Sex And Older Adults
By Arvind M. Dhople, Ph.D., Professor Emeritus, Florida Tech
Sex And Older Adults
Sexual activity is an important part of health and wellbeing and it correlates with greater enjoyment of life for older adults. People do not become asexual with age, although they might modify their sexual activity as a consequence of physiological changes.
According to the National Institute of Aging (U.S. National Institutes of Health) sexuality is the way we experience and express ourselves sexuality. It involves feelings, desires, actions, and identify, and can include many different types of physical touch or stimulation. Intimacy is a feeling of closeness and connectedness in a relationship that can occur with or without a physical component. Aging brings life transitions that can create opportunities in older adults to redefine what sexuality and intimacy means to them. Some older adults strive for both a sexual and intimate relationships, some are content with one without the other, and still others may choose to avoid these types of connections.
The first misconception is that older adults are neither sexually active nor interested in sex, so there is no reason to ask them about their sexual health. However, although the frequency of sexual activity tends to decline with age, older adults are still sexually active. In a study in England, 86% of men and 60% of women aged 60-69 years reported being sexually active, as did 59% of men and 34% of women aged 70-79 years, and 31% of men and 14% of women aged 80 years or older. Even 10% of people older than 90 years reported being sexually active in a Swedish study. In fact, in a U.S. study of people aged 75-85 years who were sexually active, 54% reported having sex two or three times per month and 23% reported having sex one or more times per week.
The second common misconception is assuming that the term sex refers only to partnered sex and intercourse, which is not the reality for many older adults who adapted their sexual activity because of erectile dysfunction, vaginal dryness, arthritis, mobility limitations, effects of medication, or serious health conditions. In a small study in Poland, older adults reported various expressions of sexuality, giving importance to physical and emotional intimacy as part of what they considered as having sex.
The third misconception is that older adults are not at risk of sexually transmitted disease, and therefore there is no need to ask about their sexual history or discuss their sexual behaviors. The rate of sexually transmitted infections among those aged 55 years or older has consistently increased and has more than doubled over the past decade. Dada from the U.S. Center for Disease Control and Prevention indicate that the prevalence of gonorrhea among those aged 55 years or older has increased from 3.5 cases per 100,000 people, in 2010, to 17.2 per 100,000 in 2020, and that syphilis and chlamydia are following similar patterns.
This generation of older adults rarely considers using protection because they came of age at a time when sex education in school did not exist, HIV was virtually unheard of, and their main concern in seeking protection was to avoid pregnancy. Today, older adults are more likely to participate in the hook-up culture of casual encounters and condom-less sex, which might be further encouraged by the availability of drugs for sexual dysfunction, and commonality of living in retirement communities, and the increased use of dating apps for seniors.
Despite a potential feeling of discomfort or even worries of offending or embarrassing their older patients, physicians need to be proactive in discussing sexual concerns and making sexual health a part of routine health care. Physicians are perfectly comfortable initiating discussions about bowel movements, an equally private health behavior, so why are sexual health discussions avoided? A sexual health problem could be a warning sign of the undiagnosed condition, a side-effect of medication, or an indication of a sexually transmitted infection, all of which are potentially treatable and important to include in a physical assessment. Physicians need to ask their older patients about sexual history and normalize conversations about sexual health. Physicians have an integral role in helping older adults to remain sexually healthy to express their sexuality in whatever manner they choose, regardless of age.