Sexual expression in later life: a review and synthesis

In the past decade, researchers have begun to study the sexual functioning of typical older persons. This review summarizes literature on the sexuality of men and women over age 50 as researched by social and health scientists. Research on the relationship of biological factors (changes accompanying aging), health (physical, mental, and medication use), psychological factors (attitudes, information about sex), relationship factors (status, satisfaction), and sexual functioning (desire, dysfunctions, treatment) to sexual behavior is reviewed. The review suggests that (a) men and women remain sexually active into their 70s and 80s, (b) aging-related physical changes do not necessarily lead to decline in sexual functioning, and (c) good physical and mental health, positive attitudes toward sex in later life, and access to a healthy partner are associated with continued sexual activity. In turn, regular sexual expression is associated with good physical and mental health. Progress in understanding later life sexuality requires development of comprehensive theoretical models, a broad focus on intimacy, attention to measures and samples, and research on couples. Progress in understanding is especially important, given the aging of populations.     

A Review of Child Sexual Abuse: Impact,Risk, and Resilience in the Context of Culture

Child sexual abuse is a problem with both a national and worldwide prevalence. In this review, the authors note that while empirical research has clearly shown the negative impact of child sexual abuse on social, psychological, and sexual functioning later in life, it has also been reported that some individuals remain asymptomatic despite a history of experiencing child sexual abuse. This implies that negative outcomes later in life are not inevitable and illustrates the critical need to elucidate how resilience may moderate the negative impacts of child sexual abuse. In addition to emphasising the role of resilience, this review also underscores the important role that cultural context plays in understanding child sexual abuse, as there are known risk factors and protective factors specific to different cultures. Similarly, one’s culture may also influence whether abuse is reported and addressed, and the topic is given special attention in this paper because it is not widely discussed within the existing literature. The impact of child sexual abuse on mental health, sexual health, and social functioning is also discussed.     

The Impact of Childhood Sexual Abuse on Later Sexual Victimization among Runaway Youth

Path analysis was used to investigate the impact of childhood sexual abuse on later sexual victimization among 372 homeless and runaway youth in Seattle. Young people were interviewed directly on the streets and in shelters by outreach workers in youth service agencies. High rates of both childhood sexual abuse and street sexual victimization were reported, with females experiencing much greater rates compared with their male counterparts. Early sexual abuse in the home increased the likelihood of later sexual victimization on the streets indirectly by increasing the amount of time at risk, deviant peer affiliations, participating in deviant subsistence strategies, and engaging in survival sex. These findings suggest that exposure to dysfunctional and disorganized homes place youth on trajectories for early independence. Subsequently, street life and participation in high‐risk behaviors increases their probability of sexual victimization.     

Disclosure of Child Sexual Abuse as a Life‐Long Process: Implications for Health Professionals

One of the aims of this research project was to develop a fuller understanding of the process of disclosure of child sexual abuse. Face‐to‐face in‐depth interviews were conducted with 22 men and women aged 25 to 70 years old, who had an early sexual experience at the age of 15 or under with someone of 18 or over. Narrative inquiry methodology was used and data was analysed using Rosenthal and Fischer‐Rosenthal's (2004) process of data analysis. Disclosure can be conceptualised as a complex and life‐long process, and most participants did not make a selective disclosure until adulthood. The findings extend Alaggia's (2004) model of disclosure to include the life stage and the person to whom the disclosure is being made. The main barriers to disclosure and possible gender differences are discussed. Family therapists need to manage the challenges inherent in disclosure of child sexual abuse at any age.     

How Does Divorce Affect Iranian Women's Sexual Well-Being?

Sexuality and divorce are two interwoven subjects with complex effects on women's sexual well-being in Iranian culture. Results of this exploratory study using focus group discussions and individual interviews revealed how the sexual well-being of women was influenced by the divorce experience through common patterns and recurring themes. A total of 26 women participated voluntarily in the study. They were approached through a selected social support group in a center in West Tehran in 2011, and all had been divorced for less than 10 years. For the majority, sexuality-related matters became complicated and jeopardized their overall well-being in postdivorce life. This finding, along with the fact that the majority were seeking financial and emotional support, implies that counseling women and providing economic support for postdivorce life might improve women's sexual well-being.     

Birth Cohort Differences in Sexual Identity Development Milestones Among HIV-Negative Gay and Bisexual Men in the United States

The coming-out process for gay and bisexual men (GBM) involves crossing sexual identity development (SID) milestones: (1) self-awareness of sexual attraction to the same sex, (2) self-acceptance of an identity as gay or bisexual, (3) disclosure of this sexual identity to others, and (4) having sex with someone of the same sex. We examined trends in SID milestones by birth cohort in a 2015 U.S. national sample of GBM (n = 1,023). Birth cohort was independent of when men first felt sexually attracted to someone of the same sex (median age 11 to 12). However, with the exception of age of first same-sex attraction, older cohorts tended to pass other milestones at later ages than younger cohorts. Latent class analysis (LCA) of SID milestone patterns identified three subgroups. The majority (84%) began sexual identity development with same-sex attraction around the onset of puberty (i.e., around age 10) and progressed to self-identification, same-sex sexual activity, and coming out—in that order. The other two classes felt same-sex attraction during teen years (ages 12.5 to 18.0) but achieved the remaining SID milestones later in life. For 13% of men, this was during early adulthood; for 3% of men, this was in middle adulthood. Findings highlight the need to monitor ongoing generational differences in passing SID milestones.     

Life Events and Sexual Risk Among HIV-Negative,Heterosexual, Methamphetamine Users

Identifying psychosocial factors associated with sexual risk behavior among methamphetamine users is essential to enhancing HIV and sexually transmitted infection prevention. This study examined the relationship between positive and negative life events and sexual risk behavior in a sample of 100 HIV-negative, heterosexually identified, methamphetamine-using men and women. Negative life event categories included death of a significant other, negative health event involving self or significant other, and child custody or visitation issues. Categories of positive life events included birth or pregnancy involving self or significant other, a positive relationship event, and a positive life change. Multivariate analyses demonstrated that negative life events were positively associated with total number of unprotected sex acts, whereas positive life events were not associated with sexual risk taking. Also, amount of methamphetamine used did not moderate the relationship between life events and sexual risk behavior. These data support future research to identify underlying mechanisms that link negative life events to sexual risk taking in this high-risk population.     

All Shook Up: Sexuality of Mid- to Later Life Married Couples

The authors integrate theoretical work on the performance of gender with a life course perspective to frame an analysis of in-depth interviews with 17 long-term married couples. The findings indicated that couples' sexual experiences are characterized by change over time, yet that change is shaped by the intersection of gender and age. Midlife couples (ages 50 - 69) were distressed by changes in their sex lives likely because they impede couples from performing gendered sexuality. The source of this distress stems from age-related physical changes; however, it manifests in different ways for husbands and wives. In contrast, later life couples (ages 70 - 86) were more likely to emphasize the importance of emotional intimacy over sex as they age. Marital sex is a source of conflict for many midlife couples because of husbands' and wives' incongruent experiences, but later life husbands and wives tend to have more congruent experiences of marital sex.     

Adult Daughters whose Mothers Come Out Later in Life: What is the Psychosocial Impact?

SUMMARY

When a family member comes out, it is a process not only for that individual lesbian but also for their entire family. Adult daughters whose mothers come out later in life have distinctive paths to navigate. This article reports findings of an interview study with six daughters who were adults when their mothers came out to them. Most daughters felt they emerged from childhood with an open mind about sexual identity, but had no idea about their mother's lesbianism until told by her. Half the participants questioned the role of women in their lives after their mother came out. Five of the six have a very close relationship, or have become closer, with their mother, since her coming out.     

A review of literature: An examination of the correlation between attachment styles and adolescent girls’ sexual behaviors

ABSTRACT

This literature review examines eight studies of parental attachment styles, sexual behavior, and health outcomes among adolescent girls. The review focuses on studies that analyzed the perceived relationships between parents and their adolescent daughters and whether instabilities of life experiences correlated with risky sexual behaviors and if high-risk sexual behaviors were associated with an increase of sexually transmitted infections, unplanned pregnancies, and other poor health outcomes in adolescent girls. Findings show adolescent girls with insecure parental attachment styles were at a higher risk of sexual behaviors, early pregnancies, and transmission of sexually transmitted infections (STI’s). The most common finding in the studies reviewed was the significant association of how higher parental communication and monitoring may prevent risky sexual behaviors at an earlier age. Recommendations for mental and health care providers include the development of treatment programs to address the importance of parent-attachment relationships and multifaceted health needs of adolescents girls. Programs can be strengthened by involving other family members, improving parent-daughter communication and relationships and emphasizing system-level change (policy, procedure, practice). Adding these elements may ultimately lead to sustained improvements over time. Future research on other family social factors (e.g., divorce and separation of attachment figure, poverty, and single-parent homes) associated with attachment and high-risk behaviors is warranted. More research is needed to exam how secure attachments among adolescent girls may prevent earlier sexual encounters, unplanned pregnancies, and STI’s.     

Resident-to-Resident Abuse in Nursing Homes as Reported by Nurse Aides

Information on the scale and scope of resident-to-resident abuse, including verbal, physical, material, psychological, and sexual abuse, is presented. Nursing homes (n = 249) from ten states were used, with a total of 4,451 nurse aides in these facilities returning the questionnaire. Most nursing homes experienced verbal, physical, material, and psychological abuse, but sexual abuse was less common. Our findings clearly show that both the scale and scope of resident-to-resident abuse is high in nursing homes. Resident-to-resident abuse is common enough to be considered an issue of concern impacting the quality of life and safety of many residents.     

How Did Erectile Dysfunction Become “Natural”? A Review of the Critical Social Scientific Literature on Medical Treatment for Male Sexual Dysfunction

This article reviews the multidisciplinary social science literature assessing the social consequences of medical treatment for male sexual dysfunction. This literature applies medicalization theory and social constructionist approaches to gender to assert that Euro-American cultural ideals of masculinity and sexuality, as well as ageism and ableism, determine which sexual changes and experiences get defined as “dysfunction” and shape the marketing and use of medical treatments for those changes. These medical responses assuage the suffering of men who become unable to meet cultural ideals for sexuality but in the process make reductive norms for male sexuality seem biologically natural. In addition, the critical social science research suggests that an economic logic underlies the process of redefining diversity and change in men’s sexual function as medical pathology. However, comparative qualitative data on men’s and their sexual partners’ experiences of sexuality and aging across world regions suggest that people do not universally accept the narrow ideals of male sexuality embedded in medical discourse regarding men’s sexual dysfunction. The diversity in people’s sexual desires across the life course and their responses to sexual function change highlight the cultural nature of medical definitions of sexual dysfunction.     

Medicalization and the refashioning of age-related limits on sexuality

This article explores the convergence of sexual medicine and anti-aging medicine as they have refashioned standards of sexual functionality and reconstructed sexual life courses. Reversing the long-held stereotypes of asexual or post-sexual seniors, expectations of continued sexual functionality as an indicator of health in later life now underpin a growing medical and therapeutic industry. While more positive images of eldersex are certainly an improvement over past views that saw older people as both undesiring and undesirable, this article suggests that caution should be exercised regarding an overly celebratory reading of the medicalized construction of "sexy seniors."     

“At My Age … ”: Defining Sexual Wellness in Mid- and Later Life

Sexual wellness is integral to quality of life across the life span, despite ageist stereotypes suggesting sexual expression ends at midlife. However, conceptualizing sexual wellness in mid- and later life is complicated by a dysfunction-based narrative, lack of a sex-positive aging framework, and existing measures that are age irrelevant and limited in scope. This study aimed to address these limitations by providing a conceptualization of sexual wellness grounded in definitions from midlife and older adults. A sample of 373 midlife and older adults (M = 60, SD = 5.84) in the United States provided a definition of sexual wellness. Using thematic analysis, multiple researchers coded qualitative responses, and results suggested a biopsychosocial-cultural framework. Findings reflect that midlife and older adults provide multifaceted definitions inclusive of various behavioral experiences, including disengaging from sex. They are also keenly aware of physical and psychological limitations and strengths, and emphasize mutual experiences and synchronicity. Midlife and older adults also reflect on age, drawing comparisons to different phases of life and often displaying adaptability in adjusting expectations. When conceptualizing sexual wellness in this population it is imperative to capture this multidimensionality, include those who are not actively engaging in sex, and be aware of the influence of ageist and dys/function narratives.     

Identity Satisfaction Over the Life Course in Sexual Minorities

A variety of models have been proposed to understand the process of coming to terms with a sexual minority identity. What has not been so clearly explored is how an individual's satisfaction with his or her sexual identity develops over the life course. This article explores satisfaction with sexual identity in a large cohort (N = 2,269) of self-identified lesbians, gay men, and bisexuals, and considers satisfaction not only from a chronos (life span) but also from a chairos (stage of development) framework. Data show a clear relationship between age group and increased satisfaction with a sexual minority identity. Resilience may be an important contributor to increased satisfaction.     

Reported change in preferred sexual activity over the adult years

Fifty‐nine women and 40 men, aged 60 to 85, participated in a study which examined changes in preferred sexual activity from young adulthood to old age. The results indicated that change in preferred sexual activity over time was common and not associated with low psychological well‐being or with unfavorable ratings on satisfaction with sex life, subjective pleasure, incidence of the preferred activity, or interest in sex in old age. However, change in preference was related to physical changes in both sexes and to opportunity factors among women. These findings suggest that sexual experience and psychological well‐being in old age are related more to the type of sexual activity that is preferred than to the occurrence of change per se.     

The AIDS epidemic in American crime fiction, 1981–2001

Abstract

From the start of the AIDS epidemic in 1981, American crime fiction began to make use of the epidemic's prevalent imagery of sex and death, semen and blood, pleasure and pain, transgression and punishment. The epidemic proved a useful atmospheric effect in crime writers' representations of the mean streets of contemporary urban life. Moreover, early characterization of HIV as a stealthy and purposive 'killer virus' was a perfect fit with one of the crime writers' favourite villains, the serial sexual murderer. Treated both nostalgically and apocalyptically, the social and sexual changes wrought by the epidemic have emerged among the key signs in the struggle against decay and disorder in portrayals of an irretrievably post-modern republic.