'You're as young as the one you feel' - Sexual Arousal in the Elderly Woman
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Professor Alessandra Graziottin |
Sexual arousal encompasses three major aspects: a) central (mental) arousal, with a massive neurobiological activation of the sensory cortex, the amygdale and the cingulated gyrus which correlates with the feeling of being aroused; b) peripheral–non genital arousal; c) genital arousal. The biological basis of sexual arousal is gradually impaired by age. Menopause has a further detrimental effect, the earlier its onset, the stronger its impact, unless a well tailored hormonal therapy is initiated .
Central arousal disorders are comorbid with loss of sexual desire and are difficult to be separated from it. Genital arousal disorders, with their main subjective symptom, vaginal dryness, are increasingly reported with age. Arousal disorders are complained of by 19–20% of women in epidemiological surveys. This figure may increase to 39–45% in postmenopausal sexually active patients. Mental arousal may be triggered through different pathways: biologically by androgens and estrogens, psychologically by motivational forces like intimacy needs such as love, tenderness, attention, bonding and commitment. Leading biological etiologies of arousal disorders in the elderly woman include: 1) loss of sexual hormones, primarily estrogen and androgens, 2) depression; 3) pelvic floor disorders; 4) vulvar dystrophy/atrophy; 5) vascular damages, more likely in smokers, diabetic, hypertensive, and/or hypercholesterolemic women.; 6) neurological diseases. However, the quality of sexual aging is powerfully modulated by individual, life-styles related, psychosexual and relational factors: healthy elderly women with a positive self-image and body image, who practice healthy life styles, who use hormonal treatment (at least with topical estrogen and testosterone), and have a satisfying affective life may fully enjoy their sexual life.
Conflict of Interest: None disclosed Financial Support/Funding: None disclosed Recorded: Sydney, Australia, April 2007
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Alessandra Graziottin
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Professor Alessandra Graziottin
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Alessandra Graziottin is currently Director of the Centre of Gynaecology and Medical Sexology at the H. San Raffaele Resnati in Milan, Italy. She is Consultant Professor at the University of Florence and the University of Parma, Italy, and Co-director of the Postgraduate Course in Medical Sexology at the University of Florence. She is also Visiting Professor and Research Consultant on Female Sexual Dysfunctions (FSD) at the Department of Urology, William Beaumont Hospital in Royal Oak, Michigan, USA. Dr. Graziottin has published: 13 scientific books (as author, co-author or editor); 60 chapters of scientific books; 60 refereed papers, 216 proceeding contributions and non refereed article. She is currently a member of the Editorial Board of Maturitas, Journal of Men’s Health and Gender, Current Sexual Health Reports, The Journal of Sexual Medicine, and referee of The Lancet, The Journal of Sex and Marital Therapy, Climacteric, Maturitas, The Journal of Sexual Medicine, The Journal of Endocrinological Investigation and The Journal of Gynaecological Endocrinology. After serving on the Board of the Italian Menopause Society from 1997 until 2001, as Vice President of the Female Sexual Function Forum, FSFF (2000-2001), and as President of the International Society for the Study of Women’s Sexual Health, ISSWSH (2001-2002), she is currently a board member of the following Scientific Societies: the Italian Society of Psychosomatic Obstetrics and Gynaecology (ISPOG), the European Society of Menopause and Andropause (EMAS), the Italian Society of Gynaecology of the Elderly (SIGITE) and the International Society for Sexuality and Cancer (ISSC). She also serves on the executive committee of the Italian Menopause Project (IMP). In June 2004 she was awarded the Honorary Membership by the Society of Obstetricians and Gynaecologists of Canada (SOGC). As a leading expert and teacher in Gynaecology and Medical Sexology, she has given more than 720 lectures at international and national meetings and courses. In October 1998 she contributed as a board member to the First International Consensus Conference on Female Sexual Dysfunction (FSD), held in Boston. In 2003 she assumed this role for the Second International Consensus Conference on FSD, in Paris, France. In 2005-2006 she chaired the FSD Sub-Committee of the International Society for Sexual Medicine (ISSM). The pertinent proceedings have been published in: Porst H. Buvat J. (Eds), ISSM Standard Committee Book, Standard Practice in Sexual Medicine, Blackwell, Oxford, UK, 2006. She is currently member of the Ethical Committee of the International Society for Sexual Medicine (ISSM).
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