Sexual Health Among Old-Aged People - Understanding the Changes

Introduction

Sexual characteristics are important for every human being. It is important not only for reproductive function but also for other functions in the body. The development of male and female characteristics begins in adolescence. With the increase in age, the development of both primary and secondary sexual features takes place. However, in the elderly population, a change in these sexual features is seen. Aging is a physiological process characterized by reduction and function changes in the cells. Also, morphological changes due to aging. Needless to say, aging affects sexual health too.

What Are the Age-Related Changes in Women?

Age-related changes in women are attributed to hormonal changes. This is known as menopause. It is nothing but the cessation of the menstrual process. This is seen in women in their mid-forties and the usual age for women to attain menopause is between 49 to 52. However, different factors may affect menopause.

1. Pathophysiology:

During birth, there are approximately 400,000 follicles present. However, as age increases, the number of follicles decreases. During puberty, around 200,000 to 300,000 remaining follicles are present in the female reproductive system. Each menstrual cycle recruits about 30 follicles, with one eventually becoming the dominant follicle. Over time, the number of follicles decreases due to ovulation and degeneration. The mature follicle, known as the Graafian follicle, is crucial in secreting hormones such as estrogen and progesterone, which are responsible for maintaining various reproductive functions. As the number of Graafian follicles decreases, the production of inhibin B also decreases. Inhibin B is involved in regulating follicle-stimulating hormone (FSH). Due to this, the level of FSH increases. This leads to the maturation of more follicles. This accelerates the reduction in the number of follicles. Ultimately, the level of estrogen decreases while the level of FSH and luteinizing hormone (LH) increases. Additionally, the concentration of serum sex hormone-binding globulin (SHBG) and dehydroepiandrosterone sulfate (DHEAS) in the blood decreases, resulting in a decrease in testosterone concentration. Furthermore, the cessation of ovulation leads to a reduction in the amount of progesterone in the blood.

2. Symptoms:

The sexual changes seen in the aged women are;

1. A low sexual drive and desire is one of the main sexual changes seen in aged women. A low level of testosterone is associated with such conditions. In this condition, symptoms like lack of sexual thoughts, fantasies, or desire for or receptivity to sexual activity can be seen.

2. Women often suffer from poor self-esteem, lack of self-confidence, and psychological instability. This is mainly caused by low levels of testosterone hormone.

3. Hormone like estrogen is associated with the balance of the microorganisms in the vaginal tissues. Alteration in the level of estrogen is associated with a change like a decrease in lactobacilli count in the vagina. This alters the pH of the vaginal tissue. As a result, symptoms like itching, dryness in the vagina, and pain in the vagina are seen. This causes repeated infection in the vagina.

4. Due to aging the death of the vaginal cells causes thinning of the vaginal wall. It is also known as vulvovaginal atrophy.

5. Orgasmic and arousal dysfunctions are very commonly seen in post-menopausal women. Women find difficulty in attaining orgasm after sufficient sexual stimulation. This is mainly related to the reduction in blood circulation in the female genital area. Also, low levels of estrogen and testosterone alter the action of the neurotransmitters.

6. Thinning of the pubic hair and sagging of the breast. There is also a reduction in the breast size. In some cases, an increase in breast size is seen due to unnatural weight gain and fat deposition.

7. Aging causes degeneration of muscles and connective tissue supporting the pelvic structure. Loss of support from tissue structure causes altered positioning of the anterior vaginal wall, posterior vaginal wall, uterus, or apex of the vagina. Often these organs are bilged out from the vagina.

What Are the Age-Related Changes in Men?

The term menopause is a misnomer due to the absence of the menstrual cycle in men. However, the changes seen in older men are also caused by hormonal changes. Many people have termed it as male menopause.

Pathophysiology:

Testosterone plays a crucial role in regulating various male sexual functions. In the body, approximately 45 percent of testosterone is bound to sex hormone-binding globulin (SHBG), a type of plasma protein that does not possess androgenic potential. Only 2 percent of testosterone remains unbound and free. Around 43 percent of testosterone is bound to albumin, another protein that does have androgenic potential. Therefore, bioavailable testosterone, which is responsible for androgenic functions, includes both albumin-bound and free testosterone. In aging men, the level of free testosterone gradually decreases by less than 1.2 percent per year. The reduction in albumin-bound testosterone and free testosterone is approximately 1 percent and 0.4 percent, respectively. Additionally, there is a decline in Leydig cell mass in the testicles, which further contributes to lower testosterone levels is also seen. In some cases, dysfunction in the hypothalamic-pituitary homeostatic control system can also be observed.

Symptoms:

1. Diminished sexual desire is one of the most important. It is related to sexual change caused by aging. It is related to low levels of testosterone and other male sex hormones in the body.

2. Elderly men often suffer from erectile dysfunction. It is a multifactorial condition caused by low testosterone levels, reduced blood flow, and neural damage. It is characterized by difficulty in erection, difficulty in sustaining an erection, and erection for a short duration.

3. Deposition of the glandular tissue causes formation of the male boobs.

4. The semen's sperm count is decreased in aging men, accompanied by noticeable changes in sperm quality. The reduced survivability of sperm is attributed to increased DNA fragmentation caused by aging. This is linked to alterations in the functioning of the Sertoli cell. Additionally, a decrease in semen volume and daily sperm production has been observed.

5. Age-related increases in the size of the prostate gland are very common. Hyperplasia of the prostate gland is caused by overgrowth of the basal cells and stromal cells.

How to Improve Sexual Health in Elderly People?

Several methods can be used to improve sexual health;

1. Overall improvement in general health is needed. Habits like chronic alcoholism and smoking should be stopped as these may cause rapid alteration in the hormonal balance. Also, the combustion of healthy food full of vitamins and minerals is needed.

2. Daily exercises are one of the best methods to counter age-related changes. Also, it helps to maintain hormonal balance and circulatory balance.

3. Vaginal moisturizers help improve the pH of the vagina. It also prevents the atrophy of the vaginal epithelium and inflammation of the vaginal tissue.

4. Hormonal replacement therapy is useful in regaining sexual health. In females, estrogen supplements, and in males testosterone supplements can be given.

Conclusion

Sexual well-being is necessary for a healthy life. However, aging causes hormonal imbalance. This is associated with several sexual dysfunctions. A healthy lifestyle, daily exercise, and hormonal treatment may delay age-related sexual changes.