J Korean Med Assoc.  2017 Jul;60(7):555-560. 10.5124/jkma.2017.60.7.555.

Sexual problems of patients in long-term care

• Kam SC
• Kim SJ
• Moon KH

• KMID: 2386596
• DOI: http://doi.org/10.5124/jkma.2017.60.7.555

Abstract

In physically and mentally impaired elderly individuals, sexual dysfunction caused by aging or illness has not received proper therapeutic attention. Moreover, the most important reason for the elderly not to express their sexual desires is the presence of social prejudice and lack of awareness regarding the sexual behavior of the aged. In particular, patients in long-term care facilities may be have less interest in or awareness of these issues than the general population. Sex among the aged is both a biological and sociocultural phenomenon, and sexual problems experienced by the elderly should be approached with this in mind. Patients in long-term care facilities often receive therapy for various diseases that can cause sexual problems. Relatively common underlying diseases affecting sexual function in long-term care patients are dementia, stroke, aging, spinal cord injury, and malignancy, as well as chronic diseases such as diabetes mellitus, hypertension, and chronic renal failure. Inappropriate sexual behavior in patients with dementia poses ethical problems. However, no guidelines exist regarding treatment for improper sexual behavior. Elderly individuals in long-term care facilities often experience difficulties having a satisfactory sex life even if they have a spouse. To facilitate a healthy sex life among elderly individuals in long-term care, both a sufficient understanding of sexuality and sexual behavior and appropriate institutional strategies are needed.

Keyword

Long-term care; Sex; Aged

MeSH Terms

Aged
Aging
Chronic Disease
Dementia
Diabetes Mellitus
Humans
Hypertension
Kidney Failure, Chronic
Long-Term Care*
Prejudice
Sexual Behavior
Sexuality
Spinal Cord Injuries
Spouses
Stroke

Reference

1. Lindau ST, Schumm LP, Laumann EO, Levinson W, O'Muircheartaigh CA, Waite LJ. A study of sexuality and health among older adults in the United States. N Engl J Med. 2007; 357:762–774.

2. Morley JE, Kaiser FE, Perry HM 3rd, Patrick P, Morley PM, Stauber PM, Vellas B, Baumgartner RN, Garry PJ. Longitudinal changes in testosterone, luteinizing hormone, and follicle-stimulating hormone in healthy older men. Metabolism. 1997; 46:410–413.

3. Benito M, Vasilic B, Wehrli FW, Bunker B, Wald M, Gomberg B, Wright AC, Zemel B, Cucchiara A, Snyder PJ. Effect of testosterone replacement on trabecular architecture in hypogonadal men. J Bone Miner Res. 2005; 20:1785–1791.

4. Bancroft J. The endocrinology of sexual arousal. J Endocrinol. 2005; 186:411–427.

5. Traish AM, Park K, Dhir V, Kim NN, Moreland RB, Goldstein I. Effects of castration and androgen replacement on erectile function in a rabbit model. Endocrinology. 1999; 140:1861–1868.

6. Hillman JL. Sexuality and aging: clinical perspectives. New York: Springer;2012.

7. Lichtenberg PA, Strzepek DM. Assessments of institutionalized dementia patients' competencies to participate in intimate relationships. Gerontologist. 1990; 30:117–120.

8. Chang YJ. Inpatient characteristics by patient evaluation chart in long-term care hospital [dissertation]. Pusan: Catholic University of Pusan;2015.

9. Lesser JM, Hughes SV, Jemelka JR, Griffith J. Sexually inappropriate behaviors: assessment necessitates careful medical and psychological evaluation and sensitivity. Geriatrics. 2005; 60:3436–37.

10. Harris L, Wier M. Inappropriate sexual behavior in dementia: a review of the treatment literature. Sex Disabil. 1998; 16:205–217.

11. Haglind E, Carlsson S, Stranne J, Wallerstedt A, Wilderang U, Thorsteinsdottir T, Lagerkvist M, Damber JE, Bjartell A, Hugosson J, Wiklund P, Steineck G. LAPPRO steering committee. Urinary incontinence and erectile dysfunction after robotic versus open radical prostatectomy: a prospective, controlled, nonrandomised trial. Eur Urol. 2015; 68:216–225.

12. Hendren SK, O'Connor BI, Liu M, Asano T, Cohen Z, Swallow CJ, Macrae HM, Gryfe R, McLeod RS. Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Ann Surg. 2005; 242:212–223.

13. Salem HK. Radical cystectomy with preservation of sexual function and fertility in patients with transitional cell carcinoma of the bladder: new technique. Int J Urol. 2007; 14:294–298.

14. Robinson JW, Moritz S, Fung T. Meta-analysis of rates of erectile function after treatment of localized prostate carcinoma. Int J Radiat Oncol Biol Phys. 2002; 54:1063–1068.

15. Peschel RE, Colberg JW. Surgery, brachytherapy, and externalbeam radiotherapy for early prostate cancer. Lancet Oncol. 2003; 4:233–241.

16. Rogers SN, Hazeldine P, O'Brien K, Lowe D, Roe B. How often do head and neck cancer patients raise concerns related to intimacy and sexuality in routine follow-up clinics? Eur Arch Otorhinolaryngol. 2015; 272:207–217.

17. Schover LR, Fouladi RT, Warneke CL, Neese L, Klein EA, Zippe C, Kupelian PA. Defining sexual outcomes after treatment for localized prostate carcinoma. Cancer. 2002; 95:1773–1785.

18. Tierney DK. Sexuality following hematopoietic cell transplantation. Clin J Oncol Nurs. 2004; 8:43–47.

19. Monti M, Rosti G, De Giorgi U, Cavallari G, Severini G, Giovanis P, Marangolo M. Sexual functions after high-dose chemotherapy in survivors of germ cell tumors. Bone Marrow Transplant. 2003; 32:933–939.

20. Paduch DA. Testicular cancer and male infertility. Curr Opin Urol. 2006; 16:419–427.

21. Kim CH. The pattern and it's change of common multimorbidity in South Korea using Korean Health insurance sample cohort database [dissertation]. Seoul: Hanyang University;2015.

22. Weinberg AE, Eisenberg M, Patel CJ, Chertow GM, Leppert JT. Diabetes severity, metabolic syndrome, and the risk of erectile dysfunction. J Sex Med. 2013; 10:3102–3109.

23. Ryu JK, Jin HR, Yin GN, Kwon MH, Song KM, Choi MJ, Park JM, Das ND, Kwon KD, Batbold D, Lee T, Gao ZL, Kim KW, Kim WJ, Suh JK. Erectile dysfunction precedes other systemic vascular diseases due to incompetent cavernous endothelial cell-cell junctions. J Urol. 2013; 190:779–789.

24. Besiroglu H, Otunctemur A, Ozbek E. The relationship between metabolic syndrome, its components, and erectile dysfunction: a systematic review and a meta-analysis of observational studies. J Sex Med. 2015; 12:1309–1318.

25. Ambler DR, Bieber EJ, Diamond MP. Sexual function in elderly women: a review of current literature. Rev Obstet Gynecol. 2012; 5:16–27.

26. Cain VS, Johannes CB, Avis NE, Mohr B, Schocken M, Skurnick J, Ory M. Sexual functioning and practices in a multiethnic study of midlife women: baseline results from SWAN. J Sex Res. 2003; 40:266–276.

27. Thomas HN, Hess R, Thurston RC. Correlates of sexual activity and satisfaction in midlife and older women. Ann Fam Med. 2015; 13:336–342.

28. Young M, Denny G, Young T, Luquis R. Sexual satisfaction among married women age 50 and older. Psychol Rep. 2000; 86(3 Pt 2):1107–1122.

29. Trudel G. Sexuality and marital life: results of a survey. J Sex Marital Ther. 2002; 28:229–249.

30. Ginsberg TB, Pomerantz SC, Kramer-Feeley V. Sexuality in older adults: behaviours and preferences. Age Ageing. 2005; 34:475–480.