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This chapter addresses the following Geriatric Fellowship Curriculum Milestones: #9, #23, #70

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LEARNING OBJECTIVES

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Learning Objectives

  • Apply a biopsychosocial model to research, diagnosis, and care of female sexual concerns among aging women.

  • Integrate into practice knowledge of population norms of sexual activity, behaviors, and problems among aging women.

  • Use knowledge of sexual physiology in aging to inform sexual history-taking, diagnosis, and treatment of sexual problems in older women.

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Key Clinical Points

  1. Older women, even those without a partner, value their sexual function and expect physicians to counsel them about sexual side effects or expected outcomes of medical conditions and treatments.

  2. An older woman with sexual dysfunction is likely to be bothered or distressed by the sexual problems, and this distress can have deleterious effects on her overall physical and mental health and intimate relationships.

  3. Older women who identify as members of a sexual minority group are marginalized and stigmatized in medical care generally, and they are particularly vulnerable with respect to receiving appropriate medical attention for their sexual concerns.

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INTRODUCTION

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Sociological evidence about sexuality of women in middle and later life has increased substantially over the last decade, but sexual function and outcomes among middle age and older women are still largely overlooked in the context of medical care. Negative societal attitudes about aging, sexuality among older people, and women’s sexuality in particular, present a significant barrier to scientific inquiry and medical attention to older women’s health concerns. Proven interventions for promoting female sexual well-being or treating women’s sexual problems are limited. Although older women experience high rates of sexual problems and the majority of partnered older women are sexually active, physicians infrequently discuss sexual health with older women. Public health attention to older women’s sexuality remains sparse.

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The 2005–2006 National Social Life, Health and Aging Project (NSHAP), funded by the National Institutes of Health, provided the first comprehensive, population-representative biosocial data on sexuality among middle age and older women and men in the United States, and it informs many of the insights presented in this chapter. The study enrolled a national probability sample of 3005 community-residing men and women aged 57 to 85 (75.5% weighted response rate), with oversampling of African-American and Hispanic people, and men in the 75- to 85-year-old age group. About half the respondents were male, half were female, and they were divided approximately equally across three age strata: 57 to 64, 65 to 74, and 75 to 85 years. Respondents participated in a face-to-face questionnaire covering social, psychological, and health domains, including detailed information on sexual relationships and functioning. In 2010 and 2011, 75% of participants in the baseline NSHAP study (Wave I) participated in follow-up interviews as part of NSHAP Wave II, providing data to understand within-individual change over time.

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This chapter first locates older women’s sexuality in a sociodemographic context, then describes sexual activity, behaviors, ...

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