Sexuality and ageing

Sexuality and sensuality contribute to a person's self-concept, which influences self-esteem and relationships with others throughout life. There are many myths surrounding ageing and sexuality fuelled by assumptions that libido and sexual needs decline along with the loss of culturally valued signs of beauty or handsomeness. By 75-85 years of age, only one-quarter of the population is sexually active; the reasons for this are many and include psychosocial factors such as loss of a partner, age-related physiological changes and illness. In older women, the major problems are reduced libido, poor lubrication and inability to climax. In males, erectile dysfunction is the central problem. Health problems are the major reason for a decline in sexuality with ageing. Drugs for the management of erectile dysfunction (phosphodiesterase-5 inhibitors) and new delivery systems to treat low libido (patches, nasal, gels, injections of testosterone) are revolutionizing sexuality in older persons. There is increased awareness of the special needs of the older homosexual. Paraphilias are life-long and do not necessarily disappear with ageing. Management of inappropriate and aggressive sexual behaviours in older persons with dementia is a major problem.