Sexuality in older adulthood

Who do we call “old”?

In the late 18th century, the average life expectancy was around 35 years, a number very far from what we observe today. In modern societies, the proportion of people aged 85 and above is increasing steadily, and researchers often describe older adulthood in three broad stages:

55 to 74 younger old
75 to 84 old
85 plus very old

Global demographics continue to shift each year. Life expectancy in developed countries increases by approximately three months annually. In 2000, adults older than 60 represented about 20 percent of Europe. This figure is expected to reach 30 percent by 2025. According to the World Health Organization, the global population of individuals aged 65 and over was around 400 million in 2000. That number may double and could reach two billion by 2050.

With this context in mind, I want to focus on a topic that still remains uncomfortable in many cultures, even though it concerns a rapidly expanding group of people. That topic is sexuality in later life.

How does society respond to sexuality in later years?

While geriatric psychiatry and age related cognitive decline are widely studied topics, sexual functioning among older adults has received far less attention. Many people who are now in their sixties and beyond grew up with limited sexual education and within cultural environments that discouraged open discussion about sexuality.

Social attitudes toward later life sexuality are usually expressed in four forms:

1. Silence

The subject is avoided entirely as if it is better left untouched. This may appear respectful, yet it also prevents sexual concerns from being recognized, discussed or treated.

2. Moral judgment and stigma

Sexual expression in older adults is sometimes seen as inappropriate or even comical. Media stereotypes such as the predatory older man or the older woman painted as desperate reinforce this belief. These attitudes often originate from long standing incest taboos and discomfort with ageing bodies and sexuality.

3. Defensive correction

Some people attempt to challenge myths and provide sexual education. However, these attempts do not always lead to open acceptance. Even where knowledge improves, real sexual concerns of older adults may still remain invisible.

4. A narrow definition of sexuality

Sex is often reduced to heterosexual intercourse alone. Yet sexuality in later life, as in any life stage, includes sensuality, emotional closeness, touch, self acceptance, romantic expression, fantasy, stimulation and the many ways two bodies can communicate desire. Penetrative intercourse is only one possibility among many.

The myth of the asexual older adult

Menopause has often been portrayed as the end of a woman’s sexuality. Many couples describe their relationship after menopause as more companion-like. For some women this period includes frustration or a sense of loss. However, loss is not inevitable and does not apply universally.

For men, ageing often brings chronic illness and increased medication use, which may affect erectile function. Medications such as antihypertensives, cardiac agents, nitroglycerin, anticoagulants, diabetes treatments, prostate medications, hormone therapies, inhalants and drugs for ulcers are all associated with erectile difficulty.

Although sexual interest may decline slightly with age, it does not disappear. In one study, no male participant reported a complete absence of sexual desire.

Among partnered men, intercourse frequency was reported on average as once per week at age 30 to 39 and once per year at age 90 to 99. The reduction is clear, yet activity does not vanish. Erectile firmness decreases with age, although many men remain sexually active without medical intervention well into late life. Non penetrating forms of intimacy such as touch, oral sex and mutual stimulation also decline gradually but continue to be practiced.

Sexual functioning and myth breaking

Sexual response changes with age, but change is not the same as inevitable decline.

• Erections may be less firm in older men, yet they sometimes last longer.
• Many men find increased pleasure through whole body stimulation, not just penile friction.
• Women often gain confidence, ease and bodily awareness as they age.
• Vaginal lubrication and orgasmic capacity may increase across the 30s and 40s.
• Emotional maturity can deepen intimacy, which in turn enhances sexual experience.

Desire in women may fluctuate around menopause, although research shows that most women over 50 report no serious sexual complaints or major decline. When sexual desire does decrease, the cause is often hormonal imbalance, relational strain or negative beliefs. All of these are modifiable and treatable.

Men may reach peak erectile performance in adolescence and early adulthood, yet sexual skill, presence and emotional attunement often strengthen with age. If sexuality is defined by rigidity and speed, youth appears preferable. If it is defined by awareness, communication, shared pleasure and erotic intelligence, the later decades may surpass the earlier ones.

Orgasm patterns also evolve. A lower orgasm frequency does not mean less satisfaction. Many women report more profound orgasms in midlife. Older men often describe pleasure as more diffuse and full bodied rather than localized only in the glans.

Health, risk and sexual safety

Research suggests that sexual activity is generally safe for older adults. In a study of 1600 participants at New England Deaconess Hospital, the risk of heart attack during intercourse was comparable to the risk associated with standing up from bed in the morning. Fewer than one percent of coronary deaths occurred during intercourse, and most of those involved extramarital encounters associated with emotional stress.

Sexual activity can lower stress, improve mood and support cardiovascular and psychological well being.

Common myths and realities

• Sexual pleasure can remain meaningful and satisfying at any age.
• Orgasms are not required for a fulfilling sexual connection.
• Non penetrative intimacy can be as gratifying as intercourse.
• Oral sex is not exclusive to youth and is frequently practiced by couples over 40.

Western culture often equates sex with penetration. Yet eroticism includes touch, breath, closeness, anticipation and the exchange of pleasure. Many people find that emotional depth and sexual satisfaction do not diminish with age. They evolve.

Sexuality in later life is not a faded echo of youth. It is a stage with its own rhythm, physiology and emotional depth. When age based assumptions soften, pleasure becomes more spacious. For many people sexuality in older adulthood is not defined by loss but by curiosity, connection and slower, more intentional intimacy. With awareness, communication and flexibility, sexual expression can remain a vital and nourishing part of life well into advanced age.

Resources & Further Reading

Websites & Professional Organisations

• Sexual Health Association — [http://www.sexualadviceassociation.co.uk]
• NHS One You: Sexual Health — [http://www.nhs.uk/oneyou/sexual-health]
• Faculty of Sexual and Reproductive Health — [http://www.fsrh.org]
• Brook (Sexual health support for young people) — [http://www.brook.org.uk]
• Family Planning Association — [http://www.fpa.org.uk]
• Royal College of General Practitioners — [http://www.rcgp.org.uk]

Books & Academic Texts

• Kaschak, E., & Tiefer, A. New View of Women’s Sexual Problems. The Haworth Press, 2001
• Panthaki, Dhun. Education in Human Sexuality, 1997
• Reay Tannahill. Sex in History, 1980

                                                                © 2019 by Shabnam Sadigova