Seeking medical help for sexual concerns in mid- and later life: a review of the literature

Research consistently reports that older people tend not to seek medical help for sexual concerns or difficulties. This article reviews the literature to examine help-seeking for, and doctor-patient interactions about, sexual problems in the middle and later life age groups. Twenty-five articles from 1999 to 2010 were identified and analyzed. Significant barriers to seeking medical help included psychosocial factors relating to the patient, such as thinking that sexual changes were "normal with ageing," and also to the doctor-for example, assuming that sex was less important to older patients than it was to their younger patients. Inadequate training at medical school for health care professionals (HCPs) was also identified as a barrier. People were more likely to seek help if their doctor had asked about sexual function during a routine visit sometime during the previous three years. However, doctors tended not to take a proactive approach to sexual health management, and indeed often had limited knowledge of later-life sexuality issues. There are clear implications for sexual well-being if the doctor does not ask and the patient does not tell. Providing education about later-life sexuality for HCPs is crucial if we are to meet the needs of older patients in useful and effective ways.     

The Impact of Body Dissatisfaction on Distressing Sexual Difficulties Among Men and Women: the Mediator Role of Cognitive Distraction

Research has demonstrated a negative impact of cognitive distraction on sexual activity, and body dissatisfaction has been associated with less satisfying and fewer sexual activities. In the current study we examined the extent to which cognitive distraction, based on body appearance and sexual performance, mediated the impact of body dissatisfaction on sexual difficulties among women and men. A sample of 493 women (M_age = 30.61) and 595 men (M_age = 37.90) completed an online survey. Women reported significantly higher levels of distressing sexual difficulties, significantly more body dissatisfaction, and greater cognitive distraction based on appearance than men. In contrast, men reported higher cognitive distraction based on performance than women. A path analysis model indicated that, for men, only cognitive distraction based on performance mediated the effects of body dissatisfaction on distressing sexual difficulties, and the mediation was only partial as body dissatisfaction had a significant direct effect on distressing sexual difficulties. In contrast, among women, both appearance-based cognitive distraction and performance-based cognitive distraction fully mediated the effects of body dissatisfaction on distressing sexual difficulties.     

Older Adults’ Experiences of Sexual Difficulties: Qualitative Findings From the English Longitudinal Study on Ageing (ELSA)

There is a growing body of evidence demonstrating that sexual activity is important to the quality of life of older adults, and that it can be influenced by physical, psychological, and social factors. However, older adults’ experiences of sexual difficulties remain relatively unexplored. This article draws on qualitative data collected as part of the English Longitudinal Study of Ageing (ELSA). Participants answered a Sexual Relationships and Activities Questionnaire (SRA-Q), which included an open comment box for further details, 1,084 (1/7) of which were completed. These data were analyzed using Template Analysis, and findings on the experiences of sexual difficulties are presented in this article. Sexual difficulties were contextualized within the couple relationship and could be detrimental to the relationship, particularly if the partner would not seek professional help. Participants reported that sexual difficulties could also have a negative impact on psychological well-being, described mainly as frustration, depression, and sadness. For some participants the supportive nature of their relationship buffered these impacts. Few had sought professional help; those who had reported helpful and unhelpful experiences. These findings add to the limited evidence base and have implications for health care in the context of global aging and a growing recognition of older adults’ sexual rights.     

Exploring the Impact of Personal and Partner Traits on Sexuality: Sexual Excitation,Sexual Inhibition,and Big Five Predict Sexual Function in Couples

Sexual difficulties are common among women and men and are associated with various mental and physical health problems. Although psychological traits are known to impact sexual attitudes and behavior, sexuality- and personality-related traits have not been jointly investigated to assess their relevance for sexual functioning in couples. The aim of this study was to investigate how psychological traits of two partners influence women’s and men’s sexual function. Data from 964 couples, representative of the adult population in Germany, were analyzed. Sexual function was assessed with the Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF). Sexuality-related traits were measured with the Sexual Excitation/Sexual Inhibition Inventory for Women and Men (SESII-W/M). Personality was measured with self-report and partner-rating versions of the Big Five Inventory (BFI). Sexual excitation was a positive and sexual inhibition was a negative predictor of sexual function in both genders. Women whose partners were sexually inhibited reported lower sexual function. Conscientious individuals reported better sexual function. Women whose partners were more conscientious also had better sexual function. Assessing partner-related factors may be helpful to identify predisposing and maintaining factors of sexual dysfunctions, especially in women.     

The Influences of Career Support and Sexual Identity on Sexual Minority Women's Career Aspirations

The authors examined the relationship between sexual identity, family/friend career support, and career aspirations in a sample of 381 sexual minority women. The results indicated that family career support and friend career support were positively related to career aspirations of sexual minority women. The results also indicated that the relationship between family career support and career aspirations depended on the level of negative sexual identity. The findings demonstrate the utility of social cognitive career theory (Lent, Brown, & Hackett, 1994, 2002) with this particular population. Limitations and implications for further research and practice are discussed.     

Obstacles to Help-Seeking for Sexual Offenders: Implications for Prevention of Sexual Abuse

ABSTRACT

Persons with potentially harmful sexual interests such as attraction to minors are unlikely to seek or receive treatment before a sexual offense has been committed. The current study explored barriers to help-seeking in a sample of 372 individuals in treatment for sexual offending. Results revealed that the shame and secrecy resulting from stigma associated with pedophilic interests often prevented our respondents from seeking professional counseling, and only about 20% tried to talk to anyone about their sexual interests prior to their arrest. Barriers to seeking and receiving psychological services included concerns about confidentiality, fears of social and legal consequences, personal shame or confusion about the problem, affordability, and challenges finding competent therapists who were adequately equipped to help them. Understanding and ultimately reducing obstacles to help-seeking can improve the quality of life for people with harmful sexual interests and potentially prevent sexual abuse of children or other vulnerable individuals.     

Effects of Sex,Sexual Orientation,Infidelity Expectations,and Love on Distress related to Emotional and Sexual Infidelity

The purpose of this study was to investigate the influence of participant sex, sexual orientation, infidelity expectations, and love on emotional responses to emotional and sexual infidelity. Participants (72 lesbian women, 114 heterosexual women, 53 gay men, and 57 heterosexual men) completed a demographic form, continuous emotion ratings in response to hypothetical infidelity scenarios, the Infidelity Expectations Questionnaire (IEQ), and the Triangular Love Scale. Sex, sexual orientation, and commitment and intimacy among partners were significant predictors of various emotional responses to sexual and emotional infidelity. Alternatively, passion among partners and expectations about a partner's likelihood of committing infidelity were not significant predictors of emotional reactions to infidelity. Across participants, sexual infidelity elicited more distressing feelings than emotional infidelity. Group differences were also found, with women responding with stronger emotions to emotional and sexual infidelity than men, and heterosexuals rating emotional and sexual infidelity as more emotionally distressing than lesbian and gay individuals. Sex and sexual orientation differences emerged regarding the degree to which specific emotions were reported in response to sexual and emotional infidelity. Clinical implications are offered, including how mental health professionals might use these findings to help clients cope with the negative effects of infidelity on romantic relationships.     

Sexual dysfunction: overview of prevalence,etiological factors,and treatments

Sexual dysfunctions and sexual problems are reviewed from the perspective of prevalence, broad etiological factors, and available treatments. Although a large percentage of individuals experience sexual problems, with estimates between 10 and 52% of men and 25 and 63% of women, the prevalence of sexual dysfunctions that meet diagnostic criteria is lower and less well established by large scale population-based studies. Sexual problems and dysfunctions are correlated with other health conditions, including cardiovascular disorders, common diseases such a s diabetes, health habits, and mental health. Adequate sexual functioning also appears to be associated with personal well-being and relationship stability, although this may be more accurate for men than women. Efficacious and effective treatments exist for some of the sexual disorders, and there is an increasing focus on medical (particularly pharmacological) treatments being tested by the pharmaceutical industry. Sexual problems and dysfunctions have been notably under-researched, particularly from the perspective on consequences to individual mental health, relationships, and family functioning.     

Sexual Rehabilitation After Prostate Cancer Through Assistive Aids: A Comparison of Gay/Bisexual and Heterosexual Men

The use of assistive aids in sexual rehabilitation after prostate cancer (PCa) was examined in 124 gay, bisexual, and other men who have sex with men (GBM) and 225 heterosexual men. GBM were significantly more likely to use assistive aids (79% versus 56%), to try multiple assistive aids (M = 1.65 versus M = 0.83) including medication, penile injection, penile implant, vacuum pump, and nonmedical sex aids, and to seek information about sexual rehabilitation on the Internet, through counseling, or in a support group. There were no differences between the groups in satisfaction with the use of assistive aids. However, use of aids was a significant negative predictor of sexual functioning for GBM and a significant positive predictor for heterosexual men. Interview accounts described satisfaction with assistive aids in terms of maintaining erectile functioning and relationships. The majority of men in the study also described hindrances, both physical and social, resulting in discontinuation of assistive aids, including perceived artificiality, loss of sexual spontaneity, side effects, failure to achieve erectile response, cost, and lack of access to information and support. It is concluded that the specific needs and concerns of GBM and heterosexual men regarding sexual rehabilitation after PCa need to be addressed by clinicians.     

A Psychometric Comparison of Three Scales and a Single-Item Measure to Assess Sexual Satisfaction

This study was designed to systematically compare and contrast the psychometric properties of three scales developed to measure sexual satisfaction and a single-item measure of sexual satisfaction. The Index of Sexual Satisfaction (ISS), Global Measure of Sexual Satisfaction (GMSEX), and the New Sexual Satisfaction Scale–Short (NSSS-S) were compared to one another and to a single-item measure of sexual satisfaction. Conceptualization of the constructs, distribution of scores, internal consistency, convergent validity, test-retest reliability, and factor structure were compared between the measures. A total of 211 men and 214 women completed the scales and a measure of relationship satisfaction, with 33% (n = 139) of the sample reassessed two months later. All scales demonstrated appropriate distribution of scores and adequate internal consistency. The GMSEX, NSSS-S, and the single-item measure demonstrated convergent validity. Test-retest reliability was demonstrated by the ISS, GMSEX, and NSSS-S, but not the single-item measure. Taken together, the GMSEX received the strongest psychometric support in this sample for a unidimensional measure of sexual satisfaction and the NSSS-S received the strongest psychometric support in this sample for a bidimensional measure of sexual satisfaction.     

The advantages and limitations of seeking sex online: a comparison of reasons given for online and offline sexual liaisons by men who have sex with men

The Internet has developed as a major site for sexual activity, both cybersex and for making contacts for sex in real life (IRL). As part of a major study of HIV-risk behavior on the Internet and IRL , we obtained on-line responses from 1,017 Latino men who have sex with men (MSM) in the U.S. Open-ended questions solicited responses regarding whether respondents preferred to meet sexual partners first IRL (48.4%), on the Internet (31.6%), or "it depends" (20%), and "why?". Data were analyzed by theme, with themes grouped into overarching domains. Data indicate that for those preferring the Internet, themes represented were ease of Internet use, its advantages for people who were shy, and its anonymity, safety, the excitement and opportunity for experimentation of Internet contact, ability to avoid interpersonal contact, and control of visuals and the environment. Reasons for preferring meeting IRL included some of the same themes, but emphasizing the importance of a "real presence" and the possibility to build a relationship. Where "it depends", key themes were contextual: mood, time, setting, alcohol and drug use, sexual needs and urgency, and relationship intentions. Antagonistic advantages were often noted for cybersex and IRL. These data suggest that motivations for making Internet sexual contact in MSM are complex, depend on the context and nature of the relationship sought, and that the Internet has allowed the development of a class of sexual contacts located between IRL and fantasy.     

The Sexual Superhighway Revisited

Abstract

Among gay men, serious health risks (unsafe sex, compulsivity) are associated with seeking sex on the Internet. To better understand the repercussions of this activity from a user's perspective, qualitative interviews with 22 gay men reporting Internet use for sexual purposes were submitted to Interpretative Phenomenological Analysis. The repercussions perceived clustered around themes of sociability (making contact and meeting consequences), sexuality (discovering and deviating), identity (becoming and concealing), and dependency. Findings may help improve the relevance and appeal of online interventions with gay men and sensitize professionals to health issues not traditionally reported in the scientific and clinical literature on gay men and Internet use.     

Distressing Sexual Difficulties in Heterosexual and Non-Heterosexual Croatian Men: Assessing the Role of Minority Stress

Although research has shown a connection between minority stressors and internalizing mental health problems, the role of minority stress has mainly been neglected in the assessment of sexual problems among non-heterosexual men. Using online samples of heterosexual (n = 933) and non-heterosexual participants (n = 561) aged 18 to 50 years, this study aimed to comparatively assess sexual difficulties and problems and explore the role of minority stress in non-heterosexual men's sexual problems. Although the age-adjusted odds of reporting rapid ejaculation, delayed ejaculation, and sex-related anxiousness significantly differed between the two groups, the overall prevalence of sexual difficulties and the associated levels of distress did not significantly differ between the samples. In multivariate assessment, anxiety and depression significantly increased the odds of reporting distressing sexual difficulties among both heterosexual and non-heterosexual participants. In the non-heterosexual sample, positive body image significantly decreased the odds of experiencing sexual problems. Pointing to a role of minority stress, highest levels of victimization related to sexual orientation increased the risk of sexual problems. This association was partially mediated by negative emotions. Our findings offer some support for a recent call to include sexual orientation among the social determinants of health recognized by the World Health Organization.     

Predictors of Family Support and Well-Being Among Black and Latina/o Sexual Minorities

ABSTRACT

Sexual minorities are receiving an increasing amount of attention within sociological research on families. However, much of the existing work on these families has been limited to largely White, middle-class, and highly educated individuals. Using national data from the Social Justice Sexuality Project, this study fills a much-needed gap by exploring predictors of family support and the relationship between family support and well-being among Black and Latina/o sexual minorities. We find that sexual identity, how out one is to one's family, and relationship status predict levels of family support. In addition, we find that among Black and Latina/o individuals, family support is an important factor influencing health and well-being. Other social statuses such as gender identity, sexual identity, and relationship status are associated with happiness and self-rated health as well. Our work suggests that sexual minorities of color have unique family dynamics that should be studied from an intersectional perspective. Further investigation into the family dynamics of sexual minorities of color should pay particular attention to individuals' positionality within systems of gender, racial, and sexual identity disadvantage to help understand their health and well-being.     

The Sexual Inhibition (SIS) and Sexual Excitation (SES) Scales: II. Predicting psychophysiological response pattens

This study evaluated the predictive value of a newly developed measure of the propensity for sexual inhibition and excitation; the Sexual Inhibition Sexual Excitation Scales (SIS/SES). Sexual, cardiovascular, and startle responses were measured in a group of 40 sexually functional men during the presentation of threatening and nonthreatening erotic films. Two levels of performance demand were created and two films were combined with a distraction task. Participants were assigned to high and low groups for each of the three SIS/SES scales. As predicted, men with high SES scores showed generally higher sexual responses. High and low SIS1 groups did not differ in their responses. Men with high and low SIS2 scores did not differ in their responses to nonthreatening stimuli; however, low SIS2 men showed greater genital response to the threatening stimuli. The findings provide support for the value of the SIS/SES scales in predicting sexual responses.     

How Common is Men's Self-Reported Sexual Interest in Prepubescent Children?

Consistent evidence exists for sexual interest in children in nonclinical/nonforensic male populations. However, prevalences for community men's self-reported sexual interest in children have been based on indiscriminate definitions including postpubescent individuals, age-restricted samples, and/or small convenience samples. The present research assessed men's self-reported sexual interest in children (including child prostitution and child sex tourism) on the community level and examined the link between strictly defined sexual fantasies and behaviors involving prepubescent children. In an online survey of 8,718 German men, 4.1% reported sexual fantasies involving prepubescent children, 3.2% reported sexual offending against prepubescent children, and 0.1% reported a pedophilic sexual preference. Sexual fantasies involving prepubescent children were positively related to sexual offending against prepubescent children. Sexual interest in children was associated with subjectively perceived need for therapeutic help. In contrast to findings from forensic samples, men who reported child pornography use exclusively were identified as a subgroup differing from contact sexual offenders against prepubescent children and men who reported both child pornography use and contact sexual offenses against prepubescent children. The empirical link between child-related sexual fantasies and sexual victimization of prepubescent children and high levels of subjective distress from this inclination underscore the importance of evidence-based child sexual abuse prevention approaches in the community. Findings are discussed in terms of their relation to pedophilic disorder.     

Electronic Media Access and Use for Sexuality and Sexual Health Education Among Men Who Have Sex With Men in Four Cities in Tanzania

Abstract

Background: Electronic media use is an important avenue for reaching stigmatized populations. We examined Internet access and use of sexually related electronic media among men who have sex with men (MSM) in 4 cities in Tanzania. Methods: A questionnaire was administered to 231 MSM in Dar es Salaam, Mwanza, Arusha, and Tanga regarding electronic media type, times of use, type of use and frequency of use of sexually-related media. Results: Mean age was 25.7?years, and 52% had completed high school. Half had access to the internet through personal electronic devices, a further quarter had access through work, 10% through friends’ devices, and only 2% had no access to the internet. Most frequently used electronic devices were personal computer followed by work smartphone, with work computer a close third. These patterns were consistent for both seeking other men for sex and finding sexual health information. All respondents had accessed sexual material electronically at some time. Substantial logged-in time was reported each week seeking/chatting with potential sexual partners (median?=?48 hr), looking at “porn” (median?=?24 hr), and searching for health information (median?=?7 hr). Over 98% indicated that they would use an anonymous/confidential online service for HIV and sexually transmitted infection testing. The majority (79%) had found sexual partners throughout the Internet in the last 24?hours, and 52% sought sexual health education online 2–3 times per week. Peak search time was evenings, increasing during weekends. Discussion: For Tanzanian MSM in cities, sexual electronic media use is high and includes work devices. Sexual health information seeking, and openness to electronic counseling and testing was almost universal. Electronic sites for sexual health access should be explored and evaluated.     

Sexual Functioning in Spanish and Portuguese Young Adults: Initial Validation of the Arizona Sexual Experience Scale

Objectives: The authors conducted an initial validation of the Arizona Sexual Experience Scale (ASEX) and examined the sexual function of Spanish and Portuguese young adults. Methods: Participants were 523 Spanish and 595 Portuguese heterosexual young adults who completed a background questionnaire, the ASEX, and measures of sexual sensation seeking, excitation, and inhibition. Results: The ASEX showed good reliability and validity. Participants reported good sexual function. The most prevalent difficulties in men were related to desire and orgasm, and to orgasm and satisfaction in women. Conclusions: This is a psychometrically sound instrument to assess sexual functioning in Spanish and Portuguese young adults.