PT: What can health care providers do to combat some of these problems?
Ardito: To put it bluntly, we need to start talking about sex. Our patients come to us with a wide variety of issues, and we need to feel comfortable at least broaching the topic of sexuality. Many elders have reported that when they were provided with accurate information they were able to incorporate new sexual knowledge and discard long-standing fears and misconceptions that had significantly limited their sexual expression for much of their lives.
Obviously, as health care providers, we have time limitations. But don't assume that patients are not sexually active just because they don't have a partner or are very old. For example, we need to make sure an 80-year-old is receiving the same information a 30-year-old would receive regarding the possible sexual side effects of antidepressant use. If we are not comfortable talking about these issues, our patients aren't really going to feel comfortable asking for help and information.
Regarding specific treatments for sexual dysfunction in older adults, Viagra [sildenafil] is perhaps the most talked about treatment for erectile dysfunction these days, but it is certainly not the only treatment available. There are other medications currently being used for the treatment of sexual dysfunction in both men and women, and research regarding future pharmacological treatments is ongoing.
It is also important to keep in mind that there are many behavioral strategies that can be used to adjust to age- or illness-related changes in sexual functioning. Patients can be directed to the appropriate sources of this information and can be assisted in communicating with their partners, which obviously makes a big difference in terms of managing any type of sexual dysfunction.
With regard to medications, estrogen has been used to facilitate desire and arousal in women and testosterone is being used in women to treat more global sexual dysfunction.
Alprostadil(Drug information on alprostadil) [Caverject, Muse] has been used successfully for erectile dysfunction in men, and it does have some vasodilation effects for both men and women. Some amphetamines, such as
methylphenidate(Drug information on methylphenidate) [Ritalin], have been used to increase sexual responsitivity in women. Medications that stimulate
dopamine(Drug information on dopamine), such as
apomorphine(Drug information on apomorphine) [Uprima], are being researched for treatment of sexual dysfunction in both men and women. Research has been done on a new vasodilator called Vasomax [phentolamine] by Zonagen. It is scheduled to be available early in 2000. Researchers at Palatin Technologies Inc. are scheduled to begin controlled studies on a hormone called PT-14, which would act directly upon the central nervous system and reportedly creates an erection whether or not a man is sexually aroused.
Americans are also looking into some of the alternative medicines. No controlled studies have yet been published, and these supplements are not approved by the U.S. Food and Drug Administration and can have negative side effects, but
Ginkgo biloba, ginseng [
Panax ginseng] and ma huang [
Ephedra sinica] are some herbal remedies that are purported to have positive sexual effects.
In terms of behavioral strategies that patients can use, health care providers don't have to be experts in human sexuality to discuss options. Patients should be reminded that basic changes in diet and exercise and cessation of
alcohol(Drug information on alcohol) use or smoking have a positive impact on libido and sexual functioning. For men, testosterone levels are highest in the morning, so scheduling sexual activity in the morning can be helpful. Testosterone levels can also rise in anticipation of sexual activity and after engaging in it, which supports the idea that being more sexually active will help one remain more sexually active. If an elder is suffering from arthritis, a hot bath prior to sex can loosen joints and increase comfort for an hour or so. Prolonged foreplay can enhance sexual arousal in both men and women. Stroke victims can work with a physical therapist to find a footboard or use other strategies to increase mobility. Making changes in sexual positions can also help partners adapt to various disabilities.
