Until recently, little has been known about women's sexuality in later life. 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 not widely available. Public health attention to older women's sexuality is virtually nonexistent.
The 2005–2006 National Social Life, Health and Aging Project (NSHAP), funded by the National Institutes of Health, provides the first population-representative, baseline data on sexuality among older women and men in the United States and 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 years (75.5% weighted response rate), with oversampling of African-American, Hispanic, 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. It is the first comprehensive, population-based study of older women's sexuality.
This chapter first locates older women's sexuality in a sociodemographic context, describes sexual activity, behaviors and problems experienced by women in later life, reviews physiological changes that affect sexual functioning as women age, and recommends a clinical approach to evaluation, prevention, and treatment of sexual problems common among older women. Older women, and their sexual relationships, are very heterogeneous. Generalizations made in this chapter, based on population data from the NSHAP study and findings from other sources, are rooted in statistical norms but should not be interpreted as a normative prescription for older women's sexuality.
Interactive Biopsychosocial Model
The interactive biopsychosocial model (IBM) provides a conceptual framework for understanding the relationship between sexuality and health throughout the life course (Figure 47-1). To the degree that medicine attends to matters of sexuality, the orientation is largely negative. The medical model approach to understanding sexuality focuses on sexual dysfunction as a problematic consequence of aging, disease, or treatment. Occasionally, medical texts suggest that older patients' complaints about sexual problems, particularly male erectile difficulties, may herald serious underlying disease and ought not be ignored. While clinically valid, this narrow conceptualization of sexuality defies its multidimensional nature and limits understanding of the meaning of sexuality for health.
The Interactive Biopsychosocial Model. (Adapted from Lindau ST, Laumann EO, et al. Synthesis of scientific disciplines in pursuit of health: the Interactive Biopsychosocial Model. Perspect. Biology Med. 46(3 Suppl):S74–S86, 2003.)
A broader framework, as defined by the IBM, conceptualizes a bidirectional relationship between sexuality and health. Sexual behavior can result ...