Sexual Health Behavior and Mental Health Among Older African American Women: The Sistahs, Sexuality, and Mental Health Well-Being Project

A qualitative study on the unmet sexual needs of older women

Sexual health in older women is one of the significant aspects of health, and planning to improve sexual health requires identifying these women's needs. This study was conducted to explain older women's unmet sexual needs. The present study was conducted qualitatively using the inductive content analysis method in 2023. The data collection tools were semi-structured interviews and field notes. A total of 29 individuals (seven sexual health care providers and 22 older women) were recruited as participants using the purposive method and the strategy of selecting participants with maximum diversity. Data were analyzed using the Graneheim and Lundman approach. Data analysis led to the emergence of 110 primary codes, 24 sub-subcategories, and eight subcategories (promoting sexual requests and desires, maintaining privacy in sexual relations, valuing sexuality, adopting strategies to reduce life's adversities, improving sexual involvement, the ability to resolve the conflicts of maternal/spousal roles, the development of preventive services related to sexuality issues in the health sector, the development of therapeutic services related to sexuality issues in the treatment sector), and three main categories (respect for sexuality, empowerment for sexuality, and the development of services related to sexual health). Based on older women's experiences, their unmet needs were related to empowering them to resolve sexual conflicts, strengthening sexuality dignity, and improving the processes and structures of the health system. In this regard, it is recommended that health and social policymakers design effective interventions to improve older women's sexual health.

Influences of Gender-Based Stigma on HIV Prevention and Care Among Older Women: A Scoping Review

ABSTRACT

Older women living with HIV are uniquely situated at multiple marginalized intersections because of their gender, age, and HIV status. However, research into how gender-based stigma (GBS) affects HIV prevention and care for older women is sparse. We conducted a scoping review to explore the relationship between GBS and HIV-related psychosocial, behavioral, and well-being outcomes among older women. Our systematic search yielded 25 articles describing 22 unique studies. We identified five main themes highlighting how GBS exists at individual, interpersonal, and societal levels to adversely affect HIV prevention and treatment among older women: (a) relationship power, safe sex practices, and intimate partner violence; (b) stigma, discrimination, and harmful stereotypes; (c) quality of care; (d) caregiving roles and responsibilities; and (e) psychological and physiological manifestations. Outstanding questions remain on best methods for measuring and conceptualizing GBS in HIV research and ways to translate research findings to public health practice.

Marital rights: Lived experiences of Iranian women with retired spouses in a qualitative study

BACKGROUND

The aim of the present study was to analyze the lived experiences of Iranian women living with their retired spouses in relation to their marital rights.

METHODS

The research method was qualitative and descriptive phenomenology. The statistical population included women living with their retired spouses in the city of Isfahan, and the sample consisted of 15 women. Data were collected through semistructured interviews, with three general questions on emotional rights, economic rights, and sexual rights, and were approved by five experts. Data were analyzed using the seven-step Colaizzi method.

RESULTS

After transcribing the interviews and coding the data, the following axial codes were identified. Emotional rights included the two categories of camaraderie and dissatisfaction. Economic rights included the four categories of economic management, economic well-being, respect for women's economic property, and economic problems. Finally, sexual rights consisted of the two categories of satisfaction and dissatisfaction with sexual relationships. The results showed that some participants were satisfied with the implementation of their rights during their spouse's retirement, while others were dissatisfied. Most current marital problems related to emotional, economic, and sexual rights result from past and unresolved marital life conflicts that lead to the escalation of family tensions.

CONCLUSIONS

According to the dissatisfied participants, the best strategy for resolving these problems was to "sweep them under the rug,", i.e., to rehire the men and protest the lack of support for the retirees by the state organization. In contrast, satisfied participants played an important role in solving the problems and actively dealt with their spouse's retirement rather than taking a passive and protesting role to realize their marital rights.

Sexual attitudes and utilization of sexual and reproductive health services among older women in southern China: a qualitative study

Objective

Sexual health plays a vital role in healthy aging. However, little is known about the sexual attitudes of and the utilization of sexual and reproductive health services by older women in China. This article is based on a qualitative study of older Chinese women in suburban areas to examine their attitudes toward sexuality and their utilization of sexual and reproductive health services.

Methods

Face-to-face semi-structured interviews were conducted with older women (ages 50 to 74) from suburbs of southern China. Participants were purposively sampled on a convenience basis and recruited when they were visiting community health facilities between June and December 2021. Inclusion criteria were older women aged 50 years and older who had sexual experience. A topic guide was used that focused on sexual activity, sexual attitudes, the utilization of sexual and reproductive health services, and the factors that influence these. Interviews were audio recorded and transcribed verbatim. We coded the data inductively and conducted a thematic analysis.

Results

Twenty-six Chinese women participated in the study. These older women had varying attitudes regarding sexual activity and its significance for older adults. The gender norms they held concerning sexual desire deemed that men had higher sexual desire than women. Most asymptomatic women did not actively seek sexual and reproductive health services. In most cases, women only sought professional services when they started to have sexual and reproductive health problems. Factors influencing the uptake of sexual and reproductive health services by older women were cost (affordability), availability, distance (accessibility), and conservative cultural norms towards sexuality.

Conclusion

The attitudes of older women towards sexual activity are diverse. While some view sexual activity as common and essential for maintaining a sense of well-being in older age, others may hold different perspectives, considering it less significant. The utilization of sexual and reproductive health services by older Chinese women, except for when they were having a specific health issue, was low. Sexual health messages and services tailored for older women are needed.

The barriers and enablers to accessing sexual health and sexual well-being services for midlife women (aged 40-65 years) in high-income countries: A mixed-methods systematic review

Midlife, beginning at 40 years and extending to 65 years, a range that encompasses the late reproductive to late menopausal stages, is a unique time in women's lives, when hormonal and physical changes are often accompanied by psychological and social evolution. Access to sexual health and sexual well-being (SHSW) services, which include the prevention and management of sexually transmitted infections, contraception and the support of sexual function, pleasure and safety, is important for the health of midlife women, their relationships and community cohesion. The objective was to use the socio-ecological model to synthesise the barriers and enablers to SHSW services for midlife women in high-income countries. A systematic review of the enablers and barriers to women (including trans-gender and non-binary people) aged 40-65 years accessing SHSW services in high-income countries was undertaken. Four databases (PubMed, PsycINFO, Web of Science and Google Scholar) were searched for peer-reviewed publications. Findings were thematically extracted and reported in a narrative synthesis. Eighty-one studies were included; a minority specifically set out to study SHSW care for midlife women. The key barriers that emerged were the intersecting disadvantage of under-served groups, poor knowledge, about SHSW, and SHSW services, among women and their healthcare professionals (HCPs), and the over-arching effect of stigma, social connections and psychological factors on access to care. Enablers included intergenerational learning, interdisciplinary and one-stop women-only services, integration of SHSW into other services, peer support programmes, representation of minoritised midlife women working in SHSW, local and free facilities and financial incentives to access services for under-served groups. Efforts are needed to enhance education about SHSW and related services among midlife women and their healthcare providers. This increased education should be leveraged to improve research, public health messaging, interventions, policy development and access to comprehensive services, especially for midlife women from underserved groups.

A Systematic Review Exploring Racial Disparities, Social Determinants of Health, and Sexually Transmitted Infections in Black Women

OBJECTIVE

To explore and describe racial disparities, the role of social determinants of health, and individual risk behaviors among Black women as related to sexual health and/or sexually transmitted infections (STIs).

DATA SOURCES

Electronic resource databases used were PubMed, CINAHL, and Google Scholar. Peer-reviewed articles published during 2010 to 2020 were considered.

STUDY SELECTION

Thirty-two studies met the criteria and included data for a total of 18,904 Black women.

DATA EXTRACTION

Data were extracted from each study using the subheadings author (year), purpose, design, sample demographics and setting, key measures, key findings, and quality assessment. In addition, PRISMA-E and PROGRESS-Plus guided data extraction to illustrate health inequity.

DATA SYNTHESIS

Black women who were more likely to report having an STI over the course of their lifetime engaged in behaviors associated with greater risk, the most common of which were unprotected sex, disproportionate partner power, and substance abuse. The primary social determinants of health associated with increased risk were lower income and lower levels of education. Black women were less likely to discuss or feel comfortable discussing their sexual health with health care providers. By contrast, engagement in safe sexual practices stemmed from internal, social, and relationship factors.

CONCLUSION

Identifying Black women who are at risk of contracting an STI is essential in driving clinical decision-making. Health care providers should be cognizant of the long-standing mistrust that Black women have of health care providers and, therefore, work to establish positive respectful and trusting relationships with open communication.

Introducing sexual dysfunction in mental care

Introduction: People with any psychiatric disorder tend to have difficulties in responding sexually. However,sexual dysfunction (SD) is usually under-recognized, even the tightly hormonal and neuronal common connexions through the brain-sex axis. Multiple sources of resistance to SD assessment and intervention persist. Areas covered: The present review aims to underline the feasibility to introduce SD evaluation in patients with any psychiatric disorders, evaluating the potential mutual benefits of their management. Expert opinion: Women and men living with mental disorders frequently display sexual difficulties; however, some of them consider sexuality as a relevant parameter of their quality of life. In fact, SD as a side effect is a frequent reason for stopping the intake of medication. What is more, a holistic approach integrating sexual function could foster a better understanding of mental pathologies due to a common origin of pathogenesis. This could improve care quality, in keeping with the global tendency toward the development of personalized medicine. Consistently, the integration of SD assessment is highly recommended in mental health, all the more so when a psychotropic drug is prescribed. An expected consequence would be a reconstruction of the healthcare professional's consideration for the sexuality of people experiencing mental disorders.

Factors Conditioning Sexual Behavior in Older Adults: A Systematic Review of Qualitative Studies

The sexual behavior of older adults, especially women, has undergone changes in recent years, though there are still certain stereotypes today related to pathophysiology, beliefs, culture and tradition that negatively affect older adults’ sexual activity. The aim of our review is to present the main qualitative studies analyzing how physiological and psychosocial factors affect sexual behavior in older adults. A systematic review of these qualitative studies was carried out. All stages of this review were carried out peer-to-peer in order to guarantee minimized bias. A bibliographical search was completed between February and April 2019, in Web of Science, Scopus, PubMed Medline, PsycINFO ProQuest and CINAHL. To analyze the findings of the selected qualitative studies, a “Thematic Synthesis Analysis” was performed, using Eppi-Reviewer 4 software (UCL Institute of Education, University of London, UK). The quality of the studies was assessed with a CASP-Qualitative-Checklist. A total of 16,608 references were screened and 18 qualitative studies were included in this review. The studies involved 2603 participants across seven countries, most being women (approximately 80%). We identified a wide variety of physiological and psychological factors that can influence the sexual behavior of older adults, such as the presence of pathologies (erectile dysfunction and menopause), the strength of spiritual beliefs, and patriarchal roles upheld by upbringings conveying that women’s role is to provide men with sexual pleasure. Biological age in relation to stereotypical models of sexual behavior, emphasized as a risk factor in the contraction of sexual diseases, seems to play a relevant role as a factor limiting sexual behavior in older adults.