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Try out PMC Labs and tell us what you think. Learn More. Brooklyn, NY. Most studies focus on sexual dysfunction, leaving aside the richer context of sexuality and sexual health, including the effect of age-related psychosocial and interpersonal changes on sexual health behaviors. Guided by the integrative biopsychosocial model and the sexual health model, this study explored the importance of sex and sexuality among OWLH to identify their sexual health and HIV prevention needs for program planning.
The triangulation approach was used to synthesize the data. We found that sexual pleasure Los Angeles California horney older women man the need for intimacy continue to be important for OWLH, but that changing sexual abilities and sexual health needs, such as the reduction of sexual desire, as well as increased painful intercourse due to menopause-associated vaginal drying, were persistent barriers to sexual fulfillment and satisfaction.
Particular interpersonal dynamics, including low perceptions of the risk of HIV transmission as related to gender, viral suppression and habitual condomless sex with long term partners without HIV transmission have resulted in abandoning safer sex practices with serodiscordant partners. Sexual health, sexuality, and sexual satisfaction among older PLWH are neglected areas of research, perhaps due to the assumption that older adults no longer engage in sexual activity.
Sexuality in HIV research has almost exclusively been placed in the context of disease prevention rather than health promotion and wellbeing, with little attention paid to desire and pleasure. Studies on sexual health and HIV have focused primarily on the reproductive needs of younger PLWH to reduce mother-to-child transmission and promote safer conception, especially for serodiscordant couples Chadwick et al. Denis and Sung-Mook found that women with HIV, in comparison to women without HIV, had ificantly lower sexual functioning, including a diminished interest in sexual activity, sexual satisfaction, and fewer orgasms.
Another study found that women with HIV reported greater sexual problems than those without HIV, and that lower sexual functioning was associated with low CD4 counts Wilson et al. Importantly, Wilson et al. However, very little is known about the changing sexual desires and sexual health needs of OWLH and how these factors may impact sexual risk behaviors.
The integrative biopsychosocial model provides a holistic approach for examining the interactions and interrelations between biological, psychological, and social factors that contribute to overall sexual health and wellbeing Lindau et al.
Proponents of the model argue that sexual literacy allows individuals to create strategies to reduce risk in their relationships and sex practices Robinson et al. This study, which is based on qualitative data collected in the in-depth interviews and focus group discussions, sought to elicit deeply personal and extremely sensitive information on how aging impacts sexual pleasure and satisfaction, as well as safer sex practices among older women with HIV. Focusing on the sexual health and wellbeing of OWLH will enable the development of effective HIV programs that are gendered and generationally tailored to meet their specific needs and ensure that risk reduction messages relevant to this population are developed.
Data from this study were collected in as part of a larger mixed method study to identify the sexual health and prevention needs of OWLH. Participants were drawn from two sources. WIHS study recruitment and protocols have ly been described Bacon et al. In order to capture variability in sexual activity and behaviors, we did not limit recruitment according to sexual orientation or level of sexual activity.
Staff identified eligible women according to the aforementioned eligibility criteria and contacted participants on the telephone to assess if they were interested in participating in the study. Informed consent was obtained by the PI in English, after explaining study procedures, risks and benefits of participation, and answering any questions that participants may have. Following approval from the Institutional Review Boards at participating sites, we recruited 50 participants and conducted 41 semi-structured interviews and 8 focus groups two at each site.
In-depth interviews were conducted first and followed by focus group discussions. Of the 50 participants, 41 completed in-depth interviews; 39 of the 50 participants were also invited to participate in a focus group discussion; 30 completed both the in-depth interviews and focus groups; eleven completed the in-depth interview only; and nine participated in the focus groups only. All focus groups and in-depth interviews took place in private rooms at recruitment sites. Each interviews lasted approximately 90 minutes; each focus group discussion lasted two hours.
Sample questions included: In what ways, if any, has your sex life changed as you have gotten older? How is sex more or less pleasurable as you have gotten older? How important is sex is for older women? Has your ability to have sex changed or not as you have gotten older? How has menopause changed sex for you?
How has getting older with HIV affected your ability to practice safer sex? How has condom use changed as you get older? What challenges do you face in using them? We explored the same questions in the focus groups and asked the women to comment on the experiences of OWLH in general rather than their personal experiences.
Demographic data, including participant age, race, ethnicity, marital status, sexual activity, employment and education were collected from all study participants.
All interviews and focus groups were recorded and resulting audio-files were later transcribed by a professional transcription service to create verbatim transcripts for coding and analysis. One advantage of combining in-depth interviews and focus group discussions was that it provided women the opportunity to choose which interview format they would prefer. Although most women were encouraged to participate in both types of interviews, we hypothesized at the outset, given the sensitive nature of the study, some women would not agree to participate in a focus group interview preferring the confidentiality and privacy of a face-to-face interview.
Finally, information gained from the in-depth interviews helped to inform and refine focus group discussions throughout the study. A thorough assessment of the quality and completeness of the data was conducted. Following a review of the a priori themes, we used thematic analysis to identify salient themes and relationships.
Once the codebook was finalized, a minimum of three researchers independently coded each transcript, and two researchers coded all transcripts. Themes from the qualitative focus groups clarified findings from the in-depth interviews, and further reflected on the sexual behavior and experiences of OWLH.
Table 1 provides information on the demographic characteristics of this sample. All of the participants who reported no sexual activity did not have an available sexual partner and stated that they were no longer interested in sex, feared HIV transmission, or did not want the aggravation of sexual relationships. Sexual pleasure and satisfaction emerged as a salient theme from this sample of participants.
Many reported that sex became more pleasurable after the age of Another participant, a year-old African-American woman from the Bronx, added that sexual pleasure increased because, in growing older, she became increasingly self-aware and knowledgeable about what she finds personably pleasurable.
Some women also noted that increasing sexual self-awareness with age made them reevaluate and appreciate sex, not just as something that is satisfied with frequency or sexy display, but as a more sensual or organic experience. One participant explained:. As you get older, you learn to appreciate it more and realize who you were…When I was younger, it was about being young, and being frisky, and being sexy. One woman noted that:.
If he can touch me… like, he may rub my breasts or feel on my breasts or something. Overall, regardless of their experiences or current situations, most of the participants described a strong desire to maintain sexual pleasure and intimacy as they aged because it was perceived as a fundamentally important aspect of what it means to them to be a woman.
I think sex is important, period! You know, for women…throughout the course of their whole adult womanhood…What I mean by that is especially as women age…I always considered myself to be a sexual individual. I know what it feels like to be pleased. I have enjoyed being pleased. You understand African American, 56, Brooklyn. In addition to themes surrounding increased sexual pleasure, many participants expressed feelings of sexual freedom as a result of the onset of menopause coupled with liberation from the fear of pregnancy and sexual freedom from traditional gender norms sex within committed partnerships.
Sexual freedom Los Angeles California horney older women man included the ability to just have sex Los Angeles California horney older women man the expectations of being in a committed relationship or needing financial support. If anything should happen to him her partnerguess what, the next man I want, I want a booty call. You do you; I do me Bronx Focus Group 1.
For another woman, the notion of freedom includes the ability to have more than one partner, and to have sex whenever she wants. Although many of the women described experiences of sexual pleasure and satisfaction as they aged, many also expressed dissatisfaction with their sex lives. He… is incompetent [impotent] …he been to his neurologist, taking the Viagra, the Cialis.
To remedy this problem, she started to masturbate, thereby addressing her sexual needs:. Another participant described feeling trapped in a sexless marriage and dysfunctional relationship:. I want to have sex with somebody right now. And now the sex is really fucked up, excuse my language. The relationship has passed its expiration date Brooklyn Focus Group 2.
Most of the participants in this study commented on their changing sexual abilities and sexual health needs, which include: new physical limitations, the increase or decline of sexual desire due to menopause; and painful intercourse due to ubiquitous vaginal drying among postmenopausal women. Changing sexual abilities for many revolved around new physical limitations. One woman described how new physical limitations altered her sexual pleasure and satisfaction:. For others, the recognition of these changes resulted in discussions or renegotiations with their partners.
One woman described setting new boundaries with her partner in terms of what she was now willing to do sexually. You got me in a position where my legs wrapped around my neck…No! In the face of these challenges, some women found new ways to circumvent their physical limitations. One participant described how she made personal modifications to sidestep the changes in her sexual capabilities:. Although many women reported being physically challenged, these challenges did not always impact their ability to become aroused and experience an orgasm; overall, women described experiencing both positive and negative changes in their ability to have an orgasm.
Several women described aging as a barrier to achieving a satisfying sexual climax. On the other hand, other women acknowledged how aging has improved their orgasm experience. It's more.
I can have three. Years ago, I didn't have that. Now, I have it African American, 50, Chicago. For many, the experience of menopause profoundly changed their ability to have and enjoy sex. We found, however, that menopause impacted the sexual health of older women with HIV in different ways. For some, menopause hampered their desire and interest in sex. Your body change, your mind changes.
That medication treatment for menopausal symptomsI do everything. I just be in bed because I feel so weak, you know. For another participant, menopause was akin to internal chaos, with the constant highs and lows of mood swings and hot flashes. Sometimes you go through your highs and lows. All these things going on in this one body! The anxiety attacks!
Oh, I get everything, the high blood pressure. Hot flashes, anxiety, depression, menopause! Almost all of the participants described the negative impact of vaginal dryness on their ability to enjoy sexual pleasure as they aged.Los Angeles California horney older women man
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“The pleasure is better as I’ve gotten older”: Sexual Health, Sexuality, and Sexual Risk Behaviors among Older Women Living with HIV