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New treatments restoring sexual pleasure for older women

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By Tara Bahrampour

When the FDA approved Viagra in 1998 to treat erectile dysfunction, it changed the sexual landscape for older men, adding decades to their vitality. Meanwhile, older women with sexual problems brought on by aging were left out in the cold with few places to turn besides hormone therapy, which isn’t suitable for many or always recommended as a long-term treatment.

Now, propelled by a growing market of women demanding solutions, new treatments are helping women who suffer from one of the most pervasive age-related sexual problems.

Genitourinary syndrome, brought on by a decrease in sex hormones and a change in vaginal pH after menopause, is characterized by vaginal dryness, shrinking of tissues, itching and burning, which can make intercourse painful. GSM affects up to half of post-menopausal women and can also contribute to bladder and urinary tract infections and incontinence. Yet only 7 percent of post-menopausal women use a prescription treatment for it, according to a recent study.

The new remedies range from pills to inserts to a five-minute laser treatment that some doctors and patients are hailing as a miracle cure.

The lag inaddressing GSM has been due in part to a longstanding reluctance among doctors to see post-menopausal women as sexual beings, said Leah Millheiser, director of the Female Sexual Medicine Program at Stanford University.

“Unfortunately, many clinicians have their own biases and they assume these women are not sexually active, and that couldn’t be farther from the truth, because research shows that women continue to be sexually active throughout their lifetime,” she said.

With today’s increased life expectancy, that can be a long stretch – another 30 or 40 years, for a typical woman who begins menopause in her early 50s. “It’s time for clinicians to understand that they have to bring up sexual function with their patients whether they’re in their 50s or they’re in their 80s or 90s,” Dr. Millheiser said.

By contrast, doctors routinely ask middle-aged men about their sexual function and are quick to offer prescriptions for Viagra, said Lauren Streicher, medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause.

“If every guy, on his 50th birthday, his penis shriveled up and he was told he could never have sex again, he would not be told, ‘That’s just part of aging,’” Dr. Streicher said.

Iona Harding of Princeton, New Jersey, had come to regard GSM, also known as vulvovaginal atrophy, as just that.

For much of their marriage, she and her husband had a “normal, active sex life.” But after menopause sex became so painful that they eventually stopped trying.

“I talked openly about this with my gynecologist every year,” said Mrs. Harding, 66, a human resources consultant. “There was never any discussion of any solution other than using estrogen cream, which wasn’t enough. So we had resigned ourselves to this is how it’s going to be.”

It is perhaps no coincidence that the same generation who first benefited widely from the birth control pill in the 1960s are now demanding fresh solutions to keep enjoying sex.

“The Pill was the first acknowlegement that you can have sex for pleasure and not just for reproduction, so it really is an extension of what we saw with the Pill,” Dr. Streicher said. “These are the women who have the entitlement, who are saying ‘Wait a minute, sex is supposed to be for pleasure and don’t tell me that I don’t get to have pleasure.’”

The push for a “pink Viagra” to increase desire highlighted women’s growing demand for sexual equality. But the drug flibanserin, approved by the FDA in 2015, proved minimally effective.

For years, the array of medical remedies has been limited. Over-the-counter lubricants ease friction but don’t replenish vaginal tissue. Long-acting mosturizers help plump up tissue and increase lubrication, but sometimes not enough. Women are advised to “use it or lose it” – regular intercourse can keep the tissues more elastic – but not if it is too painful.

Systemic hormone therapy that increases the estrogen, progesterone, and testosterone throughout the body can be effective, but if used over many years it carries health risks, and it is not always safe for cancer survivors.

Local estrogen creams, suppositories or rings are safer since the hormone stays in the vaginal area. But they can be messy, and despite recent studies showing such therapy is not associated with cancer, some women are uncomfortable with its long-term use.

In recent years, two prescription drugs have expanded the array of options. Ospemifene, a daily oral tablet approved by the FDA in 2013,activates specific estrogen receptors in the vagina. Side effects include mild hot flashes in a small percentage of women.

Prasterone DHEA, a naturally occurring steroid that the FDA approved last year, is a daily vaginal insert that prompts a woman’s body to produce its own estrogen and testosterone. However, it is not clear how safe it is to use longterm.

And then there is fractional carbon dioxide laser therapy, developed in Italy and approved by the FDA in 2014 for use in the U.S. Similar to treatments long performed on the face, it uses lasers to make micro-abrasions in the vaginal wall, which stimulate growth of new blood vessels and collagen.

The treatment is nearly painless and takes about five minutes; it is repeated two more times at 6-week intervals. For many patients, the vaginal tissues almost immediately become thicker, more elastic, and more lubricated.

Mrs. Harding began using it in 2016, and after three treatments with MonaLisa Touch, the fractional CO2 laser device that has been most extensively studied, she and her husband were able to have intercourse for the first time in years.

Cheryl Edwards, 61, a teacher and writer in Pennington, New Jersey, started using estrogen in her early 50s, but sex with her husband was painful and she was plagued by urinary tract infections requiring antibiotics, along with severe dryness.

After her first treatment with MonaLisa Touch a year and a half ago, the difference was stark.

“I couldn’t believe it… and with each treatment it got better,” she said. “It was like I was in my 20s or 30s.”

While studies on MonaLisa Touch have so far been small, doctors who use it range from cautiously optimistic to heartily enthusiastic.

“I’ve been kind of blown away by it,” said Dr. Streicher, who, along with Dr. Millheiser, is participating in a larger study comparing it to topical estrogen. Using MonaLisa Touch alone or in combination with other therapies, she said, “I have not had anyone who’s come in and I’ve not had them able to have sex.”

Cheryl Iglesia, director of Female Pelvic Medicine & Reconstructive Surgery at MedStar Washington Hospital Center in Washington D.C., was more guarded. While she has treated hundreds of women with MonaLisa Touch and is also participating in the larger study, she noted that studies so far have looked only at short-term effects, and less is known about using it for years or decades.

“What we don’t know is is there a point at which the tissue is so thin that the treatment could be damaging it?” she said. “Is there priming needed?”

Dr. Millheiser echoed those concerns, saying she supports trying local vaginal estrogen first.

So far the main drawback seems to be price. An initial round of treatments can cost between $1,500 and $2,700, plus another $500 a year for the recommended annual touch-up. Unlike hormone therapy or Viagra, the treatment is not covered by insurance.

Some women continue to use local estrogen or lubricants to complement the laser. But unlike hormones, which are less effective if begun many years after menopause, the laser seems to do the trick at any age. Dr. Streicher described a patient in her 80s who had been widowed since her 60s and had recently begun seeing a man.

It had been twenty years since she was intimate with a man, Dr. Streicher said. “She came in and said, ‘I want to have sex.’” After combining MonaLisa Touch with dilators to gradually re-enlarge her vagina, the woman reported successful intercourse. “Not everything is reversible after a long time,” Dr. Streicher said. “This is.”

But Dr. Iglesia said she has seen a range of responses, from patients who report vast improvement to others who see little effect.

“I’m confident that in the next few years we will have better guidelines (but) at this point I’m afraid there is more marketing than there is science for us to guide patients,” she said. “Nobody wants sandpaper sex; it hurts. But at the same time, is this going to help?”

The laser therapy can also help younger women who have undergone early menopause due to cancer treatment, including the 250,000 a year diagnosed with breast cancer. Many cannot safely use hormones, and often they feel uncomfortable bringing up sexual concerns with doctors who are trying to save their lives.

“If you’re a 40-year-old and you get cancer, your vagina might look like it’s 70 and feel like it’s 70,” said Maria Sophocles, founding medical director of Women’s Healthcare of Princeton, who treated Mrs. Edwards and Mrs. Harding.

After performing the procedure on cancer survivors, she said, “Tears are rolling down from their eyes because they haven’t had sex in eight years and you’re restoring their femininity to them.”

The procedure also alleviates menopause-related symptoms in other parts of the pelvic floor, including the bladder, urinary tract, and urethra, reducing infections and incontinence.

Ardella House, a 67-year-old homemaker outside Denver, suffered from incontinence and recurring bladder infections as well as painful sex. After getting the MonaLisa Touch treatment last year, she became a proslyter.

“It was so successful that I started telling all my friends, and sure enough, it was something that was a problem for all of them but they didn’t talk about it either,” she said.

“I always used to think, you reach a certain age and you’re not as into sex as you were in your younger years. But that’s not the case, because if it’s enjoyable, you like to do it just as much as when you were younger.”

Complete Article HERE!

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Better Sleep Could Mean Better Sex for Older Women

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By Robert Preidt

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.

Complete Article HERE!

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Low sexual desire, related distress not uncommon in older women

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By Kathryn Doyle

senior intimacy

Just 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.”

Complete Article HERE!

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Older Americans Having Sex, Just Not Talking About It — to Docs

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By Megan Brooks

Most older Americans are interested in sex, but only about half of those with a romantic partner are sexually active and many don’t talk about sex with their partner or clinician, according to a University of Michigan poll released today.

“Sexual health among older adults doesn’t get much attention but is linked closely to quality of life, health and well-being,” Erica Solway, PhD, coassociate director of the poll, said in a news release.

“It’s important for older adults and the clinicians who care for them to talk about these issues and about how age-related changes in physical health, relationships, lifestyles and responsibilities such as caregiving, affect them,” said Solway.

The University of Michigan National Poll on Healthy Aging asked a nationally representative sample of 1002 adults aged 65 to 80 years about their views on relationships and sex and their experiences related to sexual health.

Nearly three quarters (72%) of those surveyed have a current romantic partner (married, partnered, or in a relationship) and most (92%) have been in a stable relationship for 10 years or longer. Among those without a current romantic partner, 13% have been on a date with someone new in the past 2 years.

Taking the Sex Pulse of Older Americans

Overall, 76% of older adults said sex is an important part of a romantic relationship at any age, with men more likely than women to hold this view (84% vs 69%).

Two in five (40%) said they still have sex. Sexual activity declined with age, from 46% for those aged 65 to 70 years, to 39% for those aged 71 to 75, to 25% for those aged 76 to 80. Older men were more likely to report being sexually active than older women (51% vs 31%), as were those who said they were in good health (45% vs 22%).

About half of those with a romantic partner (54%) reported being sexually active compared with only 7% of those without a romantic partner; 92% of those who are sexually active say intimacy is an important part of a romantic relationship and 83% say it is important to their overall quality of life.

Overall, about two thirds of respondents (65%) said they were interested in sex; 30% were extremely or very interested and 35% were somewhat interested. Half of elderly men (50%) said they were extremely or very interested in sex compared with 12% of women. However, the percentage of adults very interested in sex declined with age, from 34% at age 65 to 70, to 28% at age 71 to 75, to 19% for those aged 76 to 80.

About three in four older adults (73%) said they were satisfied with their sex life, with women more likely to be satisfied than men. Those in better health were also more apt to be satisfied with their sex life.

Who’s Talking About Sex?

“This survey just confirms that the need for and interest in sexual intimacy doesn’t stop at a certain age,” Alison Bryant, PhD, senior vice president of research for AARP, a cosponsor of the poll, said in the news release.

Sixty-two percent of older adults polled said they would talk to their healthcare provider if they were having a problem with their sexual health, yet only 17% had actually done so in the past 2 years. Of those who had talked with their doctor about sexual health, 60% said they initiated the conversation themselves and 40% said their doctor started the conversation. Most of those who had talked with their provider about their sexual health said they were comfortable doing so (88%).

“Although most older adults say that they would talk with their doctor about sexual concerns, health care providers should routinely be asking all of their older patients about their sexual health and not assume that bringing up the issue will offend or embarrass them,” said Bryant.

The poll also found that 18% of men and 3% of women have recently taken medications or supplements to improve sexual function and most said it was helpful (77%).

This is a notable finding, the University of Michigan pollsters say. While some of these older adults may be taking prescription medications to aid sexual function, others may be taking over-the-counter supplements. Given potential side effects and drug interactions, they suggest providers ask patients about supplement use.

Results of the poll are available online.

Complete Article HERE!

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Older people still have sex, but it’s the intimacy and affection that matters more

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Sexuality is still an important part of life for older people, but it’s seldom discussed and rarely researched.

By and

Sexuality 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.

Complete Article HERE!

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