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Chapter 20. Sexual Disorders

Marc E. Agronin, M.D.
DOI: 10.1176/appi.books.9781585623754.393916

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Sexual issues and disorders increasingly have become a part of assessment and treatment by the geriatric psychiatrist, in both outpatient and long-term care settings. One reason for this is that aging individuals are living longer and healthier lives and expect sexuality to continue to play an important role. The renewed interest in sexuality in late life has also been fueled by changing attitudes. On the one hand, the idea of sexuality in late life has often been denied or regarded with humor or even disgust. For many younger individuals, the idea of sexuality clashes with stereotypes of their mom and dad or grandma and grandpa. The denial of sexuality in parents and grandparents then becomes the denial of sexuality in all older individuals. These defensive, distorted, and ageist ways of thinking about sexuality in late life may lead many clinicians to view sexual dysfunction as a normal and untreatable part of aging. However, several factors have led to broadened perspectives on sexuality in late life. Certainly the sexual and feminist revolutions in the 1960s and 1970s shattered many stereotypes. In addition, the widespread use of hormone replacement therapy has allowed many women to maintain more vital and enjoyable sexual function well beyond menopause. For men, the advent of numerous treatments for erectile dysfunction (ED), a relatively common sexual dysfunction in late life, also ensured the persistence of sexual function in later years. In particular, the discovery of oral erectogenic agents has revolutionized the treatment of ED and has made sexuality in late life a more common and comfortable topic of conversation. In turn, the destigmatization of sexual dysfunction has no doubt brought many older couples into treatment who might otherwise have suffered in silence and shame.

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Table Reference Number
Table 20–1. Normal age-related changes in sexual function
Table Reference Number
Table 20–2. DSM-IV-TR classification of sexual dysfunction
Table Reference Number
Table 20–3. Medical and psychiatric conditions commonly associated with sexual dysfunction in late life
Table Reference Number
Table 20–4. Medications associated with sexual dysfunction in late life
Table Reference Number
Table 20–5. Ten ways to enhance sexual function in late life

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Which of the following is the first stage of the normal sexual response cycle?
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In women, the most significant changes in the sexual response cycle occur during menopause. Which of the following changes is caused by a decrease in testosterone?
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As men age, which of the following sexual parameters increases instead of decreases?
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