Everybody's doing it: Addressing sexual health in the elderly

By Alpana Mohta, MD, DNB, FEADV, FIADVL, IFAAD | Fact-checked by Barbara Bekiesz
Published April 5, 2024

Key Takeaways

  • It is a common misconception that most older adults are not sexually active, but this isn’t true.

  • Physicians must recognize the broad range of sexual activities beyond intercourse in the elderly, including diverse practices relevant to individuals with functional impairments and those without partners.

  • Sexual wellness care in the elderly requires proactive discussions initiated by physicians, focusing on inclusive and open communication.

The average age of Americans has never been higher. According to US Census Bureau projections, the population aged 65 and above will surge from 58 million in 2022 to 82 million by 2050, marking a 47% increase—expected to represent 23% of the total population.[][]

Contrary to popular belief, the elderly maintain a keen interest in sexual activities. It’s important for physicians to provide comprehensive care to their elderly patients, which includes addressing any sexual health concerns, in this growing population with unique needs.

Scope of sex in the elderly

As indicated by a 2023 scoping review, 42% of women and 60% of men aged 65–74 are sexually active, with one-third of older adults in their 70s and 80s engaging in sex at least two times per month.[]

The National Poll on Healthy Aging, conducted by the American Association of Retired Persons (AARP) and the University of Michigan, observed that two-thirds of individuals aged 65–80 expressed an interest in sex, with more than 50% considering it vital to their quality of life.[] A Swedish study even found that 10% of individuals 90 years and older are sexually active.[] 

Reconceptualizing sexuality 

Sexual activity in the elderly is not limited to penetrative intercourse. According to an article published in the Lancet,[] the elderly “adapt their sexual activity because of erectile dysfunction, vaginal dryness, arthritis, mobility limitations, effects of medication, or serious health conditions.” 

Therefore, an inclusive view should expand to include acts like oral sex, kissing, fondling, and solo sex, which could help physicians understand the diverse circumstances of older adults, including those in the LGBTQ+ community and those without partners. 

Common sexual concerns 

The most common sexual issues in older men include erectile dysfunction (ED) and hypogonadism.[] According to estimates, 70% of men over the age of 70 experience ED. Risk factors include hypertension, diabetes, cardiovascular disease, and metabolic syndrome. 

Testosterone levels also decrease with age, impacting sexual function and overall health. Symptoms include decreased libido, osteoporosis, and reduced muscle strength. 

In aging women, menopause brings hormonal changes that affect sexual health, such as decreased libido and vaginal dryness. Vulvovaginal atrophy, common in menopausal women, causes discomfort and sexual dysfunction. 

Risk of STIs

CDC statistics indicate that from 2010 to 2020, the incidence of gonorrhea among individuals aged 55 and older escalated from 3.5 cases per 100,000 people to 17.2 per 100,000—with similar rising trends seen for syphilis and chlamydia.

This rise is indicative of unprotected sex, influenced by casual sex, and the increased use of dating apps among seniors.

Barriers to seeking sexual healthcare

Barriers to seeking sexual health advice and treatment for the elderly are multifaceted.[] They include negative cultural views and reluctance from both patients and healthcare professionals to discuss sexual health, especially in sensitive or morally controversial areas. 

This is compounded by gender, race, and age differences between doctors and patients, as well as anticipated embarrassment and misconceptions about older people's sexual needs. Additionally, stigma and stereotypes, particularly for the elderly LGBTQ+ community, who face discrimination and neglect in sexual health services regarding HIV and STI risks, lead to underdiagnosis and inadequate treatment.

Negative, dismissive, or stigmatizing responses from healthcare providers; a lack of available time during medical consultations; and previous negative experiences can discourage older adults from seeking advice or tests for STIs. This situation coincides with a a general lack of accessible information on where to seek HIV/STI tests and on sexual health for the older population.

Proactive engagement

Authors of a systematic review published in the Pan American Journal of Public Health concluded that “current research on the relationship between sexual health and subjective well-being in older age groups suggests that living a fulfilling sexual life is an essential part of subjective well-being.”[] Sexual health problems could signal undiagnosed conditions, medication side effects, or STDs, mandating an open discussion. 

However, according to a national survey, only 17.3% of older adults reported having a conversation about their sexual health with their physician in the past 2 years, and 60.5% of these discussions were patient-initiated.[] Physicians themselves must be able to initiate and normalize discussions about sexual health with older patients.

Authors writing in the BMJ suggest physicians foster an environment where open and inclusive language is used in the exam room, thereby encouraging older patients to talk about sexual health concerns.[] Physicians may consider inquiring about sexual health during consultations for chronic conditions and discuss possible sexual side effects during medication reviews or when prescribing new drugs.

What this means for you

Physicians play a key role in supporting older adults to maintain sexual health and express their sexuality in diverse ways, irrespective of age. Routine treatment for common sexual issues of elderly patients can be addressed in the form of lifestyle modifications and hormonal therapy. Beyond that, a good approach is to introduce a brief sexual health screening tool with your aging patient population and ensure confidentiality to encourage open dialogue. 

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