 Sept. 30 - Oct. 4, 2003 |
| ASSEMBLY EDITION • NEW ORLEANS |
Once when his elderly parents were visiting him, the mother of Richard Sadovsky, M.D., pointedly asked about a book he was reading, Sex After 60, and what he had learned from it.
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"I said I learned that it takes longer for older women to become ready for sex," said Sadovsky, delivering the Annual Clinical Focus course "Sex After 60" yesterday at the Scientific Assembly. "And she replied, 'Will you tell that to your father?'" said Sadovsky, drawing laughs from the crowd that had come to learn more about a topic that can be disconcerting for family physicians to discuss with their patients.
Dispelling myths
In fact, perhaps one of the more common female sex problems is hypoactive sexual disorder, said Sadovsky. This label is not without controversy, he said, noting the work of a researcher who instead describes elderly women who are "neutral, but willing to be motivated," with the appropriate partner and appropriate stimulation.
Unfortunately, most people get information about sex from TV, books and friends, rather than from health care professionals, said Sadovsky. Having pop culture as a source of information leads to misinformation, he said.
One myth: Seniors aren't interested in sex.
More than half of seniors between 60 and 70 continue to have sex regularly, said Sadovsky, an associate professor of family medicine at State University of New York, Brooklyn, and an associate editor of American Family Physician. Furthermore, of those who are active, 61 percent report that they are as satisfied or more satisfied with sex than they were in their 40s, he said.
Let's talk
You don't have to be an expert to talk to seniors about sexual health, and an FP should because it relates to patients' overall health, said Sadovsky. A vast array of medical conditions are associated with sexual dysfunction, so problems can be a tip-off to a comorbidity.
"Develop a dialogue you're comfortable using," he said, "such as, 'In order to safeguard your health, I need to ask about your sexual activity.'"
He advised, "They may smile or blush, but usually they won't hesitate to talk about it."
Inevitably, physical changes occur in the elderly, often having a negative effect on their sex lives. Men may have decreased libido or erectile dysfunction. Women may be dealing with estrogen deficiency, the after-effects of breast cancer or vaginal dryness caused by disorders such as dyspareunia. Both sexes grapple with lifestyle changes such as retirement, loss of a partner, depression and illness. Sometimes a doctor is to blame.
"We cause 20 percent of sexual dysfunction by pulling out our prescription pads," said Sadovsky. Because patients often won't self-report sexual side effects, it is important to ask patients about such effects so a dosage can be titrated before a patient discontinues use, he said.
While medications for depression often cause sexual problems, cutting back on an antidepressant is sometimes therapeutic, he said.
On the flip side, medications can enhance sex -- for both men and women, said Sadovsky.
Despite a physician's best efforts, there may come a time when outside help is needed. A patient's problems may be too challenging or may require more time than a busy FP has in an office visit.
Sadovsky urged physicians to become familiar with sex therapists in their own areas and not wait until they have a patient who needs referral.
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Copyright © 2003
by American Academy of Family Physicians.