4. Old Sex: Myths vs Fact
Myth: “Older adults don’t have sex, so we don’t need to ask
about that in our consulting rooms.”
Fact: Older adults do not show a decrease in sexual
activity until the ages of 65, and even then at least 38%
of men and 16% of women remain active through the
age of 85!
Myth: “My patient has erectile dysfunction and other health
problems, so I know he is not satisfied with his sex life.”
Fact: Although penetrative sex and orgasm may decline
in later life, sexual satisfaction usually remains high
through other mutually satisfying sexual experiences.
5. Old Sex: Myths vs Fact
Myth: “Sex is for young/healthy people. If you can’t have
babies then sex shouldn’t be happening!”
Fact: This is readily recognizable as a myth, and yet you
may encounter patients, family members, or providers
with a very similar belief system.
Myth: “My patient is 80 years old, so s/he is obviously
straight. There aren’t any old gay people!”
Fact: Approximately 5% of older adults report having
sexual partners of the same sex (8% men; 2% women).
Fewer identify as gay/lesbian, and most (2/3) are active
at least 1x/month after the age of 60 years old.
6. Old Sex: Myths vs Fact
This is an area of our practice where
stereotypes and personal judgements can
roam unchecked! Please do your reading and
listen carefully today, so we are not reinforcing
ageist beliefs about sex and sexuality!
7. Ageist/Ableist Views of Sexuality
• Glorification of youthful sex – tight skin, physical
vigor/stamina, speed, etc
• Emphasis on spontaneity
• Hyper-focus on bodily aspects of affection – specifically
those involving the genitals
• Illusion of sexuality as a well that runs dry or a flame that
burns out
• Shouldn’t need assistance or devices
8. Changes NOT Barriers
• Adults of all ages experience massive change over the
lifespan, much of which impacts sexuality. Older adults
are no exception.
• However, these changes should be viewed as barriers to
maintaining youthful standards of sexuality rather than
barriers to healthy sexuality in old age.
• Refocus on the
unique benefits of
sex later in life.
9. Social Barriers to Youthful Sex
Tend to effect women more than men:
Women are less likely to be partnered than men
38% of women over 75 are partnered vs.
72% of men over 75
Women without a partner are less likely to be sexually active
4% of unpartnered women are sexually active vs.
22% of unpartnered men
• Available partners diminish over time
• Longtime partners die or become incapacitated
• Stigma and discrimination
• Fear of rejection due to physical changes/attractiveness
• Traditional gender roles
10. Interventions for Social Changes
• Aid in socialization and widening of social networks
• Capitalize on social freedom and fewer responsibilities
• Build on longstanding relationship strengths
• Discuss traditional gender roles (specifically regarding
women being the passive partner in sexual relationships)
• Body image
• Age-related cosmetic changes in appearance
• Alterations in sexual anatomy (e.g., mastectomy); incontinence;
etc.
• Attitudes and beliefs about sex
• Sex is for reproduction
• Masturbation, fantasy, oral sex, etc. may be unfamiliar
11. Physical Barriers to Youthful Sex
• Vaginal dryness
• Thinning of the vaginal wall
• Erectile dysfunction
• Pain/Disability
• Decreased sensation
• Potential for injury
• General health problems
• Medication side effects
12. Interventions for Physical Changes
• Medical and Psycho-education
• Medical and Psychological Evaluations
• Lubricants
• Pharmaceutical Interventions
• Oral/Topical/Suppository/Injectable
• Penile Pumps/Implants/Rings
• Pillows and Positioning
• Sex Toys or Devices
13. Issues of Consent
• Dementia and other cognitive concerns
• Residential care facilities and sex
• Long-term partners and cognitive decline
• Ability to Give Consent
• Ability to describe nature of relationship
• Ability to describe risks/benefits of the behavior
• Susceptibility to coercion and exploitation
WARNING! Avoid discouraging sexual behavior generally due to ethical
concerns. Better to accurately assess ability to provide consent rather
than deny someone their right to sexual activity and satisfaction.
14. Multicultural Awareness
Cultural identities and contexts include: Race, ethnicity, immigration
status, SES, religion, sex, gender identity, sexual orientation, disability
status, age and generation, and interactions between each factor!
Providers’ beliefs and attitudes about sexuality can both support and
interfere with culturally sensitive sexual health care.
15. What Can I Do Now?
• Ask about sexual health/satisfaction regardless of age,
gender, orientation, religious preference, etc.
• Are you satisfied with your sexual life?
• If say yes, then encourage future discussion should problems emerge.
• If say no, then… “Well, I’m sorry to hear that. Is this an area you would
like help with either from me or another provider at LLVA?”
• Consider your own views of sexual health and sexuality
across the lifespan. Beware counter-transference!
• Advocate for patient’s sexual health and satisfaction
whether in team meetings, individually, or with families.
16. Remember…
Sex is fun! Even in the
midst of talking about sex,
we can model playfulness
and curiosity!
17. Resources
Principles and Practices of Sex
Therapy – Fifth Edition (2014)
Sexuality and Aging (2012)
APA Resource Guide for Aging
and Human Sexuality
http://www.apa.org/pi/aging/resources/guides/sexuality.aspx
National Institute on Aging (NIH)
https://www.nia.nih.gov/
