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Sexuality is an integral part of human expressions. Mental health plays a major role in sexuality. Several psychological interventions are proposed to increase the sexual quality of life in older women with diverse gynecologic pathology. A biopsychosocial approach utilizing brief strategies can be easily implemented in clinics to help women of all ages increase their sexual quality of life.
Female pelvic floor disorders include urinary incontinence, pelvic organ prolapse, and fecal incontinence.
These disorders increase dramatically with increasing age. Treatment of urinary incontinence can improve sexual function in older women. Pelvic organ prolapse, a hernia of the vagina resulting in a visible vaginal bulge, has also been associated with a negative impact on sexual function.
Both vaginal and abdominal approaches to surgical correction of pelvic organ prolapse have been demonstrated to improve sexual function. Research has shown that both general practitioners and specialists lack training in sexual assessments.
Behavioral health specialists, such as a psychologist, can play an integral role in helping to facilitate communication between the patient and the provider. A main focus of communication training is to facilitate open and genuine conversation between the provider and the patient. Providers are encouraged to ask open ended questions while patients are encouraged to discuss symptoms while coping with an internal state of anxiety. Despite the known prevalence of sexual dysfunction among older women, few studied empirically based interventions have been published with these women.
A biopsychosocial approach utilizing some of the aforementioned brief strategies can be easily implemented in comprehensive gynecology clinics in order to help women of all ages increase their sexual quality of life. Sexuality is an integral part of human expressions regardless of age. Most comprehensive studies on sexuality in older adults come from Duke University longitudinal study on aging [ 1 ], [ 2 ] and [ 3 ], followed by Matthias et al.
Most recently, Lindau et al. The relationship between sexuality, interest, satisfaction and other factors among older people is complex. Mattias et al. Age, gender, education, social network, and marital status were all related to sexual activity.
Frequency of sexual activity, sexual satisfaction, and interest in sex are positively associated with good health in middle age and later in life. Older women in any age category are twice as likely as males to not be sexually active. Gender difference in frequency of sexual activity, sexual satisfaction, and interest in sexual activity increased with advancing age.
Thirty-nine percent of men compared with Younger women with higher education and stronger social networks are more likely to be sexually active. Those who were married were almost 6 times more sexually active than single women. Diokno et al. Matthias et al. Thus, marriage is a good predictor of sexual activity and sexual satisfaction in elderly women. Interestingly, it does not appear to be related to sexual activity and satisfaction in elderly men. Sexual function in women declines with age [ 4 ] and [ 5 ].
In a landmark study of sexuality among community dwelling older adults in the United States, the prevalence of sexual activity declined with age [ Women were less likely to report sexual activity at any age group compared with men [ 5 ]. In one study of adults over the age of 60, In the over 70 year old population, Sexual dysfunctions, including lack of interest, difficulty with lubrication, anorgasmia and dyspareunia are common in older women.
Lack of interest in sex was reported by Difficulty with lubrication was reported by Inability to climax was reported by Pain during intercourse was reported by Associations between sexual activity and satisfaction in the elderly female population is even more complex. Limited literature exists on the relationship between sexual activity and satisfaction. It appears that sexual satisfaction in older women is directly related to their sexual satisfaction when they were younger [ 8 ] and [ 9 ].
Starr—Weiner et al. Seventy-five percent of their responding cohort stated that sexual intercourse was the same as or better then when they were younger. Instead of age, Starr—Weiner and colleagues reported ability for orgasm was related to sexual satisfaction [ 10 ].
Health status is a major factor in sexual satisfaction. Croft et al. Sexual behavior has further been linked to mobility, diabetes, coronary disease, renal dialysis, cancer, incontinence and pulmonary disease [ 7 ], [ 12 ] and [ 13 ]. Women with self-report of very good or excellent overall health were more likely to be sexually active compared with women who reported their overall health as poor or fair [adjusted odds ratio 1.
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Female pelvic floor disorders are common. In the United States, one in four women suffer from symptoms of at least one pelvic floor disorder [ 14 ]. Female pelvic floor disorders are embarrassing conditions; many women do not even discuss this condition with their doctors [ 15 ] and [ 16 ]. Female pelvic floor disorders increase dramatically with age.
Surgical procedures for female pelvic floor disorders urinary incontinence, pelvic organ prolapse, and fecal incontinence are common among older women with overinpatient and 40, outpatient procedures performed annually on women greater than 65 years old [ 18 ], [ 19 ] and [ 20 ]. Urinary incontinence is the involuntary loss of urine.
Incontinence is associated with poor self-rated health and depression in older women [ 29 ], [ 30 ], [ 31 ] and [ 32 ]. In a study of sexually active women planning surgery for hysterectomy, severe urinary incontinence was ificantly associated with decreased libido [AOR 1. Knoepp et al. Treatment of urinary incontinence can involve non-surgical or surgical options.
Sexual satisfaction in the elderly female population: a special focus on women with gynecologic pathology
Non-surgical options for the treatment of urinary incontinence include lifestyle changes, behavioral modification, pessaries, and pelvic floor muscle exercises. In a multi-center study of women undergoing non-surgical treatment of urinary incontinence with a combination of pessaries and pelvic floor muscle exercises, successful treatment of urinary incontinence was associated with a ificant improvement in sexual function [ 34 ].
No differences were noted between the women who were successful treated and those who were not in sexual arousal, libido, and dyspareunia [ 34 ]. Increase in pelvic floor muscle strength as a result of pelvic floor muscle exercises was not associated with improved sexual function as measured by the Pelvic Organ Prolapse-Urinary Incontinence Sexual Function Quesitionaire PISQa disease specific validated sexual function questionnaire [ 34 ].
Surgical correction of stress urinary incontinence has not been demonstrated to change libido, arousal, lubrication, orgasm, and sexual satisfaction in women as measured by the Female Sexual Function Index FSFI [ 35 ]. It should be noted that the FSFI is not a woman specific instrument to measure sexual function in women with prolapse and urinary incontinence and coital leakage as well as fear of coital leakage may be the most important sexual improvement a women undergoing treatment for urinary incontinence should expect [ 36 ].
No change in the prevalence of dyspareunia or ability to reach orgasm was noted before and after the midurethral sling procedure [ 37 ]. A rare with following the midurethral sling procedure is the erosion or rejection of vaginal mesh which occurs in 0.
The most common presenting Sex in women experiencing erosion or trowbridge of vaginal mesh is vaginal discharge, vaginal spotting including post-coital spottingand dyspareunia [ 40 ]. Women complaining of post-coital spotting or dyspareunia following midurethral sling procedures should be evaluated for possible old erosion.
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Pelvic organ prolapse is a hernia of the vagina resulting in a visible vaginal bulge. Women with increasing symptom distress from female pelvic floor disorders are more likely to report decreased libido, decreased arousal, infrequent orgasm, and increased dyspareunia [ 25 ].
Vaginal anatomy including total vaginal length, genital hiatus, and vaginal caliber has not been associated with improved sexual function or increased sexual activity [ 43 ] and [ 44 ]. Weber et al. In a subsequent study by Schimpf et al.
Both vaginal and abdominal approaches to surgical correction of pelvic organ prolapse has been demonstrated to improve sexual function utilizing a condition-specific validated questionnaire, the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire PISQ [ 46 ]. There has been some debate in the peer-reviewed literature about the impact of posterior repair on sexual function in women [ 47 ] and [ 48 ].
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Levatorplasty, a surgical technique of placating the levator ani muscles together, was associated with high rates of dyspareunia [ 47 ], [ 48 ] and [ 49 ]. Due to occurance of de-novo dyspareunia after these procedures, site-specific defect repair or global defect repair without levator placation was adopted [ 50 ] and [ 51 ]. However, sexual function between women undergoing pelvic organ prolapse repair with and without concomitant posterior repair was similar [ 52 ].
Fecal incontinence is the involuntary loss of stool. Fecal incontinence in women is commonly the result of an anterior laceration in the external anal sphincter following vaginal delivery. Surgical treatment of anatomic defects in the external anal sphincter is an external anal sphincteroplasty.
However, women reporting increased fecal incontinence to solid stool experienced decreased arousal, lubrication, orgasm, and overall sexual function [ 57 ]. Psycho-oncology research literature has emphasized the importance of a multidisciplinary assessment and treatment approach sexual impairment in women after gynecological cancer [ 60 ], [ 61 ], [ 62 ] and [ 63 ]. Several psychological interventions have been proposed to increase the sexual quality of life in women with gynecological cancer that can be utilized in women with diverse gynecologic pathology.