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Time to make room for sex in our care homes

We need to open up to the significance of love and sexuality in later life

The persistence of romantic love in long-term relationships is, unsurprisingly, associated with higher levels of relationship satisfaction.

By

Although Valentine’s Day is often criticised as a cynical creation by florists and the greeting cards industry, it is a useful focal point for considering love and sexuality as elements of human wellbeing that often escape attention in healthcare.

This neglect is most marked in later life, when popular discourse on late life romance is dominated by simple notions of asexuality or by ribald jokes

There are many reasons why healthcare professionals need to learn more about human love and sexuality, not least of which is a fuller understanding of the nature and meaning of ageing.

exuality is a core element of human nature, encompassing a wide range of aspects over and above those related to genital functions, and the medical literature has rightly been criticised for taking too narrow a vision of sexuality.

We need to open up to the continuing significance of love and sexuality into later life

This narrow vision is paralleled by a steady trend in the neurosciences of “neuroreductionism”, an over-simplistic analysis of which parts of the brain light up in sophisticated scanners on viewing photos of a loved one.

We need to open up to the continuing significance of love and sexuality into later life, understanding that sexuality includes a broad range of attributes, including intimacy, appearance, desirability, physical contact and new possibilities.

Studies

Numerous studies affirm sexual engagement into the extremes of life, with emerging research on the continuing importance of romantic love into late life. There is also reassuring data on the persistence of romantic love in long-term relationships, unsurprisingly associated with higher levels of relationship satisfaction.

A growing literature sheds light on developing new relationships in later life, with a fascinating Australian study on online dating which subverts two clichés – that older people are asexual and computer illiterate.

The challenge in ageing is best reflected in the extent to which we enable and support intimacy and sexuality in nursing homes. Although for many this is their new home, the interaction of institutional life (medication rounds, meals), issues of staff training and lack of attention to design of spaces that foster intimacy can check the ability to foster relationships and express sexuality.

For example, is the resident’s room large enough for a sofa or domestic furnishings that reflects one’s style, personality and sense of the romantic? Are sitting spaces small and domestic rather than large day rooms? Do care routines allow for privacy and intimacy? Is there access to a selection of personal clothes, make-up and hairdressing?

Granted, there can also be complicated issues when residents with dementia enter new relationships and the need to ensure consent in a sensitive manner, but these should be manageable with due training and expertise in gerontological nursing and appropriate specialist advice.

Supports

A medical humanities approach can provide useful supports in education from many sources, ranging from literature ( Love in the Time of Cholera), film ( 45 Years or the remarkable and explicit Cloud 9 from 2009) or opera (Janácek’s Cunning Little Vixen, a musical reflection of the septuagenarian composer’s passion for the younger Kamila Stösslová).

We, as present and future older Irish people, also need to take a step back and consider if we are comfortable with a longer view on romance and sexuality.

The Abbey Theatre did us considerable service in 2015 with a wonderful version of A Midsummer Night’s Dream set in a nursing home. We were struck by a vivid sense of the inner vitality of these older people, suffused with desire, passion and romance.

This contemporary understanding of companionship and sexuality in later life was enhanced by casting Egeus as a son exercised about his mother’s romantic choices instead of a father at odds with his daughter.

We can also take heart from an early pioneer of ageing and sexuality, the late Alex Comfort. Best known for his ground-breaking The Joy of Sex, he was also a gerontologist of distinction, and wrote knowledgeably about the intersection of both subjects with characteristic humour.

He wrote that the things that stop you having sex with age are exactly the same as those that stop you riding a bicycle: bad health, thinking it looks silly or having no bicycle, with the difference being that they happen later for sex than for the bicycle.

His openness and encouragement for our future mirror Thomas Kinsella’s gritty poem on love in later life, Legendary Figures in Old Age, which ends with the line: ‘We cannot renew the Gift but we can drain it to the last drop.’

Complete Article HERE!

The Beginner’s Guide to BDSM

Why are some women never able to orgasm? A gynaecologist explains

Dr Sherry Ross says there has long been a gender bias in the way women’s sexual dysfunction has been treated compared to men’s

 

By Olivia Blair

Despite modern society being able to openly discuss female sexuality, there remains a number of existing taboos.

One of the most glaring is female orgasms. Women are rarely taught about the intricate details of their anatomy and often work these things out through their own experimenting.

What is the best way to get an orgasm? How often should I have one? Should I be able to have one during penetrative intercourse? Why have I never had one? – questions not uncommon to hear among small friendship groups of women over a bottle of wine.

Dr Sherry A Ross, an LA-based gynaecologist with 25 years experience aims to educate with a complete guide to the vagina in her new book She-ology: The Definitive Guide to Women’s Intimate Health. Period.

In the foreword of her book, Dr Sherry notes that “talking about the mighty V outside of doctor’s offices and bedrooms has remained a major taboo” and devoted an entire chapter to the female orgasm. The Independent asked the gynaecologist and obstetrician all the questions about female orgasms that are rarely spoken about.

Why might some women never orgasm?

Attitudes regarding sex, sexuality and gender vary greatly between different cultures and religions. Certain sexual practices, traditions and taboos are passed down through generations, leaving little to the cause of female pleasure or imagination.

For some women, finding and/or enjoying sexual intimacy and sex is difficult, if not impossible. Research suggests that 43% of women report some degree of difficulty and 12% attribute their sexual difficulties to personal distress. Unfortunately, sexual problems worsen with age, peaking in women 45 to 64.  For many of these women the problems of sexual dysfunction are treatable, which is why it is so important for women to share their feelings and concerns with a health care provider.

Unfortunately, there has been a history of “gender injustice” in the bedroom. Women have long been ignored when it comes to finding solutions to sexual dysfunction. In short, there are twenty-six approved medications for male erectile dysfunction and zero for women. Clearly, little attention has been paid to the sexual concerns of women, other than those concerns that involve procreation.

How many women might never orgasm?

During my 25 years in private practice, I’ve met a number of women in their 30s, 40s and 50s who have never even had an orgasm. In fact, 10 to 20% of all women have never experienced one.

Issues related to sex are not talked about enough even with a health care provider. Let’s just start by saying, 65 per cent of women are embarrassed to say the word vagina and 45 per cent of women never talk about their vagina with anyone, not even with their doctor.

Some patients say they have pain with sex, have problems with lubrication, don’t have a sex drive or don’t enjoy sex.  My first question is “Are you having problems in your relationship?”, “Do you like you partner?” , “Are you able to have an orgasm?”, “ Do you masturbate?” These open-ended questions tend to bring out sexual dysfunction including the inability to have an orgasm.

There is a great deal of embarrassment and shame when a woman admits she has never experienced an orgasm.

Is the inability to not orgasm normal?

The inability not to have had an orgasm can reflect women’s inability to know they own anatomy and may not be a disorder at all. In a survey of women aged 16-25, half could not find the vagina on a medical diagram. A test group of university- aged women didn’t fare much better with one third being unable to find the clitoris on a diagram. Clearly, if you can’t find it, how are you going to seek enjoyment from it?

Women must first understand what brings them pleasure and in their pursuit of happiness they have to understand where their clitoris is and how to stimulate it. Masturbation is a skill.  It has to be learned, just as walking, running, singing and brushing your teeth.

What is an orgasm disorder and how would you categorise one? 

The inability to have an orgasm falls under the category of Female Sexual Dysfunction of which there are five main problems: low libido or hypoactive sexual desire disorder, painful sex, sexual arousal disorder, an aversion to sex and the inability to orgasm.

Hypoactive sexual disorder, the most common female sexual dysfunction, is characterised by a complete absence of sexual desire. For the 16 million women who suffer from this, the factors involved may vary since sexual desire in women is much more complicated than it is for men. Unlike men, women’s sexual desire, excitement and energy tend to begin in that great organ above the shoulders, rather than the one below the waist. The daily stresses of work, money, children, relationships and diminished energy are common issues contributing to low libido in women. Other causes may be depression, anxiety, lack of privacy, medication side effects, medical conditions such as endometriosis or arthritis, menopausal symptoms or a history of physical or sexual abuse.

You are the person in charge of your vagina and clitoris. First and foremost, get to know your female parts intimately. Understanding your sexual response is a necessary health and wellness skill. Make mastery of that skill a priority.

Complete Article HERE!

Childhood cancer treatment may hinder later-life sexual relationships

 

Neurotoxic treatment for cancer during childhood may influence sexual activity and relationships in adulthood, according to new research.

Study co-author Vicky Lehmann, Ph.D., of Nationwide Children’s Hospital and Ohio State University – both in Columbus, OH – and colleagues found that adults who received high-intensity neurotoxic treatment for cancer as a child were less likely to meet certain sexual and romantic milestones.

However, the team found that childhood cancer treatment did not affect overall satisfaction for sexual and romantic relationships in adulthood.

Lehmann and team recently reported their findings in the journal Cancer.

According to the American Cancer Society, it is estimated that around 10,380 children aged 15 and under were diagnosed with cancer in the United States last year.

Leukemia is the most common form of childhood cancer, accounting for around 30 percent of all cases, followed by brain and spinal cord tumors, which make up around 26 percent of all childhood cancer cases.

Childhood cancer treatment and psychosexual development

While cancer was responsible for more than 1,200 childhood deaths last year, over 80 percent of children diagnosed with the disease will survive for at least 5 years. This is due to significant advances in cancer treatment, which include surgery, chemotherapy, and radiation therapy.

However, such treatment is certainly not without risk. For example, studies have shown that cranial radiation – often used to treat brain tumors – may cause harm to the developing brain, leading to long-term neurocognitive impairment.

Previous research has shown that neurocognitive impairment as a result of childhood cancer treatment may impact social interaction in adulthood, but studies investigating the effects of such treatment on psychosexual development are few and far between.

“Psychosexual development entails reaching certain milestones, such as sexual debut, entering committed relationships, or having children.

It is a normative part of becoming an adolescent or young adult, but only comparing such milestones without taking satisfaction into account falls short. These issues are understudied among survivors of childhood cancer.”

Vicky Lehmann, Ph.D.

To address this gap in research, the team enrolled 144 survivors of childhood cancer aged between 20 and 40. A further 144 participants who were not treated for childhood cancer (the controls) were matched by age and sex.

All participants completed questionnaires on psychosexual development, sexual satisfaction, and relationship satisfaction.

To determine the brain toxicity of cancer treatments in childhood, the researchers used data from the participants’ medical charts.

Neurotoxic cancer treatment might predict later-life psychosexual issues

Overall, the team found that adults who were treated for cancer in childhood did not differ significantly from the controls in terms of psychosexual development, sexual satisfaction, and relationship satisfaction.

However, on analyzing subgroups of childhood cancer survivors, the researchers found that those who previously received treatments high in neurotoxicity were less likely to have had sexual intercourse, be in a relationship, or have had children, compared with controls.

The type of cancer treatment in childhood did not appear to affect sexual satisfaction, the team reports. “This highlights the subjective nature of psychosexual issues, and the importance of addressing any concerns in survivorship care,” notes Lehmann.

The researchers say that their findings indicate that the neurotoxicity of cancer treatment in childhood may predict the likelihood of psychosexual problems in adulthood. They add:

“Additional research is needed to delineate how neurocognitive impairment undermines social outcomes for survivors, as well as other related factors.

Given the findings of the current study, healthcare providers should assess romantic/sexual problems among survivors, especially those who received high-dose neurotoxic treatments. Referrals to psychosocial care could prevent or reduce potential difficulties.”

 
Complete Article HERE!