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Preserving Our Right to Sex in Long-Term Care

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Do you need to put your wishes in writing?

By Kevyn Burger

At age 74, Joan Price likes sex and doesn’t care who knows it.

“I plan to continue to celebrate the sexual pleasure my body can give me. Things may change and I will adapt to them, but I say, sex has no expiration date,” said Price, who calls herself an advocate for “ageless sexuality.”

While prevailing wisdom may suggest that the sex lives of 70-somethings are spoken of in the past tense, Price, a speaker, blogger and award-winning author (Naked at Our Age: Talking Out Loud About Senior Sex, Better Than I Ever Expected: Straight Talk About Sex After Sixty) has her future sex life on the brain.

Sex in Long-Term Care: Unfriendly Policies

Price worries that if she would ever live in senior housing — from assisted living to skilled nursing to hospice — her desire for sexual expression could be thwarted.

“Residents in long-term care get no privacy, so how can they explore their sexuality with another resident or solo when they can’t lock the door?” she said. In fact, many facilities’ policies are “archaic, regressive and even ageist,” according to a 2015 article in Time magazine.

One notable example, Time wrote, was at Hebrew Home at Riverdale (in the Bronx), which drew up a Sexual Expression Policy. Among other things, it “recognizes and supports the older adult’s right to engage in sexual activity, so long as there is consent among those involved.”

Price urges individuals to be frank in stating their intentions.

“It occurred to me that we need to put it in writing, while we are capable to give instructions to our spouses and grown children, about what we want when it comes to exercising our sexual rights,” she said.

‘Advance Directive’ for Sexual Expression

Price created a sort of advance directive to make clear her sexual wishes. It begins with her desire to live in a facility with a sex-positive environment.

“I want my rights respected — the right to close my door and have privacy, the right to have a relationship with someone of my choice or the right to charge my sex toys in my room and use them without being disturbed,” she said.

A few facilities that house aging residents are cautiously beginning to address their lifelong needs and desires as a body of research is emerging on the sexual activity of older adults.

Previously, sex researchers typically stopped quizzing subjects at the age of 60, since prevailing wisdom suggested people were no longer sexually active beyond that age.

Sexually Active Well Beyond 60

But a 2012 study in the American Journal of Medicine found that half the women surveyed (median age 67) remained sexually active, with sexual satisfaction increasing with age. A national survey in the UK became the first to ask people in their 70s and 80s about their sexuality and confirmed that half the men and a third of the women enjoyed active sex lives into their eighth and ninth decades.

“Many service providers for older adults have had their heads in the sand. They refused to acknowledge the sexual needs of their residents. But now the Centers for Disease Control is reporting a high number of sexually transmitted infections in this population, so we know they are active,” said Jane Fleishman, a Massachusetts-based sex educator involved in ongoing research into sexuality in aging adults. “Facilities need to think about a sex policy or directive for their residents’ safety as well as their pleasure.”

Fleishman, 63, regularly consults with older adult service and housing providers. She has noticed that the intimate needs of their clients are starting to be recognized by a small minority of them.

“Sexual well-being lowers depression, social isolation and cardiovascular disease. As lifespans increase, so will people’s ability to have new adventures and relationships later in life,” she added. “Facilities should be constructed so there are private spaces where adults can be their authentic selves.”

What to Do About Dementia

Being open about older adult sex is not without its complications. With the cognitive impairment that often accompanies aging, questions can arise about whether an individual is capable of giving consent, even if he or she had previously stated an intention to remain sexually active.

It’s a dilemma that can create liability fears for administrators who run senior housing facilities and are charged with making sure their residents aren’t mistreated or exploited.

“Adult children may have the expectation that their parents are not sexually active, and administrators have seen that there will be hell to pay if the wrong two people start getting it on under their roof,” Fleishman said. “But deciding if someone can provide consent should come in a clinical assessment. It’s a question for a geriatrician, not a family member.”

Professor Gayle Appel Doll, a gerontologist and director of the Center on Aging at Kansas State University, noted that an advance directive can’t anticipate how individuals might change with age and the onset of cognitive impairment.

“When people have dementia, we see changes in their libido leading to less interest in sex. But we also see personality changes that go the other way,” such as the straitlaced older woman “who now wants to kiss men who look like her husband,” said Doll, author of Sexuality & Long-Term Care: Understanding and Supporting the Needs of Older Adults.

Building for Privacy

In her research, Doll surveyed developers who build senior housing to see if they considered resident sexuality in their planning. She found few retirement or nursing home developers accommodating the privacy needs of future residents who want opportunities for intimacy or conjugal visits.

But Doll thinks that’s changing, due to demands of the boomers and new federal policies.

“Facilities are under pressure to let their residents make their own decisions,” she said. “Mandates coming from Medicaid and Medicare require a personal care plan that lets residents say what they want for their lives and gives more weight to their preferences.”

Doll suggests that adults speak frankly about their sexual intentions to those whom they name to carry out their stated instructions.

“Creating the elements of an advance directive gives you the opportunity to talk to the people close to you and let them know what you want. I recommend having a conversation about your sexual desires in a general way with someone who might be your durable power of attorney,” she said.

But Doll admits that she doesn’t practice what she preaches.

“This means you have to have that awkward conversation with your kids, because that’s who’s going to be in control of you. And talking about the sex life you think you will want as you age is not easy,” she said. “I’m 63, and have I talked to my two grown sons about this? No.”

Persistent Silence on Sex

The lack of communication about older adult sex underscores society’s deep discomfort with acknowledging the intimate needs of the aging population.

“Even those who work in the field can’t get over what I call the ‘ick’ factor, their disgust with even the idea of wrinkly people having interest in sex,” said Price. “I’d like to see us talk out loud about lifelong sexuality without embarrassment, guilt or shame.”

Even if they don’t choose to formalize their sexual desires in a written document, Price urged people to ask questions about sexual policies as they evaluate older adult living situations.

“This is going to be your home, not a prison, so it’s incumbent on you to explore which facilities would respect your privacy and which ones would take it away,” she said.

Complete Article HERE!

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Old people still like sex

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Sex educator Jane Fleishman says intimacy improves life regardless of age

Bodies change, but they don’t necessarily become less beautiful.

Jane Fleishman

Erectile dysfunction is a factor for many men, but it can be dealt with.

Aging doesn’t have to mean the end of intimacy.

Sex is part of living and you don’t have to be young to enjoy it, sex educator Jane Fleishman of Deerfield told a group gathered to hear her talk at the assisted living facility Christopher Heights in Northampton recently.

“I am on a mission to change the way continuing care communities treat end-of -life care,” she said following her talk in mid September. “I don’t want to wait around, I want to see change happen in my lifetime.”

To that end, Fleishman, 63, a fast-talking native New Yorker, has been traveling the country holding workshops to spread her message.

“There is no expiration date on sex,” she told the crowd of about four dozen people, mostly residents, at Christopher Heights. Sharing intimacy is an important contributor to good quality of life, she says. Older adults who are more sexually active have a lower instance of heart disease and dementia, she added. “We know that people’s well-being is affected.”

One study that seems to support that was done by a team of researchers from Coventry University in Britain who found that having an active sex life leads to less mental deterioration as people age.

In 2010 researchers surveyed men in their 70s, 80s, and 90s, and found that they continue to live sexually satisfied lives, according to a study in the medical journal the Annals of Internal Medicine.

“Sex makes you feel alive – it makes you feel sensually connected to yourself,” said Monica Levine, a clinical social worker who runs a private practice in Northampton and is a certified sex therapist.

Edie Daly, 80, of Northampton, a petite woman with short white hair who was at the talk, says sex continues to be an important part of her life. In fact, she says, the best sex of her life started only after she met her wife at age 60.

“We have a deep abiding love,” she said, adding that she can’t imagine life without sex and other intimate touch. “Sex is another form of communication.”

Getting creative

But sex doesn’t always come easy —  and that’s OK — sometimes it takes a little creativity for older adults to reach satisfaction or to accommodate their changing bodies, Fleishman says.

Joint pain from arthritis, for instance, can make sex uncomfortable. Warm baths or changing positions might make intimacy more comfortable and ease any pain, according to the National Institute on Aging, a federal government organization in Baltimore which researches health in older people.

In cases of erectile dysfunction, massage is one approach that can help, says Fleishman. For vaginal dryness, there are lubricants.

Another woman who came to the talk, Mae Lococo, 93, who lives at Christopher Heights, says her husband was “quite vigorous” in bed up until he passed away two years ago. He was also an excellent ballroom dancer, she adds. She wouldn’t mind meeting another man now, she says, but notes there is a shortage of them at her age.

Consent always a factor

There can be a dark side to sex for those who are residents of nursing homes or other facilities, says Fleishman — the possibility of sexual abuse. She encourages younger people to talk to their parents to make sure they aren’t being victimized in some way. It is important, she says, that they feel free to approach a family member or other advocate for help. Just as younger people need to be aware of the boundaries of consent, older people need to understand them too, she says. Sometimes, as people age, they may experience some cognitive decline or dementia, which can make consenting to sex more difficult. That, she says, makes it particularly important for advocates to look out for them. “Consent is complicated when you get older.”

Aging adults also must continue to be aware of sexually transmitted infections, she says. “Sometimes people say, ‘I’m not going to get pregnant, so why does he need to wear a condom?’ While older adults face the same risks as other populations, sexually transmitted diseases often aren’t on the radar of their doctors, she says.

“They might be thinking the same way their patients’ offspring are: ‘Oh, that’s granddad, he can’t be having sex’ or ‘That’s grandma, she can’t be doing it, she can barely get down the stairs.’

“Well, even if she can’t get down the stairs she still might be able to have some fun upstairs,” Fleishman said.

Get over it

At age 55, Fleishman retired from her 30-year career as director of staff development at Connecticut Valley Hospital, a psychiatric hospital in Middletown, Connecticut and went back to school to get a doctorate in human sexuality from Widener University in Pennsylvania.

In addition to holding sessions on sexuality, she is writing a book about LGBT elders. She wants people to get over feeling squeamish about sexuality among the older generation.

“When I talk to young people about what they think old people do in bed and they get all nervous,” she says. “They say, ‘Too many wrinkles’ or ‘eww.’ Well, if you are lucky enough you will get there and you will realize, it isn’t so bad.”

Complete Article HERE!

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4 things we really need to stop saying (and believing) about depression and sex

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It’s time to change your mind

By

I always say that sex and depression is the intersection of two taboo topics.

It’s especially hard to talk about the two together because, frankly, it can be hard to talk about either topic separately.

Today, we’re going to look at some commonly held (and oft-repeated) beliefs that really need to be retired in the name of destroying the stigma around these important topics.

Also, they are just not true.

Depression is hard enough to cope with on its own. Don’t make it worse by piling on unfair, untrue cliches. Know the truth about sex and depression and help end the stigma.

Depressed people don’t want to have sex anyway

In 2014, I launched a survey on the impact of depression and its treatment on sexual function and relationships.

A total of 1,100 people took that survey.

In 2015, I started interviewing participants and only then did I spot the massive flaw in my survey: it only allowed for people to give responses about decreased libido.

When I conducted a second round of interviews in 2016 I asked, ‘Did depression impact your sex life? If so, how?’ and more than 29% of the respondents reported increased sexual activity during depressive episodes.

Don’t stick it in the crazy

Stop with this. It’s ableist and frankly it’s ridiculous.

Depression is not an STI and we don’t need to quarantine all the people with depression so they don’t sexually infect you.

Certainly you get to choose who you do and do not engage in sexual activity with, but reciting a (not at all clever) catchphrase, that is based in nothing, about dismissing an entire group of people just helps further stigma and makes people feel like they need to hide their own mental illness struggles.

Sex isn’t important enough to worry about when you’re fighting depression

A scenario that came up over and over in my research was patients being dismissed by doctors or the other people in their lives when they objected to sexual side effects because sex isn’t important enough to worry about ‘at a time like this’.

In some cases, the respondents believed it – ‘I didn’t worry about sex because there were more important things to worry about!’

Listen, yes, sometimes depression treatment is a fight to stay alive and we do whatever it takes, other times, it’s about maintenance and we are allowed to want more than just survival.

People with depression are allowed to want to actually live, and for a lot of people that includes sex.

You have to love yourself first before you can love anyone else

A lot of people will never love themselves.

When we tell people they are ineligible for love until they have hit this self-love goal (I know no one who has done this), what we are really doing is telling them that they have to be a better person in order to be loved.

Another variation on this is, ‘you have to get yourself together first’.

These are all nonsense, and the domain of people who want others to believe that relationships shouldn’t involve any baggage.

Everyone’s got baggage. You don’t need to pretend yours isn’t there to be loveable.

Complete Article HERE!

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A Sexless Marriage

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Name: Tammy
Gender: Female
Age: 36
Location: Springfield IL
My parents were Laurel Canyon hippies of the first order, free love, drugs and all that stuff. I used to be disgusted by all the sex my parents were having with other people. I just couldn’t understand why they didn’t just want to be with one another or divorce and remarry someone else. As soon as I could, I left the west coast for the Midwest. Now all these years later my own marriage is in trouble. My husband unilaterally ended our sex life after the birth of our last child three years ago. I haven’t let myself go. I’m still very attractive and have even improved my body after the babies. But nothing I do brings him back to bed. He said that we have children now, and people with children don’t do that sort of thing!

To spite him for shutting me out, I turned to another man for sex. I just wanted to feel desirable again. I fear my affair will be found out and it will destroy my marriage. Funny thing, my parents with all their multiple sex partners remained happily married for 51 years till my father’s death two years ago. They were honest about their lives; I am not! I feel ashamed, but I am also having the best sex of my life and I won’t give it up.

My husband is a decent man and a good father. How can I continue to live this lie? If I come clean it will likely break up my family and I’ll look like a cheating slut. Is there any other option? I wish I could have been more accepting of my parent’s lifestyle; maybe the karma wouldn’t be so rough now.

Ahhh, bad luck doll! That karma thing sure enough can be a bitch.

If I had a nickel for every time I’ve heard this same story from a frustrated and desperate man or woman trapped in a sexless marriage, I’d have enough money to lay down my keyboard, give up my status as the most fabulous and revered sexpert in the universe and retire to Maui. Unfortunately, by the time I hear from most of the people they have already suffered through years of abstinence, all the while begging and pleading for the sex they want and need. By the time they write to me it’s often way too late. The die is cast. They’re married with kids and often have a stray affair workin’ on the side. As you suggest, Tammy, it’s a pretty unbearable situation.

My first thoughts are that by the time things get to the point of sheer desperation, a happy ending is virtually impossible. A lot of people are gonna get hurt regardless of how this resolves it self. If that’s a given, maybe you should be asking yourself; what can be salvaged from the impending wreck?

Tammy, you write something very telling in your message when talking about your parents. You say, “They were honest about their lives; I am not!” In the end, if you can reclaim your integrity, regardless if it means the demise of your marriage and family, as you currently know it, you will have regained something of inestimable value.

I also want to address your comment: “If I come clean it will likely break up my family and I’ll look like a cheating slut.” Perhaps, but at least you’ll no longer be a lyin’, cheatin’ slut. Come on, how could what others think of you trump what you already think of yourself. You are down on yourself because you expect sex in your marriage. And when that disappeared, you didn’t shut down as a sexual being. Does that equation make you so bad, a slut even?

I wholeheartedly believe that married people deserve a rich and fulfilling sex life, unless there’s mutual agreement for another arrangement. Unilaterally depriving a spouse of a rich and fulfilling sex life is an act of sexual violence. It’s the kind of sexual violence that will cause frustration, anger and desperation. And inevitably lead to infidelity, which in turn destroys the marriage and traumatizes the kids. So Tammy, if you are a cheating slut, what does that make your husband? Neither you nor your old man is without blame. So time to buck up, darlin’, and do the right thing. Regardless of how the chips fall.

And one more thing, you say you were disgusted by your parent’s hippy, free love lifestyle — at least they were open an up-front with you about who they were. Consider the trauma your kids will experience when they learn dear old mom was bumping someone other than dear old dad. What kind of example are you setting for them? You see where the honesty thing is a good idea right from the get go, huh?

Ok, so I think there’s a consensus that the truth must be told. I suggest that you generously offer your husband the first right of refusal. He may not deserve it, but that’s the way to go nonetheless. Offer to stay with him and raise your kids together, but not in a sexless marriage. If he can’t bring himself to bone you the way you need it, when you need it, with vigor and passion; then he needs to free you up to find that bone in someone else’s drawers. And if he can’t live the cuckold life he ought at least to be man enough to leave the marriage with as little stink as possible.

Good luck

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Why Men Wake up With Erections

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By </span

Have you ever wondered why men often wake up with an erection?

The morning penile erection, or as it is medically known, “nocturnal penile tumescence”, is not only an interesting physiological phenomenon, it can also tell us a lot about a patient’s sexual function.

Morning penile erections affect all males, even males in the womb and male children. It also has a female counterpart in the less frequently discussed nocturnal clitoral erection.

What causes erections?

Penile erections occur in response to complex effects of the nervous system and endocrine system (the glands that secrete hormones into our system) on the blood vessels of the penis.

When sexually aroused, a message starts in the brain, sending chemical messages to the nerves that supply the blood vessels of the penis, allowing blood to flow into the penis. The blood is trapped in the muscles of the penis, which makes the penis expand, resulting in an erection.

Several hormones are involved in influencing the brain’s response, such as testosterone (the main male hormone).

This same mechanism can occur without the involvement of the brain, in an uncontrolled reflex action that is in the spinal cord. This explains why people with spinal cord damage can still get erections and why you can get erections when not sexually aroused.

What about erections while we sleep?

Nocturnal penile erections occur during Rapid Eye Movement (REM) sleep (the phase during which we dream). They occur when certain areas of the brain are activated. This includes areas in the brain responsible for stimulating the parasympathetic nerves (“rest and digest” nerves), suppressing the sympathetic nerves (“flight and fight” nerves) and dampening areas producing serotonin (the mood hormone).

Sleep is made up of several cycles of REM and non-REM (deep) sleep. During REM sleep, there is a shift in the dominant system that’s activated. We move from sympathetic (fight and flight) stimulation to parasympathetic (rest and digest) stimulation. This is not found during other parts of the sleep cycle.

This shift in balance drives the parasympathetic nerve response that results in the erection. This is spontaneous and does not require being awake. Some men may experience nocturnal penile tumescence during non-REM sleep as well, particularly older men. The reason for this is unclear.

The reason men wake up with an erection may be related to the fact we often wake up coming out of REM sleep.

Testosterone, which is at its highest level in the morning, has also been shown to enhance the frequency of nocturnal erections. Interestingly, testosterone has not been found to greatly impact visual erotic stimuli or fantasy-induced erections. These are predominantly driven by the “reward system” of the brain which secretes dopamine.

Men don’t wake up with erections because they’ve been having sexy dreams.

Since there are several sleep cycles per night, men can have as many as five erections per night and these can last up to 20 or 30 minutes. But this is very dependent on sleep quality and so they may not occur daily. The number and quality of erections declines gradually with age but they are often present well beyond “retirement age” – attesting to the sexual well-being of older men.

It’s also important to highlight the counterpart phenomenon in women, which is much less researched. Pulses of blood flow in the vagina during REM sleep. The clitoris engorges and vaginal sensitivity increases along with vaginal fluidity.

What’s its purpose?

It has been suggested “pitching a tent” may be a mechanism for alerting men of their full overnight bladder, as it often disappears after emptying the bladder in the morning.

It’s more likely the reason for the morning erection is that the unconscious sensation of the full bladder stimulates nerves that go to the spine and these respond directly by generating an erection (a spinal reflex). This may explain why the erection goes away after emptying one’s bladder.

Scientific studies are undecided as to whether morning erections contribute to penile health. Increased oxygen in the penis at night may be beneficial for the health of the muscle tissues that make up the penis.

What does it mean if you don’t get one?

Loss of nocturnal erection can be a useful marker of common diseases affecting erectile function. One example is in diabetics where the lack of morning erections may be associated with erectile dysfunction due to poor nerve or blood supply to the penis. In this case, there’s a poor response to the messages sent from the brain during sleep which generate nocturnal erections.

It is thought nocturnal erections can be used as a marker of an anatomical ability to get an erection (a sign that the essential body bits are working), as it was thought to be independent of psychological factors that affect erections while awake. Studies have suggested, however, that mental health disorders such as severe depression can affect nocturnal erections. Thus its absence is not necessarily a marker of disease or low testosterone levels.

The frequency of morning erections and erection quality has also been shown to increase slightly in men taking medications for erectile dysfunction such as Viagra.

So is all this morning action good news?

While some men will put their nocturnal erections to good use, many men are not aroused when they have them and tummy sleepers might find them a nuisance.

Since good heart health is associated with an ability to have erections, the presence of nocturnal erections is generally accepted to be good news. Maintaining a healthy lifestyle is important in avoiding and even reversing erectile dysfunction, so it’s important to remember to eat healthily, maintain a healthy weight, exercise and avoid smoking and alcohol.

Complete Article HERE!

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