“Sexual Life in My 54 Years Has Become Brighter, More Interesting and More Diverse”: Transformative Moments of Subjectivity in the Life Course

This study aims to systematically interpret and synthesize the data obtained from qualitative research about the sexual lives of women with diabetes. A thorough literature review was conducted between May and July 2023 across five electronic databases: PubMed, Web of Science, CINAHL, EBSCO, and Science Direct Embase. Eight studies published in English since 2000, which explored the sexual experiences of women with diabetes, were included in this assessment. The sexual experiences of women with diabetes were summarized under five main themes: perception of sexuality, changes in sexual life, adapting to the new normal, unmet care needs, and expectations. This review underlines the intricate nature of diabetic women's sexual experiences, acknowledging the substantial impact of diabetes-related complications and the associated emotional stress on their quality of life and intimate relationships. The study finds that awareness varies among women, with some adapting to the changes brought on by diabetes, while others remain uninformed about its impact on their sexual health. There is a pronounced need for integrating sexual health into diabetes care routines. Many women face unaddressed sexual health concerns and require education and empathetic care from knowledgeable health professionals.

Later life relationships and in particular the role of sex within them, have often been neglected in research due to assumptions of decline and sexlessness. We contribute to a growing body of work which counters these stereotypes by examining sexual scripts within the socio-cultural context of later life relationships. We analyzed open-text comments from the English Longitudinal Study of Aging (ELSA) collected as part of a self-completion questionnaire. In Wave 6, 1065 participants (M age 67.5, SD 9.6 years) and in Wave 8, 922 participants (M age 69.1, SD 9.01 years) responded to an open-text box question. Across both waves, 38% of respondents were men and 62% were women. The analysis used a coding template developed from existing literature and adjusted to accommodate emerging topics. A gendered analysis of the interrelated topics of relationships, sex and sexuality resulted in themes which illustrate similarities and differences in how men and women negotiate sex in later life relationships. The findings confirm that sex remains integral to intimacy in later life relationships for many men and women. However, they also demonstrate that norms of age and gender interact to shape sex and relationship practices in later life. These norms limit some people’s experiences, for example, preventing them from seeking new relationships, as well as creating challenges for intimacy in partnerships. These findings extend the theoretical understanding of relationships and sex in later life.

As the number of breast cancer survivors increases, these patients with sexual problems also increase. For breast cancer survivors, sexual problems are a common and painful experience. Although breast cancer survivors often encounter sexual problems, Taiwanese women are culturally conservative and patients rarely discuss sex problems with clinicians. In this study, we used qualitative methods to better understand the changes in sexual life and related care strategies for breast cancer survivors. Twenty interviews were conducted on clinical patients enrolled in hospitals that received breast cancer treatment. The data were analysed by performing a constant comparative analysis. Three themes emerged: the causes of changes in sexual life, internal response strategies and external response strategies. Ten subthemes were identified. Changes in sexual life in patients with breast cancer in this study included changes related to body image, influence of friends and family, age, genital problems, and illegal love of a partner. Breast cancer survivors can tolerate and regulate sexual life changes by adopting internal and external response strategies. Medical staff must be sensitive and must understand strategies for dealing with sexual life changes that may occur during cancer adjustment and how these strategies can help women’s well-being in the rest of their lives.

This study aims to systematically interpret and synthesize the data obtained from qualitative research about the sexual lives of individuals who have experienced myocardial infarction (MI). A thorough literature review was conducted between November and December 2023 across five electronic databases: PubMed, Web of Science, CINAHL, EBSCO, and Science Direct Embase. This article includes 12 studies published in English since 2000 that have examined the sexual experiences of individuals who have experienced MI. This research adhered to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. We utilized the Critical Appraisal Skills Programme tool for qualitative research to evaluate the quality of all the papers included. To synthesize the data, the deductive and interpretation technique according to Sandelowski and Barroso's approach has been used. The sexual experiences of individuals who have experienced MI were summarized under four main themes: changes in sexual life, barriers to engaging in sexual intercourse, an unmet need: information, and sexuality as a part of routine care. Patients' expectations from counselling services regarding sexuality after MI are oriented towards these services providing more comprehensive information and incorporating multidisciplinary approaches. This demand clearly indicates the complex and multidimensional changes in sexual life after MI and underscores the necessity for healthcare professionals to play a more active role in this area. PROSPERO: CRD42023483112.

Sexual changes in hemiparetic patients.

BackgroundSexuality plays a critical role in a woman’s postpartum quality of life and also has a strong impact on the quality of her relationship. Given the sparse body of published literature on the subject, we aimed to explore how new mothers explain their postpartum sexual quality of life.MethodA qualitative study was carried out in Iran and Switzerland from December 2018 to March 2019. Focus groups and semi-structured in-depth interviews (IDIs) were conducted with mothers in the first four months after parturition. Mothers who were older than 18 years, were married or in a stable relationship, and experienced a low-risk vaginal birth or cesarean section participated in the study. We used Graneheim and Lundman’s approach for analyzing the data. Multiple data collection methods, maximum variation sampling, and peer checks were applied to enhance the rigor of the data.ResultsWe achieved data saturation after two focus group discussions (FGDs), 15 IDIs in Iran, and 13 IDIs in Switzerland. We extracted three themes for postpartum sexual quality of life: (a) sexual worldview, (b) interpersonal relationship, and (c) postpartum sex storm. The participants described sexual worldview as “sexual beliefs”, “sexual perceptions”, and “sexual behaviors”. The interpersonal relationship consists of “changes in postpartum interpersonal relationships” and “supportive role of the husbands/partners”. The last one, postpartum sex storm, has three categories including “direct changes in sexual life”, “indirect changes in sexual life”, and “resumption of sexual intercourse”. Differences between the two cultures were identified in some subcategories such as “sexual interests”, “comparable to the first intercourse in life”, “negative sexual behaviors of husbands/partners”, “positive sexual behavior of mothers”, “helping with child care and housework”, and “emotional support”.ConclusionNew mothers explained postpartum sexual quality of life as a three-theme phenomenon. Although most results were similar in both cultures, there were some differences. Our study’s results suggest that sexual quality of life is a topic that encompasses international as well as cultural aspects.

In this paper, we explore queer temporalities in relation to queer women and non-binary people’s sexuality later in life. Drawing on 30 interviews with 32 queer women and non-binary people aged 49-72 about sexuality and intimacy in later life, we highlight the participants’ stories about the instability and non-linearity of sexuality across the life course. First, we examine how our participants narrated later-life changes in their sexual subjectivity and how the assumption of compulsory (hetero)sexuality manifests in the participants’ stories about the unfolding of their sexual identities over the life course. We then analyze the compulsory non-sexuality imposed on women as they grow older. Finally, we explore the potential of reinterpreting sexuality in later life to destabilize pervasive normative notions of sexuality by analyzing the bodily changes the participants described. Rather than eradicating difference, such an analysis of later-life sexuality and queer temporality opens up the possibility of affirming changing desires and pleasures and acknowledging the body’s agency in shaping later-life sexuality.

Sexual self-perceptions are important aspects of sexuality, which can undergo significant change during adolescence and early adulthood. The purpose of this study was to describe these changes among girls (N=251; ages 16-25) over one year, and to examine associations of sexual self-perceptions (sexual subjectivity) with age, sexual behavior, and romantic status. Sexual body-esteem, perceptions of entitlement to desire and pleasure, sexual efficacy, and sexual self-reflection were investigated as elements of sexual subjectivity. All sexual subjectivity elements were higher among girls who had more sexual experience and/or had steady romantic partners during the study. Perception of entitlement to desire and pleasure increased over time, whereas sexual body-esteem showed the most stability and had minimal associations with sexual or romantic experiences. The greatest increases in sexual subjectivity were found among girls who began the study with the least sociosexual experience and self-reflection also increased for girls who had first coitus after the start of the study. Overall, girls who had sexual intercourse the earliest (before age 16) had the highest sexual subjectivity, but sexual subjectivity increased the most among girls without coital experience or who had more recent first coitus.

Background: Cervical cancer is one of the significant cancers in the female reproductive organs, namely the cervix. Diagnosis and treatment of cervical cancer not only affect physical health, but also psychologically and socially, especially in the context of sexual life. Physical and emotional changes that arise from treatments such as chemotherapy and radiotherapy can significantly affect women's sexual function, cause anxiety, and change the dynamics of interpersonal relationships. Subjects and Method: This study uses a qualitative approach with a descriptive phenomenological design. Data collection was conducted through in-depth interviews with five cervical cancer patients undergoing treatment at the Dr. Soedarso General Hospital, Pontianak. Data were analyzed using a thematic analysis approach to identify key themes in the experiences of changes in sexual life, emotional responses, and physical adaptation of the participants. Results: The results of the study showed that cervical cancer patients experienced various changes in their sexual lives after undergoing treatment. The main challenges faced were physical discomfort that leads to difficulty in achieving sexual satisfaction, diversion of sexual activities to meet the needs of partners, and complex emotional responses such as anxiety, depression, and feelings of hopelessness. Physically, adaptation to changes such as persistent fatigue and digestive changes were also significant problems. Conclusion: This study highlights the importance of comprehensive psychosocial support in caring for women with cervical cancer, including a holistic approach that considers physical, emotional, and interpersonal aspects. The findings also highlight the need for better sexual health education for patients and their partners, as well as the important role of families in providing adequate support. By better understanding the experiences of women with cervical cancer, it is hoped that their care and overall quality of life can be improved.

This volume, third in a series of five on sexuality in later life, brings together the experiences of women, gay men, trans women and hijra from around the world as they describe what it means to live with HIV and navigate the often fraught areas of sex, sexuality, intimacy and relationships in later life. New drug treatments have transformed the lives and expectations of people living with HIV. In this book we hear from people living in Aotearoa New Zealand, Bangladesh, India, Kenya, Switzerland, Ukraine and the United Kingdom who are not only living with HIV but also facing stigma imposed on them by others. Too often they have learned to stigmatise themselves. Since no single approach or way of writing can capture the richly diverse experiences of people in later life living with HIV, the book includes a variety of empirical research as well as personal accounts, poetry and other forms of writing from an array of perspectives and academic disciplines. As always with HIV, we find that poverty challenges our notions about the length, expectations and quality of life.

Background: The attitudes and perceptions of cervical cancer survivors (CCS) toward sexual activity after a diagnosis of cervical cancer and its treatment are unknown. This study describes the experience of CCS in Hunan Chinese about sexuality and sexual function after cervical cancer treatment. Methods: We used descriptive phenomenology to qualitatively assess these experiences. Purposive sampling was used to recruit 20 CCS. Data were collected through in-depth interviews and analyzed according to Colaizzi’s method to explore the essence of the experience in sexuality among CCS after cancer treatment. Results: Uncertainty, fear, and worry dominated the attitudes and behaviors of CCS-related to sexual activity after treatment. Four themes explain these complex emotional responses: 1) needing information; 2) dealing with sexual changes physically and emotionally; 3) communicating with a partner; 4) attribution of fault to her one-lifetime sexual partner. Conclusion: Sexual life was influenced by the physical changes associated with cervical cancer treatment. These changes in combination with inadequate information and limited communication led to uncertainty, fear and worry about engaging in sexual activity and relationship distress. Chinese CCS need targeted and patient-centered information on the change in sexual life caused by treatment, anticipatory guidance, and support in communication with providers and partners, and strategies to cope with the physical and psychosexual sequelae of treatment, all of which must be congruent with their cultural norms.

Introduction: The attitudes and perceptions of cervical cancer survivors (CCS) toward sexual activity subsequent to a diagnosis of cervical cancer and its treatment are unknown. This study describes the experience of CCS in Hunan Chinese in relation to sexuality and sexual function after cervical cancer treatment. Method: We used descriptive phenomenology to qualitatively assess these experiences. Purposive sampling was used to recruit 20 CCS. Data were collected through in-depth interviews and analyzed according to Colaizzi’s method to explore the essence of the experience in sexuality among CCS after cancer treatment. Results: Uncertainty, fear and worry dominated the attitudes and behaviors of CCS related to sexual activity after treatment. Four themes explain these complex emotional responses: (1) needing information; (2) dealing with sexual changes physically and emotionally; (3) communicating with partner; (4) attribution of fault to her one lifetime sexual partner. Conclusions: Sexual life was influenced by the physical changes associated with cervical cancer treatment. These changes in combination with inadequate information and limited communication led to uncertainty, fear and worry about engaging in sexual activity and relationship distress. Chinese CCS need targeted and patient-centered information on the change in sexual life caused by treatment, anticipatory guidance and support in communication with providers and partners, and strategies to cope with the physical and psycho-sexual sequelae of treatment, all of which must be congruent with their cultural norms.

The importance of interpersonal and sexual relations and realized sexuality in the concepts of subjective well-being is considered quite often, but the understanding of sexual well-being is presented rather vaguely, mainly in the context of medical issues as the absence of sexual dysfunction, as a component of sexual health, is equated with the satisfaction of sexual life. This article uses theoretical research methods - analysis, generalization, synthesis, conceptualization and modelling. Based on theories and approaches to subjective well-being, is highlights the concept of sexual well-being and presents a psychological model of subjective sexual well-being. We define sexual well-being as the harmonious realization by the subject of his sexuality on the bodily-physical, soul-emotional and spiritual-mental levels; a person's harmonious experience of belonging to the sex and an adaptive way of realizing this belonging. In a broad sense, subjective sexual well-being can be seen as a multifactorial construct that reflects the complex interrelationships of cultural (for example, continuum of norms accepted in culture), social (permissibility of certain thoughts and actions), psychological (cognitive, emotional and behavioral; for example, attractiveness, desirability, satisfaction, self-esteem), physical (physical attractiveness, sexual constitution) and spiritual factors (transcendence, axiological interpretation). Sexual well-being can be considered on at least two levels - non-deficient, from the standpoint of the absence of disorders and problems; and at the level of eudemonic, meaningful, existentially filled. According to the levels of sexual development, sexual well-being can be assessed at the bodily-physical level, soul-emotional and mental-spiritual level. Sexual well-being can be represented in the trinity of cognitive, emotional and conative (motivational, behavioral) components. The cognitive component includes: self-awareness as a representative of the sex, acceptance of one's own self-sexual, acceptance of one's own gender, orientation and attraction, one's own body, corporeality, acceptance of a partner, partnership, trust and openness, communication. The emotional component includes a positive assessment of oneself as a sexual subject, satisfaction with a partner, partnership, intimacy, satisfaction with sexual life. The conative component includes: libido, sexual interest, openness of experience, adaptive sexual scenarios, sexual security (absence of violence, coercion, blackmail, discrimination), freedom of expression, equal partnership. Factors of sexual well-being are individual (permissiveness, sexual interest, realized sexuality), dyadic (relationships as value, sexual communication, intimacy, trust, openness) and evaluation factors (satisfaction with one's own self-sexual, satisfaction with sexual relations, partnership, satisfaction with sexual life in general). We can talk about the levels of determinations of sexual well-being: 1) ) determinants of the personal level or microsystem (socio-demographic characteristics, sexual dysfunctions, personality traits, sexual self-disclosure, attitudes toward sexuality and subjective well-being); 2) determinants of the interpersonal level or mesosystem (characteristics of the relationship itself, sexual communication, intimacy, equality, openness, trust, romantic love, partnership), 3) determinants of exosystems (traditions, family values, social support, pregnancy, parenthood, victimization and victimization) in childhood); 4) determinants of macrosystems (religiosity and political ideology, public morals and values, freedom of expression). Further study of sexual well-being requires empirical verification of theoretical assumptions, clarification of empirical criteria of sexual well-being with the help of our developed psychological tools for psychodiagnostic measurement of this indicator.

Impact of androgen deprivation therapy on sexual function: a response

e19588 Background: In women with operable breast carcinoma the prevalence and severity of problems with sexual functions is not well defined. The aim of this prospective study was to find out the factors associated with changes in sexual life of breast cancer patients. Methods: A total of 128 women aged 31 to 83 years (mean age 58 years) with breast cancer were anonymously surveyed one day before surgical treatment and 9-12 months after treatment through questionnaires WHO DAS II, WHOQoL-8 and EORTC QLQ – BR23. The results of patients’ interviews were statistically analysed using nonparametric McNemar Test or Wilcoxon Signed Rank test. Results: Breast conserving therapy and mastectomy was performed in 52% and 48%, respectively. Adjuvant treatment comprised chemotherapy, hormonal therapy and irradiation of breast region in 39%, 55% and 42% of cases. Problems in sexual life before surgery and 9-12 months thereafter were reported in 16% and 37% of cases, respectively. Younger patients had more sexual problems than older ones after the treatment (<40 years of age 55%, 40-50 years 43%, >50 years 23%). The patients had the same interest in sex before and after the treatment. Furthermore, the frequency of sexual activity (with or without intercourse) did not change and the extent of sex enjoyable for them did not differ before and after the treatment. But a patient felt more often dissatisfaction with her body, a difficulty to look at herself naked, being less attractive and less feminine after the treatment than beforehand. The patients after mastectomy felt more often less feminine than those after breast conserving procedure. Conclusions: Many breast cancer patients feel changes in sexual life due to factors related to treatment. The patients who were younger and who had mastectomy had more problems in sexual life than older patients with breast conserving therapy.