling sex doesn’t always have to be centered on the goal of an orgasm, or penetrative sex,” she adds.
However, Liu points out that the female sexual hormone released during orgasm, oxytocin, “may also promote women’s health” by reducing cortisol and increasing estrogen.
Holbrook urges communication between partners rather than silent acceptance. “Redefining your sexuality as we age for anybody is really good. Talk to your partner about your body changes and how you can create a fulfilling sex life while embracing those changes.”
Men shouldn’t worry too much, however. Though the MSU study seems to be the research equivalent of a cold shower for older men, Liu reminds them, “Moderate sex is good for older men, too.”
Having sex frequently – and enjoying it – puts older men at higher risk for heart attacks and other cardiovascular problems. For older women, however, good sex may actually lower the risk of hypertension.
That’s according to the first large-scale study of how sex affects heart health in later life. The federally funded research, led by a Michigan State University scholar, is published online in the Journal of Health and Social Behavior.
“These findings challenge the widely held assumption that sex brings uniform health benefits to everyone,” said Hui Liu, an MSU associate professor of sociology whose vast research on the link between health and relationships has been featured in the New York Times, USA Today, NPR, Time and many other national and international news outlets.
For the current study, Liu and colleagues analyzed survey data from 2,204 people in the National Social Life, Health and Aging Project. Participants were aged 57-85 when the first wave of data was collected in 2005-06; another round of data was collected five years later. Cardiovascular risk was measured as hypertension, rapid heart rate, elevated C-reactive protein and general cardiovascular events: heart attack, heart failure and stroke.
Older men who had sex once a week or more were much more likely to experience cardiovascular events five years later than men who were sexually inactive, the study found. This risk was not found among older women.
“Strikingly, we find that having sex once a week or more puts older men at a risk for experiencing cardiovascular events that is almost two times greater than older men who are sexually inactive,” said Liu. “Moreover, older men who found sex with their partner extremely pleasurable or satisfying had higher risk of cardiovascular events than men who did not feel so.”
She said the findings suggest the strain and demands from a sexual relationship may be more relevant for men as they get older, become increasingly frail and suffer more sexual problems.
“Because older men have more difficulties reaching orgasm for medical or emotional reasons than do their younger counterparts, they may exert themselves to a greater degree of exhaustion and create more stress on their cardiovascular system in order to achieve climax.”
Testosterone levels and the use of medication to improve sexual function may also play a role. “Although scientific evidence is still rare,” Liu said, “it is likely that such sexual medication or supplements have negative effects on older men’s cardiovascular health.”
Ultimately, while moderate amounts of sex may promote health among older men, having sex too frequently or too enjoyably may be a risk factor for cardiovascular problems, Liu said. “Physicians should talk to older male patients about potential risks of high levels of sexual activity and perhaps screen those who frequently have sex for cardiovascular issues.”
For women, it was a different story. Female participants who found sex to be extremely pleasurable or satisfying had lower risk of hypertension five years later than female participants who did not feel so.
“For women, we have good news: Good sexual quality may protect older women from cardiovascular risk in later life,” Liu said.
Previous studies suggest that strong, deep and close relationship is an important source of social and emotional support, which may reduce stress and promote psychological well-being and, in turn, cardiovascular health.
“This may be more relevant to women than to men,” Liu said, “because men in all relationships, regardless of quality, are more likely to receive support from their partner than are women. However, only women in good quality relationships may acquire such benefits from their partner.”
Moreover, the female sexual hormone released during orgasm may also promote women’s health, she said.
Liu’s co-authors are Linda Waite, professor at the University of Chicago, Shannon Shen, an MSU graduate student, and Donna Wang, professor of medicine at MSU.
The research was partially funded by the National Institute on Aging, the National Institute of Child Health and Human Development, the Office of Behavioral and Social Sciences Research, and the National Heart, Lung and Blood Institute, which are all part of the National Institutes of Health.
New research from the University of Chicago investigates what happens to men’s and women’s sexual function and relationships after a heart attack in an effort to help clinicians develop better care guidelines for patients. The study, published in JAMA Cardiology, shows impaired sexual function or new problems are common after heart attacks. They occur at the same rate as a loss of general physical function and at a higher rate than the incidence of depression after heart attack, but rarely do health care providers address these issues – particularly with women.
“Too often physicians and researchers are too embarrassed to ask questions about sexual health, and yet these issues are important to many people,” said Harlan Krumholz, MD, professor of medicine at Yale and director of the Center for Outcomes Research and Evaluation, one of the authors in charge of the study. “We need to concern ourselves with gaining knowledge about how to help our patients achieve a high quality of life in all aspects of their lives.”
The data show that if a physician talks to the patient about sexual health and function after a heart attack the patient is more likely to resume sex. However, women were less likely to be counseled by physicians on what to expect and more likely to have problems with sexual function as they recover. More than half of women (59%) and less than half (46%) of men reported sexual function problems in the year after a heart attack.
“The next step is to design the optimal intervention to improve sexual function outcomes after heart attack for men and women,” said Stacy Tessler Lindau, MD, associate professor of obstetrics/gynecology and medicine-geriatrics at the University of Chicago, who authored the research. “The rehabilitation phase begins with the cardiologist counseling the patient about her or his functional capabilities and what she or he can expect, including physical, psychological, and sexual function.”
ATLANTA — Older adults in assisted-living facilities experience limits to their rights to sexual freedom because of a lack of policies regarding the issue and the actions of staff and administrators at these facilities, according to research conducted by the Gerontology Institute at Georgia State University.
Though assisted-living facilities emphasize independence and autonomy, this study found staff and administrators behave in ways that create an environment of surveillance. The findings, published in the Journals of Gerontology: Social Sciences, indicate conflict between autonomy and the protection of residents in regard to sexual freedom in assisted-living facilities.
Nearly one million Americans live in assisted-living facilities, a number expected to increase as adults continue to live longer. Regulations at these facilities may vary, but they share a mission of providing a homelike environment that emphasizes consumer choice, autonomy, privacy and control. Despite this philosophy, the autonomy of residents may be significantly restricted, including their sexuality and intimacy choices.
Sexual activity does not necessarily decrease as people age. The frequency of sexual activity in older adults is lower than in younger adults, but the majority maintain interest in sexual and intimate behavior. Engaging in sexual relationships, which is associated with psychological and physical wellbeing, requires autonomous decision-making.
While assisted-living facilities have many rules, they typically lack systematic policies about how to manage sexual behavior among residents, which falls under residents’ rights, said Elisabeth Burgess, an author of the study and director of the Gerontology Institute.
“Residents of assisted-living facilities have the right to certain things when they’re in institutional care, but there’s not an explicit right to sexuality,” Burgess said. “There’s oversight and responsibility for the health and wellbeing of people who live there, but that does not mean denying people the right to make choices. If you have a policy, you can say to the family when someone moves in, here are our policies and this is how issues are dealt with. In the absence of a policy, it becomes a case-by-case situation, and you don’t have consistency in terms of what you do.”
The researchers collected data at six assisted-living facilities in the metropolitan Atlanta area that varied in size, location, price, ownership type and resident demographics. The data collection involved participant observation and semi-structured interviews with administrative and care staff, residents and family members, as well as focus groups with staff.
The study found that staff and administrators affirmed that residents had rights to sexual and intimate behavior, but they provided justifications for exceptions and engaged in strategies that created an environment of surveillance, which discouraged and prevented sexual and intimate behavior.
The administrators and staff gave several overlapping reasons for steering residents away from each other and denying rights to sexual and intimate behavior. Administrators emphasized their responsibility for the residents’ health and safety, which often took precedence over other concerns.
Family members’ wishes played a role. Family members usually choose the home and manage the residents’ financial affairs. In some instances, they transport family members to doctor’s appointments, volunteer at the facility and help pay for the facility, which is not covered by Medicaid. They are often very protective of their parents and grandparents and are uncomfortable with new romantic or intimate partnerships, according to staff. Administrators often deferred to family wishes in order to reduce potential conflict.
Staff and administrators expressed concern about consent and cognitive impairment. More than two-thirds of residents in assisted-living facilities have some level of cognitive impairment, which can range from mild cognitive impairment to Alzheimer’s Disease or other forms of dementia. They felt responsible for protecting residents and guarding against sexual abuse, even if a person wasn’t officially diagnosed.
###
Co-authors of the study, Georgia State alumni, include Christina Barmon of Central Connecticut State University, Alexis Bender of Ripple Effect Communications in Rockville, Md., and James Moorhead Jr. of the Georgia Department of Human Services’ Division of Aging Services.
The study was supported by a grant from the National Institute on Aging at the National Institutes of Health.
Ladies, libido means sexual desire. Women having decreased libido is one of the most common complaints I hear in the office, especially for those stressed out supermoms. Trust me – you’re not alone, ladies. It is estimated that more than 40% of women experience some sort of sexual dysfunction in their lifetime. Here’s why, and what you can do about it.
Female sexual dysfunction can include problems with desire, arousal, achieving orgasm and sexual pain that causes significant distress in your life. More specifically, decreased libido is when you don’t want to engage in any type of sexual activity, including masturbation, and you don’t want to have any sexual thoughts or fantasies. Sound like someone you know? Let’s review some reasons why you may not want to have sex with your significant other:
1. Bad Relationship.
Fighting with your partner is an easy way to kill your sex drive. When you are angry or hurt, sex is the last thing on your mind. Fix your relationship — go to couples’ therapy.
2. Stress.
It doesn’t matter where the stress comes from, all of it can cause your libido to drop. It doesn’t matter if you’re stressed out from financial problems, from trying to get pregnant, or from worrying about your job – it all negatively impacts your libido. Stress can also lead to you being fatigued, which worsens the problem. Find ways to chill out ladies – I mediate daily to deal with stress, and that might work for you, too.
3. Alcohol and Smoking.
Both of these drugs have been shown to decrease sexual desire and satisfaction. While alcohol in moderation is okay, when you binge drink, sexual dysfunction starts to occur. On the other hand, any kind of smoking is bad – just quit!
Easier said than done, right? You have to know why you are smoking. Substitute that why with something else. For example, if you smoke because you are bored, instead of lighting up go to the gym.
4. Mental Illness.
Mental conditions such as depression and anxiety can also cause your libido to drop. Talk to your doctor and get treated. Sometimes medications used to treat these conditions can also cause a drop in libido – but not every medication does, so talk to your doctor.
5. Birth Control.
Hormonal birth has been shown to decrease testosterone in your body, which could lead to a lowered libido. This is because testosterone is one of the hormones that makes you horny.
Other medications such as antidepressants, anti-seizure meds, opioids, medical marijuana, antihistamines, and hypertensive medications can also decrease your sexual desire. Talk to your doctor about switching your medications if you think any are giving you a problem. Your healthcare provider can also potentially switch you to a non-hormonal birth control option, like the Paragard IUD.
6. Trauma in your Past.
Negative sexual experiences in the past can cause issues with decreased libido. Women who were raped or have been victims of domestic violence may, understandably, have issues here. Going to therapy to work through your pain can help.
7. Poor Body Image.
In a world full of fake butts and boobs, it isn’t hard to image women struggling with their body image. Not thinking you are sexy enough can cause your sex drive to plummet. If you don’t like something about yourself, change it – in a healthy way, of course. Eat clean, drink water and exercise – though, keep in mind that a lot of times this is something that you have to work out in therapy.
8. Medical Conditions.
Medical illnesses such as diabetes, hypertension, thyroid disease, congestive heart failure, or cancer can all affect libido. They can alter hormones that have an impact on your sex drive. Proper treatment of the underlying disease can often improve libido.
9. Pregnancy and Breastfeeding.
Hormones fluctuate during pregnancy and breastfeeding, which can decrease your sex drive. Being pregnant can cause you to be tired and not feel sexy, which certainly doesn’t help your libido! Do your best to focus on intimacy with your partner — also, when you have the baby, get help. Let those grandparents help out with babysitting!
10. Aging.
In menopause, estrogen levels drop drastically because the ovaries aren’t working anymore. Low estrogen causes, among other things, a dry vagina, which makes sex painful. This can lead to decreased sexual desire. Arthritis in the aging population can make having sex less fun. When vaginal dryness makes sex uncomfortable, use lubricants (try a free sample of Astroglide Liquid or Astroglide Gel, which temporarily relieve dryness during intercourse). Some women find using vaginal estrogen also helps.
A medical ethicist and a team of Australian researchers say nursing homes should not discourage residents from having sex.
Research by the Australian Centre for Evidence Based Aged Care, published in the Journal of Medical Ethics (JME), stated that sexual freedom is considered a fundamental human right by most Western societies.
While laws regarding consent and coercion must be abided, in general, people should be able to engage in sexual behavior whenever, and with whomever, they choose.
Nonetheless sexual relationships are often a no-no for many competent and healthy elderly people in residential aged care facilities, reported the New York Daily News.
Art Caplan, a medical Ethicist at the New York University Langone Medical Center, told Medscape that one of the reasons for this is that nursing homes are set up to give people very little privacy for legal and safety reasons.
FoxNews added concerns about “duty of care, anxieties about potential repercussions from relatives and ageism are other reasons nursing home staffs deny privacy or separate potential partners, according to the Australian researchers.”
New York Daily News said that nursing home staffs receive little training on the sex lives of the elderly, focusing primarily on their ability to make decisions and provide consent.
Many simply don’t look at the elderly as mature adults, but as children who must be policed.
For older people with dementia living in residential aged care facilities the issue becomes more complex, wrote the researchers in the JME.
However, the JME article added that even elderly people in the early stages of dementia still enjoy sexual relationships.
Researchers argued that even when a person receives a poor score on a mini mental state test which assesses cognitive impairment, they are often still capable of expressing preferences for a friend or lover, wrote FoxNews.
Intimate relationships can help lessen feelings of loss and loneliness that come with age, Robin Dessel, director of memory care services and sexual rights educator at the Hebrew Home at Riverdale in New York, told ABC News.
The good news is, in response to the topic of geriatric sex, some facilities such as the Hebrew Home are establishing policies to ensure staff support for residents’ rights, wrote AgingWell.com.
“Clinical staff needs to understand that elderly long-term care residents have very real sexual needs that might exceed what staff would consider their clinical needs,” Dessel told AgingWell.com.
Caplan believes this awkward topic of geriatric sex should be discussed by doctors with patients and families as someone prepares to enter a nursing home because, as he stated, sex is a part of old age.
Name: Billy
Gender: Male
Age: 46
Location:
I have heard it’s normal for sex drive to diminish as you age. I’ll run this by you. I’m a 46 year old male and the last time I was at a strip club with bare boobs bouncing around me, you may as well have rolled a grapefruit across the floor. Actually, I can see more use from the grapefruit. I don’t recall the last time I did it, and jerking off was almost disgusting. My tool has shrank to nothing. I barely touch it and it just dribbles, it doesn’t fire off anymore. I don’t even like to touch it to go piss anymore. I’ve had to shave around it, so I actually find it, to keep from pissing my pants. Is this normal?
No, Billy, this isn’t normal. I think you already know that too, right?
Do you know anything about andropause? If not, you ought to. Here’s what I suggest. Use this site’s search function in the sidebar. Type in the key word: “andropause” and you will come up with a wealth of information about this issue.
You can also use the CATEGORY pull down menu. Look for the subcategory: Sex and Aging, under the main category: Aging. Everything is alphabetized.
But for the time being, here’s a typical question and response —
Name: Wilson
Gender: male
Age: 58
Location: Lancing MI
I’m a successful entrepreneur, in decent health (I could stand to lose a few pounds.) I have just about everything a man could want in life, but I’m miserable. I have no energy and I feel like I’m sleepwalking through my life. I have no sex drive at all; my wife thinks I’m having an affair…I wish. Even Viagra doesn’t do the trick anymore. Is this just old age, or what?
Old age, at 58? Middle age, perhaps! Regardless what we call it, you sound like you’re in the throws of andropause — male menopause — ya know, the change of life!
Never heard of such a thing? You’re not alone. It’s only been recently has the medical industry has begun to pay attention to the impact changing hormonal levels has on the male mind and body. Most often andropause is misdiagnosed as depression and treated with an antidepressant. WRONG!
Every man will experience a decrease testosterone, the “male” hormone, as he ages. This decline is gradual, often spanning ten to fifteen years on average. While the gradual decrease of testosterone does not display the profound effects that menopause does, the end results are similar.
There is no doubt that a man’s sexual response changes with advancing age and the decrease of testosterone. Sexual urges diminish, erections are harder to come by, they’re not as rigid, there’s less jizz shot with less oomph. And our refractory period (or interval) between erections is more pronounced too.
While most all of us have heard of a mid-life crisis, and it’s tragic consequences — red convertible sports cars, comb-overs, and the trophy wife or lover — fewer have heard of andropause. A mid-life crisis is essentially a psycho-social adjustment to aging — bored at work, bored at home, bored with the wife or partner — that sort of thing. Andropause, although it may coincide with a mid-life crisis, is not the same thing. Andropause is a distinct physiological phenomenon that is in many ways akin to female menopause.
Unlike women, men can continue to father children after andropause, but like I said, the production of testosterone diminishes gradually after age 40. I suppose you know that testosterone is the hormone that stimulates sexual development in the male infant, bone and muscle growth in adult males, and is responsible for our sexual drive. But did you know that by the age of 55, the amount of testosterone secreted into our bloodstream is significantly lower than at 45. And by age 80, most male hormone levels have decreased to pre-puberty levels.
Men, are you over 50? Are you feeling weak, lethargic, depressed, and irritable? Do you have mood swings, hot flashes, insomnia, and decreased libido, like our buddy Wilson, here? Then you too may be andropausal. You need to get some lead back in your pencil!
All kidding aside, andropausal men might want to consider Testosterone Replacement Therapy (TRT). Ask your physician about this. Just know that some medical professionals resist testosterone therapy, mistakenly linking Testosterone Replacement Therapy with prostate cancer. Even though recent evidence shows prostatic disease is estrogen-dependent rather than testosterone-dependent. However, before starting a testosterone regiment, insist on a complete physical, including blood work and a rectal examine. Mmmm, rectal exams!
Testosterone is available in many forms — oral, injectable, trans-dermal and by way of implants. The oral form is not recommended because of the high risk of liver damage. But injections, patches, pellets, creams and gels might be just the answer. I encourage you to be informed about TRT before you approach your doctor, because the best medicine is practiced collaboratively — by you and your doctor.
Sexuality is much more than having sex even though many people think only about sexual intercourse when they hear the word. Sexuality is sometimes equated with intimacy, but in reality, sexuality is just one way that we connect with a spouse or partner we love (the true meaning of intimacy). Our sexuality encompasses how we see ourselves as men and women, who we are attracted to emotionally and physically, what turns us on (eroticism), our thoughts and fantasies, and yes, also what we do when we are sexually active, either alone or with a partner. Our sexuality is connected to our image of ourselves and it changes over the years as we age and face threats from illness and disability and, eventually, the end of life.
Am I still a sexual being?
Illness can affect our sexuality in many different ways. The side effects of treatments for many diseases, including cancer, can cause fatigue. This is often identified as the number one obstacle to sexual activity. Other symptoms of illness such as pain can also affect our interest in being sexually active. But there are other perhaps more subtle issues that impact how we feel about ourselves and, in turn, our desire to be sexual with a partner or alone, or if we even see ourselves as sexual beings. Think about surgery that removes a part of the body that identifies us as female or male. Many women state that after breast cancer and removal of a breast (mastectomy), they no longer feel like a woman; this affects their willingness to appear naked in front of a partner. Medications taken to control advanced prostate cancer can decrease a man’s sexual desire. Men in this situation often forget to express their love for their partner in a physical way, no longer touching them, kissing them, or even holding hands. This loss of physical contact often results in two lonely people. Humans have a basic need for touch; without that connection, we can end up feeling very lonely.
Just talk about it!
Communication lies at the heart of sexuality. Talk to your partner about what you are feeling, how you feel about your body, and what you want in terms of touch. Ask how you can meet your partner’s needs for touch and affection. The most important thing you can do is to express yourself in words. Non-verbal communication and not talking are open to misinterpretation and can lead to hurt feelings. Our sexuality changes with age and time and illness; we may not feel the same way about our bodies or our partner’s body that we did 20, 30 or more years ago. That does not mean we feel worse – with age comes acceptance for many of us – but we do need to let go of what was, and look at what is and what is possible.
The role of health care providers
Health care providers should be asking about changes to sexuality because of illness or treatment, but they often don’t. They may be reluctant to bring up what they see as a sensitive topic and think that if it’s important to the patient, then he or she will ask about it. This is not good. Patients often wait to see if their health care provider asks about something and if they don’t, they think that it’s not important. This results in a silence and leaves the impression that sexuality is a taboo topic.
Some health care providers are afraid that they won’t know the answer to a question about sexuality because nursing and medical schools don’t provide much in the way of education on this topic. And some health care providers appear to be too busy to talk about the more emotional aspects of living with illness. This is a great pity as sexuality is important to all of us – patients, partners, health care providers. It’s an important aspect of quality of life from adolescence to old age, in health and at the end of life when touch and love are so important.
Ask for a referral
If you want to talk about this, just do it! Tell your health care provider that you want to talk about changes in your body or your relationship or your sex life! Ask for a referral to a counselor or sexuality counselor or therapist or social worker. It may take a bit of work to get the help you need, but there is help.
When Wu first moved in, Zhang told his neighbors that Wu was his gan erzi, or adopted son, whom he met online. (The Chinese concept of gan erzi allows for a sort of informal adoption of adults, with no legal or religious implications.) “I had this vague idea that they might be gay,” says 74-year-old Lu Shize, who lives downstairs. “But it’s none of my business to ask about his private life,” Lu adds.
You must be logged in to post a comment.