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Sexual desire in later life.



Human sexuality This article is about human sexual perceptions. For information about sexual activities and practices, see Human sexual behavior.
Generally speaking, human sexuality is how people experience and express themselves as sexual beings.
 is generally an understudied area of scientific investigation, and researchers have been particularly neglectful ne·glect·ful  
adj.
Characterized by neglect; heedless: neglectful of their responsibilities. See Synonyms at negligent.



ne·glect
 of the study of sexuality in the aging population. Since the number of elderly persons in the U.S. doubled from nearly 17 million in 1960 to 35 million in 2000, and is projected to reach 53.7 million by 2020 (United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area.  Bureau of the Census Noun 1. Bureau of the Census - the bureau of the Commerce Department responsible for taking the census; provides demographic information and analyses about the population of the United States
Census Bureau
, 2002), this topic takes on particular importance.

Much of the prior research reflects a biological or medical perspective on human sexuality. It assumes that as people age, physical changes, hormonal changes, or chronic illnesses reduce or eliminate sexual desire and sexual behavior sexual behavior A person's sexual practices–ie, whether he/she engages in heterosexual or homosexual activity. See Sex life, Sexual life. . This literature reflects the general trend toward the medicalization medicalization Social medicine A term for the erroneous tendency by society–often perpetuated by health professionals–to view effects of socioeconomic disadvantage as purely medical issues  of human sexual functioning, which has accelerated in the past 20 years (Tiefer, 2004). It overlooks psychological and social influences on sexuality.

A Biopsychosocial Perspective

In contrast, what is needed is a biopsychosocial perspective, one that combines biological, psychological, and socio-environmental factors (DeLamater, 2002). Any approach to the study of human sexuality that stresses only one dimension, such as biology or sociology, is counterproductive (Rossi, 1994). This paper applies such a model to the understanding of sexual desire in women and men over the age of 45. The components of the model are listed in Figure 1.
Figure 1. Biopsychosocial Model of Sexuality

Biological Influences
  Hormonal system
  Vascular system
  Illness/treatment

Psychological Influences
  Sexual information
  Attitudes toward sexual expression
  Mental Health
  Depression/Treatment

Social Influences
  Availability of a partner
    Length of relationship
    Quality of relationship
  Income


Among the biological influences are the hormonal and vascular systems and illnesses and associated treatments. Important psychological influences include sexual information, sexual attitudes, and mental health. Within the category of relational influences, the availability of a partner is a prerequisite for partnered sexual activity. Income is also relevant as an index of access to resources related to health, such as living standard.

We believe that biological factors provide a necessary but not sufficient condition for sexual functioning. In addition to biological capability, the person must have knowledge and attitudes supportive of sexual activity. The availability of a partner also influences sexual expression.

The purpose of this study is to examine how levels of sexual desire are associated with these biopsychosocial factors. We first discuss sexual desire. Next, we review the literature on the relationship between the biospychosocial influences and sexual desire. Then we will present data from a survey of a representative sample of 1,384 persons age 45 or older. The variables in our analyses include age, illnesses, and medication use; attitudes, expectations, and knowledge; and presence or absence of a sexual partner, education and household income. In particular, we wanted to determine whether sexual desire declines with age, and, if it does, identify which of these factors are the main influences. We are especially interested in the impact of attitudes, which reflect the influence of cultural values and stereotypes.

Sexual Desire

There is no universally accepted definition of sexual desire. Often it is confused with other aspects of human sexuality. In fact, sexual desire can be associated with sexual behavior but is simultaneously separate from it.

Theorists and researchers in the area of sexual desire have used two main frameworks. The first and most common assumes that sexual desire is an innate motivational force (i.e., an instinct, drive, need, urge, appetite, wish, or want). The second framework emphasizes the relational aspects of sexual desire, conceptualizing desire as one factor in a larger relational context.

As early as 1886, von Krafft-Ebing (1886/1965) discussed sexual desire as a powerful "physiological law" that arose jointly from cerebral activity (e.g., using the imagination) and the pleasurable physical sensations associated with this cerebral activity. Freud, too, conceived of sexual desire as a biological fact, an innate, motivational force. Following in their footsteps, Kaplan (1977, 1979) stated that sexual desire is an appetite or drive that motivates us to engage in sexual behavior. Like other drives, such as hunger, sexual desire is regulated by the avoidance of pain and the seeking of pleasure, and it is produced by the activation of a specific neural system in the brain.

Other researchers choose to define sexual desire not as a biological force but as a cognitive or emotional experience, such as wishing or longing (Everaerd, 1988; Schreiner-Engel, Schiavi, White, & Ghizzani, 1989). According to according to
prep.
1. As stated or indicated by; on the authority of: according to historians.

2. In keeping with: according to instructions.

3.
 Heider (1958), desire is a motivational state that arises from within the person and that represents the person's own wish or want. Desire is therefore a subjective, psychological condition that is not necessarily reflected in an individual's actual or potential actions.

The aforementioned theorists and researchers emphasize the intra-individual nature of sexual desire. That is, some innate biological need arising from within the body (and considered by some to be subject to learning and socialization socialization /so·cial·iza·tion/ (so?shal-i-za´shun) the process by which society integrates the individual and the individual learns to behave in socially acceptable ways.

so·cial·i·za·tion
n.
 processes) produces a subjective state of sexual desire that impels the individual to seek out or become receptive to sexual objects and experiences.

Other investigators, however, view desire as an externally generated phenomenon. Desire is located in the partner rather than in oneself since it is a feeling of being drawn to the other (Verhulst & Heiman, 1979). Sexual desire originates from an external source of stimulation located within the desired object rather than from some need arising within the desiring individual.

Levine (1987), however, argues that sexual desire is generated and influenced by both internal and external events. According to his model, sexual desire is a personal, subjective experience that is defined as "the psychobiologic energy that precedes and accompanies arousal and tends to produce sexual behavior" (p. 36). Levine believes that desire is best viewed as the product of an interaction among (a) the neuroendocrine neuroendocrine /neu·ro·en·do·crine/ (-en´do-krin) pertaining to neural and endocrine influence, and particularly to the interaction between the nervous and endocrine systems.

neu·ro·en·do·crine
adj.
 system, which yields a biologically-based sexual drive; (b) the cognitive processes Cognitive processes
Thought processes (i.e., reasoning, perception, judgment, memory).

Mentioned in: Psychosocial Disorders
 that generate the wish to behave sexually; and (c) the psychologically based, motivational processes that result in the willingness to behave sexually.

In this paper, we have operationalized sexual desire in the terms of cognitive events (sexual thoughts, sexual fantasies sexual fantasy Psychology Private mental imagery associated with explicitly erotic feelings, accompanied by physiologic response to sexual arousal. See Sexual desire. ). Our concept of sexual desire is not associated with any overt sexual activity. We believe that thoughts and fantasies represent motivational aspects of sexual experience and therefore may serve as indirect measures of sexual desire (Sherwin, 1988).

Biological Influences

Age. Kinsey, Pomeroy, and Martin (1949) stated that of the eleven factors that are significant in understanding human sexuality, none seemed more important than age. Sexual behavior in women and men declines steadily from adolescence into older age, and to a lesser extent there is diminution Taking away; reduction; lessening; incompleteness.

The term diminution is used in law to signify that a record submitted by an inferior court to a superior court for review is not complete or not fully certified.
 in sexual desire (Maurice, 1999). Some researchers report that older adults continue to be interested in sex as long as poor health does not affect their sexual desire. In particular, aging does not appear to have any effect on female sexual desire (Masters, Johnson, & Kolodny, 1994).

However, Levine (1998) concludes that sexual desire for both women and men changes considerably in older ages. McKinlay and Feldman (1994) reported that in their study of men ages 40 to 70, sexual desire and frequency of sexual thoughts and dreams decreased with age. In Schiavi's study (1999) of healthy men ages 45 to 74 years who were living in stable sexual relationships, sexual desire decreased as age increased. Others have also found that sexual interest declines in aging women (Hallstrom & Samuelsson, 1990; Osborn, Hawton, & Gath, 1988). One cause of these conflicting results may be variation in the measure of sexual desire employed. Another may be the failure to take into account the influence of other relevant factors.

Hormones. A second biological factor is sex hormones sex hormone
n.
Any of various steroid hormones, such as estrogen and androgen, affecting the growth or function of the reproductive organs and the development of secondary sex characteristics.
. It appears that sexual desire is influenced by androgens Androgens
Male sex hormones produced by the adrenal glands and testes, the male sex glands.

Mentioned in: Acne, Congenital Adrenal Hyperplasia, Finasteride, Homocysteine, Polycystic Ovary Syndrome, Salpingo-Oophorectomy

 in men and by estrogens Estrogens
Hormones produced by the ovaries, the female sex glands.

Mentioned in: Acne, Polycystic Ovary Syndrome

estrogens (es´trōjenz),
n.
 and androgens in women (American College of Obstetricians and Gynecologists The American College of Obstetricians and Gynecologists (ACOG) is a professional association of medical doctors specializing in obstetrics and gynecology in the United States. It has a membership of over 49,000[1] and represents 90 percent of U.S. , 2000). As one ages, there are many changes in the production and functioning of sex hormones (Morley, 2003). Women experience an almost complete cessation of the production of estradiol estradiol /es·tra·di·ol/ (es?trah-di´ol) (es-tra´de-ol) the most potent estrogen in humans; pharmacologically, it is often used in the form of its esters (e.g., e. cypionate, e.  (principal estrogen) by the ovaries Ovaries
The female sex organs that make eggs and female hormones.

Mentioned in: Choriocarcinoma

ovaries (ō´v
 at the time of menopause; before menopause the ovaries produce 95% of estradiol (Sherwin, 1992). In the absence of estrogen, atrophic atrophic /atro·phic/ (a-tro´fik) pertaining to or characterized by atrophy.
Atrophic
A wasting of cells and tissues.
 changes of the vagina vagina: see reproductive system.
vagina

Genital canal in females. Together with the cavity of the uterus, it forms the birth canal. In most virgins, its external opening is partially closed by a thin fold of tissue (hymen), which has various forms,
 occur. Decreased estrogen levels can also result in diminished vaginal lubrication lubrication, introduction of a substance between the contact surfaces of moving parts to reduce friction and to dissipate heat. A lubricant may be oil, grease, graphite, or any substance—gas, liquid, semisolid, or solid—that permits free action of , which, in turn, might cause discomfort or pain during intercourse (Maurice, 1999). Thus, cessation of sexual activity in older women may reflect the fact that intercourse is painful rather than a decline in sexual desire. In men, testosterone testosterone (tĕstŏs`tərōn), principal androgen, or male sex hormone. One of the group of compounds known as anabolic steroids, testosterone is secreted by the testes (see testis) but is also synthesized in small quantities in the  levels decline gradually from age 40 to age 70; the total decline in free testosterone is typically 30 percent (Schiavi, 1999).

Studies suggest that testosterone is associated with increased levels of sexual desire and enjoyment of sex in some post-menopausal women (Sarrel, 1999; Sarrel, Dobay, & Wiita, 1998; Sherwin, Gelfand, & Brender, 1985). According to several researchers, sexual desire in women is, in biological terms, more dependent on androgen androgen (ăn`drəjən): see testosterone.
androgen

Any of a group of hormones that mainly influence the development of the male reproductive system.
 levels than on estrogen levels (Anonymous, 2002; Masters et al., 1994; Vander, Sherman, & Luciano, 2001). In women, approximately 50% of testosterone is made in the adrenal glands Adrenal glands
The two glands that are located on top of the kidneys. These glands secrete several hormones, including the glucocorticoids which, among other things, influence the way the immune system works, and the mineralocorticoids, which affect retention of
, with the other half being produced by the ovaries during the reproductive years (Anonymous, 2002). The cessation of ovarian ovarian /ovar·i·an/ (o-var´e-an) pertaining to an ovary or ovaries.

ovarian

pertaining to an ovary.


ovarian agenesis
 function that accompanies menopause does not significantly reduce the levels of androgens reaching the brain (Masters et al., 1994). In contrast to the supposed importance of androgen levels, others say that receptor number and sensitivity are more important. Even though testosterone replacement therapy testosterone replacement therapy Androgen replacement therapy, see there  (TRT TRT Transportation Research Thesaurus
TRT Tribunal Regional do Trabalho (Brazil)
TRT Türkiye Radyo Televizyon Kurumu
TRT Tinnitus Retraining Therapy
TRT Testosterone Replacement Therapy
TRT Thai Rak Thai Party
) is being prescribed for sexual difficulties, data regarding its efficacy, especially in affecting sexual desire, is inconclusive at this time (American College of Obstetricians and Gynecologists, 2000; Anonymous, 2002).

Illness. Chronic disorders, such as cardiovascular disease Cardiovascular disease
Disease that affects the heart and blood vessels.

Mentioned in: Lipoproteins Test

cardiovascular disease 
, diabetes, arthritis, and cancer, may have negative effects on sexual functioning and response (Maurice, 1999; Schiavi, 1999). These diseases impair sexual function both directly, by acting on physiological mechanisms (by interfering with the endocrine, neural, and vascular processes that mediate sexual response) and reproductive structures, and indirectly, by limiting total body function.

Cardiovascular diseases, such as myocardial infarction myocardial infarction: see under infarction. , hypertension, and peripheral vascular insufficiency INSUFFICIENCY. What is not competent; not enough.  (atherosclerosis atherosclerosis (ăth'ərōsklərō`sĭs): see arteriosclerosis.
atherosclerosis
 or hardening of the arteries
), are commonly associated with sexual response problems (Schiavi, 1999). Many studies have reported a loss of sexual drive in as few as 10% to as many as 70% of patients after myocardial infarction (Papadopoulos, 1989). Studies on sexual behavior after a stroke report decreased levels in sexual desire (Angeleri, Angeleri, Foschi, Giaquinto, & Nolfe, 1993; Boldrini, Basaglia, & Calanca, 1991). There are, however, methodological issues to be considered in evaluating the results of these studies, including the lack of consideration of (a) age effects and (b) the level of sexual function and desire prior to infarction. Further, all of the cited research involved treated patients, confounding confounding

when the effects of two, or more, processes on results cannot be separated, the results are said to be confounded, a cause of bias in disease studies.


confounding factor
 the effects of disease and treatment.

Hypertension is prevalent among older adults, and it is also associated with peripheral vascular disease Peripheral Vascular Disease Definition

Peripheral vascular disease is a narrowing of blood vessels that restricts blood flow. It mostly occurs in the legs, but is sometimes seen in the arms.
, myocardial infarction, and stroke (Schiavi, 1999). Although there are numerous studies on the sexual consequences of anti-hypertension treatment, there are few on sexual functioning in persons with these illnesses who are not receiving treatment (Schiavi).

Diabetes mellitus diabetes mellitus

Disorder of insufficient production of or reduced sensitivity to insulin. Insulin, synthesized in the islets of Langerhans (see Langerhans, islets of), is necessary to metabolize glucose. In diabetes, blood sugar levels increase (hyperglycemia).
, which has vascular effects on blood vessels Blood vessels

Tubular channels for blood transport, of which there are three principal types: arteries, capillaries, and veins. Only the larger arteries and veins in the body bear distinct names.
, is one of the most frequent systemic disorders associated with sexual problems in aging adults (Masters et al., 1994; Schiavi, 1999). Schiavi, Stimmel, Mandeli, and Rayfield (1993) found that diabetic men, screened for nondiabetic pathology, show decreased levels of sexual desire compared to age-matched healthy controls. The duration of the disease (insulin-dependent or noninsulin-dependent diabetes) and type of treatment do not appear to be significantly related to the occurrence of sexual problems (Schiavi). On the other hand, Masters et al. (1994) contend that men with diabetes do not have decreased levels of sexual desire.

Sexual functioning and response in diabetic women have been studied less extensively. However, it has been found that diabetic neuropathy Diabetic Neuropathy Definition

Diabetic neuropathy is a nerve disorder caused by diabetes mellitus. Diabetic neuropathy may be diffuse, affecting several parts of the body, or focal, affecting a specific nerve and part of the body.
, a condition that affects the nerve supply to the pelvis, can cause impaired sexual desire in women (Masters et al., 1994). Unfortunately, there are few controlled studies of the psychology of sexual dysfunction sexual dysfunction

Inability to experience arousal or achieve sexual satisfaction under ordinary circumstances, as a result of psychological or physiological problems.
 in those with diabetes (Bancroft & Gutierrez, 1996).

Arthritis in aging adults is a major cause of discomfort and disability. It has often been assumed that those with arthritis have sexual difficulties, but this has seldom been systematically investigated (Schiavi, 1999). One study of males (mean age 58) reported that there were decreased levels of sexual desire in the arthritic patients in comparison to the control group of non-arthritic men (Blake, Maisiak, Kaplan, Alarcon, & Brown, 1988).

Prostate disease occurs frequently in aging men. It is the second most prevalent cancer, present in almost 90% of men ages 80 and older, and the second most common cause of death from cancer (Masters et al., 1994; Schiavi, 1999). Sexual dysfunction is a common complication of this disease and its treatment (Jakobsson, Loven, & Hallberg, 2001). Fortunately, nerve-sparing prostatectomy nerve-sparing prostatectomy Urology Any prostatectomy intended to preserve sexual function  has been proven to have positive effects on the sexual functioning of patients (Gralnek, Wesells, Cui, & Dalkin, 2000). Even though nerve-sparing operations can often provide preservation or recovery of sexual functioning, recovery also depends on the age of the patient (Catalona & Basler, 1993; Miyao et al., 2001). Moreover, conclusions are limited by insufficient information about sexual response and functioning prior to surgery, other diseases, and medications (Schiavi).

Medications. Numerous prescription drugs prescription drug Prescription medication Pharmacology An FDA-approved drug which must, by federal law or regulation, be dispensed only pursuant to a prescription–eg, finished dose form and active ingredients subject to the provisos of the Federal Food, Drug,  have adverse effects on sexual functioning, including antidepressant antidepressant, any of a wide range of drugs used to treat psychic depression. They are given to elevate mood, counter suicidal thoughts, and increase the effectiveness of psychotherapy.  and anti-hypertension medications. Moreover, adverse drug effects have been reported much more frequently in the aging population than in the general population (Wade & Bowling, 1986). Gender differences should also be examined. The use of prescribed medications and the rate of adverse effects of drug therapy are consistently higher in female than male elderly populations (Schiavi, 1999).

Many prescription drugs cause sexual side effects Side effects

Effects of a proposed project on other parts of the firm.
. However, knowledge is limited by inadequate information on the specifics of drug action, such as how drugs are distributed, metabolized, excreted, and targeted in older persons, especially women. Medications may influence sexual responses, which include desire, by nonspecific effects nonspecific effects,
n.pl outcome other than predicted or caused by the treatment being employed. See also nocebo and placebo.
 on general well-being, energy level, and mood (Schiavi, 1999).

Drugs for the treatment of high blood pressure represent the single largest medication group responsible for sexual side effects. These drugs include alpha-blockers, diuretics Diuretics Definition

Diuretics are medicines that help reduce the amount of water in the body.
Purpose

Diuretics are used to treat the buildup of excess fluid in the body that occurs with some medical conditions such as congestive heart
, and calcium 2 channel blockers Channel blockers are chemical substances, ranging from ions to complex organic molecules, that bind inside the pore of an ion channel and block the flow of ions through that channel.  (Masters et al., 1994). Previous studies have shown that the incidence of drug-induced sexual dysfunction increases as men take increasing dosages of anti-hypertensive drug treatments (Levine, 1998).

Drugs used to treat psychiatric disorders can also cause sexual side effects. Antipsychotic medications Antipsychotic medication
A drug used to treat psychotic symptoms, such as delusions or hallucinations, in which patients are unable to distinguish fantasy from reality.

Mentioned in: Bipolar Disorder
, tricyclic antidepressants Antidepressants, Tricyclic Definition

Tricyclic antidepressants are medicines that relieve mental depression.
Purpose

Since their discovery in the 1950s, tricyclic antidepressants have been used to treat mental depression.
, monoamino-oxidase (MAO MAO - An early symbolic mathematics system.

[A. Rom, Celest Mech 1:309-319 (1969)].
) inhibitors, and sedative drugs may contribute to decreasing levels of sexual desire (Schiavi, 1999; Segraves, 1989). However, among drugs used to treat psychiatric illnesses, the selective serotonin reuptake inhibitors Selective Serotonin Reuptake Inhibitors Definition

Selective serotonin reuptake inhibitors are medicines that relieve symptoms of depression.
Purpose
 (SSRIs) are perhaps the major culprit with regard to diminished sexual desire. The effects of SSRIs on sexual functioning seem strongly dose-related and are also connected to the tendency for SSRIs to accumulate over time (Rosen, Lane, & Menza, 1999).

Psychological Influences

Psychological factors are major determinants of the intensity of sexual desire. Yura and Walsh (1983) state that attitudes, knowledge, and expectations of one's self by one's self; without help or prompting; spontaneously.

See also: Of
 and one's sexual partner impact personal behavior. Sexual attitudes, knowledge, and sexual experiences in earlier years are closely interwoven in·ter·weave  
v. in·ter·wove , in·ter·wo·ven , inter·weav·ing, inter·weaves

v.tr.
1. To weave together.

2. To blend together; intermix.

v.intr.
 with sexual desire (Butler, Lewis, Hoffman, & Whitehead, 1994). Negative attitudes toward sex among older women and men are common (Story, 1989). In part, these attitudes reflect America's youth-oriented culture. American popular culture equates sex appeal with the characteristics of a youthful body, such as a firm body and smooth skin (Levy, 1994). Another contributor is the emphasis on reproduction. In populations where the primary purpose of sexual intimacy is seen as reproduction, it is considered inappropriate for a post-menopausal woman to continue to be sexually active (Deacon, Minichiello, & Plummer, 1995; Levy; Story). We are especially interested in the relative impact of such attitudes on sexual desire.

Sexuality is socially and culturally constructed (Irvine, 1990; Masters et al., 1994; Stock, 1984; Tiefer, 1991, 2004). Culture provides a set of expectations, beliefs, and attitudes about sexuality, and women and men draw on these to attach meaning to their experiences. In the U.S., aging women and men's sexuality is influenced by a cultural environment that is fraught with both ageism ageism Geriatrics A bias or belief that may be held by a health care provider that depression, forgetfulness, and other disorders are a normal part of aging and that older individuals will not benefit from treatment of mental disorders. Cf elderly.  and sexism (Abu-Laban, 1981; Sanford, 1998; Shaw, 1994). Sociocultural so·ci·o·cul·tur·al  
adj.
Of or involving both social and cultural factors.



soci·o·cul
 factors work to minimize or deny the existence or value of sexuality for older persons (Gott & Hinchliff, 2003). Cole (1988) describes her sample of menopausal-aged women as having a sense of "despair about their lives [because they were] holding an image--perhaps a male image, or a youthful image--of how sex is supposed to be."

The images available in U.S. society about sexuality and the aged are negative. Sex is seen as unseemly, even unnatural in the old. One elderly gentleman contended, "We're supposed to be asexual asexual /asex·u·al/ (a-sek´shoo-al) having no sex; not sexual; not pertaining to sex.

a·sex·u·al
adj.
1. Having no evident sex or sex organs; sexless.

2.
, and those who refuse to be so are branded dirty old men" (Stock, 1999, p. 51). The media bombards us with a plethora of sexual images, mainly those of young, energetic people. The sexuality of older women and men is rarely portrayed in a positive light (Brown, 1989; Levy, 1994). These images influence many older people's beliefs, leading to the conclusion that sex is only for the young and beautiful (Hillman Hillman was a famous British automobile marque, manufactured by the Rootes Group. It was based in Ryton-on-Dunsmore, near Coventry, England, from 1907 to 1976. Before 1907 the company had built bicycles.  & Stricker, 1994). These stereotypes and myths set in motion a self-fulfilling prophecy self-fulfilling prophecy, a concept developed by Robert K. Merton to explain how a belief or expectation, whether correct or not, affects the outcome of a situation or the way a person (or group) will behave. . Older people may withdraw from any form of sexual expression and ignore or suppress sexual desire because it is "sick," "unsuitable," or "wrong." According to Sloane (1993), many older women and men do feel asexual.

Health care providers may contribute to the silence surrounding sexuality in aging by not talking with their aging and elderly patients about sexuality issues (Fallowfield, 2002; Stead, Fallowfeld, Brown, & Selby, 2001). Some doctors do talk to their older patients about sexuality. In fact, some prescribe sexual education classes as a form of sex therapy. In a study by White and Catania (1982), the experimental groups (ages 60 to 83 years) showed significant increases in sexually permissive permissive adj. 1) referring to any act which is allowed by court order, legal procedure, or agreement. 2) tolerant or allowing of others' behavior, suggesting contrary to others' standards.


PERMISSIVE.
 attitudes after attending educational classes that included information on physical, social, and psychological aspects of sexuality and aging.

Aging women and men with inadequate knowledge of sex and sexuality may be vulnerable to faulty expectations and concerns about performance (White & Catania, 1982). There is a widespread assumption that vaginal intercourse is the only "real sex" (Blank, 2000); therefore, if the person, by reason of dysfunction or disease, is unable to have intercourse Verb 1. have intercourse - have sexual intercourse with; "This student sleeps with everyone in her dorm"; "Adam knew Eve"; "Were you ever intimate with this man?" , he or she may lose interest in sex. To meet the challenge of maintaining sexual activity during the aging process, couples have to make love with what they have. Hands and mouths are reliable; penises and vaginas are not. However, it is common for couples to end their sexual lives together because one or both partners believe that an erection is necessary to "get the job done" or see non-coital sex non-coital sex Sexology Any form of safe sexual activity that does not include vaginal penetration–eg, masturbation, frottage. See Safe sex practices.  as immoral or perverse (Blank; Cogen & Steinman, 1990; Levine, 1998).

Relational Influences

The presence or absence of a sexual partner is an extremely important factor in understanding differing levels of sexual desire and activity among aging women and men. Many people consider sexual intimacy to be only or most appropriate in marriage (Levy, 1994). Many older persons are not married or no longer live with a spouse. There are 26.6 million men and 33 million women over 55; only 74% of the men and 50% of the women are married and living with a spouse (Smith, 2003). This gap in the living situation of men and women increases with age.

Marriage is the most common social arrangement within which normative sexual activity takes place (Rossi, 1994; Schiavi, 1999). Thus, the death of a spouse usually leads to the cessation of sexual behavior (Rossi). Women tend to marry older men, which is a main reason that women are more likely to be widowed. Women outlive out·live  
tr.v. out·lived, out·liv·ing, out·lives
1. To live longer than: She outlived her son.

2.
 their mates, often by a decade or more (Sanford, 1998). As a result, 40% of older women live alone, compared with 16% of older men (AARP AARP, a nonprofit, nonpartisan national organization dedicated to "enriching the experience of aging"; membership is open to people age 50 or older. Founded in 1958 by Ethel Percy Andrus as American Association of Retired Persons, AARP now has over 30 million , 1997).

According to Masters et al. (1994), many older women who are without a sexual partner for an extended amount of time drift into a state of sexual disinterest dis·in·ter·est  
n.
1. Freedom from selfish bias or self-interest; impartiality.

2. Lack of interest; indifference.

tr.v.
To divest of interest.

Noun 1.
. "This is often a way of coping psychologically with their circumstances: by turning off their interest in something they don't have and see little likelihood of getting, they prevent themselves from becoming frustrated frus·trate  
tr.v. frus·trat·ed, frus·trat·ing, frus·trates
1.
a. To prevent from accomplishing a purpose or fulfilling a desire; thwart:
 or depressed" (Masters et al., p. 479).

For those who do have a sexual partner, monotony in sexual relationships, such as predictability of sexual activities and over-familiarity with the partner, may also contribute to a loss in sexual desire (Levy, 1994). As the length of the marital relationship Noun 1. marital relationship - the relationship between wife and husband
marital bed

family relationship, kinship, relationship - (anthropology) relatedness or connection by blood or marriage or adoption
 increases, habituation habituation

Reduction of an animal's behavioral response to a stimulus, as a result of a lack of reinforcement during continual exposure to the stimulus. Habituation is usually considered a form of learning in which behaviours not needed are eliminated.
 to sex with one's partner increases and frequency of sexual activities The frequency of sexual activity of humans is determined by several parameters, and varies greatly from person to person, and within a person's lifetime.

The frequency of sexual intercourse might range from zero (sexual abstinence) for some to 15 or 20 times a week.
 declines. Norms that limit sexual activities to marriage, combined with the habituation effect, may cause early diminution of sexual desire (Call, Sprecher, & Schwartz, 1995). One study on the relationship between women's menopausal status and sexual desire found that women who were of menopausal status had lower sexual desire compared to when they were in their 40s (No women were on hormone replacement therapy Hormone Replacement Therapy Definition

Hormone replacement therapy (HRT) is the use of synthetic or natural female hormones to make up for the decline or lack of natural hormones produced in a woman's body.
 or had a surgical menopause surgical menopause Gynecology Cessation of native estrogenic activity after bilateral oophorectomy in a premenopausal woman , and all had a partner.) (Avis, Stellato, Crawford, Johannes, & Longcope, 2000). Past research also found that married women who reported lower levels of desire were more likely to agree that interest in sex declines with age, and were more likely to say that they were less aroused now than when they were in their 40s (Avis et al., 2000).

On the other hand, the results of the Duke studies (Pfeiffer, Verwoerdt, & Davis, 1972; Verwoerdt, Pfeiffer, & Wang, 1969) found that marital status marital status,
n the legal standing of a person in regard to his or her marriage state.
 had little effect on sexual interest. In data from the Consumers Union survey on sex and aging involving 4,246 men and women over the age of 50, the majority of happily married women and men rated sex as important in marriage, while 54 percent of unhappily married wives rated sex as being "of little importance" (Brecher & Editors, 1984). These results suggest that satisfaction with the relationship may be an important influence on desire; results such as those reported by Avis may reflect marital unhappiness rather than loss of desire.

Sex is important for many unmarried older adults, too (Masters et al., 1994). Some fulfill their desire for sexual intimacy within a long-term committed relationship A committed relationship is an interpersonal relationship based upon a mutually agreed upon commitment to one another involving exclusivity, honesty, or some other agreed upon behavior. . We have little information about the sexual activity of older persons who live alone.

Household income is potentially an important social factor. Other things equal, an individual or couple with a higher income has access to health care and activities that may maintain general physical and mental health. Better health, in turn, is likely to be associated with sexual desire. The problem of decreased to almost nonexistent non·ex·is·tence  
n.
1. The condition of not existing.

2. Something that does not exist.



non
 sexual desire is significantly more common in women of lower social class (Garde & Lunde, 1980; Hawton, Gath, & Day, 1994; Osborn et al., 1988). This may be due to a lack of sex education, to either age or social class, or to negative attitudes held by the women and their partners.

METHOD

Study Population and Procedure

The American Association American Association refers to one of the following professional baseball leagues:
  • American Association (19th century), active from 1882 to 1891.
  • American Association (20th century), active from 1902 to 1962 and 1969 to 1997.
 of Retired Persons' (AARP) Modern Maturity Sexuality Survey was a mail survey completed by 1,384 women and men ages 45 and older. The survey was designed by the editorial staff of Modern Maturity and the AARP Research Group, with the assistance of Dr. John McKinlay John McKinlay (26 August 1819 – 31 December 1872), was an explorer of Australia. Early life
McKinlay was born at Sandbank on the River Clyde, Scotland, third son of Dugald McKinlay. He emigrated to Sydney when 17 years of age.
 of the New England New England, name applied to the region comprising six states of the NE United States—Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, and Connecticut. The region is thought to have been so named by Capt.  Research Institute and NFO NFO Info File (file type extension)
NFO New Fund Offer
NFO National Farmers Organization
NFO Naval Flight Officer (US Navy)
NFO National Family Opinion
 Research. A commercial data collection agency, NFO maintains a consumer panel of 565,000 individuals who are broadly representative of the population of the United States and who have agreed to participate in surveys. From this consumer panel, NFO drew a representative sample of 3,450 persons ages 45 and older. This sample was balanced to nationally representative quotas using the Current Population Survey.

Of the sample, 2,206 eligible persons were contacted by telephone and informed about the survey. Potential respondents were told that "the purpose of the study is to better understand the role of sexuality in the lives of mid-life and older persons." They were also given the usual assurances of confidentiality. On March 8, 1999, surveys were mailed to the 1,709 men and women who agreed to participate (77% of those contacted). Each questionnaire was sent with a $1 cash incentive to encourage completion and return of the questionnaire. By March 22, 1999, 1,384 participants had returned completed surveys (81% of those who were sent the survey, 62% of those contacted). The final data were weighted to reflect Census estimates for age and gender of the over-45 population. The margin of potential sampling error for the final sample (745 women and 639 men) is +/- 2.6%.

The following research questions were addressed in this study:

1. What influences are related to low sexual desire in older women and men?

2. What biopsychosocial factors are the primary influences related to decreasing sexual desire?

Measure

Level of sexual desire. Level of sexual desire was measured by two questions: "How frequently do you feel sexual desire? This feeling includes wanting to have sexual experiences, planning to have sex, and feeling frustrated due to lack of sex," and "How frequently do you have sexual thoughts, fantasies, or erotic dreams?" Each question was answered using an 8-point scale from 1 (more than once a day) to 8 (not at all). We created an index of desire by computing the average of the numeric responses to these two items. If the participant answered neither item, no score was computed. The reliability (alpha) of this scale was .86 for men and .87 for women.

Illnesses. Illnesses were measured by a list of 8 illnesses prefaced by the request to "Indicate which of the[se] conditions you have been diagnosed with." Four of the illnesses listed were chosen by 10% or more of the sample. Diabetes, high blood pressure, and arthritis met the 10% criterion for both women and men. The fourth illness included for women was depression, and the fourth illness included for men was an enlarged prostate Enlarged Prostate Definition

A non-cancerous condition that affects many men past 50 years of age, enlarged prostate makes urinating more difficult by narrowing the urethra, a tube running from the bladder through the prostate gland.
. We constructed a summary measure of the number of these four illnesses reported by each respondent. Also, each person who reported being diagnosed with an illness was asked whether she or he was currently receiving treatment for that illness; answers were recorded as (Y/N Y/N Yes/No ).

Medications. Medications were selected from a list comprised of 11 items. The questionnaire asked the respondent, "In the past two weeks, have you taken any of the following prescription drugs?" Respondent reports (Y/N) of taking the medication were correlated with desire; four medications were correlated significantly (p < .01) with desire for women, and 2 medications were correlated significantly for men.

Attitudes toward sex. Attitudes toward sex were measured with a series of nine Likert scale Likert scale A subjective scoring system that allows a person being surveyed to quantify likes and preferences on a 5-point scale, with 1 being the least important, relevant, interesting, most ho-hum, or other, and 5 being most excellent, yeehah important, etc  attitude items. The items are listed on Table 1. Potential responses for each item ranged from 1 (strongly agree) to 5 (strongly disagree). We conducted factor analyses of the responses to these nine items separately for women and for men. The results are shown in Table 1. In each analysis, three factors attained eigenvalues eigenvalues

statistical term meaning latent root.
 greater than one, but the third had no items that attained loadings of .50 or greater. Looking at the remaining factors, for both men and women, factor 1 includes items f, g, and h, which assess the respondent's attitudes about sex for the self; the reliability (alpha) of the scale for women is .833, and for men, .829. Item e attained a loading of .51 in the analysis for women, but only .30 in the analysis for men; it was not included. We used the three items to create a mean score for each participant, provided that the participant had answered at least two of the three items. Factor 2 includes items a, b, and c, which assess attitudes toward sex in relationships; the reliability (alpha) of the scale is .748 for women and .79 for men. We used the three items to create a mean score for each participant, provided that the participant had answered at least two of the three items. The two factors explained 44% of the variance in the analysis for men and 48% in the analysis for women.

Household income. Household income was reported by each respondent. The resulting distributions for men and women were divided into quartiles. The distributions of reported income differed for women and men. For women the household income categories are as follows: 1 = $7,500-$19,999; 2 = $20,000-$37,499; 3 = $37,500-$74,999; 4 = $75,000-$175,000+. For men the household income categories are as follows: 1 = $7,500-$14,999; 2 = $15,000-$29,999; 3 = $30,000-$59,999; 4 = $60,000-$175,000+.

RESULTS

Demographic Characteristics

Table 2 displays basic demographic characteristics of the sample. Men are more likely to be employed than women. The sample is primarily European-American. About 56% of the men and 64% of the women are married and living with a partner. In order to assess the representativeness of the sample, we compared the age and relationship status distribution for the (weighted) sample with that of the United States population ages 45 and older (United States Bureau of the Census, 2002). Two differences were noted. Men ages 45 to 54 in the sample were less likely to be married and more likely to be widowed, as were women over 75. Differences in the other cells were generally less than 4%.

Sexual Desire

Responses to the two items used to measure sexual desire were combined to form an index as described earlier. The average desire score for men was 2.82 (SD = 1.53, n = 627), and the average for women was 3.0 (SD = 1.46, n = 709), with a score of 1 indicating high desire. Note that men on average report slightly higher levels of desire than women.

Age

The results show that there is a strong positive relationship between increasing age and low levels of sexual desire for both women and men. To allow for cross-gender comparison, we divided the distributions of desire scores for men and for women into groups. For women, the "low desire group" represents 22.9% of women; all have a desire score of 8. The "high desire group" for women represents 22.2% of women; their desire scores range from 1 to 3.5, inclusive. For men, the "low desire group" represents 21% of men; their desire scores range from 6.0 to 8.0, inclusive. The "high desire group" represents 26.9% of men; their desire scores range from 1.0 to 1.5, inclusive. The relationships between age and desire for men and for women are displayed in Table 3. The percentage of men and women attaining low scores on desire increases from less than 5 percent at ages 45 to 49, to 59 percent or more at ages 80 to 84. The correlation between sexual desire (index score) and age (continuous) is .51 for women (p < .000, n = 704), and .52 for men (p < .000, n = 625).

Illness

High blood pressure is significantly related to low levels of sexual desire for both women and men. Nearly the majority of women and men who have been diagnosed with high blood pressure have desire scores in the lowest groups. As noted earlier, each person reporting an illness was asked whether he or she was currently being treated. We can measure the effect of treatment by comparing the percentage of those diagnosed with high blood pressure who attain low scores on desire with those who were diagnosed and treated who attain low scores. There was a slight decrease in the percentage of women and men with a very low level of desire who have been diagnosed and treated. The correlation between hypertension and desire was small but significant: .12 among men (p < .01) and .15 among women (p < .01).

Among men, we found that diagnosis of an enlarged prostate was related to low levels of desire (r = .14, p < .01). Again, the correlation is small but significant. Comparison of desire score distributions before and after treatment showed little change.

Diagnoses of diabetes, arthritis, and depression were not significantly related to levels of sexual desire for women. A diagnosis of diabetes was not significantly related to levels of sexual desire for men.

Medications

Regular use of four medications is significantly related to low levels of sexual desire in women. These prescription medications include anticoagulants Anticoagulants
Drugs that suppress, delay, or prevent blood clots. Anticoagulants are used to treat embolisms.

Mentioned in: Embolism, Heart Valve Replacement
, cardiovascular medications, medications to control elevated cholesterol, and medications for hypertension. The correlations are small, ranging from .13 to .19. Among men, only reports of taking anticoagulants and medications for hypertension are significantly related to low levels of sexual desire; the correlations are .17 and. 14, respectively.

Attitudes Toward Sex

The correlations of the two attitude indices with sexual desire are shown in Tables 4 and 5, for women and men. For women, scores on the index of attitudes about sex in relationships (items a, b, and c) are significantly correlated with desire; women who strongly agree that sexual activity is important to their quality of life and their relationships attain high desire index scores (r = .19, p < .000.), reflecting low desire. With regard to the second index, women who strongly agree that they do not enjoy sex and that they would be happy never having sex again have lower desire index scores (r = -.57, p < .000.), reflecting high desire. The results are similar for men, with correlations of .31 and -.47, respectively. These correlations are substantial and significant for both men and women.

We can gain insight into the interrelations of attitudes and desire by looking at the endorsement of the attitude items by men and women with the highest and lowest scores on desire. Sixty percent of women who have desire scores in the lowest group (23% of the sample) disagree or strongly disagree that "sexual activity is important to my overall quality of life," whereas less than 2% of these women agree or strongly agree with this statement. Seventy percent of women who score in the highest group on desire (23% of the sample) agree or strongly agree that "sexual activity is important to my overall quality of life," whereas a little more than 7% of these women disagree or strongly disagree with Verb 1. disagree with - not be very easily digestible; "Spicy food disagrees with some people"
hurt - give trouble or pain to; "This exercise will hurt your back"
 this statement.

This trend is similar for men. Most men who score in the lowest group of desire (21% of the sample) disagree that "sexual activity is important to my overall quality of life," and most men who score in the highest group of desire (27% of the sample) are more likely to agree with this statement.

Nearly 98% of women with scores in the highest group of desire disagree or strongly disagree that "sex is only for younger people." Surprisingly, 42% of women who score in the lowest group of desire disagree or strongly disagree that "sex is only for younger people." Nearly 97% of men who score in the highest group of desire disagree or strongly disagree that "sex is only for younger people." More than 75% of the men who score in the lowest group of sexual desire also disagree or strongly disagree that "sex is only for younger people."

Partner Presence / Marital Status

The survey included a categorical measure of marital status and a question asking whether the respondent had a sexual partner. All of the married persons answered "yes" to the latter, as did an additional 1.7 percent of women and 3.5 percent of men. We used the sexual partner measure, recognizing that in most cases the partner is a spouse. The data presented in Table 6 show that there is a marked difference in the percentage of aging men and women who have a sexual partner.

For women, having a sexual partner is highly related to the level of sexual desire. (See Table 4.) The correlation is -.41 (p < .01), indicating that women who have a partner attain lower desire scores, reflecting higher levels of desire. For men, the correlation is much smaller, -.19 (p < .01). Thus, the relationship between desire and having a partner is much stronger for women.

The impact of a partner on one's sexual desire depends in part on the characteristics of the partner. Each participant who reported having a partner was asked whether the partner had any physical or emotional limitations "which restrict your sexual activity." We constructed an index of both presence and limitations (Y/N) of partner; a score of 1 indicates a partner with no limitations, a score of 2 indicates presence of a partner with limitations, and 3 indicates no partner. The average desire scores for women are 5.19, 5.72, and 7.06, respectively (univariate ANOVA anova

see analysis of variance.

ANOVA Analysis of variance, see there
, F = 91.67, p < .000, df = 2). Pairwise comparisons indicate that each is significantly different from the other two (p < .004). The average scores for men are 3.78, 3.84, and 4.85, respectively (ANOVA, F = 14.02, p < .000, df = 2). Pairwise comparisons indicate that the score for men with no partner is significantly different from the means of the other two groups (p < .001). The relationship is much stronger for women (partial [Eta.sup.2] = .189) than for men (partial [Eta.sup.2] = .045).

Household Income

The data show that household income is negatively correlated with sexual desire scores both in women (r = -.35, p < .000) and in men (r = -.28, p < .000). Thus, older persons with greater income experience higher levels of desire.

In summary, the bivariate bi·var·i·ate  
adj.
Mathematics Having two variables: bivariate binomial distribution.

Adj. 1.
 results indicate that among women, age, high blood pressure, prescription medications, negative attitudes toward sexuality, absence of a sexual partner, and low household income are correlated with low sexual desire. The substantial correlates (> .40) are age, attitudes, and presence of a partner. Thus, medical/biological, psychological and relational factors are related to desire. We conducted regression analyses with sexual desire as the outcome variable and all of the variables listed above as predictors. We used two-stage models, entering the biomedical bi·o·med·i·cal
adj.
1. Of or relating to biomedicine.

2. Of, relating to, or involving biological, medical, and physical sciences.
 and relational factors in step 1 and entering attitudes in step 2. We noted in the Introduction our view that biological factors are necessary but not sufficient explanations of desire. The biopsychosocial model The biopsychosocial model is a general model or approach that posits that biological, psychological (which entails thoughts, emotions, and behaviors) ,and social factors (abbreviated "BPS") all play a significant role in human functioning in the context of disease or illness.  suggests that psychological and social factors will explain variance beyond that explained by biology. We are especially interested in attitudes, which are largely socially constructed and reflect the influence of culture. The results for women are displayed in Table 7.

Among women, the following predictors were significantly (p <.000) associated with desire in step 1: presence of a sexual partner, education, age, number of medications taken regularly, and number of diagnosed illnesses. The adjusted [R.sup.2] for Model 1 is .348. When the two attitude indices are added, the variables that were significant in step 1 remain significant, with the exception of education, and the attitude indices are also highly significant (p < .000). The results suggest that attitudes mediate the effect of education. The adjusted [R.sup.2] for Model 2 is .585, indicating that inclusion of attitudes substantially increases the variance explained. The change in [R.sup.2] is highly significant (F = 189.74, p < .00). The largest coefficients are associated with attitudes toward sex for self, age, attitudes toward sex in relationships, and having a sexual partner. Thus, attitudes are substantially related to sexual desire in women, and there is an effect of age that is not explained by illnesses or medications taken regularly. Having a partner is also associated with having greater desire.

Among men, the bivariate results indicate that age, high blood pressure, enlarged prostate, anticoagulants and medications for hypertension, presence of a sexual partner, negative attitudes toward sexual activity, and income were all negatively correlated with reported sexual desire. The substantial correlates (> .40) are age and attitudes. In step 1 of the regression analysis In statistics, a mathematical method of modeling the relationships among three or more variables. It is used to predict the value of one variable given the values of the others. For example, a model might estimate sales based on age and gender. , only two variables were significantly (p < .000) associated with desire: education and age. Older men and men with less education reported lower desire. Presence of a sexual partner, number of medications, and number of diagnosed illnesses were not associated with desire. The adjusted [R.sup.2] is .313. In Model 2, both attitude indices are associated with desire (p <.000), and the adjusted [R.sup.2] increases to .478. The change in [R.sup.2] is significant (F = 94.79, p <.00); results are displayed in Table 8. Thus, attitudes are also substantially related to sexual desire in men, and there is an effect of age that is not explained by illnesses or medications taken regularly. However, having a partner is not associated with having greater desire among men.

DISCUSSION

This study explored biopsychosocial factors, including age, illness, medication use, attitudes, marital status, presence or absence of a sexual partner, and household income, in relation to sexual desire in a representative sample of women (n = 745) and men (n = 639) over the age of 45.

Age

The results indicate that age is significantly associated with desire, net of the effect of other variables studied. The relationship is stronger among men ([beta] = .35) than among women ([beta] = .26). These results are consistent with previous findings (Hallstrom & Samuelsson, 1990; Kontula, 2002; Levine, 1998; Maurice, 1999; McKinlay & Feldman, 1994; Osborn et al., 1988; Schiavi, 1999). Sexual desire decreases as women and men age. However, sexual desire does not decrease as fast as popular belief dictates. In our study, it is not until age 75 or older that the majority of women and almost a majority of men report a low level of sexual desire.

Illnesses and Medications

Although being diagnosed with some illnesses and reports of taking medications to lower cholesterol were negatively correlated with desire, these predictors were not significant in the regression analyses for men. These predictors were significant in the analyses for women, although the standardized coefficients are not large. Women who report taking a greater variety of medications in the two weeks prior to the survey have lower desire scores ([beta] = .11). Women who report having been diagnosed with more illnesses also have lower desire scores ([beta] = .12). Note that relatively few participants report taking those medications thought to affect desire. Although these drugs, such as drugs for high blood pressure, may substantially affect those who take them, their use is not widespread. Thus, biological factors have a modest effect on female sexual desire.

Attitudes Toward Sex

Negative attitudes toward sex are correlated with low sexual desire. In the regression analyses, rating sex as important to one's self was associated positively and substantially with desire (for men, [beta] = -.27, for women [beta] = -.44), controlling for age. Rating sex as important to one's relationships was also a significant predictor of desire (for men, [beta] = .25; for women [beta] = .19) The effects of attitudes are larger than the effects of any other predictor included in our analyses except age.

Education

Education was significantly related to desire for both men and women in Step 1 of the regression. When attitudes are added in Step 2, it is no longer significantly related for women and the [beta] in the male analysis is smaller. We believe that attitudes mediate much of the relationship between education and desire. Greater education may undermine the negative stereotypes of sexual expression by older persons.

Presence of Partner

Even though sexual desire remains intact in healthy older persons, they need a partner, especially an interested partner, in order to continue partnered sexual activities, and for some, to continue having sexual desire. The absence of a partner or an interested partner can be an obstacle for many. In our study, having a partner is a significant predictor of desire among women but not among men. More than 78% of the women who have a low level of sexual desire are without a sexual partner, and more than 83% of the women with a high level of sexual desire have a partner. Also, 84% of the men with a high level of desire have a partner. What is surprising is that the majority of men with a low level of desire have a partner. Also, whether the partner has limitations that affect the respondent's sexual activity is related to reports of desire by women but not by men. These results suggest that a woman's desire is attuned at·tune  
tr.v. at·tuned, at·tun·ing, at·tunes
1. To bring into a harmonious or responsive relationship: an industry that is not attuned to market demands.

2.
 to her relationship context, but a man's desire is not.

These results provide some order to the scattered findings of past research. Across this sample of persons 45 and older, the principal influences on sexual desire are age and the importance of sex to the person. For women, having a partner, taking medications and being diagnosed with illnesses also play a modest role. These results suggest that stereotypes of older persons as not interested in sexual intimacy are wrong. They also suggest that negative attitudes about sexual activity among older persons need to be challenged so that future cohorts are not influenced by such attitudes. It is particularly important that health care professionals not convey negative attitudes to older patients. Finally, we should scrutinize scru·ti·nize  
tr.v. scru·ti·nized, scru·ti·niz·ing, scru·ti·niz·es
To examine or observe with great care; inspect critically.



scru
 economic and residential arrangements for the elderly and structure them to facilitate rather than hinder intimate relationships.

More generally, given the set of questions asked, the results provide little support for an exclusively medical model of sexuality among the aging. In our results, the most significant influences are psychological (attitudes) and relational (the presence of a partner). These results are based on a large sample of men and women ages 45 and older. Although the completion rate of 62% of those contacted may be a limitation, the age and marital status of those who returned questionnaires closely parallel the national population.

LIMITATIONS/FURTHER RESEARCH

Our literature review identified several influences on the sexual desire and functioning of older persons. The one set of influences discussed for which we do not have measures is hormones. Ideally, future research should not only collect comprehensive survey data of the type reported here, but also measure levels of estrogen and testosterone on at least a subsample sub·sam·ple  
n.
A sample drawn from a larger sample.

tr.v. sub·sam·pled, sub·sam·pling, sub·sam·ples
To take a subsample from (a larger sample).
 of participants.

Another area for further research is the study of preexisting pre·ex·ist or pre-ex·ist  
v. pre·ex·ist·ed, pre·ex·ist·ing, pre·ex·ists

v.tr.
To exist before (something); precede: Dinosaurs preexisted humans.

v.intr.
 sexual difficulties and earlier sexual experiences. Understanding a subject's sexual history will give researchers a stronger basis for predicting current sexual functioning, which will help to weave a more complete picture.

An important limitation is the racial homogeneity Homogeneity

The degree to which items are similar.
 of the sample. Our data do not include enough non-Caucasian participants to investigate links between race and sexual desire. Even though race is usually strongly correlated with socio-economic and education status, we believe that it is low socio-economic and education status, and not race, that may play a culpable Blameworthy; involving the commission of a fault or the breach of a duty imposed by law.

Culpability generally implies that an act performed is wrong but does not involve any evil intent by the wrongdoer.
 role in low sexual desire. Within different races exist different cultures. Cultures provide different ideologies, definitions, and attitudes for framing sexual functioning and experiences. This is also an area of research that needs to be expanded.

A potentially important limitation is the fact that measures of diagnosed illness and of medications taken are self-report. Bias due to failure to remember may be a factor, particularly among the elderly. In this study, such bias should be less influential on reports of medication taken, since the questions asked about medications taken in the two weeks prior to the survey. Research linking respondents' self-reports to their pharmaceutical records in relation to measures of sexual functioning would be a desirable, albeit difficult, next step.

As important as quantitative research Quantitative research

Use of advanced econometric and mathematical valuation models to identify the firms with the best possible prospectives. Antithesis of qualitative research.
 is, it offers only limited insights into the complex world of psychological, social, and cultural meanings of sexual functioning. Qualitative research Qualitative research

Traditional analysis of firm-specific prospects for future earnings. It may be based on data collected by the analysts, there is no formal quantitative framework used to generate projections.
 methods are necessary to complement quantitative methods in order to learn how older people think about sexuality. In addition, qualitative research needs to be done on the differences and similarities of sexual desire in men and women. Several of our findings suggest that there are important differences in sexual desire between women and men.
Table 1. Factor Analysis of Sexual Attitude Items

Item                                              Gender

                                            Men            Women
                                         (n = 618)       (n = 683)

                                        1       2       1       2

a. Sexual activity is important
   to my overall quality of life.     -.267    .811   -.481    .588

b. Sexual activity is a critical
   part of a good relationship.       -.104    .898   -.266    .803

c. Sexual activity is a duty to
   one's spouse/partner.               .068    .560   -.137    .464

d. Sexual activity is a
   pleasurable, but not necessary,
   part of a good relationship.        .218   -.004    .121    .000

e. Sex becomes less important to
   people as they age.                 .361    .025    .506   -.072

f. I do not particularly enjoy sex.    .789   -.116    .867   -.120

g. I would be quite happy never
   having sex again.                   .845   -.174    .857   -.217

h. Sex is only for younger people.     .693   -.108    .695   -.156

i. People should not have a
   sexual relationship if they are
   not married.                        .276   -.029    .287    .012

Note. Analyses using SPSS 9.0, maximum likelihood extraction,
verimax rotation, pairwise deletion.

Table 2. Demographic Characteristics of the Sample

                                % Women      % Men
                                (n = 740)   (n = 636)

Employment Status
  Full time                       28.4        45.7
  Part time                       13.6         8.4
  Retired                         40.0        41.7
  Not employed                    18.0         4.1

Race
  White                           87.4        88.9
  Black                           10.9         8.9
  Asian                            1.2         1.9

Relationship Status
  Married/living with partner     64.4        56.4
  Separated                        1.7         0.7
  Divorced                        11.5         9.8
  Widowed                         16.1        22.1
  Never married                    3.7         8.0

Table 3. The Relationship Between Age and Sexual
Desire by Gender

              Women (n = 704)    Men (n = 620)

               Low      High     Low      High
Age           desire   desire   desire   desire

45-49 years     2.60    43.80     3.10    33.33
50-54 years     8.80    32.46     3.77    20.75
55-59 years    11.36    25.00    11.00    26.00
60-64 years    23.26    13.85    18.29     4.89
65-69 years    26.92    10.26    21.13     5.63
70-74 years    46.05     7.90    38.00     2.00
75-79 years    49.12     5.26    27.08     2.08
80-84 years    85.29     2.94    50.00     3.85
85-89 years    73.30     0.00    50.00     0.00
90-94 years   100.00     0.00     --       --

Note. Values expressed as percents of total. For women, low
desire = the bottom 22.9% of the desire distribution and high
desire = the top 22.2% of the distribution. For men, low
desire = the bottom 20.7% of the distribution and high
desire = the top 26.3% of the distribution.

Table 4. Correlations between Health Measures, Sexual Attitudes,
and Sexual Desire, Women (N = 745)

                                     Medications

                       Thin                             Blood
                       Blood     Heart    Cholesterol   Pressure

Medications
  Heart                .45 **
  Cholesterol          .24 **    .22 **
  Blood Pressure       .22 **    .22 **      .28 **
  Nervous Condition    .04       .03         .02         .04

Partner               -.12 **    .13 **      .04         .17 **

Illnesses
  Diabetes             .18 **    .15 **      .17 **      .20 **
  Blood Pressure       .20 **    .18 **      .27 **      .91 **
  Arthritis            .10 **    .11 **      .08         .15 **
  Depression          -.01      -.03        -.05        -.05

Desire                 .16 **    .19 **      .13 **      .15 **

Attitude subscales
  Relationship         .01       .02         .01        -.02
  Self                -.12 **   -.12 **     -.09 *      -.12 **

                      Medications                 Illnesses

                        Nervous                           Blood
                       Condition    Partner   Diabetes    Pressure

Medications
  Heart
  Cholesterol
  Blood Pressure
  Nervous Condition

Partner                 -.01

Illnesses
  Diabetes               .01        -.09 *
  Blood Pressure         .03        -.19 **    .21 **
  Arthritis              .14 **     -.14 **    .11 **      .17 **
  Depression             .70 **     -.03       .02         .04

Desire                   .04        -.41 **    .02         .14 **

Attitude subscales
  Relationship           .00         .15 **    .04        -.02
  Self                  -.03         .25 **    .00        -.13 **

                                                           Attitude
                            Illnesses                     subscales

                      Arthritis   Depression   Desire    Relationship

Medications
  Heart
  Cholesterol
  Blood Pressure
  Nervous Condition

Partner

Illnesses
  Diabetes
  Blood Pressure
  Arthritis
  Depression            .18 **

Desire                  .05          -.01

Attitude subscales
  Relationship         -.03          -.01       .19 **
  Self                 -.06          -.03      -.57 **        .06

* Correlation is significant at the 0.05 level (2-tailed).

** Correlation is significant at the 0.01 level (2-tailed).

Table 5. Correlations between Health Measures, Sexual Attitudes,
and Sexual Desire, Men (N = 639)

                                     Medications

                       Thin                              Blood
                       Blood     Heart    Cholesterol   Pressure

Medications
  Heart                .42 **
  Cholesterol          .37 **    .27 **
  Blood Pressure       .34 **    .35 **      .34 **
  Nervous Condition    .15 **    .18 **      .11 **      .10 *

Partner               -.03      -.01         .05         .07

Illnesses
  Diabetes             .10 *     .18 **      .21 **      .14 **
  Blood Pressure       .28 **    .30 **      .31 **      .86 **
  Arthritis            .21 **    .28 **      .08         .15 **
  Prostate             .24**     .20 **      .10 *       .08 *

Desire                 .17 **    .05         .04         .14 **

Altitude subscales
  Relationship         .04      -.01         .00        -.04
  Self                -.10 *    -.04        -.04        -.12 **

                      Medications                 Illnesses

                        Nervous                           Blood
                       Condition    Partner   Diabetes   Pressure

Medications
  Heart
  Cholesterol
  Blood Pressure
  Nervous Condition

Partner                 -.00

Illnesses
  Diabetes              -.01        -.06
  Blood Pressure         .09 *       .10 *     .19 **
  Arthritis              .19 **     -.04       .08 *      .16 **
  Prostate               .04        -.09 *     .04        .08 *

Desire                   .02        -.19 **    .04        .12 **

Altitude subscales
  Relationship           .01        -.17 **    .00        .00
  Self                  -.05         .21 **   -.05       -.10 **

                                                         Attitude
                           Illnesses                    subscales

                      Arthritis   Prostate   Desire    Relationship

Medications
  Heart
  Cholesterol
  Blood Pressure
  Nervous Condition

Partner

Illnesses
  Diabetes
  Blood Pressure
  Arthritis
  Prostate              .12 **

Desire                  .11 **    -.14 **

Altitude subscales
  Relationship          .01        .03        .31 **
  Self                 -.11 **    -.07       -.47 **       -.06

* Correlation is significant at the 0.05 level (2-tailed).

** Correlation is significant at the 0.01 level (2-tailed).

Table 6. Presence of a Sexual Partner by Age and Gender

Age           % Women (n = 737)   % Men (n = 635)

45-49 years         83.12              83.46
50-54 years         76.72              82.08
55-59 years         71.13              88.24
60-64 years         65.91              87.80
65-69 years         50.62              73.61
70-74 years         40.48              74.51
75-79 years         27.12              79.25
80-84 years         21.05              44.83
85-89 years          0.00              57.14
90-94 years         25.00               --

Table 7. Regression, Lack of Sexual Desire, Women
(n = 673)

Model   Variables                       [beta]    p

  1     Has a sexual partner             -.26    .00
        Surgically postmenopausal         .02    .64
        Household income                 -.04    .18
        Educational attainment           -.13    .00
        Age                               .35    .00
        Number of medications taken       .17    .00
        Number of illnesses diagnosed    -.15    .00

  2     Has a sexual partner             -.13    .00
        Surgically menopausal             .05    .05
        Household income                  .04    .10
        Educational attainment           -.04    .11
        Age                               .25    .00
        Number of medications taken       .10    .00
        Number of illnesses diagnosed    -.10    .00
        Attitude: Self                   -.44    .00
        Attitude: Relationship            .19    .00

Note. [R.sup.2] Model 1 = .35; [R.sup.2] Model 2 = .59.
The change is significant, p < .001.

Table 8. Regression, Lack of Sexual Desire, Men (n = 609)

Model   Variables                       [beta]    p

  1     Has a sexual partner             -.07    .05
        Household income                 -.05    .146
        Educational attainment           -.20    .00
        Age                               .47    .00
        Number of medications taken      -.02    .63
        Number of illnesses diagnosed    -.01    .86

  2     Has a sexual partner              .03    .34
        Household income                 -.04    .18
        Educational attainment          -.152    .00
        Age                              .356    .00
        Number of medications taken      -.04    .296
        Number of illnesses diagnosed    .013    .74
        Attitude: Self                   -.27    .00
        Attitude: Relationship            .25    .00

Note. [R.sup.2] Model 1 = .32; [R.sup.2] Model 2 = .48.
The change is significant, p < .001.


Note: The editorial processing of this manuscript was carried out by former Associate Editor F. Scott Christopher.

We gratefully acknowledge the American Association of Retired Persons American Association of Retired Persons: see AARP.  for giving us access to the data from AARP / Modern Maturity Sexuality Survey, 1999, conducted for AARP by NFO Research, Incorporated. We also acknowledge Sara Moorman with thanks for additional data analyses and the careful editing of a semi-final draft.

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Manuscript accepted September 2, 2004

John D. DeLamater

University of Wisconsin-Madison “University of Wisconsin” redirects here. For other uses, see University of Wisconsin (disambiguation).
A public, land-grant institution, UW-Madison offers a wide spectrum of liberal arts studies, professional programs, and student activities.


Morgan Sill

University of Michigan (body, education) University of Michigan - A large cosmopolitan university in the Midwest USA. Over 50000 students are enrolled at the University of Michigan's three campuses. The students come from 50 states and over 100 foreign countries.

Address correspondence to Dr. John DeLamater, Department of Sociology Noun 1. department of sociology - the academic department responsible for teaching and research in sociology
sociology department

academic department - a division of a school that is responsible for a given subject
, University of Wisconsin, 1180 Observatory Drive, Madison, WI 53706; e-mail: delamate@ssc.wisc.edu.
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