Review
Sexual Activity and Aging

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Abstract

Sexuality is an important component of emotional and physical intimacy that men and women experience throughout their lives. Research suggesting that a high proportion of men and women remain sexually active well into later life refutes the prevailing myth that aging and sexual dysfunction are inexorably linked. Age-related physiological changes do not render a meaningful sexual relationship impossible or even necessarily difficult. Many of these physiological changes are modifiable. There are various therapeutic options available to patients to achieve maximum sexual capacity in old age.

This article reviews the prevalence of sexual activity among older adults, the problems these adults encounter with sexual activity, and the role of the health care professional in addressing these problems. The physiological sex-related changes that occur as part of the normal aging process in men and women are reviewed, as well as the effect of age-related physical and psychological illness on sexual function. The attitudes and perceptions of the media and general public toward sexual activity and aging are summarized. An understanding of the sexual changes that accompany the aging process may help general practitioners and other doctors to give practical and useful advice on sexuality as well as refute the misconception that aging equates to celibacy. A thorough awareness of this aspect of older people’s quality of life can raise meaningful expectations for aging patients.

Section snippets

Prevalence of Sexual Activity in Older Adults

Gott15 surveyed 335 individuals in the United Kingdom aged between 50 and 90 years; 81.5% were currently involved in one or more sexual relationships. A global study by Nicolosi et al16 concluded that 53% of men and 21% of women aged 70 to 80 years engaged in sexual intercourse during the 12 months preceding the interview. Lindau et al17 conducted a longitudinal survey and clinical study on the sexuality in a nationally representative cohort of 3005 US adults aged 57 to 85. Seventy-three

Sexual Activity of Older Women

Most of the older population is female. By 2050, it is predicted that 65% of octogenarians will be women.44 The sexuality of older women is influenced by many factors, including general physical and mental well-being, quality of relationship, life situation, marriage status, menopausal status, education, social class, stressors, and self-perception.45, 46, 47, 48 The prevalence of sexual dysfunction is high24; Laumann et al49 in 1999 reported 43%, whereas Lindau et al17 in 2007 reported 50%

Sexual Activity of Older Men

Baumeister et al57 surveyed a broad range of available evidence on the relative strength of sex drive and found that, by all measures, men have a stronger sex drive than women. Lindau and Gavrilova58 concluded that sexual activity, good-quality sex life, and interest in sex were higher for men than for women and that this gender gap widened with age.

Significant changes in penile structure occur with aging. The concentration of elastic fibers and collagen decreases with age. In addition, it is

The Influence of Illness on Sexual Activity

Physical illness can affect sexual function directly by interfering with endocrine, neural, and vascular processes that mediate the sexual response; indirectly by causing weakness or pain; and psychologically by provoking changes in body image or self-esteem.76 Medical problems that have been linked to sexual dysfunction include diabetes mellitus,6, 17, 22, 24, 34, 36, 64, 65, 66, 67, 77, 78, 79, 80, 81 hypertension,6, 19, 24, 34, 36, 64, 65, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82

The Role of the Health Care Professional

In a survey carried out by the American Association of Retired Persons (1998), 1500 men and women aged 50 years or older expressed a need for health care providers to promote an open, accepting environment in which sexual issues can be discussed.94 Lightner95 reported that fewer than 5% of older women volunteered their sexual problems during office visits to their general practitioner; however, when specifically asked by the general practitioner, nearly 20% shared their sexual concerns. Gott

Attitudes Toward Sexual Activity Among Older Adults

Prejudice exists at all levels of society, finding its basis in overgeneralized, learned attitudes toward individuals who do not conform to what is perceived to be normal within that society. Waterman98 reported that college students were more surprised and more disgusted by incidents of sexuality of those who were 70 to 75 than those who were 30 to 35. They also found the scenarios less acceptable and less appropriate. Allen et al99 suggests one reason for the negative attitudes of older

Sexual Activity in Nursing Homes

There is a lack of information available in the literature regarding sexual activity of older adults in long term residential care. The transition into residential care can mark the end of many types of freedom for older people. It can be very distressing for residents to eliminate sexual activity from their lives when entering a nursing home.105 Indeed, many couples are separated on admission.106 Studies such as that of Lindau et al17 demonstrate the importance of sexuality in the lives of

Inappropriate Sexual Behavior in Dementia

Differentiation between abnormal and normal sexual behaviors is a challenge for service providers in older populations; thus, a thorough medical and sexual history should be obtained before any management strategies are implemented.114 The prevalence of inappropriate sexual behavior (ISB) ranges between 2% and 17% of patients with dementia and is more commonly seen in men.115, 116 ISB can cause a conflict between respecting the patient’s autonomy and preventing psychological and physical trauma

Conclusions

We conclude that regular sexual activity is a normal finding in advanced age. Many older men and women are sexually active despite the increase of sexual dysfunction with age; appropriate consideration must therefore be given to the needs of the aging population in the planning and delivery of health care, and institutional and support services to help sustain their right to a sex life after 65. The past few decades have seen a marked increase in mean life expectancy in the developed world.

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