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This chapter examines the topic of sexuality in older adults: sexual behaviours and attitudes about ageing; types of sexual dysfunction and their prevalence; physiology and pathophysiology of the male and female sexual response; medical conditions affecting sexuality; endocrinological, psychiatric and psychosocial factors; female and male sexual dysfunctions and disorders; assessment and treatment considerations.
In this new millennium, the topic of sexuality in older adults has finally come of age. Whereas conversations about the sexual behaviours of mature men and women were once whispered and private, it is now acceptable openly to discuss these matters in magazines and newspapers, on television, and even at dinner parties. The psychological and physiological impact of ageing on sexuality is particularly timely for a variety of reasons. The first reason has been labelled the ‘Viagratization of America’, a phenomenon that has expanded worldwide (Kingsberg, 2002). The development of phosphodiesterase type-5 (PDE-5) inhibitors, beginning with Viagra (sildenafil) in 1998, sparked a renewed interest in exploring the sexual activities of older people. Once men had a non-invasive method for treating the inevitable sexual effects of ageing, the topic took the media world by storm. Previously a matter of patient reticence, older men began to present to their physicians anticipating the provision of particular therapies to enhance sexual performance. Viagra became a household name. Even a former American presidential candidate, Bob Dole, became a spokesperson for Viagra and discussed his erectile dysfunction (ED) in television ads.
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