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Some related Articles:
Sex
in the Elderly (March 16, 2000)
Staying
Sexual Into the Golden Years (March 25, 2000)
Sex
and the Elderly Man (March 16, 2000)
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Sex
and the Elderly Woman
Hosted
by: Mark Pochapin, MD, Weill Medical College of Cornell University, New
York
Participants:
David Kaufman, MD - Columbia University, College of Physicians and
Surgeons
Patricia Bloom, MD - Mount Sinai-New York University Medical Center
Dagmar O'Connor, PhD - Columbia University
ABC News, March 16, 2000
MARK POCHAPIN, MD: Hi, thank you for joining us today. Today
we're going to focus on people who are considered "the elderly."
However, when we think about elderly people, we often think about people
who are not very active. Today, not only are we going to talk about
activity, but also we're going to talk about sexual activity.
Starting with us today are a
few of my guest panelists. To my left is Dr. David Kaufman, who's an
assistant professor of clinical urology at Columbia University.
Welcome. Sitting next to David is Dr. Patricia Bloom. She's
the chief of geriatric medicine at St. Luke's/Roosevelt Hospital here in
New York City. Welcome, Patricia. Sitting next to her is Dr.
Dagmar O'Connor, who's a psychologist, a sex therapist, and really the
first woman sex therapist to be trained by Masters and Johnson in New York
City. Thank you all for joining us today.
Let's start off with sex and
the elderly woman. When we talk about "elderly woman,"
what are we talking about? David, what is considered to be elderly
now?
DAVID KAUFMAN, MD: I
think that really has changed dramatically over the last few decades.
As the Baby Boomers are getting older, it's really hard to consider
somebody over the age of 55, which might have been considered a senior in
the past, as elderly, because they're just really exhibiting behavior
patterns that they've been exhibiting for a long time. I think that
probably for the purposes of this discussion, we should really be speaking
about the eighth decade of life, if my panelists agree with me there.
DAGMAR O'CONNOR, PhD: I
often think that the woman feels old when she enters menopause.
That's the first real sign of loss of reproductiveness and the purpose of
life. That is the time when most of the trouble starts in terms of
sexual functioning.
PATRICIA BLOOM, MD: So
you would say any time between 45 and 55.
DAGMAR O'CONNOR, PhD: I
would think so.
PATRICIA BLOOM, MD:
Although technically speaking, as a geriatrician, it's over the age of 65.
But I will agree with David that our, I guess as all of us approach, we
like to push it.
DAVID KAUFMAN, MD: I
don't like the 45 part being considered elderly.
PATRICIA BLOOM, MD: But
especially talking about sexual activity, I think what is interesting is
that people don't even conceive of people over the age of 80 being
sexually active. But I think you would agree, surveys show that
actually the majority of people over the age of 65 are still sexually
active. And even when you get into the 80 and above, still about a
quarter to a third of elderly, even women and men, have sexual activity.
And that's something that people generally don't think about or wouldn't
believe is true.
MARK POCHAPIN, MD: Right.
It's actually, certainly not a topic that you hear much about. It's
not a focus in either medical schools or in curriculum, and it's something
that seems to be appropriate, given the fact that there are plenty of
people who are sexually active who are considered elderly.
DAGMAR O'CONNOR, PhD: I
treat quite a few couples who are in their eighties, and it's a surprise.
They would never dare to tell their grandchildren or their children that
they could sneak away and see a sex therapist.
MARK POCHAPIN, MD: Let's
start with the physical changes. Obviously as someone gets older,
there are physical changes that occur in their body. David, what is
occurring in a woman from a medical perspective that might make sexual
activity different?
DAVID KAUFMAN, MD: I
think what comes to mind first is, along with menopause and the changes
that accompany menopause, there's a decrease in the ability of women to
lubricate as they get older, and that certainly impacts on their ability
to enjoy sex, and perhaps participate in sex because of their lack of
enjoyment.
There are also medical
conditions that occur, such as atrophic vaginitis, which occurs as women
get older, where the tissue itself becomes less elastic and the vaginal
opening becomes smaller, and that also interferes with a person's ability
to participate in sex, and certainly enjoy sex. Now, all of these
problems have medical solutions to them, and I'm sure Dr. Bloom takes care
of these conditions on a regular basis.
MARK POCHAPIN, MD: Now,
what do you do? Do you actually address these problems with the
patient, or do they actually tell you about them?
PATRICIA BLOOM, MD:
That's a very good question. In fact, a big part of what I do is
training young physicians. And we really have to remind them to ask
about sexual activity because, as I said, people have assumptions that, if
you're over a certain age, you're not sexually active. And I think
it's very helpful for elderly people, if the doctor does ask them.
Because, as you said, they might be somewhat embarrassed or think that
it's not a problem that's okay to bring up in the office. So, yeah,
I think the physician should ask.
In addition, the actual changes
in the vagina and the surrounding tissues are a critical part of what
affects older women, but in addition to that are their medical conditions,
which can influence either their interest or their ability. And
there's a whole range of that, from women with heart disease, who might
get chest pain when they're vigorously sexually active, to people with
lung disease who might get breathless, or people with arthritis who have
difficulty positioning themselves.
And then there's the whole
affect of conditions, which influence women's self esteem, which might
just be changes in the body. We live in such a society that thinks
you have to be a svelte, lithe young thing to be sexually active. So
there might just be embarrassment about shifts in body composition or
having a stomach. Or, farther down the line would be things like
having had a mastectomy or a colostomy bag or other conditions like that,
where women would really have a loss of self-esteem and feel embarrassed,
especially if it's with a new partner. Then the situation of having
a new partner late in life is a whole new thing that Dagmar probably deals
with.
DAGMAR O'CONNOR, PhD:
It's a very difficult thing. I think even younger women have body
image problems. And then it gets quadrupled when you get into old
age. But the nice thing about old age, remember, that your partner
also loses his eyesight. It's not as dramatic. But many of the
women prefer to have sex in the dark. Many of their partners, men,
are much more visually oriented than women and it becomes a problem.
"Why do we always have to have it in the dark?"
PATRICIA BLOOM, MD: Do
you find that you can convince women to somehow shed that embarrassment
and feel somehow more accepting of their bodies?
DAGMAR O'CONNOR, PhD:
Absolutely.
PATRICIA BLOOM, MD: How
do you get them to do that?
DAGMAR O'CONNOR, PhD: I
run sexual self esteem workshops for women of all ages, and men as well.
Part of it is learning to love your body the way it looks right now.
And I remember a woman who said to me "I didn't learn to love my body
until I lost it."
MARK POCHAPIN, MD: That's
very interesting. I think sort of in a crisis oriented society, you
could see that happening. In all medical care, it seems to be
related to when something's a problem, people address.
DAGMAR O'CONNOR, PhD:
It's also important that some of these problems, vaginal problems, there
are things you can do about them, and by the time they end up with me in
the sex therapy, some of the thinning of the vagina and the painful
intercourse can be taken care of by some friction, and what I call
traffic. The tissue is the same as any tissue in our body. The
more we rub it, if we don't do it too much, the more it stretches.
So I work a lot with women to make them more comfortable by just practical
means. And also getting them ointments or lubrications.
MARK POCHAPIN, MD: How do
women come to a sexual therapist? In other words, do they come on
their own? Is it a physician that refers them? Is it a
urologist or geriatrician? Because as we said earlier, this is
really a subject that doesn't get much attention.
DAGMAR O'CONNOR, PhD: A
mixture. I get referrals from all of you, and I also get referrals
from my book/video packet, which is a do-it-yourself video packet for sex
therapy. Couples start using it, and then they get stuck somewhere
and they call me. And the so-called transference has already taken
place. They know me already.
Also by friends. You feel
safe when you have a friend who says "I know this person, and they
make me feel safe." So that's another way.
MARK POCHAPIN, MD: The
self-esteem issue is interesting to me, because that's obviously an issue
that's not age related. That begins way back, but seems to become
more of an issue as someone gets older. Or maybe it just becomes
more of a focus. But how do you address that? What do you do
about someone who really doesn't have the self-esteem to move ahead?
DAGMAR O'CONNOR, PhD:
It's very often asking them to confront the problem upfront. If you
learned that you have to look like a model in order to be sexual, you have
to start looking at what you've got. And I have the women stand nude
in front of a mirror and look at their bodies and draw pictures, as an
artist. I say: "I don't want any comparisons."
You've got to come away from this event loving five things about your
body. They may start with their feet or their fingernails, but they
slowly have to grow to love it. You only do that if you look at it
often.
MARK POCHAPIN, MD: Pat,
as a geriatrician, you see someone, let's say, for a problem with chronic
lung disease or a problem with chronic heart disease. You put it in
the appropriate social setting. When does the issue of sex and
sexual function come up? Is that something that you bring up with
every patient you see? Or is it something that you wait to be
addressed with you?
PATRICIA BLOOM, MD: I
try, as part of the initial assessment, to ascertain whether people are
sexually active. If they are, is it satisfying? Are they
having problems with it? If they're not, do they wish they were?
That sort of gives them permission to talk about it. They might not
want to explore it very much on that visit, but at least it opens the door
to communication. And then, hopefully, I on every visit will ask
them if there's anything else they're concerned about. They may
bring it up on subsequent visits, see if it's not something that's
bothering them at the time of their initial visit.
But I think having an open door
kind of dialogue is helpful. Similarly, I think with, talking about
self-esteem, a lot of these issues have to do with communication.
Getting into what does the person want. That is at the basis of all
of these issues, whether it's with a partner, an old partner or a new
partner. And, interestingly, for some elderly people, that's the
biggest issue. They don't have a partner.
There are some interesting
relationships that form as a result of that. Some women who've been
heterosexual all their lives may form a very nice relationship with
another woman. And some people who just don't have a partner at all
might find that self-expression of sexuality is something that they enjoy
exploring in their later years.
DAGMAR O'CONNOR, PhD:
Making love to yourself, as I call it, is an important part of being
sexual. It's not what we say is shameful that we do quickly, but
when you make love you give yourself foreplay, and you take your time, and
you give yourself love.
PATRICIA BLOOM, MD: The
thing that it's important, I think, for everyone to remember, is that when
we're talking about elderly people, people who are elderly now, whether
you're talking about 65 or 75 or whatever, most of that category of people
grew up, their whole lives, not talking about sex. I think that
people's willingness to be open and talk about sex came later. There
has been a sexual revolution.
DAVID KAUFMAN, MD: There
has been a sexual revolution, certainly, lately, because of the
pharmaceutical.
MARK POCHAPIN, MD: In
older patients?
DAVID KAUFMAN, MD: Well,
I think so. I think in everybody. But since the advent of some
of the new pharmaceuticals that have come out, of course, Viagra by
Pfizer, where there are now commercials on television with ex-presidential
candidates talking about their sexual problems, it really has opened up
the door and allowed for people to come and acknowledge that there may or
may not be a problem in their lives. And I think they are speaking
about it more.
When Viagra hit the pharmacy
shelves, my office was inundated with people who are suddenly facing the
fact that they do have a problem. And now that they knew that there
was something available that was fairly easy to take, a pill, they were
really coming out of the woodwork looking for answers.
And since we're on the topic of
women right now, there has been some amount of research, based in Boston,
of using this drug Viagra in the treatment of female sexual dysfunction.
When the news articles hit the stands about the results of that research,
I had a tremendous number of women ask me questions about its possible
role in their treatment.
MARK POCHAPIN, MD: There
is a role, possibly, for women using Viagra?
DAVID KAUFMAN, MD: That's
still under examination. I don't know how technical you want to get
right now, but there's no question that drugs such as Viagra will increase
clitoral blood flow. Which is really analogous to what Viagra does
in men, that it improves the quality of the erection. And that's
been proved with Doppler ultrasound, that clitoral blood flow does
increase. Now, of course, female sexuality is probably more
complicated that than, so just because they have increased clitoral blood
flow doesn't mean that their sex drive and their ability to enjoy sex, and
their ability to reach orgasm, for instance, is necessarily improved.
But the drug does work, and it does do what it's supposed to do, which is
increase blood flow.
MARK POCHAPIN, MD: The
point being that there are now drugs being aimed at older people, for the
sole purpose of engaging in sex, is really something that goes along with
the fact that we have to start talking about that.
Well, I appreciate the three of
you on our panel tonight. It's a very interesting topic. I
certainly learned quite a bit, and I'm sure our audience has learned quite
a bit as well. Older people have a life, and with that life they
should enjoy the same pleasures that they did when they were younger.
This is Dr. Mark Pochapin.
Thank you for joining us tonight.
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