Archive for the ‘Men’s Health-Erectile Dysfunction’ Category

LATE ADULTHOOD: PSYCHOSOCIAL CONSIDERATIONS

Wednesday, July 20th, 2011

In part, our cultural negativism about sex and romance in the geriatric years is a reflection of an attitude called ageism, a prejudice against people because they are old, that is similar to the more familiar prejudices of racism and sexism in our society. As Butler and Lewis note: “The ageist sees older people in stereotypes: rigid, boring, talkative, senile, old-fashioned in morality and lacking in skills, useless and with little redeeming social value.” These same authors observe that ageism in relation to sexuality is the ultimate form of desexualization: “if you are getting old, you’re finished.”Ageism is not restricted to heterosexuals, either, as this quotation from Gay and Gray: The Older Homosexual Male shows:Many older gay men believe that younger gays react negatively to them. Most older gays feel that young people sometimes take advantage of them, do not welcome their company in bars, clubs, and bathhouses, do not care to associate or form friendships with them, and think they are dull company.It is interesting to note that in a recent study, college students estimated that average married couples in their sixties had intercourse less than once a month and expected that married couples in their seventies had intercourse even less often. As we will see, these are underestimates of actual behavior, showing that young adults are susceptible to ageism in their thinking — at least when it comes to sex.Kinsey and his colleagues were the first to examine systematically the effect of aging on sexual behavior. Although their studies indicated that sex continued well into late adulthood, they also described a general decline in the frequency of sexual activity for both men and women across the adult age range. A number of other studies confirmed these overall trends, with most reports suggesting that the decrease in sexual activity is partly due to diminished health and partly a reflection of cultural attitudes and expectations.More recently, a longitudinal study done at Duke University has found that patterns of sexual activity actually remain relatively stable over middle and late adulthood, with only a modest decline appearing in most individuals. For example, men who were sixty-six to seventy-one years old at the start of this study had no overall decline in sexual activity scores over the next six years, and a majority of men and women in the fifty-six to sixty-five age bracket at the beginning of the study had stable rates of sexual activity during this same time period. However, in those over age sixty-five, 18 percent of the men and 33 percent of the women completely stopped sexual activity with their partners over a six-year period.Various studies of sexual behavior in late adulthood indicate that the male’s declining interest seems to be the major limiting factor to continued sexual activity. This declining interest, however, may say more about cultural expectations which become self-fulfilling prophecies than anything else. While the pattern of sexual activity among aged people varies considerably, coital frequency in early marriage and the overall quality of sexual activity in early adulthood correlate significantly with the frequency of sexual activity in late adulthood.It is interesting to note that most researchers who claim to be studying sexual activity rates in the elderly have actually restricted themselves to studying coital behavior, as though other forms of sexual activity “don’t count.” Many adults over sixty continue to masturbate, although these are almost entirely individuals who masturbated when they were younger. Not surprisingly, elderly people without sexual partners tend to masturbate more frequently. In couples over sixty, other forms of sexual stimulation continue to be utilized (for example, oral sex and manual stimulation); they not only provide some variety, but also can be a source of pleasure and closeness even if the male is unable to obtain or maintain erections. Here is what one seventy-eight-year-old man told us:In my mid-sixties, I had a real problem getting it up. Sexual intercourse became impossible and I got very upset over it at first. But my wife just found other ways to excite me, and after a while — when I relaxed more, I guess — my problem disappeared. Now, even though she doesn’t always want to have intercourse when I do, we still use our mouths and tongues on each other, and we plan to keep doing it, too.In late adulthood, the longer life span of women, combined with their tendency to marry men who are their age or slightly older, frequently creates a situation of widowhood. At the same time that fewer men of the same age are available as new sexual partners, younger men tend to focus their attentions on women under forty. Thus, sexual opportunities and social contacts with men are often extremely limited for these mature women who might otherwise be enthusiastic sexual partners.In the last few years, a new trend is emerging in which not all women in the sixties or older who find themselves widowed or divorced are passively accepting their fate. Some women in this situation are using their ingenuity to find new partners, as shown by the following ad from the personal classified section of a well-known magazine:Tall, handsome intelligent man sixty to sixty-five, wanted for attractive, lively sixty-two-year-old widow with fantastic figure and modern values. If you’re interested in romance more than golf, send a photo and your phone. Box xxx.Although a sixty-five-year-old widow (or widower) may have an interest in sexual activity, social pressures may prevent sexual opportunities or belittle their meaning via snide jokes (e.g., only”dirty old men” are interested in sex, and “dirty old women” should “act their age”). As prolonged abstention from sexual activity in old age leads to shrinking of the sexual organs (just as a healthy arm loses strength and coordination if put in a sling for four months), the older adult is truly faced with a sexual dilemma — “use it or lose it.”An often-neglected aspect of aging in our society is that many elderly persons are relegated to nursing homes or other long-term care facilities for health reasons, to “protect” themselves, or for the convenience4>f their children. Although research on sexual behavior in this population is understandably sparse, a number of authorities have spoken out in favor of making provisions in such facilities (such as making private rooms available) for those who desire sexual interaction. While most nursing home administrators seem opposed to this notion, and some facilities actually insist on segregating men and women even if they’re married, both ethical considerations for protecting the rights of the elderly and more practical considerations having to do with maintaining self-esteem and personal well-being lead us to advocate change in this area. However, it should be noted that permitting sexual expression in the institutionalized elderly is not the entire solution to their plight. Additional steps must be taken to overcome loneliness and boredom in the nursing home environment so that these facilities are not unintentional prisons for our older adults.In the United States, where there is little preparation or education for aging, it is not surprising that many people are uninformed about the physiological changes in their sexual function in their sixties and seventies. They may mistakenly view these normal “slowing down” processes as evidence that loss of function is imminent. Brief preventive counseling during middle age might result in significant change in this area, but changed attitudes toward sex and aging seem even more necessary. What people must recognize is that given good health and the availability of an interested and interesting partner, there is no reason that sexual enjoyment should have to come to an end in late adulthood. Perhaps the ultimate test of whether we have lived through a sexual revolution will be if attitudes toward sexuality in old age are transformed.*102\342\2*

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SEMINAR TRAINING FOR CONTRACEPTIVE CARE – COMFORT WITH SEXUAL MATTERS (MALE DOCTOR)

Tuesday, April 7th, 2009

A male doctor was faced with a patient whose calling card was a rather vague account of irregular bleeding on the Pill. The doctor noticed that she seemed rather withdrawn and unhappy. In response to a general enquiry about other worries she began to tell him about the sexual abuse she had suffered from her father in her early teens. Suddenly the doctor noticed that she appeared overwhelmingly attractive. The strength of his feelings in response made him stop listening to what she was saying. He reported to the group that he was able to recognize his own feelings, and the fact that they had stopped him listening. He managed to say nothing to the patient, and resolved to make himself listen to her story some more. Gradually, the sense of sexiness wore off, and by the end of the consultation he felt comfortable enough to consider the possibility of a genital examination without anxiety.

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PSYCHOSEXUAL PROBLEMS IN THE CONTRACEPTIVE CONSULTATION – FURTHER TREATMENT OR REFERRAL? (REFERRAL

Tuesday, April 7th, 2009

Referral should take place after mutual agreement between the patient (who is complaining) and the doctor. The purpose is to obtain a specialist opinion, or investigations or treatment not available from the referring doctor. Reluctance or even resistance will be encountered if the patient has been sent by another person, such as the partner, for treatment, when they do not perceive that they have a problem (as with Mr S.). It might be possible to suggest to a partner that the patient complaining will need the assistance of that partner in the therapy, thus engaging their interest at the outset.

However, if the doctor insists on referring both partners when only one is complaining, there may be serious difficulties for the therapist to whom the couple are referred. Both partners need to accept an adult and responsible role during therapy. The therapist offers interpretation and suggestions about changes, but it is up to the individuals to make use of them. More often, a therapist, whether using cognitive therapy, behavioural techniques or psychotherapeutic interpretations, will empathize with the person who seeks help for the problem. A partner who has not acknowledged that he or she has a problem is much harder to engage in therapy, and may opt out by not attending either physically or mentally, or even undermining therapeutic endeavours in a subtle fashion.

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PSYCHOSEXUAL PROBLEMS IN THE CONTRACEPTIVE CONSULTATION – CHOICE OF VENUE AND DOCTOR (OLDER AGE GROUPS)

Tuesday, April 7th, 2009

The older age groups may also be reluctant to reveal their sexual activity to their regular medical attendants (or their staff), but for slightly different reasons. They may not wish to bother their doctors – who they view as caring for ill people – with their contraceptive needs which they feel are less important. They may fear that their sexuality is not acceptable to their doctors, to the staff or to other patients whom they encounter in the surgery and who may enquire why they are attending. One woman in her 40s travelled many miles to attend a clinic far from her home. Married to the minister of a strict religious sect, she could not risk revealing to her husband’s flock that she was sexually active and needed to use a diaphragm to prevent pregnancy. She could not refuse him intercourse, nor did she wish to do so, although she felt it was somehow wrong and sinful not to be above such base human emotions. She feared further pregnancy with advancing years, but saw her need for contraception as a betrayal of her husband’s teaching which had to be concealed from his congregation. Her ambivalent attitudes had made her an unpopular patient at the family planning clinic she attended; she had managed to make most of the staff feel that they were somehow dealing in something unsavoury and undesirable.

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STERILIZATION: SENSIBLE CHOICE OR SERIOUS TROUBLE? – SELF-SACRIFICE FOR THE SAKE OF THE PARTNER (COUNSELLING)

Tuesday, April 7th, 2009

Counselling did help this couple towards an acceptance of their situation, but years of suffering might have been avoided if they had been encouraged to make a joint decision regarding their future together when the wife had recovered from her third delivery. However, it must be recognized that it is easy to be wise after the event, and with hindsight the patient may find it easy to blame the doctor for inadequate discussion. At times of stress people do not really hear those things that they do not wish to hear, as the following case demonstrates.

A married couple attended the subfertility clinic over a period of several years. As time passed the anguish of the woman and the grief of the husband became increasingly distressing. The man was in his 50s, tall, distinguished and successful. He had agreed to a vasectomy in his first marriage because his wife suffered from a severe depressive illness which recurred after each childbirth. He had felt that she had suffered so much that he should have the operation. His wife died some 10 years after the vasectomy and after a time he had remarried a much younger woman. They both wished for children, and he underwent reversal of vasectomy.

This man was totally unprepared for the very poor semen analyses after reversal. He felt that he had not understood that the operation should be regarded as irreversible when the vasectomy was discussed. He did volunteer that he had been under considerable stress at the time, and he felt now that it would have been more appropriate if his wife had been sterilized as she could not have had another pregnancy safely. At the time he had felt she had suffered enough.

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THE SEXUAL NEEDS OF PEOPLE WITH DISABILITIES – CONTRACEPTIVE NEEDS (EMOTIONAL TIME)

Tuesday, April 7th, 2009

A group of people who have particular need are those who are terminally ill. If sexuality and disability are difficult words to put together, then sexuality and dying are even more so. This is an emotional time with many issues to be addressed. Among these, personal relationships are sometimes overlooked. The worries of both doctor and patient over what people may think if these needs or difficulties are acknowledged can be acute. When time is of the essence people need to use it in whatever way seems important to them. Increasing incapacity and the loss of part of their life which has always been important to them matters a great deal. They do not appreciate being put on a waiting list for psychosexual counselling. They need swift and appropriate attention so that they can utilize their remaining time together in the best way, feeling free to use what physical contacts are available to them to maintain and develop the fullest possible relationship to the end.

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PATTERNED OFFENDERS

Monday, March 30th, 2009

Shortly after we began interviewing sex offenders it was evident to us that some of them committed the same offense over and over again in what seemed a compulsive repetitious pattern of behavior. Feeling that these individuals are of particular concern to society, we have in this chapter labeled them “patterned” offenders and compared them to other sex offenders who do not exhibit this repetitious pattern of offense behavior. The latter we labeled “incidental” offenders.

The separation of offenders into the patterned or incidental categories is based either on the record of criminal conviction or on the individual’s admission to a history of offense behavior for which he was not convicted. For example, a man with two convictions for exhibition was categorized as a patterned exhibitionist, and so was the man who had but one conviction but told us he had repeatedly exposed himself to women. The individual labeled incidental was the man with only one offense of a given type and no indication of additional activity of that same type.

Obviously only a few types of sex offenses lent themselves to this patterned as against incidental dichotomy; for example, virtually 100 per cent of our offenders vs. adults would by definition be patterned offenders. In other instances, as in the aggressors vs. children, the sample was already too small for further division. Consequently, we made the patterned vs. incidental analysis on but six groups: the heterosexual offenders vs. children, the incest offenders vs. children, the homosexual offenders vs. children, the aggressors vs. adults, the peepers, and the exhibitionists.

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SEX OFFENDERS: RECIDIVISM

Monday, March 30th, 2009

In general, it may be said that there are very few good studies of recidivism and that no study has examined the recidivism of a large sample of first offenders throughout their criminal careers. Most studies of offenders of any type have focused on what can be called “failure” populations. An extended analysis of the criminal records of a population that is currently institutionalized is the common technique. Thus, excluding the first offenders, all other persons are “failures” in terms of remaining outside institutions. The primary defect of these studies, and of ours also, is that there is not present (and cannot be) in the institutionalized population those first offenders who do not get convicted the second time, and those second offenders who do not get convicted the third time, and so on. What these studies do show is the profile of previous offenses committed by men currently in prison. The degree to which their criminal careers are similar to the careers of men who did not return the next time, whatever time that might have been, is at present moot.

Recidivism rates vary considerably for different types of offenders; this is partially a function of the offense and partially a function of the length of sentence. Certain types of offenders, primarily those with a traditional career of property offenses, serve relatively short sentences and have high rates of recidivism both when released on parole and on unconditional release. Part of this recidivism rate is due to years of exposure in the free community, but also part is due to an involvement in social groups with standards and values at variance with majority sentiments. The opposite picture, in terms of both exposure and criminal subculture involvement, is observed in the case of both homicide and sex offenders.7 Except for exhibitionists, peepers, and those convicted of statutory rape, most other sex offenders receive fairly long sentences, cutting down years of exposure. This is also practically inevitable in homicide cases. All the other offender groups show relatively low recidivism rates when parole-violation rates are computed, for in addition to the years spent in institutions away from objects of their offenses these sex offenders (as well as those noted above) are not supported by social groups or norms which perpetuate offense behavior.

Taking the total convictions, sexual and nonsexual in nature, it appears that half of the sex offenders have more convictions than the prison group and half have fewer. There were 3.5 convictions per capita for the prison group; at one extreme were the aggressors vs. children with 5.5 and at the other the incest offenders vs. adults with 2.4 convictions. We may equate number of convictions with recidivism despite the fact that in some cases what was one unit of behavior resulted in convictions on several charges.

In general, the aggressors are the most recidivistic group. In per capita convictions they rank first, fifth, and sixth (5.5 to 3.9 convictions). Of the four groups with the smallest proportions of first offenders, three are the aggressors with only 17, 11, and 8 per cent of the members having one conviction on their records. In the rank-order of those with seven or more convictions they rank first (28 per cent of the aggressors vs. children had seven or more, convictions), fourth, and fifth.

The second most recidivistic are those offenders who do not make physical contact: the peepers and the exhibitionists. In per capita convictions they are second and third (4.3 for the exhibitionists and 4.2 for the peepers). They again rank second and third in the proportion who had seven or more convictions, this being true for one fifth of the peepers and 16 per cent of the exhibitionists. The recidivism of these two groups is a product not only of their compulsivity but also of the tendency for the courts either to omit imprisonment or mete out short sentences for these nuisance offenses.

As a group the incest offenders are the least recidivistic, averaging 2.4 to 3.0 convictions per capita. Moreover, slightly more than two fifths of the incest offenders vs. minors and adults were first offenders, ranking first and second. In a rank-order of those with seven or more convictions the incest offenders occupy the lowest three positions, with only 2 to 4 per cent showing such extreme recidivism.

The heterosexual offenders also have few repeaters: compared to those in other groups many were first offenders (they rank fourth, fifth, and sixth) and the per capita numbers of convictions are also low (2.8 to 3.0). Except for the incest offenders, they had the fewest members with seven or more convictions.

Lastly, there is a definite correlation between recidivism and age of the sexual object. In all four of our tripartite groups the men whose offenses were against children have more per capita convictions than those (within the same tripartite group) whose objects were older. Similarly in a rank-order of first offenders those who offended against adults or minors include larger proportions of first offenders than those who offended against children or who used force against females of any age.

Thus far we have been speaking of recidivism in terms of crimes of all sorts, yet a study of sex-offense recidivism yields much the same picture. The exhibitionists and peepers again are the most recidivistic (3.1 and 2.5 sex offenses per capita, ranking first and second) and the aggressors come next, ranking fourth, fifth, and seventh with from 2.0 to 2.2 offenses. The incest offenders and heterosexual offenders once more are the least recidivistic of the tripartite groups, the incest offenders vs. adults again having the lowest rate: 1.2 sex offenses per capita.

If one looks at recidivism solely as repetition of the specific offense, rather than any sex offense, the picture becomes somewhat confused. The exhibitionists and peepers still monopolize the top ranks (2.1 and 1.6 specific sex offenses per capita), and the incest and heterosexual offenders vs. adults the bottom ranks (1.0 and 1.1), but all other offenders and aggressors are mixed in helter-skelter between these extremes. However, it is worth noting that ranking high in this specific sex-offense recidivism (third and fourth ranks) are the homosexual offenders vs. adults and minors: our two most homosexually oriented groups. Strong homosexual motivation and recidivism are, in our culture, necessarily linked. An incest offender can turn to unrelated females, an aggressor can learn to win cooperation, the pedophile can try to satisfy himself with older girls, but the homosexual offender is, in most states, trapped in a situation where his activity is apt to be punished regardless of the age, relationship, or cooperativeness of his male partner.

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MARRIAGE: FREQUENCY OF MARITAL COITUS

Monday, March 30th, 2009

The frequency of sexual intercourse in marriage varies greatly among the different groups. This fact produces some drastic changes in the rank-orders of coital frequencies during various age-periods. The median frequencies are, naturally, more stable than the mean frequencies, but even in the median frequencies there are some cases of sudden variation—as, for instance, the rise of the exhibitionists from last place at age-period 21-25 (with a coital frequency of 2 per week) to fourth place at age-period 26-30 (with a frequency of 2.5). While rank-order changes, ordinarily one does not find increases in actual frequency—the picture is generally one of inexorable decrease in frequency with increasing age, and the range in variation of frequency correspondingly narrows.

In terms of median frequency, it appears that the most active groups are the aggressors vs. adults, the offenders vs. children, and homosexual offenders vs. minors. Interestingly enough, the latter two groups had only a moderate amount of coitus before marriage, and the aggressors vs. adults never rose above third rank in this activity. Clearly, when marriage makes coitus more easily available the whole picture changes; it is evident that the premarital frequencies reflect savoir faire, appearance, social milieu, and other factors as much as or more than they reflect what one may term “sex drive” or strength of motivation. The control group begins in second rank in age-period 16-20 and exhibits thereafter a rather uniform and gradual decline in frequencies resulting in the group occupying intermediate status in the rank-orders.

There is considerable variation in which groups exhibit low frequencies, but the homosexual offenders vs. children are more uniformly low than other groups. It is interesting that the offenders vs. adults, who were the most active sexually before marriage, always rank low in frequency of coitus within marriage. The prison group and the offenders vs. minors, both of whom distinguished themselves with high frequencies before marriage, lapse into moderate to low frequencies thereafter.

Examination of the frequencies suggests that in the great majority of cases actual protracted coital deprivation cannot be a major factor in sex offenses committed by men currently married. One sees that while a minority of the sex-offender groups exceeds the control group in frequency of marital coitus, the others do not lag far behind, and between ages twenty-six to thirty-five the majority of sex-offender groups exceeds the prison group. Even in those age-periods wherein the control or prison groups rank high, their absolute frequencies are not greatly above those of the sex offenders.

Mean frequencies of marital coitus are extremely erratic. About all one can say is that the aggressors vs. adults and the homosexual offenders vs. minors tend to have higher frequencies, while the incest offenders vs. adults and the offenders vs. minors (after age thirty) have very low frequencies. All incest offenders are to be found in the lower halves of the rank-orders, and the exhibitionists are usually to be found with them.

In both means and medians the occasional high ranking of homosexual offenders is noteworthy. This seeming inconsistency led us to examine in detail the case histories of the ever-married homosexual offenders vs. adults. Some of these men were more heterosexual than homosexual in orientation, and their homosexuality did not reduce their frequencies of marital coitus. However, some men were definitely more homosexual than heterosexual and often had markedly underdeveloped premarital histories, yet these men married (generally briefly and but once) and began marital coitus with high frequencies. It is true that since marital coitus tends to be more frequent in early marriage than in late, the coital frequencies of brief marriages will exceed those of long-time marriages, but this explanation alone does not suffice. We presently cannot explain why some predominantly homosexual males have a brief but intense (in terms of frequency) unheralded outburst of heterosexuality generally in marriage. The best explanation that occurs to us is based upon the strength of “sex drive.” The homosexual offenders seem to have the greatest “sex drive”; note that their total sexual outlet always exceeds that of other groups. Given individuals with a strong “drive” and with various degrees of heterosexual inclination, put them in a situation where coitus is available (marriage), and one may expect occasional high coital frequencies.

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EARLY SEX KNOWLEDGE: AGE AT FIRST KNOWLEDGE OF COITUS

Monday, March 30th, 2009

Whereas in many preliterate cultures the knowledge of coitus comes early and naturally, the acquisition of such knowledge is, in our culture, much more belated and more often traumatic. Belated though it may be, the great majority of our sample knew of coitus before reaching puberty. Taking thirteen as an arbitrary age approximating the onset of puberty, and studying the percentages of only those who learned of coitus at thirteen or older, we can see a few interesting facts emerge. Of our sexually most restrained group, the incest offenders vs. adults, a full 36 per cent learned of coitus at or after age thirteen; this is the greatest percentage recorded. The peepers, of whom also a substantial proportion are sexually inhibited, are in second place with 32 per cent, and the exhibitionists are third. Conversely, one of the most sexually active groups, the prison group, is next to last in rank-order with but 16 per cent who had not learned of coitus before thirteen. However, the inference is weakened by the fact that about one fourth of the heterosexual offenders vs. minors and adults, both also sexually active groups, were ignorant of coitus prior to age thirteen. This curious fact is probably the result of their reaching puberty relatively late;

22 per cent of the heterosexual offenders vs. minors did not reach puberty until age fifteen or later. Since an interest in sex is intensified at and near puberty, and since interest leads to acquiring knowledge, it is reasonable to suppose that deferred puberty correlates with belated knowledge. This is substantiated by the fact that the incest offenders vs. adults lead in delayed puberty, and, as pointed out above, 36 per cent learned of coitus at or after age thirteen.

All in all, the age at which a male gained his first knowledge of coitus does not correlate with the age at which he had his first coitus, and correlates with age at puberty only in extreme cases (i.e., late knowledge with very late puberty, early knowledge with very early puberty). Evidently numerous variables are involved in a complex fashion.

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