A 45 year old man develops a neurological condition rendering him multiple physical health difficulties and depression. He has been married for five years. At an initial assessment from a health professional, he is asked about the impact these changes are having on his relationship with his wife, and whether he is interested in and still able to have a sexual relationship with her. When problems are detected, an open discussion takes place regarding what help he might benefit from, and whether it would be useful for him and his wife to receive help as a couple.
So why don’t we ask older people later in life about their sexual lives and sexual relationships? Why don’t we ask when we know that changes in physical and mental health often impact on sexual functioning? What are we afraid of?
The stereotypes and assumptions about older people and sex seem to fall into a number of categories. Frequently there is an assumption that older people are basically ‘asexual’ so therefore it is irrelevant and unnecessary to even raise the topic. Older men who are still interested in sex are seen as “dirty old men” and are the butt of jokes and even feature regularly on greeting cards about ageing. Women don’t fare much better, they can be seen as “sex maniacs” for showing an interest in sex “at your age”. Nowhere can this anxiety be seen more obviously than in care homes where members of staff can become extremely alarmed, angry and disgusted at any sexual behaviour displayed by their residents. The message clearly communicated for older people is that sex is not for them.
We know that a fulfilling sexual life has a significant positive impact on emotional well-being. Health professionals need to overcome their own anxiety and embarrassment and ask questions from a position of respectful curiosity. Getting the balance right is essential. It is important not to over sexualise older people too which can result in older people feeling pressure to still be interested in sex when they’re not anymore. Additionally when questions are asked about sex and sexual relationships too often healthcare professionals make assumptions about sexuality, assuming heterosexuality. This results in communicating a message that other forms of sexuality cannot be discussed or are unacceptable and results in the perceived “invisibility” of the Lesbian, Gay, Bisexual and Transgender Communities in later life.
In relation to dementia and other long term conditions we often happily discuss changes in relationships connected to caring roles, personality and behaviour changes including aggressive behaviour, impulsivity and disinhibition, finances, capacity and consent issues. However, even when older people discuss how their relationship with their partner has changed, how often do we ask questions that identify in what way the relationship has changed, including their sexual relationship? Feedback from older people is that it is much easier to have a conversation about sexual issues when initiated by a healthcare professional. One significant consequence of not talking about sex is that sexually transmitted infections in the UK have doubled in 50-90 year olds in the last ten years!
We need to be asking the questions so people later in life know they can discuss sex should they want to. If we don’t ask the questions we can’t expect those we work with to feel this is a topic open for discussion. As professionals we need to start being comfortable talking about sex.
Dr Philippa Hyman
Consultant Clinical Psychologist
Red & Yellow Care