Sexuality as a taboo Case Study
Sexuality in old age is a subject with many taboos where common sense believes that older people lose their sexual appetite. The movie, Cocoon is a total representation of the stereotypes our society has on top of aging. The male erection is presented as impossible, and the woman is a passive partner (Morrissette, 1996). It is essential to learn the importance of sexual experiences for the elderly and society's negative perception of these practices. Ignoring this issue emerges as a public health problem. That is, the sexuality of the elderly comes to the fore, not because of their negligence or annulment but of sex-borne diseases, such as HIV/AIDS (Zornitta, 2008). The studies about this subject contribute in a parsimonious way to the promotion of changes in attitudes about the sexuality of the elderly, bringing benefits to the quality of life of this population.
There was a greater interest in studies on the health of the elderly in the 20th century (Soares et al., 2011). Thanks to the knowledge acquired through studies over almost a hundred years, significant advances have been made in aging science. However, there is still a long way to go to break taboos and improve the lives of the elderly (Soares et al., 2011). The discovery of the acquired immunodeficiency virus (HIV) pandemic in the early 1980s had a tremendous social impact, for be constructed as a disease contracted only by homosexual men, causing stigma and prejudice (Zildene & Leite, 2011). As a result, the incidence of HIV in the Australian population over 50 years old grew from 5% to 43?tween 1986 to 2016 (Woods, 2019). ‘Assuming a continuation of the current trend in annual notifications, the total number of diagnosed PLHIV in Australia would increase by 38% from 24,646 in 2017 to 34,095 in 2027’ (Woods, 2019). In developing countries, the HIV load is even more significant, according to a study conducted in South Africa by Hontelez et al. (2011), which shows that the number of HIV infections in older adults is expected to increase by about 50% in the next 15 years.
According to UNAIDS (2005), the spread of AIDS among the elderly may be associated with a failure in prevention efforts in this age group. Campaigns for the elderly population are essential, but knowledge alone is not enough to change behavior so that the individual is able to adopt safe practices in order to avoid infection. Above all, it is necessary to focus on sociocultural aspects to reduce risks and vulnerabilities.
According to Viana and Madruga (2010), the elderly should feel comfortable expressing emotions and needs without being fearful or ashamed when discussing problems regarding sexuality. On the other hand, health professionals must be free from prejudice, speak directly about the subject, answer all questions without beating around the bush or embarrassment, show that they want and need to discuss the topic with interest, and show scientific data on some subjects. This is because, if the elderly person wishes. The aforementioned authors also emphasize the need for an environment with privacy, the development of support, and discussion groups with accurate information for those who wish to discuss old taboos and give suggestions for possible problem resolutions.
Although aging is the subject of research in the most diverse areas of scientific knowledge, with regard to the theme of sexuality, studies are scarce. Most of the existing studies address issues about dysfunctions and changes in the sexual functioning of men and women, bringing a few reflections on how the elderly have emotionally dealt with their sexuality. For Gabriel et al. (2010), studies that elucidate the sexuality of the elderly from the perspective of their quality of life are necessary since they are not always understood in this context.
According to Baron et al. (1989), social psychology is ‘the scientific field that seeks to understand the nature and causes of individual behavior in social situations.’ The very definition of social psychology gives a central place to the influence that social and cognitive processes exert on the perception and interaction of individuals with others (Smith & Mackie 1995). Thus, social psychology has as its object of study everything that concerns the interaction and reciprocal influence between individuals and between them and society. Social psychologists investigate constructs such as attitudes, beliefs, norms, group processes, gender, social cognition, social representations, prejudice, and stereotype, among others, thus observing the broad dimension of their field.
In this sense, it is clear that the knowledge built by social psychology as a discipline has much to offer for the understanding of sexuality as an object of study and research. Despite the creation of the term 'sexuality' having located sex as an area of human behavior subject to scientific study in the context of biology and health, the mere emergence of this term at the end of the 19th century caused a change in the way of discussing and understand sex, decisively transforming the social meanings of this type of behavior (Mottier, 2008).
From what has been exposed on the subject, it was observed through the Theory of Social Representations, the idea of ??the conception of sexuality in aging as a social phenomenon, composed of the historical, political, economic, and cultural dimensions, in addition to the biological one, in which was composed, in order to describe on which bases they are theoretically based, and what challenges, beliefs, and stereotypes interfere with it. According to Moscovici (1978), Social Representations are almost tangible entities. They circulate, intersect and crystallize incessantly through a speech, a gesture, an encounter in our everyday universe, thus constituting a particular modality of knowledge whose function is the elaboration of behaviors and the communication between the participants. individuals. Social representations are motivated by interactions and communications within social groups, perceiving the situation of individuals with regard to matters that are the object of their day-to-day.
Therapy is essential and has the responsibility to recognize the stereotypes and experiences of the elderly. However, it must also be able to provide information about normative development so that the elderly need facts on which to base their myths or valid expectations (Watter & Boyd, 2009). Not talking about sexuality can lead to undiagnosed or untreated sexual problems that lead to mental problems such as depression and social isolation (Lindau et al., 2007). Individual or family therapy uses support groups covering topics such as menopause, erectile dysfunction, or HIV, which help reduce feelings of isolation by providing older clients with a community of peers dealing with similar issues (Hochman, 1987).
Geriatric studies such as Lichtenberg (1997) and Mayers and McBride (1998) show that when physicians and staff working with older adults are informed and comfortable talking about sexuality, clients are more comfortable talking about it. In addition, older people who are more knowledgeable about sexuality have more positive attitudes toward sex and are more sexually active, so education is a valuable tool for clinicians in any setting (Hillman, 2008; Walker & Harrington, 2002; Willert & Semans, 2000).
An example case representing sexuality in the elderly is the Case Vignette (Willert & Semans, 2000), where a couple, Alfred (68 years old) and Maria (63 years old), started going to therapy because of erectile problems from Alfred. The therapist gave the couple an open and safe space for them to share how their sex life has been for the 40 years of the marriage. It is essential for the therapist to ask for the patient medical data and sexual history to see if there is something that can affect sexual functioning. The information should include the frequency of sexual encounters across the lifespan, erectile dysfunction in men and discomfort in women, sexual techniques, sex after retirement, menopause, and bereavement concerns (Kennedy et al., 1997). It has been said that one of the most significant predictors of sexual activity in people aged 60 and over is the success of their sexual adjustment in middle age (Levine, 1998). If the couple in their middle years were sexually active, they would likely remain active. If the couple was inactive, they hardly started activities in their later years.
Alfred and Maria reported a satisfying sex life until Alfred's ejaculatory problems began. However, their sexual script, like their roles within the family, seemed rigid and unchanging. Maria, who had never had sexual intercourse before Alfred, let him take the lead during their limited foreplay and coitus. Both came from a traditional family where the man knew better, and sexuality was not open to discussion.
In examining the couple's sexual history, it is clear that some of the sexual difficulties they now face are due to their lack of sexual knowledge and traditional beliefs about sexuality. Treatment for this couple should begin with reducing the couple's lack of knowledge about the typical physiological declines accompanying aging. The couple was presented with literature on sexual changes in aging men and women. When Alfred learned that as many men age, their ability to get and maintain an erection decline, he expressed great relief.
Later in therapy, the couple's sexual needs were addressed directly.
The couple was encouraged to focus on pleasure and intimacy rather than performance. Because the couple had a limited sexual repertoire, the therapist provided instruction on manual and oral techniques to facilitate sexual arousal. Educational materials and information on foreplay techniques were provided. Because of Alfred's arthritis, the couple was also advised to take a warm bath before sex and to try new positions, such as side by side (Kennedy et al., 1997).
By addressing sexuality and sexual issues with older adults in a considerate, non-judgmental, and non-discriminatory manner, counselors can give older adults a place to discuss their concerns.
Many professionals receive little training in working with older adults and even less in sexuality; these individuals, as well as students and early career professionals, may feel uncomfortable discussing sexual concerns with older clients, which can do them a real disservice (Langer, 2009; Zeiss, 1997; Zeiss & Kasl-Godley, 2001). Failure to address these concerns with an older adult client can contribute to "depression, anxiety, sadness, disappointment, or shame" (Langer, 2009, p. 758). It is important for counselors to develop their knowledge, attitudes, and skills, including self-awareness, so that they can counsel older adults on various sexual concerns, not just physical ones.
Research on older adults' attitudes toward sexuality will continue to guide this effort. When working with older adult clients who are ethnic or sexual minorities, counselors may encounter challenges in treatment based on clients' experiences of racism, discrimination, or violence. Treatment may also be challenged by the counselor's own unexamined biases (Grossman, 2006; Sue & Sue, 2008).
Recognizing that the older adult client is a unique individual with a combination of racial, ethnic, gender, sexual, cultural, religious, and socioeconomic identities can prevent the professional from viewing the client primarily in terms of age. As the population of older adults grows, more research is warranted on sexuality and its expressions among older adults who identify with one or more ethnic or cultural minority groups and as members of one or more sexual minority groups.
