Feature

Talking sexual health with older patients


Amanda Lyons


15/11/2018 2:03:12 PM

Dr Sue Malta and her research team want to promote more positive social perceptions of older people’s sexuality, in general practice and beyond.

Many older patients continue to have active and healthy sexual lives.
Many older patients continue to have active and healthy sexual lives.

It is no secret that Australia’s population is ageing.
 
But that doesn’t mean older Australians are leaving the pleasures of the bedroom behind – and nor should they, argues Dr Sue Malta.
 
‘Having a healthy sex life when you’re older, even when you do have disability and disease, is actually really good for your health and wellbeing, and also your overall cognition and cognitive function,’ the Melbourne School of Population and Global Health research fellow told newsGP.
 
‘So there’s lots of reasons for people to remain sexually active in later life, and for GPs to encourage them to be so, if that’s what the older patient wants.’
 
Our culture contains many deeply embedded stereotypes about older people, and one of the strongest is that they are asexual. But, as shown by Sex, Age & Me, a national study conducted on the sexual and romantic relationships of over 2000 Australians aged 60 and older, this is very far from the case: almost three-quarters (72%) of respondents reported having engaged in a variety of sexual practices in the preceding year, ranging from penetrative intercourse to mutual masturbation.
 
Despite this kind of eye-opening data, stereotypes about older people’s sexuality – or lack of – persist, even among older people themselves and the health professionals who treat them.
 
The Sexual Health and Ageing, Perspective and Education (SHAPE) project, for which Dr Malta is a researcher and project coordinator, also revealed these stereotypes could cause significant barriers in discussion of sexual health between GPs and older patients.
 
‘GPs don’t want to initiate these conversations, they want them to be patient-led,’ Dr Malta said.
‘But older patients won’t talk to GPs because they are embarrassed, and for reasons that go back to an historical lack of sex education when they grew up: the context and eras these patients were born into, they just didn’t talk about sex.
 
‘So it leads to this Catch-22 situation.’
 
The SHAPE team wanted to further investigate the reluctance of GPs to raise sexual health issues with older patients, so they conducted semi-structured interviews with 15 GPs and six practice nurses throughout Victoria. The resulting paper, ‘Do you talk to your older patients about sexual health?’ was published in the most recent edition of The Australian journal of general practice (AJGP).
 
Sue-Malta-text.jpgDr Sue Malta wants to promote positive views of older people’s sexuality as Australia’s population ages.
 
Dr Malta explained that semi-structured interviews allowed the researchers to access richer and more detailed information from their GP respondents.
 
‘It’s very easy to say ‘“yes, no” in a survey. We don’t really find out people’s underlying or unconscious views and attitudes,’ she said.
 
Researchers ultimately found many of the GPs feel uncomfortable broaching the subject of sexuality with older patients, and some found it difficult to reconcile sexuality with ageing.
 
As one GP said, ‘It’s a bit like you don’t really want to know your mum and dad have sex, you know? Because that’s just gross’.
 
However, as Australia’s ageing population grows, and divorce, online dating and sexually transmissible infections (STIs) become more common among older people, neglecting issues of sexual health can lead to harms.
 
‘There’s a whole issue around [the fact that] they’re not practising safer sex, so the STI rates are going up,’ Dr Malta said. ‘It has gone up 50% in five years, but from a low base.
 
‘But if we continue in this vein, with more and more single older adults coming into the population, this could potentially be more of an issue in the future.’
 
Furthermore, if GPs and other health professionals are unaware that they should be looking out for sexual health issues in older patients, they may miss important signs.
 
‘A lot of the symptomology [of STIs] actually mimic diseases of ageing,’ Dr Malta said. ‘So if there is a stereotype of the asexual older person in the GP’s mind, and an [older patient] has a symptom that might or might not be an STI, which side do you think the GP is going to err on? Not the possible STI.’
 
A vivid anecdote that Dr Malta encountered during her teaching work is a telling illustration of the importance of not making assumptions.
 
‘One of the registrars at a presentation I gave had a consultation with an older man, a gentleman on a walking frame, who was 90 or so, and presented with what looked like an STI,’ she said.
 
‘The consultant the registrar was working under said, “No, it wouldn’t be an STI, just look at him, he’s past it. That’s ridiculous.” But the registrar decided she would ask him.
 
‘So she asked and he said, “Yes, actually, it could be an STI. I went to see a prostitute last week and it was the best thing I’ve done in ages”.
 
‘So the registrar then had the opportunity to have that discussion about safer sex and give him some treatment.’
 
Many of the GPs interviewed for Dr Malta’s paper felt they would appreciate interventions designed to help facilitate discussions about sexual health during consultations with older patients.
 
Dr Malta agrees this would be helpful, but believes it would also be useful to start earlier, with better information about ageing and sexuality provided during general practice (and other medical) training.

'In training, you learn about ageing, but in the context of disease and dysfunction,’ she said.
 
‘So the only thing about sex and ageing you might learn is about erectile dysfunction, how beta blockers affect your ability, vaginal dryness, menopause, prolapse. You don’t actually learn about positive sexuality in later life.’
 
Dr Malta has found that most older patients would like sexual health screening to become a normalised part of routine care in general practice. She also believes it is necessary to make changes in overall health policy to make it more inclusive.
 
‘There is no sexual health policy targeting older adults,’ she said. ‘They get lumped into general sexual and reproductive health policy, and the only mention that’s made of them is about menopause and the like.
 
‘There should be a specific sexual health policy for older adults because the issue is more involved than we think.’



Ageing ageing and sexuality AJGP Australian journal of general practice general practice research sexual health





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