Summary block sexuality
Sexual health and relationships after age 60 – Minkin, M.J. (2016)
At older age, many people are still sexually active. 50% of the respondents have at least one
sexual problem. 60% of women with a relationship (age>60) is sexually active and 13% of
women without a relationship (age>60) is sexually active.
Predictor of sexual activity was a partner (married or living together). Also, higher prior
(eerdere) sexual satisfaction, lack of depression, younger age and lower BMI.
Absence of dyspareunia (pain shortly before, during or shortly after sex) was important for
sexual satisfaction. Also, good communication was associated with higher sexual
satisfaction.
- Ospemifene: improve dyspareunia (improvements in Female Sexual Function Index)
Menopause (Vulvo Vaginal Atrophy) interferes with overall healthy sexual functioning. VVA
negatively affected relationships.
- Failing to treat menopausal symptoms appropriately
- Breast cancer survivors have very high incidence of VVA
Breast, gynaecological and prostate cancers pose challenges (vormen uitdagingen) to sexual
dynamics. Female patients treated for cancer receive not enough counselling, support or
treatment to keep or retrieve sexual function. Little women (7%) sought advice or medical
help for sexual problems, while 40% was interested in receiving care.
Addition of psychotherapeutic interventions (to hormonal and non-hormonal medications)
can improve arousal, satisfaction and overall well-being, while decreasing depression.
Erectile dysfunction in a partner brings various challenges to sexual dynamics. The treatment
of prostate cancer has sexual impact as erectile dysfunction, dry ejaculation, leakage of urine
with orgasm, penile shrinkage (penis krimp), incontinence and bowel (darm) dysfunction.
Prostate cancer therapy has negative impact on sexual relationships and worsen over time.
- Female patients ask for input on their partner’s conditions
, - Men with ED need to be screened for cardiovascular disease. Coronary artery disease
show symptoms of ED three years earlier
- ED after prostatectomy: lower partner satisfaction. Men distress, diminished feeling
of masculinity (verminderd gevoel van mannelijkheid) and anxiety about performance
- In ED and prostate cancer men are willing to talk about sexual issues, but they prefer
the health care provider to start the conversation
Saturation model: prostate cancer is extremely sensitive to variations in androgens at low
concentrations and indifferent (onverschillig) to normal and high concentrations.
Gynaecologists, oncologists, urologists and psychologists can jointly treat.
Cultural norms are important in assessing expectations in mature sexual relationships.
- Japan: Older men peak in the past, while wives think desire is less important than the
source of wellbeing and vitality. Sibling-like relationships as couples grow older
- China: attitudes much more liberal
- Black women: higher frequency of sexual intercourse
- Hispanic women: lower physical pleasure and arousal
- Chinese and Japanese women: noted less arousal
Sexuality and Islam – Dialmy, A. (2010)
Sexual standards in Islam are paradoxical: sexuality is allowed and encouraged but
discriminated between male and female, marital and non-marital and between heterosexuality
and homosexuality.
Nikah: marriage and coitus. The privileged space of pleasure. It is necessary that the husband
takes into account the rights of his wife during coitus.
Nikah for man: reflects male point of view.
- Man chooses his wife
- He is allowed to marry four wives in case of illness, infertility (onvruchtbaarheid) or
aging of his wife
, - Men sexually active for life
- Moslem men allowed to marry Jewish and Christian women (for Women this is
legally forbidden Moslem women are not allowed to marry non-Moslem men)
- Children must be Moslem (so father must be Moslem) expand high birth rate
- Status: achieved through production of large families (childless couple is regarded
with contempt = minachting)
o Extended family with many children (preferably boys) can be a strong family,
providing economic and political security
- Men have the right to own sexual slaves in unlimited number (also before marriage).
Women could own slaves but they are not allowed to have sexual intercourse with
them
- Women is chosen as a wife. Qualities: beauty, wealth (rijkdom), origin or piety
(godvruchtigheid)
- Preferable for the man to marry a virgin: virginity prevents woman for remaining
sentimentally bound to a former (blijvend sentimenteel gebonden zijn) husband or
from taking the initiative when it comes to sex
- Husband = sexual master. Physical domination lying on top of women
- Sodomy: is forbidden (=tegen natuurlijk)
o Who takes a woman from behind is cursed
o Sodomy of women is illicit (ongeoorloofd)
o Who takes a woman from behind is not seen by God on Judgment Day
o Sodomy of the wife, this minor homosexuality
Three rational evidences to prohibit sodomy of the wife
- The contact of the penis with faeces is even more harmful than with menstrual blood
sodomy of faeces is forbidden more severely than coitus during menstruation
- Sodomy does not provide pleasure to the women
- The women suffer physically and psychologically from being sodomised
The wife’s right to have an orgasm is acknowledged not only for sexual reasons. It is
considered to be the wife’s fidelity (trouw).
Male control of women’s body. Female sexuality (uncontrolled) lead to social chaos.
, Homosexuality
- Homosexuality is a shame
- Koran did not have a legal sanction against this sin (homosexuality)
- Homosexuals are imprisoned (gevangen), whipped (geslagen) or sentenced to death
(veroordeeld tot de dood)
- Acceptance of sexuality by Islam is partial. It favours men and certain ways of
expressing one’s sexuality sexuality is constrained by (gedwongen) patterns of
male and heterosexual domination
Sexual practices
- Between repression and openness
- Partial modernisation had an impact on sexual practices leading to greater tolerance
- Schooling of women and their involvement in the labour market led to rise of the
average age of the girl at first marriage
- In some Moslem countries there is free access to contraceptives before marriage and
the possibility of having an abortion or reconstruction of the hymen (maagdenvlies)
Premarital sexuality
- Premarital female sexuality result of increase of the mean age at the first marriage and
existence of sexual substitutive practices
- Sexual activity among Moslem women starts earlier than marriage
- Girls seek to satisfy their desire, to love, to be rewarded in return for their services, to
emigrate, to forget to affirm themselves
- Premarital sexuality does not necessarily mean defloration
- The will to keep hymen intact for marital ends leads girl to adopt alternative practices:
intercrural coitus (between thighs) and interlabial coitus (between labia majora
=schaamlippen)
- Also possible to suture (hechten) the hymen before wedding
Female pleasure
- First: wife must satisfy her husband’s desire and producing a large number of male
children
