Aging and Human Sexuality Resource Guide

Introduction

We don't discuss sexuality enough when considering the lives of older adults. It's easy to assume that aging brings dramatic changes and that sexuality is not a topic that concerns older adults to any great degree. Sometimes, however, events bring about a dramatic shift in awareness and understanding. The highly-publicized events following the release of the medication Viagra (sildenafil) provided a vivid example of such an event. Suddenly the country was swept with evidence that older adults are vitally concerned with sexuality. The evidence included the involvement of a former candidate for United States President, Bob Dole, publicly extolling the medication and what it had done for him, and also included dramatic statistics on the immediate response in terms of numbers of prescriptions written for Viagra. More recently, in 2006, the film Away From Her, brought issues of sexuality in couples dealing with dementia into sympathetic attention, with Julie Christie starring as an older woman with Alzheimer’s disease whose sexuality remains vibrant. While we still see many casual advertisements and media stories equating sexuality only with the young, there has been a paradigm shift in my lifetime toward a greater understanding that sexuality is an important part of life, throughout one’s lifetime.

For many years, I experienced such paradigm shifts among Psychology interns and Medical Residents who received training in a clinic for sexual dysfunction at the VA Palo Alto Health Care System, the Andrology Clinic, as part of their training in Geriatrics or Clinical Geropsychology. They met with patients, most of whom were over 60 and some of whom were well into their 80s, who cared very much about their sexual experiences and relationships and who would speak candidly and movingly about why they were seeking help for problems in sexual function. My experience was that interactions with these patients did more to change negative stereotypes about aging in these health professionals in training than any other training experiences they had. As interns frequently commented, "You just never think the same about your older clients (or your grandparents) after you have an 80 year old woman telling you how much she enjoys oral sex."

However, it is not easy for health professionals in training to find information to learn more about aging and sexuality, once they have realized how important this topic is. This website helps to solve that problem. It contains a wealth of citations for empirical evidence on aging and sexuality, summary chapters, case presentations, and resources to use for education in teaching settings or with clients. It is our hope that it will serve to further openness and sensitivity in health care professionals, as they try to attend to a vitally important topic that does not lose its power with age.

Antonette M. Zeiss, Ph.D.
APA Committee on Aging member (2001-2003)

Journal Articles

Sexual activity and function in middle-aged and older women
Addis, I. B, Van Den Eeden, S. K., Wassel-Fyr, C. L., et al. (2006). Obstetrics & Gynecology, 107, 755-764.

This analysis estimates the prevalence and predictors of sexual activity and function in a diverse group of women aged 40–69 years. Women completed self-report questionnaires on sexual activity, comorbidities, and general quality of life. Of the sexually active women, 60% had sexual activity at least monthly, approximately two thirds were at least somewhat satisfied, and 33% reported a problem in one or more domains. Satisfaction with sexual activity was associated with African-American race, lower BMI, and higher mental health score. More reported sexual dysfunction was associated with having a college degree or greater education, poor health, being in a significant relationship, and a low mental health score. Middle-aged and older women engage in satisfying sexual activity, and one third reported problems with sexual function. Demographic factors as well as some issues associated with aging can adversely affect sexual frequency, satisfaction, and function.

Changes in sexual function in middle-aged and older men: Longitudinal data from the Massachusetts male aging study
Araujo, A. B., Mohr, B. A., & McKinlay, J. B. (2004). Journal of American Geriatric Society, 52, 1502-1509.

The objective of this study is to describe within-individual change in sexual function over a 9-year period and to determine whether the amount of change differs by age group (men aged 40 to 70). Within-person change included the following sexual function variables: sexual intercourse, erection frequency, sexual desire, ejaculation with masturbation, satisfaction with sex, and difficulty with orgasm. Unadjusted analyses showed significant longitudinal changes over the 9-year period in all domains of sexual function except frequency of ejaculation with masturbation, which showed no change between baseline and follow-up. Adjusted for baseline sexual function, within-person change in all outcomes was strongly related to age, with decline in sexual function becoming more pronounced with increasing age. Number of erections per month declined by 3, 9, and 13 in men in their 40s, 50s, and 60s, respectively.

The relationship between depressive symptoms and male erectile dysfunction: Cross-sectional results from the Massachusetts Male Aging Study (MMAS)
Araujo, A. B., Durante, R., Feldman, H. A., Goldstein, I., & McKinlay, J. B. (1998). Psychosomatic Medicine, 60(4), 458-465.

Objectives of this study were (a) to determine whether male erectile dysfunction (MED) is associated with depressive symptoms and (b) to determine whether this association is independent of aging and para-aging factors. Data were obtained from the Massachusetts Male Aging Study (MMAS), a cross-sectional, population-based multidisciplinary survey of health in 1,265 normally aging men (aged 40-70 years) conducted from 1986 to 1989.

The relationship between depressive symptoms and MED in middle-aged men is robust and independent of important aging and para-aging confounders, such as demographic, anthropometric and lifestyle factors, health status, medication use, and hormones.

Men's sexual health after midlife
Bartlik, B., & Goldstein, M. Z. (2001). Psychiatric Services, 52(3), 291-93, 306.

Describes the normal physiologic changes that occur as men age as well as the physiologic causes of male sexual dysfunction. The psychological, cultural, and relationship factors that may contribute to the premature loss of sexual functions in older couples are also described. Medical treatments and sex therapy techniques that have been found to be useful are reviewed. An overview is provided of important issues for the clinician in addressing sexuality with older patients.

Sexuality, health care and the older person: An overview of the literature
Bauer, M., McAuliffe, L., & Nay, R. (2007). International Journal of Older People Nursing, 2(1), 63-68.

This paper reviews recent literature around sexuality, health care and older adults. The construction of sexuality, importance of sexuality to older adults, sexual diversity in old age, and sexuality and health are discussed. Also discussed are the myths and stereotypes associated with this topic, and the medical, social, healthcare, and institutional barriers to sexuality and sexual health in later life.

The sexuality of elderly people on film: Visual limitations
Bildtgard, T. (1998). Journal of Aging & Identity, 5(3), 169-183.

Explores how the sexuality of older persons is depicted in mainstream film drawing on content & discourse analyses of 1990-1995 Nordic & North American films opening in Swedish cinemas & casting older adult characters in leading roles. To an overwhelming degree, older persons were depicted as having no sexual life at all with a need for tenderness & warmth replacing sexuality. Findings were interpreted in a cultural perspective: the common assumption, even among older persons, seems to be that they do not have a sexual life.

Sexual function in 1,202 aging males: Differentiating aspects
Bortz, W. M., Wallace D. H., & Wiley D. (1999). Journal of Gerontology, Series A, Biological Sciences and Medical Sciences, 54(5), 237-41.

This survey seeks to extend knowledge of the relationship of sexual attitudes and preferences to sexual functioning in a large group of community-dwelling 58-94 year old men. Although age correlated consistently with increased erectile dysfunction and decreased sexual activity, a substantial number of older men continued active sexual behaviors supported by positive attitudes toward sexual function. Both health status and perceived partner's responsiveness are prominent moderators of the age effect.

Nottingham Study of Sexuality and Ageing (NoSSA II): Attitudes of care staff regarding sexuality and residents: A study in residential and nursing homes
Davies, H. D., Zeiss, A. M., Shea, E. A., & Tinklenberg, J. R. (1998). Sexuality and Disability,16(3), 193-203.

Research indicates that older adults continue to be sexually active well into later life; however, few health care professionals ask about their sexual functioning. This is even more true when one partner in a couple has a diagnosis of dementia, and the other partner is labeled as a caregiver. This paper addresses means of fostering acceptance by professionals and families and creating an environment that nurtures sexuality in couples coping with dementia.

Sexual desire in later life
DeLamater, J. D., & Sill, M. (2005). Journal of Sex Research, 42(2), 138-149.

There has been relatively little research on sexuality in later life, particularly among persons over 60 years of age. This literature suggests that age, hormone levels, specific illnesses, and various medications negatively affect sexual functioning in older persons. This study reports results from a survey of a large sample (N = 1,384) of persons age 45 and older that included measures of a variety of biological, psychological and social factors that potentially influence sexual functioning. Bivariate and multivariate analyses are conducted separately for women and men. The principal influences on strength of sexual desire among women are age, the importance of sex to the person, and the presence of a sexual partner. Among men, they are age, the importance of sex to the person, and education. In this sample of the population of older persons, attitudes are more significant influences on sexual desire than biomedical factors.

Sexual feelings and sexual life in an Italian sample of 335 elderly 65 to 106-year-olds
Dello Buono, M., Zaghi, P. C., Padoani, W., Scocco, P., Urciuoli, O., Pauro, P., & De Leo, D. (1998). Archives of Gerontology and Geriatrics, 6, 155-162.

Studied aspects of sexual interest and activity in 335 older adults (aged 65-106 yrs) recruited at consulting rooms of GPs in Padua, Italy. Ss were participating in an international, multicenter, quality of life study aimed at providing a global, reliable image of sexuality up to an advanced age. Roughly one-third of the Ss reported being still interested in sex. The most important variables in maintenance of sexual activity were being male, married, younger, and cognitively unimpaired; having a higher educational level; being self-sufficient; and being satisfied with the present life. Educational level, age, and social functioning lose importance in the case of sexual interest, which remains more present than activity, even in very advanced age. Absence of arthrosis and maintenance of good social-relational functions for men and absence of depression and anxiety for women are predictive of sexual interest and activity.

Association of sexual problems with social, psychological, and physical problems in men and women: A cross-sectional population survey
Dunn, K. M., Croft, P. R., & Hackett, G. I. (1999). Journal of Epidemiology and Community Health, 53(3), 144-8.

Investigated the association of sexual problems with social, physical, and psychological problems. 789 men and 979 women responded to a mail questionnaire sent to a stratified random sample of the adult general population (aged 18-75 yrs) from four general practices in England. Results indicate that sexual problems cluster with self-reported physical problems in men, and with psychological and social problems in women. In men, erectile problems and premature ejaculation were associated with increasing age. Erectile problems were most strongly associated with prostate trouble, but hypertension and diabetes were also associated. Premature ejaculation was predominantly associated with anxiety. In women, the predominant association with arousal, orgasmic, and enjoyment problems was marital difficulties. All female sexual problems were associated with anxiety and depression. Vaginal dryness was found to increase with age, whereas dyspareunia decreased with age.

Medications that may contribute to sexual disorders: A guide to assessment and treatment in family practice
Finger, W. W., Lund, M., & Slagle, M. A. (1997). Journal of Family Practice, 44, 33-43.

Approximately 15% to 25% of family practice patients have concerns about sexual function and are most comfortable discussing these issues with their family physician. While many physicians have avoided this topic in the past, citing lack of knowledge and skill, the family practice setting is ideal for a preliminary evaluation of sexual dysfunction and treatment for certain etiologies. This especially is true for changes in sexual function secondary to medication effects. This article provides basic guidelines designed to assist physicians in evaluating the effects of medications and other substances on sexual function. Also included are lists of medications known or suspected to have adverse effects on sexual function. Physicians are encouraged to address the sexual concerns of their patients and to incorporate these guidelines and the medication lists into their evaluation.

Behavioral interventions for sexual dysfunction in the elderly
Fisher, J. E., Swingen, D. N., & O'Donohue, W. (1997). Behavior Therapy, 28(1), 65-82.

Reviews and evaluates the status of information regarding sexual dysfunction in advanced age. Argues that the behavioral approach has considerable promise for the conceptualization of the sexual problems of older adults, because in rejecting the medical model of nomothetically defining psychological disorders, it allows for considerable variability for individuals to define their problems in living. The utility of this feature for guiding behavior therapists in helping the elderly understand their sexual functioning is discussed, and a research agenda addressing the limitations in the extant literature regarding the assessment and treatment of sexual dysfunction in old age is proposed.

General practitioner attitudes to discussing sexual health issues with older people
Gott, M., Hinchliff, S., & Galena, E. (2004). Social Science & Medicine, 58, 2093-2103.

How health professionals perceive and manage later life sexual problems remains relatively unexplored and, in particular, little is known about the attitudes of GPs, who represent the first point of contact for most older people in the UK who experience sexual health concerns. This paper draws on qualitative data generated from in-depth interviews with 22 GPs working in demographically diverse primary care practices in Sheffield, UK. Analysis identified that GPs do not address sexual health proactively with older people and that, within primary care, sexual health is equated with younger people and not seen as a ‘legitimate’ topic for discussion with this age group. However, it was apparent that many beliefs held about the sexual attitudes and behaviors of older people were based on stereotyped views of ageing and sexuality, rather than personal experience of individual patients. The discussion considers the implications of these findings for primary care, particularly in relation to education and training.

Correlates of spouse relationship with sexual attitude, interest, and activity among Chinese elderly
Guan, J. (2004). Sexuality & Culture: An Interdisciplinary Quarterly, 8(1), 104-131

The purpose of the study was to investigate current sexual attitudes and behavior patterns of rural Chinese older adults and to assess the effects of spouse relationships. The subjects were interviewed by village doctors and social workers in six villages selected along the Yellow River in central China utilizing a structured questionnaire. The symbolic interaction perspective and ecological developmental approach provide theoretical frameworks for understanding the interactional, associational, and transformational nature of sexuality. The findings confirmed that aging itself abolishes neither the need nor the capacity for sexual activity. However, sexual attitude, interest, and activity were directly affected by spouse relationships. Chinese culture for thousands of years has sought to narrow sexual activities to the purpose of reproduction and, therefore, has likely suppressed sexual needs. This study is among the first investigations in shaking the traditional taboo of talking about sex. It is not only to provide information about Chinese older adult who constitute one-fifth of the world population of the aged, but also adds to the body of knowledge of older adult sexuality, especially to the gerontological literature of non-Western traditions.

Forever young: A health promotion focus on sexuality and aging
Henry, J., & McNab, W. (2003). Gerontology & Geriatrics Education, 23(4), 57-74

Sexuality is one of the least understood aspects of aging, and society often seems to imply that sexuality does not have a place in the lives of older people. This article provides an overview of sexuality and aging, including myths and common physical, emotional, and social concerns. It offers suggestions as to how health-care professionals can take a prevention, or health promotion, focus that emphasizes education toward maintaining quality of life for this growing population group, and as a result, help them optimize their sexual quality of life to the fullest extent during the "golden years" of their lives.

A correlational framework for understanding sexuality in women age 50 and older
Johnson, B. K. (1998). Health Care for Women International, 19(6), 553-64.

Bio-psychosocial perspectives of sexuality in 657 women aged 50 and older were studied. Significant predictors of sexual interest, participation, and satisfaction were identified. Findings suggest a bio-psychosocial model for clinicians in assessment and intervention with older women and sexual issues; educators to organize teaching about aging and female sexuality; and researchers to investigate older women's sexuality.

Is the functional ‘normal’? Aging, sexuality and the bio-marking of successful living
Katz, S., & Marshall, B. L. (2004). History of the Human Sciences, 17(2), 53-75.

This article raises the question of ‘normality’ today and the fracturing of health ideals along new lines of enablement and function. In particular the study asks if ‘functional’ and ‘dysfunctional’ are displacing ‘normal’ and ‘pathological’ as master biopolitical binarisms, and if so, what distinctions can be drawn between them. The discourse of ‘function’ and ‘dysfunction’ is certainly ubiquitous in two areas of research and practice: gerontology and sexology. In the former case ‘functional health’ is linked to successful aging represented by technical tests around activities of daily living (ADLs) and risk-assessment profiles. In the latter case, sexual function and dysfunction have become all-encompassing markers of heterosexual competence, now largely detached from reproductive imperatives, but refashioned as integral to responsible and successful self-management. Presenting examples from both cases, the article concludes that functionality, circulating under the signs of ‘normal’, ‘natural’ and ‘healthy’, furnishes economic, technological, educational, professional, pharmacological and policy fields with a rich intellectual, practical and regulatory resource.

The impact of aging on sexual function in women and their partners
Kingsberg, S. A. (2002). Archives of Sexual Behavior, 31(5), 431-437.

Aging has a powerful impact on the quality of relationship and sexual functioning. The psychological impact of aging after midlife is a particularly timely topic, given improved medical and psychological understanding of sexuality in both women and men as well as significant improvement in the conceptualization of female sexuality and evolving treatment advances for female sexual dysfunctions. It is time to dispel the stereotype of the midlife woman in order to more effectively address emotional and sexual issues arising in her relationships. Regardless of the length or nature of the relationship, its quality is enhanced by emotional intimacy, autonomy without too much distance, an ability to manage stress, and to maintain a positive perception of self and the relationship. To understand and treat effects of aging on sexuality, it is important to address the three components of sexual desire: drive, beliefs/values, and motivation, as well as the social context of a woman's life. It is also essential to understand how the physiological changes in female as well as male sexual functioning impact desire. Further, other health-related changes that occur with aging must be recognized and addressed.

The psychological impact of aging on sexuality and relationships
Kingsberg, S. A. (2000). Journal of Women's Health & Gender-Based Medicine, 9(Suppl.1), S33-S38.

Aging has a powerful impact on the quality of relationships and sexual functioning. The psychological impact of aging after midlife is a timely topic given improved understanding of sexuality in both women and men, as well as more effective treatment for age-related sexual dysfunctions. Regardless of the length or nature of the relationship, its quality is enhanced by emotional intimacy, autonomy without too much distance, an ability to manage stress and distractions by external factors, and achieving a satisfying sexual equilibrium. Perception of the quality of the primary relationship and sexuality is influenced by other factors in a person's life. Thus, the relationship must be examined and issues must be addressed taking these external factors into consideration. Among the most powerful external factors is one's occupation or avocation which tends to strongly influence one's sense of identity, self-esteem, and self-worth. To understand and treat effects of aging on sexuality, it is important to address the three components of sexual desire: drive, beliefs/values, and motivation, as well as the sexual equilibrium within the primary relationship. It is also essential to understand how the physiological changes in sexual functioning affect desire and equilibrium.

Sexual problems among women and men aged 40-80 years: prevalence and correlates identified in the global study of sexual attitudes and behaviors
Laumann, E. O., Nicolosi, A., Glasser, D. B., et al. (2005). International Journal of Impotence Research, 17, 39-57.

The Global Study of Sexual Attitudes and Behaviors (GSSAB) is an international survey of various aspects of sex and relationships among adults aged 40–80 y. An analysis of GSSAB data was performed to estimate the prevalence and correlates of sexual problems in 13,882 women and 13,618 men from 29 countries. Several factors consistently elevated the likelihood of sexual problems. Age was an important correlate of lubrication difficulties among women and of several sexual problems, including a lack of interest in sex, the inability to reach orgasm, and erectile difficulties among men. We conclude that sexual difficulties are relatively common among mature adults throughout the world. Sexual problems tend to be more associated with physical health and aging among men than women.

A cross-national study of subjective sexual well-being among older women and men: Findings from the global study of sexual attitudes and behaviors
Laumann, E. O., Paik, A., Glasser, D. B., et al. (2006). Archives of Sexual Behavior, 35, 145-161.

Subjective sexual well-being refers to the cognitive and emotional evaluation of an individual’s sexuality. This study examined subjective sexual well-being, explored its various aspects, examined predictors across different cultures, and investigated its possible associations with overall happiness and selected correlates, including sexual dysfunction. Data were drawn from the Global Study of Sexual Attitudes and Behaviors, a survey of 27,500 men and women aged 40 to 80 years in 29 countries. The cross-national variation of four aspects of sexual well-being (the emotional and physical satisfaction of sexual relationships, satisfaction with sexual health or function, and the importance of sex in one’s life) was explored using cluster analysis, and relationships among sexual well-being, general happiness, and various correlates were examined using ordinary least squares regression and ordered logistic regression. Results from the cluster analysis identified three clusters: a gender-equal regime and two male-centered regimes. Despite this cultural variation, the predictors of subjective sexual well-being were found to be largely consistent across world regions.

Clinical perspectives on sexual issues in nursing homes
Lichtenberg, P.A. (1997). Topics in Geriatric Rehabilitation, 12(4), 1-10.

Reviews sexual attitudes and practices in nursing homes from four perspectives: sexual attitudes and practices as perceived by residents, sexual disinhibition among residents as perceived by nursing staff, attitudes toward sexuality by nursing and allied health care staff, and ethical issues in sexuality and dementia. Sexual expression in older adults with and without dementia may bring different challenges. For the cognitively intact, the issue of privacy is primary to their ability to enjoy sexual relations. In dementia patients, the question of their competency may be paramount. A model of assessment for competency to participate in an intimate relationship is proposed that uses informed consent as its cornerstone and the use of interdisciplinary teams is recommended to address sexuality issues in the nursing home.

A study of sexuality and health among older adults in the United States
Lindau, S. T., Schumm, L. P., Laumann, E. O., Levinson, W., O’Muircheartaigh, C. A., & Waite, L. J. (2007). New England Journal of Medicine, 357(8), 762-774.

The article report the prevalence of sexual activity, behaviors, and problems in a national probability sample of 3005 U.S. adults (1550 women and 1455 men) 57 to 85 years of age, and we describe the association of these variables with age and health status. The prevalence of sexual activity declined with age; women were significantly less likely than men at all ages to report sexual activity. Among respondents who were sexually active, about half of both men and women reported at least one bothersome sexual problem. The most prevalent sexual problems among women were low desire, difficulty with vaginal lubrication, and inability to climax. Among men, the most prevalent sexual problems were erectile difficulties. Fourteen percent of all men reported using medication or supplements to improve sexual function. Men and women who rated their health as being poor were less likely to be sexually active and, among respondents who were sexually active, were more likely to report sexual problems. A total of 38% of men and 22% of women reported having discussed sex with a physician since the age of 50 years. Women are less likely than men to have a spousal or other intimate relationship and to be sexually active. Sexual problems are frequent among older adults, but these problems are infrequently discussed with physicians.

The new virility: Viagra, male aging and sexual function
Marshall, B. L. (2006). Sexualities, 9(7), 345-362.

While it was once assumed that sexual function and virility naturally declined with age, the sexual capacities of the aging body have more recently been aligned to new performative standards, particularly for men. This article explores the history and contemporary dimensions of this new culture of virility. The first section reviews shifting scientific and cultural narratives of the sex/age problematic. The latter part of the article explores how the robust post-Viagra ‘men's health’ industry has expanded the medicalization of masculinity and male sexuality in later life, particularly via the recuperation of the ‘male menopause’ as ‘androgen deficiency in the aging male’. As the aging male body is opened up to new manifestations of dysfunction and disorder, attention is drawn to emerging understandings of risk, health and surveillance in relation to sexual function.

Sexual activity and satisfaction among very old adults: Results from a community-dwelling Medicare population survey
Matthias, R. E., Lubben, J. E., Atchison, K. A., & Schweitzer, S. O. (1997). Gerontologist, 37(1), 6-14.

Examined the relationship between sexual satisfaction (SXS) and sexual activity (SA), and socio-psychological factors in 1,216 elderly Ss (mean age 77.3 years) of the UCLA Medicare Screening and Health Promotion Trial. For men, the best predictors of SA were being younger and having more education; while for women, it was being married. For both sexes, the best predictors of SXS were being sexually active and a positive mental health. The main predictors of SA were being married, having more education, being younger, being male, and having good social networks; while those for satisfaction with SA were being sexually active, being female, having good mental health, and better functional status.

Sexuality training for caretakers of geriatric residents in long term care facilities
Mayers, K., & McBride, D. (1998). Sexuality and Disability, 16(3), 227-236.

A training program on sexuality of geriatric residents for caretakers and administrators in a long term care facility was quite effective in eliciting interest and participation. The workshop's training focused on (1) attitudes toward sexuality and the elderly; (2) terminology and communication; (3) residents' rights and abilities to make decisions about their sexuality; and (4) information sharing and handouts: information to carry away from the session and share with co-workers. There is a need for education of caregivers and administrators to ensure that they are not influenced by their own misconceptions and value judgments about elder sexuality in offering care to their residents. Aspects of dementia diagnoses and the aging process are discussed, with emphasis on the manner in which they affect staff attitudes about geriatric sexuality.

Barriers to the expression of sexuality in the older person: The role of the health professional
McAuliffe, L., Bauer, M., & Nay, R. (2007). International Journal of Older People Nursing, 2(1), 69-75.

Older people frequently experience barriers to the expression of their sexuality. Many of these barriers are influenced by the health professionals and services that care for them. This paper will outline these barriers and identify strategies that the healthcare professional can implement to help improve practice in this area.

Psychosexual and psychosocial aspects of male aging and sexual health
Metz, M. E., & Miner, M. H. (1998). Canadian Journal of Human Sexuality, Male Sexual Health, 7(3), 245-259.

The scientific literature on the physiological and psychosocial aspects of male aging, and the impact of aging on male sexual function and sexuality is summarized and discussed. A bio-psychosocial model for conceptualizing the interaction between the various aspects of the aging process is proposed as a means of assisting men in adapting to their changing sexuality in a positive way.

Sexual healthcare needs of women aged 65 and older
Nusbaum, M. R. H., Singh, A. R., & Pyles, A. A. (2004). Journal of the American Geriatrics Society, 52 (1), 117-122.

The objective of this cross-sectional study is to compare prevalence and type of sexual concerns and interest in and experience with discussing these concerns with physicians for women younger than 65 and 65 and older. Older women had a similar number of sexual concerns as younger women and were more likely to be concerned about their partner's sexual difficulties. Older women were less likely to have ever had the topic of sexual health raised during healthcare visits. Even though these women were more likely to report youthful-appearing physicians as hindering the topic of sexual health, the majority indicated that they would have discussed their concerns had the physician raised the topic and were interested in a follow-up appointment to do so. Although the types of sexual concerns vary in frequency, women aged 65 and older have a similar number of sexual concerns as younger women. Older women want physicians to inquire about their sexual health. This discussion should include inquiries about their partner's sexual functioning. To overcome age as a barrier to this discussion, younger physicians should be particularly attentive to initiating the topic of sexual health.

Sexuality and the chronically ill older adult: A social justice issue
Pangman, V. C., & Seguire, M. (2000). Sexuality and Disability, 18(1), 49-59.

Sexuality can give an embellished meaning to life. Attitudes toward sexuality have generated devaluing reactions from society regarding older adults. These actions have relegated sexuality to be invisible. As the proportion of the older population, relative to the younger generation increases, and as chronic health problems become more prevalent nurses will encounter more elderly people with sexual concerns. Nurses, educated in the field of gerontology and sexuality, are in favorable position to assess the older adult and to provide health teaching and sexual counseling regarding the sexual concerns of the older adult. Nursing research and policy development are complementary avenues whereby sexuality can be made more visible for the older adult who is experiencing chronic illness. These nursing strategies will facilitate the recognition of the elderly and their rights. These rights need to be respected and exercised to promote social justice in order to enhance their quality of life.

Sexuality in the lives of older people
Russell, P. (1998). Nursing Standard, 13(8), 49-53.

Some of the physical, psychological and social aspects of sex and sexuality in later life are described in this article. Its purpose is to raise nurses' awareness and understanding of sexuality in older people.

Introduction to sexuality in late life
Sharpe, T. H. (2004). The Family Journal, 12(2), 199-205.

Sexuality is an aspect of human development often ignored at various stages of life, especially late life. With the aging of society, increased longevity, improved health, and rising affluence, the understanding of normal sexual development in aging humans becomes progressively more important. Normal sexuality among those in late life may relate more to societal views based in part on ageist myths and misconceptions and an overemphasis on disease processes. It is important for both health and mental health professionals to educate themselves about the specific challenges and rewards of sexuality in late life.

Assessment of psychosexual adjustment after insertion of inflatable penile prosthesis
Tefilli, M. V., Dubocq, F., Rajpurkar, A., Gheiler, E. L., Tiguert, R., Barton, C., Li, H., & Dhabuwala, C. B. (1998). Urology, 52(6), 1106-1112.

Psychosexual benefits obtained from multicomponent penile implant surgery in- patients with erectile dysfunction were examined. Thirty-five patients undergoing penile prosthesis implantation were given a psychosexual questionnaire before surgery and at 3 months, 6 months, and 1-year intervals after surgery. There was an increase in the frequency of sexual activity; an improvement in satisfaction with sex life; and a decrease in feelings of sadness, depression, anxiety, anger, frustration, and embarrassment related to sexual activity. The study demonstrates significant improvement in the psychosexual well being of multi-component penile implant recipients, with attainment of a high level of patient satisfaction up to 1 year after surgery.

Evaluation of quality of life for prostate cancer patients who have undergone radical prostatectomy surgery
Tomicich, S. F. (2007). American Journal of Men's Health, 1(5).

Prostate cancer is an epidemic among aging men. It is essential that research be conducted with the purpose of determining the outcomes of various treatment options. For this study, a sample of radical prostatectomy patients completed a written questionnaire for the purpose of evaluating whether the radical prostatectomy for clinically localized prostate cancer has an effect on quality of life. In addition, demographic factors were examined to determine if they had an effect on quality of life after this surgical procedure. Data appeared to show that urinary, bowel, and sexual function are determinants of quality of life that are affected by having the radical prostatectomy procedure. Due to the numerous treatment options available for prostate cancer, more research regarding quality of life should be undertaken to determine the best possible treatment option for the patient.

Affectivity and sexuality in the elderly: Often neglected aspects
Umidi, S., Pini, M., Ferretti, M., Vergani, C., & Annoni, G. (2007). Archives of Gerontology and Geriatrics, 44(Suppl.1), 413-417.

Sexuality and affectivity constitute a complex phenomenon involving many spheres: biological, psychological and social. To investigate these aspects, we distributed a dedicated questionnaire, followed by an interview, to 130 older adults in Milan and 100 in Monza. The answers indicated that the older adults communicate their emotions regarding the affective and sexual sphere, with different levels of desire for physical contact. The main variables were sex, age, marital status, co-morbidity and poly-pharmacotherapy, the perception of health status and of oneself, past experiences, cultural conditioning and social factors.

Comparative demographic and sexual profile of older homosexually active men
Van de Ven, P., Rodden, P., Crawford, J., & Kippax, S. (1997). Journal of Sex Research, 34(4), 349-360.

A national telephone survey of 2,580 homosexually active men in Australia, ages 25 and under to 50 and older, was conducted in May and June of 1992. Participants were asked questions about demographics, types of sexual partners, attachment to the gay community, HIV/AIDS, and sexual practices. Participants aged 50 and older were likely to live alone (52.7%); to be or have been married (62.9%); to have children (56.4%); less likely to have disclosed their sexual orientation; and although attachment to the gay community was quite strong, less than younger men's in terms of social attachment, cultural involvement, and sexual involvement. Older men were also less likely to have been tested for HIV antibodies and reported having had as many male and female sexual partners in the past 6 months as did younger men. There were no significant age differences in rates of condom use during anal intercourse with regular or casual male partners; however, the older men were more likely to have no anal intercourse with casual partners.

Knowledge and attitudes toward sexuality of a group of elderly
Walker, B. L., & Ephross, P. H. (1999). Journal of Gerontological Social Work, 31(1-2), 85-107.

Investigated the knowledge and attitudes of a group of elderly toward sexuality and staff practices related to the expression of older adult sexuality in a long-term care setting. Responses to 159 items divided among 4 forms were solicited from 68 older adults living in long-term care facilities or attending a senior center. Information about the Ss' educational level, ethnicity, religiosity, political preferences, marital status, health, and importance of intimacy and sexuality was collected. Items related to masturbation, family issues, and personal issues were left unanswered more than other items. As a group the Ss tended to be somewhat knowledgeable, answering 67% of the knowledge items correctly. They were also somewhat tolerant toward sexuality issues, answering an average of 58% of the items in that direction. Finally, they supported relatively proactive responses of staff toward sexuality issues, agreeing on average with 69% of the items where staff took actions in support of older adult sexual expression. Ss tended to think that there was little sexual activity taking place in nursing homes but that the residents continued to be interested in sexual expression. This information will be applied in the development of a training program for long-term care staff.

Staff and elderly knowledge and attitudes toward elderly sexuality
Walker, B. L., Osgood, N. J., Richardson, J. P., & Ephross, P. H. (1998). Educational Gerontology, 24(5), 471-489.

This study compared older adults' and long-term care staff members' knowledge and attitudes toward sexual expression in older adults. The 159-item Knowledge and Attitudes Toward Elderly Sexuality (KATES) scale was developed and administered to staff members and older adults recruited from a variety of settings; respondents were 126 long term care staff members (mean age 40.25) and 68 older adults (mean age 71.8), including 13 long term care residents and 55 community-dwelling participants of a recreational program. Staff was significantly more likely to rate sexuality as very important than older respondents (73% versus 50%). Older adults had less tolerant attitudes toward sexuality than staff and were more likely not to respond to sensitive items, such as those related to masturbation, family issues, loneliness, and widowhood. Only 13% of staff and 21% of older respondents agreed with the statement "We should not allow gays and lesbians to live at our facility"; however, 55% of staff and 60% of older respondents agreed with the statement "Homosexuality is unnatural." Forty-seven percent of older adults believed that staff should call family members if a resident became involved in an intimate relationship, compared with 26% of staff, and 43% of older adults believed that staff should help residents obtain erotic videos or magazines if they asked for them, compared with only 10% of staff.

A kiss is still a kiss? The construction of sexuality in dementia care

Ward, R., Vass, A. A., Aggarwal, N., Garfield, C., & Cybyk, B. (2005). Dementia: The International Journal of Social Research and Practice, 4(1), 49-72.

This article explores descriptions of the sexuality and sexual expression of people with dementia residing in care. It is argued that accounts offered by care workers are mediated by their own perspectives and interests. Data from the study, alongside a review of existing research findings, suggest that gender has a crucial influence upon the interpretation and response to sexual expression in care settings. Interviews with care staff revealed that such expression is often deemed problematic. Factors maintaining the invisibility of the homosexual population in care are also discussed. It is concluded that there exists a need for greater consultation with residents regarding sexuality and for an exploration of the range of sexualities in care.

Sexuality and aging--usual and successful
Wiley, D., & Bortz, W. M. (1996). II, Journals of Gerontology: Series A: Biological and Medical Sciences, 51A(3), M142-M146.

Examined the effects of an instructional program on older adults' self-reported sexual attitudes and sexual performance. Results showed that over two-thirds of respondents at pretest reported having an active sexual partner. Sixty percent reported a decreased frequency of sexual activity in the past 10 years, 32% reported no change in frequency, and 8 percent reported an increase. Seventy-one percent of men and 52% of women reported a desire to increase the frequency of sexual activity.

Knowledge and attitudes about later life sexuality: What clinicians need to know about helping the elderly
Willert, A., & Semans, M. (2000). Contemporary Family Therapy: An International Journal, 22(4), 415-435.

In the family therapy field we have often overlooked older adults and in particular addressing sexual concerns within the context of couple’s therapy with older adults. The projected life-span of the older adult has increased due to improvements in medical technology and due to a better quality of life which promotes longevity. Included in this paper are the specific age-related physical, emotional, and sexual changes common in later life as well as a clinical case vignette of an older adult couple presenting with a sexual issue. Current sexuality education programs for older adults are reviewed as well as clinical implications for therapists who treat older adults.

Negotiating sexual agency: Postmenopausal women’s meaning and experience of sexual desire
Wood, J. M., Mansfield, P. K., & Koch, P. B. (2007). Qualitative Health Research, 17(2), 189-200.

The purpose of this feminist grounded theory study was to understand the meaning and experience of postmenopausal women's sexual desire. Data collection from 22 postmenopausal women who were ongoing participants of the TREMIN Research Program on Women's Health occurred via audiotaped, telephone-based, semistructured interviews. Women's descriptions of their sexual needs and desires led to the discovery of the core category, negotiating sexual agency, which refers to women's ability to act on behalf of their sexual needs, desires, and wishes. Women negotiated their sexual agency within three main domains (or axial codes): their own sexual self, their partners, and the medical system. An important finding was women's internalization of sociocultural assumptions that privilege their male partners' sexual needs over their own. The findings of this study, especially the contexts in which women negotiate their sexual agency, are important for women, women's health care providers, and women's life partners to understand.


Affection and sexuality in the presence of Alzheimer's disease: A longitudinal study
Wright, L. K. (1998). Sexuality and Disability, 16(3), 167-179.

Affection and sexuality were studied longitudinally for two groups of couples, one with an Alzheimer's disease (AD) afflicted spouse and the other spouse the primary caregiver and a second group with both spouses relatively healthy. Affectional expressions were not different for the two groups prior to illness onset but declined significantly for the AD group five years into the illness trajectory; affection remained stable for the well group. Based on follow-up data obtained two years later, outcomes for afflicted spouses were taken into consideration, and the pattern for affection was reexamined. Affection increased significantly after nursing home placement of an ill spouse. Fewer AD than well couples were sexually active five years into the illness trajectory. The problem of hypersexuality in a few male afflicted spouses had abated two years later. The number of well couples who were sexually active also declined over time, but several couples continued at the same or higher levels of sexual intimacy. The study contrasts normal aging from pathological deviations within a human developmental perspective.

An observational study of sexual behavior in demented male patients
Zeiss, A. M., Davies, H. D., & Tinklenberg, J. R. (1996). Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 51A(6), M325-M329.

An observational study across 9 observation periods examined whether patients with dementia will display disinhibited, inappropriate sexual behavior. Ss were 40 patients (aged 60-98 yrs) with a dementia diagnosis living in institutional settings. On average, Ss displayed 43 appropriate sexual behaviors, 1.48 ambiguous behaviors, and .83 inappropriate behaviors. This was not evenly distributed across Ss, however; only 18% of patients ever displayed a sexually inappropriate behavior, and these were usually brief and minor. Inappropriate sexual behavior was observed in only 1.6% of the observed 1-minute time segments.

Books

Sex over 50
Block, J. D., & Bakos, S. C. (1999). Paramus, NJ: Reward Books.

This book speaks to the growing group of aging Americans who are looking for professional, practical advice on how to make the transition to deeper, richer, more sophisticated sexual relationships. Debunked are the myths of the youth-beauty obsession and our stereotypes of sexuality and aging, showing what it takes to be a mature lover and recapture the passion once believed to be the exclusive province of our youth.

Handbook of counseling and psychotherapy with older adults
Duffy, M. (Ed.). (1999). Hoboken, NJ: John Wiley & Sons, Inc.

This handbook provides a much needed resource in treatment approaches for mental health professionals who provide counseling and psychotherapy to older clients. Part I focuses on a series of treatment modalities, including the use of psychotherapy process, group and expressive approaches, family and intergenerational interventions, and social and community interventions. Part II provides conceptual and best practice interventions for a series of specific problems, including a chapter on treatment of sexual problems in older adults. This volume will be useful to a variety of interested persons, including experienced geropsychologists and geropsychiatrists, geropsychiatric nurses and social workers, and counselors who focus on mental health and aging. It will also be an important resource for experienced general therapists who wish to develop greater proficiency in working with older adults.

Seasons of the heart: Men and women talk about love, sex, and romance after 60

Gross, Z. H. (2000). New York, NY: New World Library.

Sharing personal stories, this book explores the sexual, romantic, and platonic joys of relationships after 60. Chapters include "Not the End of the Song: Love When the World Says 'No' and Elders Say 'Yes,'" "Troubles and Triumphs: The Baggage We Bring," "Flowers in Winter: Men Speak of Elder Love," "A Durable Fire: The Long-Lasting Marriage," and "Love and Mortality: Gay Men and Lesbians As They Age."

Sexuality in mid-life
Levine, S. B. (1998). Center for Marital & Sexual Health. Plenum Press: New York, NY.

Provides a discussion of the psychology of love in the middle years. It bears repeating that love and sex are not only for the young; but also to individuals in their 40s, 50s, and beyond, sexuality presents a markedly different set of challenges. Women and men who understand the nature of these differences can accommodate the physical and psychological aspects of aging, and nurture a healthy and satisfying sexual life. Likewise, therapists who take these developments into account will be more helpful to their middle-aged clients.

Handbook of clinical gerontology assessment
Lichtenberg, P. (Ed.). (1999). Wiley series on adulthood and aging. Hoboken, NJ: John Wiley, Inc.

This handbook of assessment in clinical gerontology offers clinicians reliable and valid assessment tools with case examples in each chapter for assessing functional age, psychosocial health, comorbidity, and pathological behavior deficits in older adults, as well as guidelines on assessing cognitive functioning, mental health, and ability to engage in self-care. One chapter specifically provides information on assessment of sexual function and problems in older adults.

Clinical geropsychology
Nordhus, I. H., VandenBos, G. R. et al. (Eds.). (1998). Washington, DC: American Psychological Association.

Relevant and accessible psychological services for aging adults are imperative, yet few mental health professionals are familiar enough with this rapidly growing population to provide quality care. Clinical Geropsychology, written for practicing clinicians, graduate students in training, and other scientifically informed mental health professionals, provides guidance for individuals working with aging populations.

Comprehensive Review of Geriatric Psychiatry 2nd Edition
Sadavoy, J., Lazarus, L.W., et al. (Eds.). (1996). Sexuality and aging. Washington, DC: American Psychiatric Press.

There are occasional special situations that draw senior patients to clinicians for sexual help and guidance. The majority of seniors will seek counseling from their physicians about sexual questions and problems related to normal changes of aging in sickness and in health. Much can be done in these situations to provide a careful physical check, health care where needed, and reassurance when indicated. Sexual dysfunction after age 50 and treatment covered in this chapter include: brief sex therapy, impotence or erectile disorder, chemical treatment, surgical treatment, mechanical devices, premature ejaculation, inhibited male orgasm and hypoactive sexual desire.

Aging and male sexuality
Schiavi, R. C. (1999). Cambridge, England: Cambridge University Press.
This book presents an up to date overview of the sexuality of aging men for clinicians and students, taking account of physiological, psychological, interpersonal and social influences, as well as the impact of medical illness and drugs.

Sex, intimacy, and aged care
Sherman, B. (1999). Philadelphia, PA: Jessica Kingsley Publishers.
This book offers a sympathetic perspective as well as constructive ideas for dealing with older people's feelings, desires and behavior, and explodes the myths surrounding sexuality as a normal part of life.

Book Chapters

Senior sexual health: The effects of aging on sexuality
Bradford, A., & Meston, C. M. (2007). In L. VandeCreek, F. L. Peterson Jr., & J. W. Bley (Eds.), Innovations in clinical practice: Focus on sexual health (pp. 35-45). Sarasota, FL: Professional Resource.

By the year 2030, nearly 20% of people in the United States will be 65 years of age or older and a similar trend is developing in many parts of the world. The maintenance of good health and general well-being in later life has implications for sexual relationships and behaviors. Sexuality in older adults is often misunderstood, misrepresented, or left invisible. An overview of the influence of aging on the sexual lives of men and women is provided.

Sexuality in midlife and later life couples
Burgess, E. O. (2004). In J. H. Harvey, A. Wenzel, & S. Sprecher (Eds.), The handbook of sexuality in close relationships (pp. 437-454). Mahwah, NJ: Lawrence Erlbaum Associates Publishers.

Diverse life course experiences shape opportunities for sexual partnership, sexual attitudes, and sexual behavior in later life. This chapter explores the ways that aging influences sexual behavior. Research suggests that the incidence and frequency of sexual activity are lower among older cohorts than younger ones. These changes are due to physiological changes with aging and changes in the opportunity to engage in sexual activities. This chapter explores our current understanding of sexuality and aging by (1) identifying the demographic profile of older adults; (2) addressing current patterns of sexuality among midlife and older adults; (3) exploring changes in sexuality with aging; and (4) making suggestions for future research. Finally, this chapter concludes with a discussion of problems with current research on sexuality and aging.

Golden sexuality: Sex therapy for seniors
Davis, L. M. (2007). In L. VandeCreek, F. L. Peterson Jr., & J. W. Bley (Eds.), Innovations in clinical practice: Focus on sexual health (pp. 261-276). Sarasota, FL: Professional Resource Press/Professional Resource Exchange.

Our society is very youth focused and promotes the stereotype that older men and women are uninterested and uninvolved in sexual activity. In this chapter, Larry M. Davis dispels this myth. From his perspective as a sex therapist, he sees an increasing number of couples in their 50s and older who seek a new personal awareness and sexual connectedness. He shares the therapeutic process of guiding older men and women in taking their sexuality to a new and deeply satisfying level.

The aging bisexual: The invisible of the invisible minority
Dworkin, S. H. (2006). In D. Kimmel, T. Rose, & S. David (Eds.), Lesbian, gay, bisexual, and transgender aging: Research and clinical perspectives (pp. 37-52). New York, NY: Columbia University Press.

In today's youth-oriented culture the aged are invisible. Even more invisible are elders who identify as bisexual. This chapter reviews what we know about bisexuality (covering types of bisexuals, development of a bisexual identity), gender differences, relationships (covering couples, marriages, and families), community support, and common concerns of the aging bisexual. It ends with implications for service providers and researchers.

Sexuality in the lives of aging lesbian and bisexual women
Garnets, L., & Peplau, L. A. (2006). In D. Kimmel, T. Rose, & S. David (Eds.), Lesbian, gay, bisexual, and transgender aging: Research and clinical perspectives (pp. 70-90). New York, NY: Columbia University Press.

This chapter reviews available research on the sexuality of aging lesbian and bisexual women. We begin by considering how sexuality is conceptualized and presenting research on general characteristics of lesbian sexuality. Next we review empirical studies on sexuality, first in lesbian relationships and then for single lesbians. Available scientific information about life span issues and about the sexuality of bisexual women is presented. We conclude with a discussion of sexual health and problems among lesbians.

Sexuality at midlife and beyond
Johnson, B. (2007). In M. S. Tepper, & A. F. Owens (Eds.), Sexual health Vol 1: Psychological foundations (pp. 291-300). Praeger perspectives: Sex, love, and psychology. Westport, CT: Praeger Publishers/Greenwood Publishing Group.

Women 65 years and older outnumber their male counterparts by three to two. Furthermore, 71 percent of men in this age group are married compared to 43 percent of the women; thus, more women than men in this age group live alone. These changing demographics clearly have implications for the multidimensional concept of sexuality for aging men and women. Sexuality is a lifelong aspect of being human and affects aspects of our personhood. Although there continue to be myths of the "asexuality" of adults and aging, many older adults have continued to be sexually interested, active, and satisfied.

Sex therapy with aging adults
Leiblum, S. R., & Segraves, R. T. (2000). In S. R. Leiblum, & R. C. Rosen (Eds.), Principles and practice of sex therapy (3rd ed.) (pp. 423-448). New York, NY: Guilford Press.

With the increase in life expectancy and the ever-growing population of health older adults, sexual intimacy is an important quality of life issue. The advent of safe, easily administered vasoactive agents has changed the type of sex therapy desired by older couples. In some instances, the availability of a possible return of function for one member of a couple may create friction in the relationship. In other instances, it helps restore valued intimacy. Clinicians have a variety of pharmacological and therapeutic options available to them based on the sexual changes in aging men and women, assessment of current sexual function, and presence of diseases and conditions that affect sexual behavior.

What's age got to do with it?
Moll, E. C. (2002). In L. D. Burlew, & D. Capuzzi (Eds.), Sexuality counseling (pp. 195-208). Hauppauge, NY: Nova Science Publishers.

This chapter explores the current issues related to sexuality and counseling older persons. Cultural considerations including gender sensitivity are discussed. Developmental factors relative to gerontology, sexual changes, institutional life, in addition to the positive and not so positive aspects of sexuality and aging are noted. Strategies for counselors to use in assessment and intervention with older persons and sexual issues are included.

Sexual dysfunction
McConaghy, N. (1998). In M. Hersen, & V. B. Van Hasselt (Eds.), Handbook of clinical geropsychology (pp. 239-271). The Plenum series in adult development and aging. New York, NY: Plenum Press.

Sexual dysfunction in older adults is one of the topics that are discussed in the handbook. Age and decline of sexuality is the focus.

Sexuality and aging
Pedersen, J. B. (1998). In I. H. Nordhus, G. R. VandenBos, S. Berg, & P. Fromholt (Eds.), Clinical geropsychology (pp. 141-145). Washington, DC: American Psychological Association.

Sexual behavior and sexual desire in older people previously were assumed to be rare. This is now known to be untrue. It was earlier assumed that biological factors, such as menopause among women, represented nature's signals to the person that the time in life had come where sexual activity ought to stop. However, sexuality in older people is not just biologically determined, it is multidetermined. Sexuality is a lifelong force, and there are qualitative and quantitative changes that occur with age, as they do in other areas of human activity. Recent sexological studies point to the importance of sociocultural and psychological factors in determining the fate of sexuality among older people. Topics discussed include: methodological difficulties, normal sexual aging, and sexual problems in old age.

Later life sexuality
Sharpe, T. H. (2006). In R. D. McAnulty, & M. M. Burnette (Eds.), Sex and sexuality, Vol 1: Sexuality today: Trends and controversies (pp. 133-151). Westport, CT: Praeger Publishers/Greenwood Publishing Group.

The subject of sexuality triggers awkwardness and discomfort in many people. The topic of older adults' sexuality evokes even more discomfort, if not disgust. Although sexuality is a fundamental need across the life span, society typically ignores the sexual needs and concerns of older adults. Late life is a stage of development like any other across the life span. Aging brings with it many challenges similar to those faced in childhood or adolescence. Sexuality, sexual behavior, intimacy, and relationships are fundamental human needs, whether we are 14 or 84. This chapter will address some of the unique tasks that we face as we age and how they affect our sexuality.

Sexual changes in the aging male
Siegel, L. A., & Siegel, R. M. (2007). In A. F. Owens, & M. S. Tepper (Eds.), Sexual health Vol 2: Physical foundations (pp. 223-255). Praeger perspectives: Sex, love, and psychology. Westport, CT: Praeger Publishers/Greenwood Publishing Group.

This chapter focuses on the many sexual changes that occur in men as they get older and addresses some special considerations, such as illness and disease, grief and loss, self-perception, and sexual identity. In addition, several treatment and therapeutic options are explored and strategies to help aging men maintain sexual comfort over the course of normal human development are discussed.

Gay men and aging: Sex and intimacy
Wierzalis, E. A., Barret, B., Pope, M., & Rankins, M. (2006). In D. Kimmel, T. Rose, & S. David (Eds.), Lesbian, gay, bisexual, and transgender aging: Research and clinical perspectives (pp. 91-109). New York, NY: Columbia University Press.

This chapter focuses on sex and intimacy among aging gay men. After providing an overview of the literature on gay men and aging, the authors examine intimacy needs, as well as life span and identity development in this population. Cultural considerations and aging are examined, as are issues in intimacy and identity, dyadic long-term relationships, and aging, sexuality, and physical attractiveness. Other issues confronting this aging population are intimacy versus loneliness, sexual activity, and sexually transmitted diseases. The authors conclude by providing clinical recommendations to address the full range of these issues.

Assessment of sexual function and dysfunction in older adults
Zeiss, A. M., Zeiss, R. A., & Davies, H. (1999). In P. A. Lichtenberg (Ed.), Handbook of assessment in clinical gerontology (pp. 270-296). Wiley series on adulthood and aging. Hoboken, NJ: John Wiley & Sons, Inc.

This chapter provides specific strategies for obtaining basic information about sexuality as a part of any clinical encounter, thus showing respect for the older adult as a sexual being and for the importance of recognizing sexuality as core quality of life issues, and a strategy for a thorough assessment of sexual problems, when they become a focus of treatment. Finally, the chapter reviews special issues in the assessment of sexuality in the lives of older adults with dementing illness and their partners.

Sexual dysfunction: Using an interdisciplinary team to combine cognitive-behavioral and medical approaches
Zeiss, A.M. & Zeiss, R.A. (1999). In M. Duffy (Ed.), Handbook of counseling and psychotherapy with older adults (pp. 294-313). Hoboken, NJ: John Wiley & Sons Inc.

This chapter reviews evidence to support the view that although aging is associated with a general decline in various factors related to sexual function, sexual satisfaction can, and most typically does, remain stable over the life span, as long as health is maintained. The authors also argue that, when working with sexual concerns of the older adult, an interdisciplinary approach to evaluating, diagnosing, and treating sexual dysfunction is essential, and an example of a clinical program offering such an approach is described.

Information for Older Adults and Their Families
Organizations

Sexuality Information and Education Council of the United States (SIECUS)
130 W. 42nd ST, Suite 350, NY, NY 10036-7802

SIECUS is a national, nonprofit organization which affirms that sexuality is a natural and health part of living, Incorporated in 1964, SIECUS develops, collects, and disseminates information, promotes comprehensive education about sexuality, and advocates the right of individuals to make responsible sexual choices.

American Association of Sex Educators, Counselors and Therapists (AASECT)
P.O. Box 1960
Ashland, VA 23005-1960
Phone: 804-752-0026
Fax: 804-752-0056

AASECT is a national professional organization that certifies qualified health and mental health practitioners in dealing expertly and ethically with the sexual concerns of individuals, couples, and families. A list of ASSECT certified professionals within specified geographic areas is available by writing and including a self-addressed, stamped, business-sized envelope.

The Foundation for the Scientific Study of Sexuality
P.O. Box 970, Peck Slip Station New York, NY 10272-0970

FSSS is a nonprofit organization devoted exclusively to supporting scientific research related to sexuality; it is the only foundation whose sole primary mission is to promote funding for conducting scholarly, scientific research to further our understanding of all aspects of sexuality.

The Kinsey Institute for Research in Sex, Gender, and Reproduction
Morrison 313, Indiana University, Bloomington, IN 47405

The Kinsey Institute for Research in Sex, Gender, and Reproduction is a private, not-for-profit corporation affiliated with Indiana University. Dr. Alfred Kinsey (1894-1956) founded the Institute in 1947. Its mission is to promote interdisciplinary research and scholarship in the fields of human sexuality, gender, and reproduction. The Institute carries out this mission through: development of specialized collections of resources for scholars; programs of research and publication; interdisciplinary conferences and seminars; and provision of information services to researchers. Its Web site supports interdisciplinary research and the study of human sexuality.

The Society for the Scientific Study of Sexuality
P. O. Box 208 Mount Vernon, IA 52314-0208

The Society for the Scientific Study of Sexuality (SSSS) is an international organization dedicated to the advancement of knowledge about sexuality. It is the oldest organization of professionals interested in the study of sexuality in the United States. SSSS brings together an interdisciplinary group of professionals who believe in the importance of both the production of quality research and the clinical educational, and social applications of research related to all aspects of sexuality.

AARP
601 E Street, NW, Washington, DC 20049

AARP is a nonprofit organization dedicated to helping older Americans maintain lives of independence, dignity, and purpose. A recent edition of AARP's bi-monthly magazine, Modern Maturity, Sept-Oct 1999, included the results of the first nationwide inquiry into the sexual attitudes and practices of adults aged 45 and older. This survey and other information about sexuality are available at AARP's website and Ageline database.