Sexual Behavior and the Elderly in Cross-Cultural Perspective

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The biological guidelines for changes in sexual functioning as individuals grow older may be somewhat biased as they are based on and reflect Western cultural expectations about the elderly rather than physiological capability. Changes in certain biological factors that often occur in elderly persons may have a psychological influence sexual activity. Dementia and

neurodegenerative disorders that cause loss of cognitive functions can affect sexual behavior by causing relationship difficulties that have subsequent effects upon the couple’s sex life.

The aging process for women’s sexual life (as it relates to Western society) is marked by menopause. As women grow older the physiological effects of aging on sexual function are primarily caused by decreased amounts of estrogen and progesterone after menopause. There is a marked decrease in vaginal lubrication, and thinning of vaginal mucosa which can cause intercourse to be painful if the vaginal walls become too thin. Other biological changes that occur in older women include reduced size of clitoral, vulvar, and labial tissue, decreased size of the cervix, uterus, and ovaries, and loss of elasticity. For many women, the biological changes associated with menopause are said to be associated with varying psychological changes. According to Anne Bolin in the text Perspectives on Human Sexuality, the cross-cultural experience of menopause is largely determined by the cultural perception of it. The Inis Beageans, an Irish community noted for their repressive sexual attitudes, believe that one of the consequences of menopause is mental illness, so that some of the physiological symptoms reported among western women are regarded as signs of insanity. In societies where menstruation is regarded as taboo, the post-menopausal woman gains more freedom and flexibility in interaction, thus being allowed to interact with non-kin males and act in ways in groups in which propriety in young women is demanded. We should also note that the biological changes that occur in some older women in Western society are offset by the psychological freedom to enjoy sexual activity without the possibility of pregnancy.

In older men the levels of testosterone and sperm production decline, however, the rate of declination and how that impacts the male sexually is subject to debate. Biological changes in sexual functioning that occur in men with aging include slower, less firm erection, more time to

reach orgasm, decreased force of ejaculation, longer time to get an erection after orgasm, fewer spontaneous erections, and erections that come and go even during intercourse. These changes usually are due to less blood supply to the genitals, wearing out of venous valves, slower neuronal reflexes, decreased testosterone and pain from the natural changes of life that occur with aging,. Psychologically, this may steer an older man into thinking or feeling that he can not or should not be as sexually active in older age. The biological problems that hinder an active sex life for older men led to the creation of and large market for erectile dysfunction drugs.

Unfortunately, many older adults that are sexually active on a regular basis unknowingly engage in behavior that places them at high risk for STD infection, even higher than their younger counterparts. A fact sheet published by AIDS InfoNet reports that about 29% of all people with AIDS in the United States are age 50 or over (in 2001, this proportion was 17%). It was also reported that in some cities, as many as 37% of people with AIDS are in this age group, with the number of people diagnosed with AIDS increasing. About half of the older people with AIDS have been infected for one year or less (it is important to note that most of these numbers are based on information from 33 states in the US). It is estimated that by 2015, half of the 1 million Americans living with HIV will be older than 50. HIV/AIDS typically affects young and middle-aged adults; however, heterosexual HIV transmission is higher in this age group than in any other. According to a report published by the Centers for Disease Control, persons aged 50 and older accounted for 15% of new HIV/AIDS diagnoses and 24% of persons living with HIV/AIDS (increased from 17% in 2001). The same report indicated that in 2005, persons aged 50 years and older accounted for 35% of all deaths of persons with AIDS, with these rates steadily rising. From a cross-cultural perspective, case reporting from the World Health

Organization from 2003 to 2006 shows the proportion of older HIV-positive individuals has climbed from 20% to 25% and numbers of cases have risen in all 5-year age bands from 45 years to 65 years and older; using serology, 11% of 2006 incident cases are in older individuals. In WHO’s European Region, 8% of reported cases in 2005 are older. A study published by AVERT.org indicates that in the United Kingdom, the Health Protection Agency reported that almost 4,000 HIV-infected people who were accessing care in 2006 were aged 55 years or over. Analysis of infection data collected from VCT centres in Uganda between 1999 and 2002 found that 4.6% of those who presented at the centres were older people. Of these, 20% tested HIV positive (23.9% of women and 18% of men). South Africa's national household HIV survey in 2005 found a prevalence of 10.8% among people aged 50-54, 4.5% among those aged 55-59, and 3.9% among those aged 60 or over. Data from low-income countries on this subject is sketchy at best; HIV/AIDS surveillance is commonly conducted in antenatal clinics in low-income countries, largely because many people have little other direct contact with medical services. Data from these clinics does not provide information about people who are above child-bearing age; estimates must be based on household surveys, voluntary HIV testing and counseling (VCT) services.

While HIV infection in seniors can occur by other means, the majority of new infections appear to be directly related to risky sexual practices. Engaging in sexual activity with multiple partners is one risky behavior which occurs among the elderly, widows and widowers in

particular. As with individuals of any age that are sexually active, this behavior is especially dangerous when one is unaware of the partner's sexual history and HIV/AIDS status. Older adults are also not very likely to be watchful for unusual rashes, discharges, or genital lesions

that may be indicative of a sexually transmitted disease. In addition we should also note that aging itself puts seniors at an even greater risk for HIV infection. Dry, thinner vaginal walls associated with menopause may increase the risk of vaginal tears and increase chances of contracting HIV. Since older adults are less like to accommodate for these age related