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Sexuality of the old people
Courses of Geriatrics

Sexuality is inherent in the human life. Although its demonstrations are very variable, we meet it in a form or another at all the ages of the life.


xuality: “does not indicate the activities and the pleasure which depend on the operation of the genital apparatus, but a whole series of excitations and activities present as of childhood, which present an irreducible pleasure at the satisfaction of a fundamental physiological need (hunger, function of excretion) and which is found as component in the form known as normal of the sexual love (Laplanche and Pontalis: Dictionary of the psychoanalysis).

Physiological changes of ageing and sexuality:

• At the woman, ageing does not involve sufficiently important modifications to block the sexual intercourse and to reach the orgasm.

The menopause can constitute one period of crisis, during which the woman must give up her capacity procreating.

It can cause suffering (can lead to a anxio-depressive syndrome).

• The changes are more numerous in the sexual behavior of the man: it would seem that ageing more affects the sexual life of the man that of the woman.

Another important data: the shortage of the male partners, due to the difference between the life expectancy female and male life expectancy.

The refusal of the sexuality of the old people belongs to a cultural stereotype which wants that these last are regarded as ugly, impotent, unhappy and impotentes.

The values related on the body and the beauty would belong to youth, while old age would share the loss of autonomy and the pain.

It is difficult for us to consider the sexuality of the old people because let us perceive we them like parents: it is the phantasm of the primitive scene (sexual intercourse of the parents) which becomes here still all its extensive (this aspect of their life represents a too important threat for Ego).

The old people have to make with the glance of their family (the age and the dependence operate an inversion of the responsibilities relative/children, which confers to the children a right of glance on the life of their parents.)

Place sexuality in the institution: it is subjected to the social stereotypes of the sexuality of the old people, but as to the place as looking after them agree to leave him.

The reactions of the professionals vary from one person to another, which can involve contradiction on the level of the team.

The hospital it is the collective whole, the permanent glance of the other; whereas sexuality needs autonomy and does not put up itself with the community.

Ageing, Handicap, autonomy and dependence:

As of our youth, our way of life, the way in which we build ourselves are founded on our dependence and our capacity of autonomy with respect to our environment.

Ageing is one period of the life during which we are brought to find balances between our aspirations, our capacities, our means and those of the people who surround us.

WHO defines various concepts being able to lead to a dependence:

• Deficiency: existence of a disturbance, compared to the biomedical standards, which is responsible for a fall of function.

• Incapacity: measure the importance of the disturbance.

• The handicap (or the disadvantage): measure how the incapacity is compensated or not.

The concept of dependence underlies a relation of need.

One distinguishes:

• Physical dependence: incapacity to achieve without the assistance of a third person 3 acts of the everyday life (to mobilize themselves, nourish themselves, get dressed, deal with the care of hygiene).

• Emotional dependence: gets along within the framework of normality like a need to communicate and a refusal of loneliness.

• Psychological dependence: incapacity to even control oneself.

• Economic dependence: it can be induced by the passage to the retirement.

Autonomy is not defined like the absence of dependence, but like the capacity which has an individual to even control him, including managing its dependences.

It is about an independence compared to a decision and not compared to a means.

Physiological ageing is responsible for a fall of performance of the various bodies of our body; it does not involve a fall of the functions being able to be responsible for a physical dependence.

The physical dependence is the consequence various diseases whose frequency increases with the age.

To manage the dependence is one of the major objectives of the geriatrics.

The field of response to the dependence and to maintains autonomy belongs to the various speakers.

Whatever its level on a scale, the dependence dune nobody must cause a reflexion of the team in order to avoid her aggravation. The answers go from substitution to the compensation.

But it is always necessary to make in kind avoid the loss of autonomy at the time of the hospitalization (in the acts of the everyday life, the nursing and the care…).

Because our action of looking after will have a considerable importance in the capacity of the patient to maintain his autonomy.

Moreover, the hospital is not always regarded a place of life for the patients but as a place of work for looking after.

There is a culture of the pain: the institutions thus privilege the care the diseases, and the assumption of responsibility of the pain.

Painful bodies and bodies of pleasure do not belong to the same world.

Evolution of sexuality with the age and the answers of looking after:

One observes behaviors regressed towards:

• The mouth: the pleasure related to this zone takes as object the food, the embraces, relational greed (old people which “vampirisent” their entourage)

- skin: there are a pleasure of touched through the prolonged contacts (handshakes), but there are also somatic complaints which call the examinations and palpated).

• The anal zone and faeces: certain authors evoke this investment through functional pathologies like the diarrhoea or the constipation.

The regression at this stage leads to fecal plays index of aggressiveness and of great anguish, this regression can be maintained in the language without there being passage to the act.

• The genital zone: it can be the subject of exhibition more or less controlled, of more or less discrete masturbations.

• There are sublimated sexual behaviors: they make it possible to express desires and impulses on an intellectualized mode (painting, writing…).

The message can be sexual but it is not accompanied by one passage to the act.

On the other hand it offers to the individual a satisfaction by slackening the sexual instincts.

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