The Role of Sexual Activity from the Perspective of Older Adults: A Qualitative Study

The Role of Ageist Sexual Stereotypes in the Network of Sexual Difficulties, Sex and Relationship Satisfaction Among Adults Aged 50

As people age, their sexual activity, including sexual and relationship satisfaction, may change due to the onset of health and sexual difficulties and the activation of internalized ageist sexual stereotypes. We studied whether ageist sexual stereotypes were relevant for the importance of sex for people aged 50+ and how sexual and relationship satisfaction are interlinked with health and sexual difficulties when ageist sexual stereotypes are considered. Data for the network analysis were collected from a sample of 897 Czechs and Slovaks aged 50-96 (52% men, mean age = 62.01). Two models were analyzed - with and without the inclusion of ageist sexual stereotypes. The findings indicated that ageist sexual stereotypes play an important role in the sexuality of women and men aged 50 + .The fewer ageist sexual stereotypes people had, the less sexual difficulties they reported and the more they perceived sex as important. The inclusion of stereotypes into the models, however, weakened the negative link between sexual difficulties and the importance of sex for both women and men. These findings show that the effect of ageist sexual stereotypes are likely complex in the sexual lives of people aged 50 +.

Engaging older Australians in sexual health research: SHAPE2 survey recruitment and sample

BACKGROUND

Sexual health research rarely includes older age groups and the sexual health needs of older Australians are not well understood. Older adults are online in increasing numbers; however, internet surveys involving samples of older adults and sensitive topics remain uncommon. In 2021, we developed an online survey to explore the sexual health needs of Australians aged 60+years. We describe here survey recruitment and sample obtained, comparing it with national population data (Australian Bureau of Statistics) and the sample of the similar 'Sex, Age and Me' study from 2015.

METHODS

We recruited 1470 people with a staggered three-phase strategy: (1) emails to organisations and community groups; (2) paid Facebook advertising; and (3) passive recruitment. Half (50.6%) found out about the study via an organisation or group and just over a third (35.7%) from Facebook.

RESULTS

The sample was equally balanced between men (49.9%) and women (49.7%) (0.4% other gender identities). Participants were aged 60-92years (median 69years) with all Australian States/Territories represented. Facebook recruits were younger, more likely to be working rather than retired, and more likely to live outside a major city, than those recruited by other means.

CONCLUSIONS

Using the recruitment methods described, we successfully obtained a diverse and fairly representative sample of older Australians within the constraints of a convenience sample and on a modest budget. This research sheds light on ways to engage an under-served demographic in sexual health research. Our experience shows that many older adults are amenable to recruitment for online sexual health surveys using the approaches outlined.

Sexual activity, sexual satisfaction and their correlates among older adults in China: findings from the sexual well-being (SWELL) study

Background

Sexual activity is important to the holistic health of older adults. However, the sexual lives of older adults are understudied. We aimed to investigate the prevalence and correlates of sexual activity and sexual satisfaction among older adults in China.

Methods

In this multi-centre cross-sectional study, individuals aged 50 years and older were recruited from four regions in China between June 2020 and December 2022. An investigator-administered questionnaire was completed to collect information on socio-demographics, health status (general health and specific health), and sexual health characteristics. Sexual activity (including vaginal, oral, or anal sex) in the past year was treated as sexually active. Sexual satisfaction was measured using a validated five-point Likert scale. Logistic regression was used to assess correlates of sexual activity and sexual satisfaction.

Findings

3001 older adults (1182 women and 1819 men, mean age 60.3 ± 7.8 years) were recruited. Most participants were living in urban areas (1688, 56.2%), in a stable relationship (2531, 84.3%), and satisfied with life (2141, 71.3%). 46.8% of men and 40.7% of women were sexually active. Better self-reported general health status (good: aOR 0.53, 95% CI 0.34-0.82; fair: 0.47, 0.29-0.76; bad or very bad: 0.58, 0.35-0.96; versus very good), no difficulty walking upstairs (0.63, 0.41-0.97), diabetes (0.64, 0.42-0.98), and menopause (0.57, 0.36-0.92), were associated with sexual activity among women. Such an association was not found among men. Among sexually active participants, about three-quarters (men: 73.6%, women: 73.4%) were sexually satisfied. Self-reported general health status (men [good: 0.25, 0.12-0.53; fair: 0.17, 0.08-0.37; bad or very bad: 0.15, 0.06-0.34]; women [good: 0.27, 0.10-0.70; fair: 0.11, 0.04-0.30; bad or very bad: 0.11, 0.04-0.32]), life satisfaction (men: 1.73, 1.22-2.46; women: 2.23, 1.34-3.71) and talking about sexual preferences with a partner (men: 1.77, 1.23-2.56; women: 2.93, 1.69-5.09) were associated with sexual satisfaction.

Interpretation

Older adults who had better health status and talked easily with their partners about their sex life were more likely to report sexual satisfaction. For women, better self-reported general health status and lack of disability were associated with sexual activity. Further research should address measures that improve sexual satisfaction, especially among sexually active older adults.

Funding

This study was supported by the Natural Science Foundation of China International/Regional Research Collaboration Project [72061137001] and the Economic and Social Research Council [ES/T014547/1].

Trajectories of intimacy in later-life: a qualitative study of Czech and Polish narratives

Intimacy has been identified as an important component of satisfying sexual activity in later life. While the existing literature reports that the importance of intimacy increases with age, the mechanisms behind this process have not been extensively researched. Even less is known about later-life sexual intimacy among women and men from former communist countries. This study explored the nuances of sex and intimacy by interviewing 50 Polish and Czech women and men aged 60 to 82. Data were analysed thematically using an inductive approach. Three main themes were developed to represent the extent to which intimacy was part of participants' lives: 1) lifelong representation of sex as an intimate connection between individuals; 2) later-life shift towards intimacy-oriented sex for two main reasons: health-related necessities and a new relationship context; and 3) no intimacy whatsoever. The study findings indicate that a later-life refocus from an instrumental, penetrative-oriented view of sex towards a wider variety of intimate behaviours may be beneficial, not only for improving quality of sexual life, but also to gain new ways to express emotional connections between the partners.

Sexual Difficulties in People 50+: A Content Analysis of Sex-related Queries Posted on Professional Counseling Websites

Although sexual activity has been found to be both important and challenging for people aged 50+, relatively little is known about the concerns that they have with respect to their sexual lives and how help-seeking behavior manifests on counseling platforms. A sample of 293 sex-related queries that Czechs aged 50+ posted on professional counseling websites were subjected to a quantitative and qualitative content analysis. The majority of posts were written by men and their dominant issues were erectile difficulties, partner's lack of interest in sex, and drug use/interaction when treating sexual difficulties and other ailments. Using a thematic analysis, the study showed that sex-related concerns were based within the context of worries about maintaining relationships and re-partnering in mid- and later life, and probing for the normal aspects of aging and the associated changes in sexual health. The online setting of the counseling websites facilitated the posting of both general and personalized queries to get oriented in problems, to triangulate with previous information, and to check the treatability of difficulties when past treatments failed. These findings suggest that online counseling puts a great demand on professionals' knowledge and understanding of the specifics of later-life sexual health.

The Role of Non-penetrative Partnered Sex Activities in the Associations Among Erectile Difficulties, Sex and Relationship Satisfaction in Men Aged 50

Objectives

This study examined the associations among erectile difficulties, sexual satisfaction, and relationship satisfaction, and whether there is a buffering effect of non-penetrative partnered sex on relationship satisfaction in men aged 50+ who report erectile difficulties.

Methods

An analysis of survey data from 431 Czech men (aged 50-96, Mdn = 64).

Results

Engagement in non-penetrative partnered sex did not moderate the relationship between erectile difficulties and sexual and relationship satisfaction, but it was linked to higher sexual and relationship satisfaction.

Conclusions

The buffering effect of non-penetrative practices for the link between erectile difficulties and relationship satisfaction has not been supported.

Sexuality, quality of life and psychological well-being in older adults: A correlational study

Objective

This study aimed at analyzing the relationship between general health status, quality of life, and sexual life among older adults.

Study design

This descriptive-correlational design study was conducted with the participation of 323 (169 female and 154 male) older people at the age of 65 + . The participants were clients of the outpatient services in a general hospital in Istanbul. Data were collected with the General Health Questionnaire, Arizona Sexual Experiences Scale, and Quality of Life Scale.

Results

Psychological well-being had no association with sexuality scores whereas quality of life had a significant association. Older people with better quality of life had less sexual dysfunctionality. Participants who were up the 75 years old, who have lower education, lower economic status, unemployed, having chronic diseases seemed to experience higher ASEX scores, meaning that higher sexual dysfunction, lower GHQ scores and lower quality of life level.

Conclusions

Sexuality in older people changes over time and continues to hold its importance. Less sexual dysfunction seemed to relate with higher quality of life in older people. Researchers should consider the importance of the quality of life on sexual satisfaction in older people.

Predictors of Sexual Function and Performance in Young- and Middle-Old Women

Background: Maintaining sexual life in older women might be perceived as a measure of healthy and successful aging. This study aimed to establish the prevalence of female sexual dysfunction (FSD) based on the DSM-5 criteria and predictors of sexual performance in older women. Methods: A total of 185 women between 55 and 79 years old were included in the study. Validated scales were used to assess sexual function (Changes in Sexual Function Questionnaire (CSFQ)), the propensity for sexual excitation/inhibition (Sexual Excitation/Sexual Inhibition Inventory for Women), and sexual anxiety/avoidance (Body Exposure during Sexual Activity Questionnaire (BESAQ)). Multiple regression was used to assess the factors affecting sexual function and the prevalence of FDS. Results: Sexual distress was diagnosed in 14.1% of women, and FSD in 16.2% (n = 53), whereas sexual problems (CSFQ) were diagnosed in 33.3% of women, and distressing sexual concerns in 35.1%. Women with a lower number of male sexual partners (β = −0.22), a better attitude toward sex (β = 0.25), higher importance of sex (β = 0.31), a higher level of sexual excitation (β = 0.34), and that were sexually active (β = 0.39) had better sexual function, as evaluated by CSFQ. Conclusions: Most older women remain sexually active. The diversity of sexual activity in later life should be affirmed to encourage women to be sexually active and to strengthen the response to sexual stimuli.

Sexual Activity and Related Factors of Older Women in Hunan, China: A Cross-Sectional Study

BACKGROUND

Sexuality has an important impact on people's physical and mental health, but current research on the sexual activity of older Chinese women has many limitations and more detailed studies are needed.

AIM

The objective was to determine the prevalence of sexual activity and related factors in women aged 55 to 85 years in Hunan, China.

METHODS

Based on the data from the Hunan Provincial Women Health Needs Survey in 2018, we conducted a secondary analysis of 2,401 older women aged 55 and above. The dependent variable was sexual activity, and independent variables included sociodemographic characteristics, health behaviors, reproductive and chronic medical history, and psychological characteristics. All statistical analyses were performed using SPSS 26.0. Chi-square test was used to assess the association between categorical variables, and binary logistic regression was used to examine factors related to sexual activity.

OUTCOMES

Sexual activity and related factors.

RESULTS

The prevalence of sexual activity among older women was 12.5% (301/2401) in the past month. Having a partner (OR = 1.484; 95% CI, 1.048-2.101; P = .026), jogging (OR = 2.061; 95% CI, 1.391-3.054; P < .001), dancing (OR = 1.477; 95% CI, 1.106-1.974; P = .008), vegetarian-based diet (OR = 2.197; 95% CI, 1.334-3.618; P = .002), meat-based diet (OR = 2.196; 95% CI, 1.144-4.216; P = .018) were positively associated with being sexually active. Whereas, aging (OR = 0.781; 95% CI, 0.647-0.942; P = .010), living in the urban (OR = 0.628; 95% CI, 0.488-0.808; P < .001), hypertension (OR = 0.702; 95% CI, 0.520-0.949; P = .021), and anxiety (OR = 0.680; 95% CI, 0.475-0.972; P = .034) were negatively associated with being sexually active.

CLINICAL IMPLICATIONS

Health care workers need to be aware that older women still have sexual activity and understand the needs of older women for sex education, take the initiative to discuss safe sex with them, and solve their sexual problems.

STRENGTHS AND LIMITATIONS

This is one of the largest studies to determine the prevalence of sexual activity among older women in China and its related factors. In addition, new factors such as exercise types and eating habits related to sexual activity were discovered. The limitation of this study is that it did not use a specific questionnaire to assess the sexual activity and did not consider physical tenderness other than sexual intercourse.

CONCLUSIONS

Some older women still have had sexual activity in the past month and factors such as lifestyles that can be changed and chronic diseases that can be self-managed were found to predict sexual activity. Li T, LuoY, Meng Y, et al. Sexual Activity and Related Factors of Older Women in Hunan, China: A Cross-Sectional Study. J Sex Med 2022;19:302-310.

‘Why would I want sex now?’ A qualitative study on older women's affirmative narratives on sexual inactivity in later life

The existing research tries to understand the reasons for discontinuing sex in later life with the assumption that people want to be sexual. Although the growing body of literature informs that sex remains an integral part of older adults’ lives, a substantial number of older adults declare not being sexually active. This study aimed at exploring motives for deliberately choosing sexual inactivity among older women. Semi-structured interviews with 16 Polish women (aged 65–82) were thematically analysed in relation to the sexual scripts theory and the participants’ specific socio-cultural background. Three main themes regarding the reasons for cessation of their sex life were identified: ‘I am glad that sex does not concern me anymore’, ‘I am satisfied with my memories’ and ‘The right one’ or no one. The results indicate that some women give up sex for good, with no regrets or feeling of a loss; for others, it may be a temporary decision, its duration dependent on meeting the right partner. Developing sexual agency may encourage discontinuing their sex life – a choice perceived as optimal and liberating. Personal factors and the memories of marital relationships seem to shape older women's (a)sexual expectations. Acknowledging these nuances may contribute to a better understanding of older women's sexual functioning; implications for consideration in further research and practice are also discussed.

Factors Associated with Four Sexual Behaviors among Married/Partnered Women Ages 60 and Older in the United States

Women ages 60 and older vary in sexual behaviors. This study examined the prevalence of vaginal intercourse, outercourse, and receipt and performance of oral sex reported among 461 married/partnered women age ≥ 60 years in the United States and factors associated with these four sexual behaviors. Using data from the National Social Life, Health, and Aging Project, associations between participants’ socio-demographics, health indicators, sexual perceptions, communication, and sexual behaviors were examined. In the past year, 53.6% reported having vaginal intercourse, 56.0% outercourse, and 21.7% receiving and 20.6% performing oral sex. Women with depressive symptomology were less likely to report intercourse and outercourse (p < 0.05). Women endorsing pleasurable sex as necessary to maintain relationships were more likely to report all four behaviors (p < 0.01). Women who communicated openly with partners were more likely to report intercourse (p = 0.002), outercourse (p = 0.001), and performing oral sex (p = 0.025). Findings may inform strategies about positive sex perceptions and strengthening partner communication.

Associations among Sexual Activity, Relationship Types, and Health in Mid and Later Life

Despite a growing amount of research on sexuality in mid and later life, relatively little is known about the associations among sexual activity, relationship types, and health. This paper analyzes data from the Survey of Health, Ageing and Retirement in Europe (SHARE) for the subpopulation of respondents residing in the Czech Republic (N = 1304, 49% women; M_age = 69.1, SD_age = 8.0). Hierarchical ordinal regression models showed that persons who stayed in newly formed or less traditional relationship types, such as dating, Living-Apart-Together (LAT) relationships, and cohabitation, reported a higher frequency of sexual activity than married people. Overall, the dating and LAT relationship group displayed the highest sexual frequency and the lowest incidence of chronic diseases. People in marriages and cohabitation were comparable with respect to the number of chronic diseases. The findings suggest that sexual activity is intertwined with later-life relationships and sexual frequency may vary according to the relationship type. Future research may benefit from probing the extent to which partnered sex is important for maintaining bonds between older partners with separate households.

Perceived Changes in Sexuality during the COVID-19 Pandemic among Adults in the United States

In the United States, the COVID-19 pandemic has decreased partnered sexual behavior and increased the use of enhancement (e.g., toys). This has been partly attributed to reduced social interactions and stress. However, individuals’ perceptions of changes are missing in research. This study aims to examine how adults perceive changes in their sexuality during the pandemic. We conducted a nationwide survey of US adults from April–June 2020 (N = 326). This qualitative study examines the open-ended responses using thematic analyses. The following themes emerged from the data: (1) changes in the purpose of sex; (2) changes in sexual identity; (3) decreases in sex drive and desire; (4) increases in sex drive and desire; (5) fluctuations in sex drive and desire; (6) increased sexual experimentation and reflection. The stress, changes in home responsibilities and living situations, and time spent with partners (more or less) has affected individuals by increasing or decreasing their sex drive and desire. Participants responded to changes with self-reflection and awareness, and incorporating new practices (e.g., technology, kink). The purpose of sex has shifted in order to gain intimacy or connect, or to pass time. These changes were perceived as both positive and negative, and more research is needed to determine the durability of these changes.

Factors Conditioning Sexual Behavior in Older Adults: A Systematic Review of Qualitative Studies

The sexual behavior of older adults, especially women, has undergone changes in recent years, though there are still certain stereotypes today related to pathophysiology, beliefs, culture and tradition that negatively affect older adults’ sexual activity. The aim of our review is to present the main qualitative studies analyzing how physiological and psychosocial factors affect sexual behavior in older adults. A systematic review of these qualitative studies was carried out. All stages of this review were carried out peer-to-peer in order to guarantee minimized bias. A bibliographical search was completed between February and April 2019, in Web of Science, Scopus, PubMed Medline, PsycINFO ProQuest and CINAHL. To analyze the findings of the selected qualitative studies, a “Thematic Synthesis Analysis” was performed, using Eppi-Reviewer 4 software (UCL Institute of Education, University of London, UK). The quality of the studies was assessed with a CASP-Qualitative-Checklist. A total of 16,608 references were screened and 18 qualitative studies were included in this review. The studies involved 2603 participants across seven countries, most being women (approximately 80%). We identified a wide variety of physiological and psychological factors that can influence the sexual behavior of older adults, such as the presence of pathologies (erectile dysfunction and menopause), the strength of spiritual beliefs, and patriarchal roles upheld by upbringings conveying that women’s role is to provide men with sexual pleasure. Biological age in relation to stereotypical models of sexual behavior, emphasized as a risk factor in the contraction of sexual diseases, seems to play a relevant role as a factor limiting sexual behavior in older adults.