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Sexuality and the Older Patient

Within the walls of the pelvic rehabilitation clinics, we often hear more intimate details than we ever imagined we would, could, or perhaps should. With increasing patient care experiences, most therapists demonstrate increased knowledge, awareness, and with some practice, increased skill at discussing sensitive issues such as sexuality. Because every person and then every person's relationship is unique, we are sometimes asked questions by our patients such as this: "Should I be having more sex?" "Am I normal?"

I have sometimes been surprised when a patient reports that he or she is "not having sex often enough" and for that patient it means that daily sexual activity is no longer happening. Other patients are quite satisfied with their sexual activity occurring 2-3x/month. And of course we meet patients who have gone for "years" without engaging in sexual activity, perhaps because of pain, or lack of intimate partnership, or medical issues with a partner. It is very useful to avoid having expectations for what we as therapists think a patient should or should not be doing, whether that pertains to a particular sexual practice or to a level of involvement with a partner.

Having said all of the above, let's talk about sexual health in the older patient. Most of us have met patients who are in the seventh, eighth, or ninth decade of life and who are hopeful to continue engaging in sexual activities. I recall working with a couple in their eighties who wanted to improve their sexual health: the woman reported she had not had an orgasm "since her 5th child was born." Needless to say, that had been a long time. Within a few weeks of therapy (and her partner learning to help her with pelvic muscle tender point releases) the patient reported joyfully that she again was able to achieve orgasm and increased sexual satisfaction.

To read more about this topic, please check out this link to the article, "Sexuality in Older Age: Essential Considerations for Healthcare Professionals." The article discusses omissions in national healthcare policies related to sexuality and the older patient (this study refers to the UK) as well as the prejudice that the older person becomes "asexual." This issue is compounded by not only the older patient being uncomfortable talking about sex with the medical provider, but also by the fact that the provider may be uncomfortable bringing up the topic. In the section titled "Recommendations" there is a list of helpful questions for the provider listed as "Box 1." These are great questions to add to your dialogue with older patients.

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