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Like homosexuality, sex problems and their treatment are no longer taboo topics. They are widely discussed in the media, the movies, and by medical experts throughout the world. The importance of good health care, proper nutrition, and appropriate medications to the maintenance of an active sex life are generally recognized. Moderation in the intake of food, coffee, alcohol, and tobacco; proper exercise; protection against sexually transmitted diseases (STDs); and an awareness that if you do not use it, you will lose it are recommended ("Sexuality and Aging," 1997). Perhaps most important of all are love and respect for one's sexual partner and acceptance of sex as normal and desirable at all ages.

Good physical health and a cooperative, understanding partner are necessary but sometimes insufficient in dealing with a sexual problem that has strong emotional components. In such cases, some form of reeducation or psychotherapy may be required.

The rapid but effective treatment of sexual inadequacy was pioneered by Masters and Johnson (1970). Many of the patients seen by them and their students were older adults who had stopped having sexual intercourse because of a misunderstanding about the normal biological changes that accompany aging. An illustrative case is described in Report 6-1. After 1 week of therapy, this couple had regained confidence and sexual functioning. The therapy helped them to realize that the increased time to attain an erection and the reduction in seminal fluid by the man, in addition to the decreased vaginal lubrication by the woman, were normal problems of aging with which they could deal. The couple became convinced that, despite these problems, they could continue to enjoy sexual intercourse.

Additional procedures for treating sexual dysfunctions are described by Masters et al. (1994). In treating impotence and other problems in older adults, sex therapists may advocate a variety of techniques ranging from the

Treatment of Sexual Inadequacy

Mr. and Mrs. A. were 66 and 62 years of age, respectively, when referred to the foundation for sexual inadequacy. They had been married 39 years.

They had maintained reasonably effective sexual interchange during their marraige. Mr. A. had no difficulty with erection, reasonable ejaculatory control, and . . . had been fully committed to the marriage. Mrs. A., occasionally orgasmic during intercourse and regularly orgasmic during her occasional masturbatory experiences, had continued regularity of coital exposure with her husband until 5 years prior to referral for therapy.

At age 61,... Mr. A. noted for the first time slowed erective attainment. Regardless of his level of sexual interest or the depth of his wife's commitment to the specific sexual experience, it took him progressively longer to attain full erection. With each sexual exposure, his concern for the delay in erective security increased until finally . . . he failed for the first time to achieve an erection quality sufficient for vaginal penetration.

When coital opportunity (next) developed,., . erection was attained, but again it was quite slow in development. The next two opportunities were only partially successful from an erective point ofview, and thereafter, he was secondarily impotent.

After several months, they consulted their physician and were assured that this loss of erective power comes to all men as they age and that there was nothing to be done. Loath to accept the verdict, they tried on several occasions to force an erection with no success. Mr. A. was seriously depressed for several months but recovered without apparent incident.

Although initially the marital unit and their physician had fallen into the sociocultural trap of accepting the concept of sexual inadequacy as an aging phenomenon, the more Mr. and Mrs. A. considered their dysfunction, the less willing they were to accept the blanket concept that lack of erective security was purely the result of the aging process. They reasoned that they were in good health, had no basic concerns as a marital unit, and took good care ofthemselves physically... . Each partner underwent a thorough medical checkup and sought several authoritative opinions (none of them encouraging),refusing to accept the concept of the irreversibility of their sexual distress. Finally, approximately 5 years after the onset of a full degree of secondary impotence, they were referred for treatment.

Source: Masters and Johnson. 1970, pp. 326-328. Used with permission.

viewing of pornographic movies and live strippers to self-stimulation and sex education programs (Butler & Lewis, 1993). Many therapists also recommend masturbation and fantasy for adults who do not have sexual partners and want to reduce their sexual tensions.

Because there are many misunderstandings pertaining to sex in later life, gerontologists and sex therapists have emphasized the reeducation and reas surance of both older adults and the general public concerning sex after age 60 (Butler & Lewis, 1993). Adults of all ages need to realize that sexual activity in the later years is desired by and satisfying to older adults and important to their physical and mental well-being. The nature and extent of these activities, which may include not only sexual intercourse but oral sex, masturbation, and other practices as well, are generally consistent with those engaged in during the earlier adult years. Some readjustment is usually necessary to maintain satisfying sexual relationships in later life, but people with available partners can usually manage the changes necessitated by physiological decline (Starr, 1993).

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