The Senior Sex Education Experience (SEXEE) Study: Considerations for the Development of an Adult Sex Education Pilot Intervention
Overview: Remaining sexually active into later life has health benefits and risks, but middle-aged and older adults (MOAs) receive virtually no sex education. Unprecedented spikes in the prevalence of later-life sexual dysfunction and disease notwithstanding, no study to date has conceptualized a framework for an evidence- and needs-based sex education program for adults. Using the biopsychosocial and sexual health models as guiding theories, this research conceptualized one such program. Methods: A key component of analysis assessed physicians’ and adults’ lived experiences, needs, and recommendations directly, integrating findings into a usable framework. The purposive sample included 17 adults, ages 53 to 77 (M = 65; SD = 7.63; 64.70% female) and six physicians, including two family medicine providers, two geriatricians, and two urogynecologists (M = 56.16; SD = 13.34; 50% female). All participants provided basic demographic information and completed a measure of late-life sexual knowledge. MOAs participated in three separate focus groups to determine their needs, interest in, and suggestions for an educational intervention, while providing additional insights into their lived experiences with aging and sexuality. Physicians completed semi-structured interviews to describe their experiences discussing sexual health, identify the perceived facilitators and barriers to those discussions, and elicit their program recommendations. Constructivist grounded theory oriented qualitative coding techniques. Results: Late life sexual knowledge appeared suboptimal among MOAs and physicians alike. Both groups agreed on the value of an adult sex education program. Of the 21 separate educational modules proposed, physicians and MOAs shared six, including (a) sexual changes with aging, (b) the spectrum of sex, (c) STDs, (d) health and sexuality, (e) sex and dementia, and (f) dating. Adults reported receiving and internalizing ageist messages about their sexuality. Though MOAs and physicians considered sexuality important to successful aging, both identified individual, dynamic, and environmental barriers to clinical sexual health discussions, including (a) time and other logistical barriers; (b) ageist assumptions, attitudes, and beliefs about sexuality; (c) physicians’ perceived lack of knowledge or experience; and (d) avoidance and discomfort. However, they agreed on five facilitators, including (a) bedside manner, (b) rapport, (c) privacy, (d) standardized sexual health assessment, and (e) a comfortable clinical setting.