CHALLENGES TO INTIMACY: Intimacy beyond illness or in later life

What does intimacy look like after illness, ageing, or moving into residential aged
care? 

In this thoughtful and compassionate episode of the Wellbeing Podcast by
Wolper Jewish Hospital, host Julie McCrossin is joined by leading Australian experts in sexual health, ageing and dementia care to explore one of the most overlooked aspects of wellbeing - human connection.

Dr Tanya Mazzini, Dr Sue Malta and Dr Linda McAuliffe discuss how intimacy
evolves throughout life, why touch and emotional safety matter so deeply, and the
challenges many people face navigating sexuality after menopause, chronic illness
or cognitive decline. The conversation also examines relationships in residential
aged care, the impact of family attitudes, and why education and open communication is so important.

Warm, honest and deeply human, this episode challenges stereotypes about ageing and reminds us that intimacy, dignity and connection matter at every stage of life.

Our expert panel included:

• Dr Tonia Mezzini: Sexual Health Physician and researcher specialising in sexual function and dysfunction in older adults and the impacts of chronic illness and medication
• Dr Sue Malta: Sociologist and Qualitative Researcher, who focuses on sexuality in older age, disease, or disability
• Dr Linda McAuliffe: Registered psychologist and Senior Research Fellow with the Australian Centre for Evidence-Based Aged Care, La Trobe University, with research interests in sexuality and older adults

(Recorded May 13th 2026)

Thank you for listening to The Wellbeing Podcast by Wolper Jewish Hospital series. 

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Transcript

SPEAKER_02 0:00

This WALPA podcast is brought to you by Walpa Jewish Hospital, providing truly personalized care to people from all cultural and religious backgrounds.

SPEAKER_04 0:10

Welcome to the Walpa Wellbeing Forum, hosted by Walpa Jewish Hospital and Friends of Walper. And it's my pleasure to say that our topic is intimacy after illness and in later life. And my name's Julie McCrossen, and it's my pleasure to be your host. And I should say that the definition of an older person in Australia is 65 and over. And so I can tell you that I certainly fall into this category. And it's just a real uh pleasure that you've joined us for this important topic. I should let you know that WALPA Jewish Hospital is a specialist medical rehabilitation and palliative care hospital in the eastern suburbs of Sydney. And WALPA welcomes people from all cultural and religious backgrounds while offering care within a framework of Jewish culture and religious values and, of course, dietary requirements. And I'd like also to acknowledge the generous donation from the Schell family in memory of their husband and father, Dr. Alan Schell, OAM. Alan, Dr. Schell was a long-term supporter of Walper Jewish Hospital and a passionate advocate for health education. And in keeping with this vision, Walper will dedicate the donation to ongoing health education initiatives, including this series of webinars every year. And a reminder that this webinar is being recorded and it will be available to view on the WALPA website. And it also is now being turned into an audio podcast. Well, look, it gives me enormous pleasure now to welcome our panel. And I'd like to welcome Dr. Tonya Metsini, a sexual health physician, Dr. Sue Moulter, a sociologist and researcher at the University of Melbourne, who focuses in her work on sexuality in older age, and Dr. Linda McCaula, a senior research fellow at the Australian Centre for Evidence-Based Aged Care, based at La Trobe University, and who's done 20 years of research in this field. And welcome to you all. I'll give a fuller uh amount of information about you as each of you speak. And I think I'll start, if I may, with Dr. Tonya Metsini, the sexual health physician. So Tonya is a medical uh doctor working in Adelaide, and she specializes in women's health, but including uh additional qualifications in relation to psychiatry and other matters. So her work includes a focus on cancer survivorship and mental health and all sorts of things about sexuality and intimacy and function, uh, particularly for older women. You're working, Tonya, I think, with mainly women. Obviously, we need to define intimacy. And um, we've spoken, and I think you said the pleasure of intimacy and deep connection can be experienced in many ways, but touch is the key. You talk to us a little bit more about how we should think about intimacy in our conversation.

SPEAKER_00 3:20

Well, when Julie, when we were talking about this in the in preparation for this, we were talking about different ways that people might experience intimacy. And often the assumption is that we're talking about penetrative sex. Now, of course, that is not the only definition of intimacy, and that might not be appropriate for you within the context of your relationship or your stage of life or what's going on for you in terms of your health. Intimacy is about that connection, it's about that understanding that we can have of our partners, of the people that we care about, that's facilitated through touch, and it's not necessarily at all about penetrative sex, and it's not necessarily always about erotic touch either. We were talking also about um how you know people's intimate needs might change over their um lifespan. So there might be a different focus in your sexual activity when in you when you're younger, and if you're focusing on fertility and trying to achieve a pregnancy, that's going to have a different spin on how you experience intimacy. And then, of course, as we get older with different healthcare challenges presented, that will influence how people experience intimacy. And being able to be flexible and adaptable will help people to be able to maintain that intimate connection.

SPEAKER_04 4:38

You told me that emotional and physical safety is the key to all good intimacy and good sex.

SPEAKER_00 4:46

Yeah, I think because I get asked this quite a bit, you know, what makes good sex? Um, and you know, it's it's not about adequate amounts of lubrication or um fancy lingerie or particular sexual gymnastics or particular positions. I I really think it boils down to the safety that you feel in the interaction. So the safety that you feel emotionally with the person that you're being intimate with, safety from judgment, safety from pain, physical pain, emotional pain, safety from you know, in risk of infection or unplanned pregnancy. That safety and that sense of safety allows you to explore, it allows you to be curious, it allows you to be empathic in your communication because intimacy is a, it's a, you know, it's a a process of communication, it's a connection, and you need to be able to make yourself vulnerable for that to work well, and so you need to feel safe in order to for that transaction, for that interchange to occur. But it's actually quite a complex interaction, and when bodies change, and often in the context of illness or aging, and you have to do things differently, it can be really difficult to know how to have that conversation. And we tend to panic a bit, so we just don't know how to use our words, and then everyone stops talking, and then they end up in clinic with me because they don't feel like they can say to their partner what they really need to say about what they want and what's working and what's not working.

SPEAKER_04 6:24

Yes, because you often you you when you're seeing people, you prefer to see um a man and a woman together. Um obviously there are gay people in the world, but we'll just um but you prefer to see a couple together, first of all. Is that correct?

SPEAKER_00 6:42

No, no, actually the opposite. So whoever is the patient is the presenting person. I usually like to give them space and time to talk about everything that's going on in the relationship because we do um need people to have that safe space, and sometimes we do need to screen for intimate partner violence and coercion, and this is where the safety comes in. Generally, I'll see people on their own, um, gather the history, work out exactly what's going on, and then work out when when we're going to bring the partner in for a more collaborative approach.

SPEAKER_04 7:17

If I could welcome now Dr. Sue Moulter uh to uh to join us. And Sue is a sociologist and researcher at the University of Melbourne who's focused on sexuality and older age and a lot of your research and and your PhD, Sue, was entitled Love, Sex and Intimacy in New Late Life Romantic Relationships, both online and offline. I I've got a couple of quotes that Sue's given me from people you spoke to for your research. So let me begin by reading the first one from Adam, not his real name, who was 66 and who had had significant cancer surgery. And his quote was: I'm far from normal in that I have a huge scar across my stomach and my penis does not work. I may have medical problems that limit sexual intercourse, but I'm still able to have a fulfilling sex life. Even though I have to be a little bit creative nowadays, I'm fortunate that my partner is creative too, also that she is such an understanding person and we get so much from it. Can you tell us what does that illustrate to you from what you learnt in your research about I guess the definition of intimacy and calibration, recalibration after illness or or in later life? And welcome.

SPEAKER_03 8:37

Thank you. I spoke to a lot of older adults um about repartnering in later life, and for many of the women, um, it was often the first time they'd ever had an orgasm because they were able to actually talk about what they wanted, um, going back to Adam, for instance, and a lot of the people I interviewed, as they got older and issues, um, health issues occurred, they had to redefine what sexuality and sexual intimacy meant for them. And when the penis didn't work the way it used to, one of my participants, Larissa, who had terrible fibromyalgia, she said Well, what is that fibromyalgia? It's um a lot of pain on movement, and I think it's muscle and joint pain, isn't it? And um, she was in terrible pain and used a walker to walk around. She was in her 70s. For her, she said that there's so much more fun you're gonna have with sex when penises no longer work the way they used to. So she and others like her were able to redefine sex away from penetration, as Tonya said, and find other ways of being sexual, a lot of which involve skin on skin, touching in ways that people hadn't even thought of before, being able to have their partners for a woman touch their um vagina and their clitoris in ways that they didn't have previously, actually made a huge difference to them. And just being stroked and held, even sometimes a hand on the face was often more than enough intimacy for some people. So the definition of intimacy certainly changes for people as they age.

SPEAKER_04 10:52

And should we make it clear, as I think came out in your research, that um not wanting intimacy or not wanting touch is okay too? Do you know is that well, what would you say about that?

SPEAKER_03 11:05

We know from the research that there are people who are asexual, but they're not interested in sex, or they lose interest as they get older. This certainly happens for a lot of single older women, particularly through menopause and post-menopause. It doesn't mean it's always like that. A lot of people have uh renewed uh interest in um being sexually intimate once they've gone past that terrible time of um menopause, but um it's okay. It's intimacy for you is what it is for you, and if you're not interested in being sexual, don't feel pressured. That's entirely your prerogative. And um, everybody has their own feelings around being intimate.

SPEAKER_04 12:06

Tonya, when you say everyone's getting what they need, throughout life, people talk about uh the challenge of different levels of desire and in in in couples. And I'm assuming that still can emerge in later life. In your work uh with your women clients and when you have uh you know conversations with the husbands or partners as well. How do you manage that as you get older? Is it any easier?

SPEAKER_00 12:31

Desire discrepancy is probably um one of the hot topics in sexual difficulties, um, and one that you know causes can cause couples a lot of grief. And there are different reasons for it. You know, there's a different reason for a diet desire discrepancy when you've got young children, um, and then it might be different again, you know, in the busyness of midlife. Um one of the the um most recent books I've read on the topic is by a woman called Emily Nagosi, who's an American sex educator, and she writ she's written a book called Come Together. And in the introduction, in the first you know, couple of pages, she talks about the idea that if you're just waiting for random desire or horniness to strike as the only reason for initiating intimacy or responding to an invitation to intimacy, then you might be waiting for a very long time, particularly once you're in an established, you know, long-term relationship. There's a natural waning of desire. As we get to know our partners a little bit more, we trade off the erotic and the exciting for security. And so she talks a lot about emotional libido and considering from an empathic point of view, if you have a partner who has a higher desire for physical intimacy than you do, then considering how can you step up to meet that need, um, but how can they also make that easier for you? So, how can that person with the higher libido facilitate you to have an emotional libido so that it's easier for you to say, oh, well, you know, it's been a couple of days, yep, maybe we should. Or if you do tap them on the shoulder, that they're more responsive to that, to that invitation. And also then for the person with the higher libido to acknowledge that you are inviting someone to intimacy, you're not demanding, you're not expecting, and you it's this is a two-way communication. So both partners need to be working to make it a safe space to invite and to respond. Yes, the vagina questions are definitely one for me. Um, so we know that something like 60 to 85 percent of women within five years of their last menstrual period will experience vaginal atrophy, and that's a condition where declining estrogen levels translate into decreased collagen and therefore decreased elasticity in the vagina, and so that can make the vagina less supple, less elastic, and less able to accommodate touch and penetration, and that can cause significant pain, and that can be a really negative aversive experience that makes women want to avoid any kind of sexual touch or penetration. So there are a range of hormonal and non-hormonal products that you can talk to your GP or gynecologist about. Um, there are vagifem is a vaginal pessary, and then there's a cream called ovestin, there's also an ovestin ovule, there's a DHEA, which is a testosterone precursor as a vaginal pessary. And these treatments are they're hormonal, but they're not considered to be HRT. And we know that HRT is hormone replacement therapy, or it's been rebranded as menopausal hormonal therapy as a blatant marketing exercise, essentially. Um, so there are hormonal treatments, and you do need to discuss them with your doctor. Low dose vaginal estrogen is appropriate for women with a lived experience of breast cancer. We know that there's no increased risk of recurrence with low-dose vaginal estrogen, but often women will need additional emollients and lubricants to help with that. So there's a whole range of options for people to choose from. Breast cancer nurses are often very well versed in these options. Um, your gynecologist and medical oncologist might also have some options, but look for things that are oil-based, so um containing olive oil rather than coconut oil. Coconut oil can block the pores around the skin, so that's not really a very good choice. I jokingly say coconut oil is for when you're making muffins, not for your muffin. Um, hyaluronic acid-based products are also very helpful because they help to restore the elasticity and the stretch and functional capacity. Um, so those non-hormonal emollients and lubricants in conjunction with varying amounts of vaginal estrogen or DHEA can be absolute game changers for women. So there are certainly options.

SPEAKER_04 17:14

And it strikes me that this information is so important if you have a male partner or husband that they understand the hesitation that may occur for women around penetration as as they age, that it's not a rejection of the man, it's a concern about discomfort or even pain. Is that right?

SPEAKER_00 17:34

Yeah, and the experience that I have is that often these women um that women present and they're surprised by their symptoms. So if they're not aware that some of these changes are going to occur in menopause, how can we expect their husbands or male partners to understand about these changes? If we don't have the education, they're even less likely to. So often the conversation is around explaining this is what menopause is, this is what vaginal atrophy is. When she's saying no, it hurts, it's not because it's a rejection of you, which is often what partners hear, and this is where the difficulty with desire discrepancy becomes so fraught, because if you say no, it's often interpreted as a rejection of the whole person rather than just the activity at this time when you're tired and you'd rather just have a nap. Um, so explaining the biology to the male partner and the female partner, and sometimes both female partners, is hugely important and a big um I spend a lot of a big part of what I do. I feel like I spend a lot of time explaining what is normal to people about their sexual health and how their bodies work um with aging. So and I just wonder have you got any knowledge you could share with us about the sort of products that are available? Well, the issues around erectile dysfunction are related both to hormonal influences. So for men who've had prostate cancer, they might have hormonal blockades, so complete androgen blockade as part of their treatment because prostate cancer is testosterone dependent. So there's the hormonal influence, and then there's also the mechanical influence, so there's been damage to the prostate. And then there are also issues around circulation, and so for as we age, circulation to um our peripheries, so to our brain, to our eyes, to our heart, to genitals, to penises can be compromised, and that's why it's so important to look after cholesterol, to look after blood pressure, so that your microcirculation is intact. And um uh, you know, often a conversation with men about giving up smoking is about if you would like your penis to continue to work into your older years, you might want to stop smoking now because that's going to damage the circulation and impact on erectile function. Prostate cancer is is driven by testosterone, like breast cancer is driven by estrogen. Part of the treatment is to block those hormones so that the cancer cells don't grow. And then that can have a negative impact on libido, so desire for intimacy and also performance in intimacy.

SPEAKER_04 20:11

Yeah, look, thank you very much. But I want to welcome now Dr. Linda McAuliffe, who's a senior research fellow at the Australian Centre for Evidence-based aged care, based at La Trobe University. And Linda is also a registered psychologist. And welcome, Linda, and um, 20 years research into sexuality and older people in residential aged cares. You've done some recent research where you sent out a couple of different vignettes or stories to um residential aged care homes. Can you tell us about uh the first of those stories that you sent out and the sort of uh results and reactions you got from the staff and the lessons we can learn from that about intimacy within residential aged care? Welcome.

SPEAKER_02 21:00

Thanks, Julie, and and uh thanks, Walper, for for having me on the panel. Um I guess the first thing to say is that you know uh that sexual expression and sexual enjoyment doesn't end with a diagnosis of dementia, and and that's um and yet that's a myth that you know is kind of prevalent in in society. Um as you said, a lot of our work has been in residential age care and um uh and the most recent uh project that we did was to send out um uh a vignette about a couple called Norm and Carol. And um and the the situation was that Norm and Carol had um were living in residential age care and had formed a mutually satisfying relationship. Um, they were often seen in each other's company. And holding hands and maybe sharing a kiss and just generally enjoying each other's time. And what we wanted to do was to ask people working in residential age care, well, what would you do in this situation? Would you intervene? And we were encouraged by the response, which was that you know, the majority of people said, no, of course we wouldn't intervene. They're enjoying each other's company. Um, you know, this is a lovely thing to happen. Um and then what we did is we we uh we changed the vignette slightly, and uh we changed it according to factors that we know from the research can have an influence on um on people's um you know beliefs about whether a relationship should in fact form or continue. And so those factors were things like the the level of intimacy that the couple was experiencing, the level of um cognitive impairment that was present within the relationship, um, the involvement of family and how verbal the family was in in communicating their their um um uh displeasure with the relationship. Um and another factor that I can't quite think of at the moment, but the what was interesting is that uh when we looked at the responses to this second vignette. Yeah, well, to to this to the the series of variations based on those factors, we we we found that people's responses varied quite a lot. And so um people were much more likely to intervene when there was perhaps you know a vocal family member involved or uh when you say vocal, you're basically saying that they're uncomfortable with it, they don't look want it. Yeah, absolutely, and and that can be difficult for for family members to um uh I think generally there's a lack of education about dementia and sexuality, and so it's not often on people's radar, um, especially family. And um yeah, and so uh family is definitely a um uh a consideration there. Um and uh yeah, so family often have strong views about what mum or dad should or shouldn't be doing um once they move into residential edge care.

SPEAKER_04 24:35

And so what do you have, can you give us some sort of estimate of what proportion of respondents said that um if family were not happy with it, or for their own values uh uh uh as individuals or as an institution, they would actually seek to intervene and stop that uh an in a more intense level of intimacy, for example, going to each other's rooms in the day or night.

SPEAKER_02 24:58

Yeah, I I think um the the involvement of family, I think it was something like uh one of one of the factors that was most influential in the staff's response factor or degree of cognitive impairment wasn't as much of a factor as um as family, family involvement was.

SPEAKER_04 25:14

Okay, how interesting. And the key um takeaway uh results from that research, what that in terms of uh what your centre for uh evidence-based aged care, what conclusions did you draw from that research to what needed to happen?

SPEAKER_02 25:30

So, what what this piece of research did was it showed that um people's responses to an intimate relationship in aged care um vary considerably, and so their their practice varies. And we already know that um uh sometimes um policies aren't in place to guide staff, and we know that there's a lack of education across the board when it comes to this topic. And so a lot of what our work is centered on is trying to support staff who are often coming from cultures where they haven't had that basic, even basic high school uh sex education. Um, and so then they're kind of thrown into an environment where they they don't know how to respond, and yet they're they know that they'll be held responsible for things that that happen in that environment. So I think uh yeah, it's about supporting staff with education and uh families with education, and we have a um a resource that um we can provide um that we've developed to support partners and family members.

SPEAKER_04 26:42

Um sexuality resource. Um and and through Dementia Australia or in partnership with Dementia Australia, you're involved in education of staff in residential age care, residential homes. Is that correct?

SPEAKER_02 26:56

Uh with uh Dementia Training Australia, we've developed um some workshops so residential age care facilities or nursing homes can need support in this area, they can uh approach DTA who will come out and speak to them and offer this.

SPEAKER_04 27:13

There's also a national dementia helpline, 1-800-100-500, 1-800-1-800-100-500. I just mentioned that because some in my life I've actually had a lot to do with friends of different ages, because of course, illnesses like Parkinson's disease or multiple sclerosis, there's many ways one can end in needing uh you know full-time care in a residential setting as well as aging. And um uh, you know, there are some um centres that manage this very well and do allow a degree of autonomy. I mean, I gather your centre does believe in, as it were, sexual rights for people with dementia. Uh what do you what do you mean by that?

SPEAKER_02 27:58

Yeah, absolutely. I mean, I think we're we're we're all entitled to um, you know, enjoy intimacy and um and express our sexuality, and that doesn't change because we change where we live or it because we, you know, have uh an illness or if we develop a cognitive impairment. And so we're we're very um uh you know, we feel strongly about supporting people to enjoy uh the comfort that can come from having from sharing an intimate relationship um during a time of life that may be difficult for other challenging reasons.

SPEAKER_04 28:36

Uh if I could ask Sue Malter to join us. I I when I uh discussed this with Linda uh before this evening, I I was very struck by these stories about places not having a policy to guide staff, that individual staff members were sometimes left to manage this without guidance or education, because I think we know from our general understanding of the media, let alone the Royal Commission into aged care, that uh they have enormous difficulties hiring staff in residential aged care, and people may not have a very much educational background at all in uh to handle such a sensitive and sophisticated question. And so I began to think about that um that scenario of a couple where there was some cognitive impact and a desire for more than holding hands in the public room, if I could put it that way. They wanted to perhaps go to each other's rooms or whatever. And looking at it from the point of view of the staff, the family, and then the person themselves. Let's let's start from the point of view of the staff. So, just your thoughts. If a staff person's in that situation, what might be going their concerns and anxieties about that?

SPEAKER_03 29:47

Well, I I guess from the research it shows that staff are concerned about coercion, about the fact that the person who might have some cognitive impairment may not be fully aware and cognizant of what it might be going to happen. And we do know that sexual assaults can occur in aged care. We do know that, but I think also and so this is a very um difficult area to work in, and um hats off to Linda for working in this area because there's a range of appropriate responses for this kind of situation, and but I'm mindful that there was a case in the States of a man and his wife. His wife was the person in care, and she had dementia, but she herself initiated sexual activity with the husband. They went to her room, they had sex, but it was either a staff member or a family member, I can't remember which, who found out and was appalled that this had happened. And that man was then charged, but I think in the end he was exonerated because they brought in some clinicians who were able to testify that even though this wife had cognitive impairment, she was able to show that she wanted to be sexually active. So, I mean, I think it's a very difficult area to be working in. There's no blanket yes or no, but I also think that having a positive attitude and allowing for a range of different expressions of intimacy in aged care is really important.

SPEAKER_04 32:07

Well, this is an issue, of course, with the National Disability Insurance Scheme, and there's been some you know lurid and unhelpful media looking at um, you know, whether that you know tax money shouldn't be spent on sexual intimacy. And you know, this it again it goes to this question of a lack of education, sophistication, and leadership, because uh, I have I do know of a nursing home that handle this very well, but they have very good leadership and good board and and lots of education. Just before I turn to what may affect the family, Linda, would you like to comment on your your observations or thoughts on what may be the concerns for the staff in these situations who may wish to what do what's best for their residents, but uh what what would be their, you know, what's going through their minds, their concerns?

SPEAKER_02 32:56

Yeah, often for staff, um uh it it they're they're they're juggling a lot of different different things in mind at once. So, you know, sometimes a person has a husband or a wife who is living in the community. And so um, you know, for that staff member they're they're conflicted about where where um you know what do they do in in such a situation. Um I think also often it's given um the potential for thing for for for unwanted sexual behaviour, uh often it's about concerns about litigation and um you know not wanting to be seen as not providing a safe environment.

SPEAKER_04 33:47

Yeah, like a care.

SPEAKER_02 33:48

Yeah. Yeah. Um so I think I think in the absence of strong support uh for staff, then those the tendency to to adopt a more conservative kind of you know, um approach is is there. I mean we we heard recently about a um uh two residents who um were separated. Um one was actually moved into another wing uh because um the staff just felt that it wasn't appropriate for for them to have a relationship. And this was hand holding and enjoying each other's company. Um so I I think there's a there's I think generally nurses working in aged care are very supportive of um of of positive relationships and and and wanting to facilitate that, but I think that they just need the um the structures and supports in place to help them do that without fear of um being seen as having done the wrong thing.

SPEAKER_04 34:57

I I'll just stay with this topic a little bit longer, partly because of even though it's a relatively small proportion of Australians that do go into residential age care, it there will be some of us for whom it will happen. And so this is quite a you know, it's a sensitive matter, but just uh concisely, Sue, what might be the concerns for family, both legitimate or or or or less legitimate, whatever your thoughts are, but what's what's the family thinking when they go through this situation?

SPEAKER_03 35:24

Unfortunately, I think that um we've all been children, we've all been children of parents. So imagining that your parent is sexually active or would want to be sexually active when they're in age care is a very difficult concept for a lot of families. We a lot of society suffers from um age perceptions about older adults and being sexual anyway, that we look at um grey hair or white hair or walking stick, and we we can't imagine that that person would be sexually active. I think when you then put the overlay of an aged care uh facility on top of that, that it creates a more of a barrier to imagining that that could even be a possibility. And so for families, having to even contemplate that a parent, because usually it's one parent, not both, who are in the facility, and I shouldn't say facility, my apologies. Um I think it's really difficult to just contemplate that their parent would be want to be sexually active, and they can't and they're trying to be protective. I understand that, but at the same time, they could be doing their parent a big disservice.

SPEAKER_04 37:08

And what about yourself? If you can think of it from the point of view of being a resident yourself, you know, I I'm I have a friend just two years older than me who's in residential aged care because of um Parkinson's disease. And uh she is considerably younger than many of the other residents. She doesn't have cognitive impact at this point, but she's in that residential aged care. Um, is it is it possible to think of it from the resident's point of view?

SPEAKER_03 37:35

Yes, I know. If I had to go into age care, one of the first things I'd like to take with me is my vibrator. So I would like to be able to get new batteries if it's not an electric one, or if I can't access the PowerPoint that's a bit behind the unit that's next to the bed, that someone would help me be able to do that, and to be able to have the privacy in my room and to be able to have that time out without it being uh a giggle amongst the staff or um a shock to the staff, and I think for a lot of older women that will become more of the norm as we go forward, but again, you have to then the families are going to have to somehow be cognizant. Oh, mum wants to take a vibrator. Did you know she had a vibrator?

SPEAKER_04 38:40

So it's really important because it's a time of recalibration for for children as well. Linda, do you have has your centre done any research on family influence on access to intimacy and aged care? Because I'd like to support your submission to the Australian Research Council. I'm 71, I need you to get hot on this topic, quick smart.

SPEAKER_02 39:04

Well, you know, what one of my colleagues likes to say that, you know, she wouldn't speak to her her daughters about her sex life and they don't speak to her to her about theirs. And and um, and yet, you know, when when we move into residential age care, sometimes, you know, where where does privacy, you know, how do we ensure that we we meet the needs of the person and also um do it in in a in a way that respects the person's dignity and privacy.

SPEAKER_04 39:36

Just even the number where you could lock your door would be probably a whole lot of valid reasons, extremely rare. It's a very, very interesting topic. If I could just bring in Tonya Mazzini as well, if just your comments on what you've been listening to so far.

SPEAKER_00 39:50

Well, it it is a really complicated um topic, and and yes, there are issues around duty of care and safety, but we seem to infantilize still in our society older people. So we assume that because their hair is grey and that they need a walking stick, and maybe their back is bad, and maybe their memory isn't as good, that they're somehow lesser in their personage. And we are still the same people inside with the same desires and the same needs. And the need for touch and that skin hunger is so important for maintaining your health. There's been a lot of research done on the benefits of skin-to-skin touch. And Julie and I were talking about the research that Harry Harlow did in the 50s, and Linda, you'll know about this, where he did experiments with a terrycloth monkey. So they did these experiments on on animals and and monkeys, and it's heart-renting to watch. And they found that the baby monkeys would spend most of their time with a terry cloth-covered monkey mum, and as little time as they needed with the mum that had the the monkey mum that had the bottle. So she was wire, but she had a bottle.

SPEAKER_04 41:06

So food.

SPEAKER_00 41:06

She had food. So one monkey model had food and one had comfort. And they consistently chose the the mum model that provided them with comfort. And we know that touch boosts your immune system, reduces stress, reduces anxiety, increases oxytocin, helps you to sleep, helps you to normalize and um regulate your emotions. So that touch and skin-to-skin touch is so important. It doesn't necessarily need to be sexual or erotic. It can be having a manicure, having a pedicure, going to the hairdresser.

SPEAKER_04 41:47

A massage.

SPEAKER_00 41:48

A massage. When my nonna was in the nursing home, um, one of the things that happened for her that she'd never had done in her life was to have her nails painted. This was, you know, a busy Italian, you know, um mum of four. Having her nails painted was something that was never on her agenda. But when she was in the nursing home, that was part of her routine care. And she really enjoyed it, not because she needed pretty nails, but because the touch and the massage was a way to connect and it was pleasurable and it was safe and it was comfortable. But to answer your question, Julie, we we're not very good at giving people privacy. We we do the faux knock where you knock on the door and walk in as you're kind of announcing that you're coming in the in the room. So people's capacity to have some private time, and yes, we need to be mindful of safety. And what if someone falls out of the bed and falls on the floor and hurts themselves and nobody can come and assist them? But you know, we do have sophisticated things like two-way locks, and we can have a sign that you put on the door that says, please give me some privacy if hotel changes.

SPEAKER_04 42:56

Do not disturb, yeah.

SPEAKER_00 42:57

Do not disturb. I'm having some quiet time. You know, hotels can do it. Why can't we do it in palliative care facilities? Why can't we do it in nursing homes? Why can't we do it in hospitals? So that people can have time with their partners. And there's a really good TV series that's on Disney called Dying for Sex, and it's based on a true story, a podcast about a woman's um journey through her diagnosis from breast cancer to metastatic disease, and how she really learned to understand herself by exploring her sexuality. And there's quite a lot of the TV show was spent exploring how she was able to do that in a hospital setting and the difficulties that the doctors had and that the nurses had with letting this woman who was unwell, and and the even the language we use, letting someone have privacy while they're dying so that they could have dignity. So, you know, with this very um paternalistic approach. approach to what we will allow people to do, even when you know they know their own minds and they know what they need. And we, you know, need to be much more passionate, uh, much more empathic and compassionate about you know looking after people.

SPEAKER_04 44:16

I'm just gonna if you could all stay with me, but I'm gonna leave the nursing home for a moment. And Sue, I just don't want to um uh fail to mention as um the part of your research went to I'm just reminding people of the name of your PhD, Love, Sex and Intimacy in New Late Life Romantic Relationships. Just give us a quick snapshot of that proportion of older people who are, and remember it's 65 plus is our definition in Australia, um, who are having a sexual reawakening in later life. And sadly part of the evidence is an increase in sexually transmitted diseases among uh people in later life. Just a snapshot of of that.

SPEAKER_03 44:58

Well I can't give you any definitive numbers because we don't collect it routinely about how many um sexually transmitted infections there are amongst older adults, but we do know that it's increasing.

SPEAKER_04 45:16

And I think one of the links I sent you was about um encouraging older adults particularly those in new those in new late life romantic relationships to um use condoms or to use some form of protection because and I wasn't meaning to go to illness by the way I was more seeing it as evidence of sexual activity. So we perhaps put the illness to the side and normal sex health education applies but that late late life divorce is more common so and that online dating is also influencing older people.

SPEAKER_03 45:54

Yeah so um we're all caught up in um the internet these days and older adults now have the time it took them a while to catch up but now they're um most many older people are using the internet and my PhD student um did a survey of older Australians and asked them where they got their sexual health information from and most of them get it online in her survey because they don't get it from their doctor because very few doctors actually talk to them about it. So they go online and whether the resources that they're finding is actually are actually adequate or not is a moot point at this stage. There are some really good resources out there but equally there are some questionable ones. So um but one of the ones I wanted to mention that I forgot to mention before was the Healthy Mail um website which used to be I think it was called Androgen Australia or um something like that and that's um and Linda you've given us a booklet's a sexuality resource that the Australian Centre for Evidence based aged care has developed it's called Sexuality Assessment Tool.

SPEAKER_04 47:20

I've had a quick look at it it's quite comprehensive information. Cancer Council New South Wales Cancer Council Australia have got some brilliant resources on intimacy and sexuality after cancer and while it's related to cancer the information applies to I think any serious illness and it is very useful.

SPEAKER_01 47:39

So we'll we'll and we'll follow up healthy mail I think that's been that's been mentioned as well I know you work in women's health as well do we need more education with general practice on this it's a challenging area in in a normal general practice as I'm sure Tonya would agree uh consultations run 10 minutes maybe 15 uh this is always a long consult anything to do with sexual function anything to do with chronic pain anything to do with sociobiological determinants of you know sexual function they're all overlapping and so probably the um topic is not well suited to your run-of-the-mill general process no exactly that's so interesting and uh that's why so many people look to refer to people like Tonya and there are few people who do that sort of work and many people cannot afford to go private and to my knowledge we don't have services like that at public hospital outpatients departments.

SPEAKER_04 48:44

We've only got a moment left Tony but would you like to make a final comment I can feel you moving.

SPEAKER_00 48:49

Yeah I I agree Linda it's so difficult to have these conversations in in short appointments and when I was teaching medical students we'd we'd try and teach them how to kind of salami and and do these you know conversations over multiple appointments. I'm lucky enough as a specialist to have an hour for my first patient appointment and sometimes you're still only you know sort of scratching the surface in that one hour. But having access to resources is really useful. The research tells us that doctors are waiting for the patients to raise the issue and sort of hoping that they won't and the research also tells us that it's patients that are hoping that the doctors will start the conversation because then it normalises and validates and so one of the jobs I've done is to teach medical students how to raise that conversation in a way that's safe. And just a simple question like asking how are things at home?

SPEAKER_04 49:46

How is your relationship concerned unfortunately it's terrible it's like the 12 minute GP appointment my time has just run out but I at least we've started the conversation thank you to Walpa Jewish Hospital for initiating it and a big thank you to our panel and to Lena as always for her sensitive bringing of questions to us. And also a reminder that this webinar has been recorded and it will be available on the Walpa Jewish hospital website in a week or two. There's a whole series of them there including our last one from earlier this year on weight management which had a lot on the injectables at GLP1s but also on a whole lot of other weight management strategies. And that was very popular webinar and that is now online. Our next webinar is on stroke awareness and management and it's on Wednesday the 1st of July and we really want welcome you to come and to let people know about it obviously another enormously important topic. My name's Julia McCross and it's been a thorough pleasure to be with you and thank you and good night