Geriatric sexuality

“Aging and sexuality are two subjects beset by anxiety and erroneous folklore; many of the problems of each of them originate from misinformation.” Comfort and Dial, 1991 [1]

Over a decade ago an issue of Clinics in Geriatric Medicine was devoted to geriatric sexuality. This was a pioneering effort that was forged before Bob Dole and Rafael Palmeiro sold Viagra on television. Throughout the past decade, major advances have been made in the understanding of the biological basis of erectile dysfunction (impotence) and andropause and their treatment [2], [3], [4]. Unfortunately, these advances have led many physicians to medicalize sexuality while paying even less attention to the role of relationships and intimacy in maintaining quality of life. There have been no advances in our understanding of sexuality in the older woman to parallel those that are related to male sexuality.

This issue covers the dramatic advances in the biology of male sexuality that have been made in the last decade. The meaning of the Women's Health Initiative results to older women [5] is also explored, as is the importance of testosterone as a behavior modulator in men and women. Some articles probe the role of disease and medication in producing sexual dysfunction, highlighting the importance of frailty in impairing sexuality as we age [6], [7]. Other articles examine the importance of counseling as a tool for managing sexual dysfunction and marital discord, while still others discuss the problems associated with sexuality when an older person is institutionalized. Finally, this issue contains articles that address the emergence of a substantial cohort of older gays and their unique needs, the problems of older persons who may have had lifelong paraphilias or who develop new paraphilias as they develop cognitive impairment, and sexually transmitted diseases in older persons.

It is my hope that health care professionals will find this issue of the Clinics in Geriatric Medicine helpful for increasing awareness and knowledge of sexuality in our older friends and patients. Unfortunately, as was the case at the time of the last issue on geriatric sexuality, there remains a tremendous need for research in this area. A Men's Health Initiative similar to the Women's Health Initiative must be commenced as soon as possible, as should research on the changes in females that alter sexual responsiveness for aging.