Vaginal dryness is very common and can be remedied by allowing more time for the woman to get aroused and by using lubricants that are available over the counter. Kegel exercises can be utilized to strengthen the muscles of the vaginal floor, which can enhance sensation and orgasm. Again, communication is a huge key to decreasing a sense of failure, anxiety or pressure. It is important to allow elders to talk about these issues rather than just ceasing sexual activity. Health care providers can help elders maintain open lines, or reopen long-neglected pathways of communication and self-expression.

PT: What about HIV and AIDS in elderly populations?

Ardito: AIDS is often regarded as a young person's disease. Since the beginning of the epidemic in the United States in the early 1980s, however, 10% of all AIDS cases are diagnosed in Americans 50 years and older [AARP, 1998].

This is a complicated issue for the elderly because HIV and AIDS are often misdiagnosed in this population, as symptoms often mimic other illnesses. Elders are also at a greater risk than younger people of conversion of HIV into AIDS, and conversion is more rapid. Also, many of the present treatment options for HIV and AIDS are not viable for elders who might have multiple medical conditions and be taking multiple medications. Elders are not getting sexual education and AIDS prevention information. They are less likely to use condoms, less likely to get AIDS tests and less likely to be asked about this issue. Health care professionals can attempt to address this by trying to increase AIDS education and doing risk assessments in this population. Knowing where to direct elders who are in need of these selective resources is also important. Often, elders don't know where to go when they do find out they have the disease and may receive less support than other age groups.

PT: What about sexuality in nursing homes?

Ardito: This is also an often-neglected issue. The bottom line is you don't lose your legal right to sexual expression when you sign into a nursing home. It often gets more complicated, however, because it becomes more of a public issue with staff, and often family members, involved. It gets even more complicated when looking at nursing home residents with dementia.

In addition to privacy issues, there are issues of problematic sexual behavior as well as appropriate sexual behavior. So it is again important for health care providers to assist nursing homes in addressing the sexual needs of residents in a sensitive, safe and respectful manner that promotes high quality of life rather than taking more rights away from these residents.

PT: What does the future hold for the field of late-life sexuality?

Ardito: We are just beginning to explore and understand this area. There is a great deal of research that needs to be done about the present cohort of elders; there is going to be even more to learn as younger generations age, bringing with them different values, experiences and knowledge regarding sexuality. It is an ever-changing field. Definitely, we need to talk more about it, ask more about it and do more research in the area.

For many older adults, sexual expression is not just some frivolous pleasure, but it is integral to attaining or maintaining a high quality of life. We as health care providers can focus on promoting this high quality of living.
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