Aging and Male Sexuality is an impressive book written by an impressive man. Dr. Schiavi is Emeritus professor, Department of Psychiatry, Mount Sinai School of Medicine, New York. He is former president of both the International Academy for Sex Research and the Society for Sex Therapy and Research. He is a consummate clinician and a meticulous researcher. He is an authority on sexuality and the aging male.
The book contains 14 chapters: Aging and sexuality: concepts, issues and research methods; Sexuality in the aged male; Research evidence; Neurobiology of aging male's sexuality; Aging and marital sexuality; Aging and homosexual relationships; The social context; Nature and prevalence of sexual disorders in the aged; Impact of medical illness on sexuality; Psychopathology and sexuality in aging; Effects of drugs and medications; Role of psychosocial factors; Assessment of sexual problems and Management of sexual problems.
The material in these chapters is comprehensive, well digested and readable, and there are case histories to enrich the texts and to bring stark scientific facts to life.
The author presents an array of theory and methods ranging from biomedical to psychosocial ones to address changes in male sexuality, as well as recent developments in psychotherapy for sexual problems.
Schiavi starts by defining the aged. We learn that, at present, there are more than 30 million people over the age of 65 in the United States. He makes an interesting statement that men, regardless of age and sexual function, will likely welcome a prescription to enhance sexual performance and improve quality of life. We become aware that 30% of men are completely sexually inactive by age 70. Yet, at all ages, men reported higher levels of sexual interest and activity than women. The frequency, duration and degree of nocturnal penile tumescence (NPT) decrease significantly with age. The author suggests that clinical evaluation and therapeutic interventions should also consider psychological factors, as well as the quality of marital relationships. These 2 aspects are well elaborated in separate chapters of the book. In the small chapter on homosexual relationships it is stated that, contrary to some beliefs, older homosexual men report satisfactory social and sexual lives; they have stable relationships, many friends and lower levels of depression than younger homosexuals.
There is a good chapter on the impact of medical illnesses on sexuality, in which the effects of surgery or cardiovascular, endocrine and neurological diseases on sexual functioning are discussed. There is also an important chapter on prescription medications and nonprescription drugs, in which the effects of psychiatric medications, in particular, are discussed.
An interesting aspect of the book is the inclusion of case studies after each chapter, with comments from the author.
This book should interest all psychiatrists, especially those working in the area of psychogeriatrics and sexual dysfunction.
Pierre Assalian, MD
Montreal, Quebec, Canada