Everything You Ever Wanted to Know About Sex (in the Elderly), But Were Afraid to Ask

Abstract & Commentary

By Allan J. Wilke, MD, Residency Program Director, Associate Professor of Family Medicine, University of Alabama at Birmingham School of Medicine—Huntsville Regional Medical Campus, Huntsville. Dr. Wilke reports no financial relationship to this field of study.

Synopsis: Sexuality is an important aspect of life for older Americans.

Source: Lindau ST, et al. A study of sexuality and health among older adults in the United States. N Engl J Med. 2007;357:762-774.

Lindau and colleagues sampled Americans aged 57 to 85 years, living independently in 2004 to learn about their sexual habits. A total of 1550 women and 1455 men were interviewed. The interviews were conducted at home in English or Spanish, as appropriate, and a basic physical examination was performed and blood, salivary, and vaginal mucosa specimens were obtained for laboratory analysis. Items of interest included marital history, recent sexual partnerships, sexual activity, sexual problems, physical health, and whether sex had been discussed with a physician since turning 50 years of age. The correspondents were grouped by sex and age (57-64, 65-74, and 75-85 years). They were predominantly Caucasian and increasingly so as the age of the subgroups increased, reaching 86% by age 75-85 years. More than half had at least some college education. Eighty percent were married or widowed with a greater percentage of men being married than women in every age group. The majority rated their health status as good to excellent. At all ages, men were more sexually active than women. The percentage of individuals engaging in sexual activity dropped with increasing age. The frequency of sexual activity also declined with age, but even in the 75-85 years group, more than half were having sex at least two or three times a month. Rating one's health more favorably was associated with a greater likelihood of sexual activity for both sexes, but, here again, healthy men were more likely than healthy women to be sexually active. Of the individuals who were in a relationship, very few reported it to be homosexual (3 of 1198 men and five of 815 women). Being in a relationship was highly associated with being sexually active in the previous year. Sexual activity for both sexes included masturbation, vaginal intercourse, and oral sex. Sexual problems were common. For men they included difficulty in achieving or maintaining an erection, lack of interest in sex, climaxing too quickly, anxiety about performance, and inability to climax. The problems that women experienced included lack of interest in sex, difficulty with lubrication, inability to climax, finding sex not pleasurable, and pain. Chronic diseases (in particular diabetes mellitus) were associated with less frequent sexual activity. Discussions about sex with a physician were infrequent: 38% of men and 22% of women.

Commentary

With the possible exception of frequency of sexual activity, the results of this survey are not too surprising. We are not comfortable talking about sex. Rent the movie Kinsey for an insightful portrayal of our reluctance. We physicians are really uncomfortable discussing sex with our elderly patients. However, sexual activity is an important component of quality of life in the elderly.1,2,3 Additionally, sexually transmittable diseases (including HIV/AIDS) are a problem in our older population. While the estimated number of HIV/AIDS cases remained stable among persons 65 years and older in 2005, they increased among persons aged 55-59 and 60-64 years.4 There is a price to be paid for our disinclination to speak about sex. We owe it to our older patients to develop our communication skills in this area.

References

1. Haren MT, et al. Andropause: a quality-of-life issue in older males. Med Clin North Am. 2006;90(5):1005-1023.

2. Kaiser FE. Sexual function and the older woman. Clin Geriatr Med. 2003;19(3):463-472, v. Review.

3. Hajjar RR, Kamel HK. Sex and the nursing home. Clin Geriatr Med. 2003;19(3):575-586.

4. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2005. Vol. 17. Rev ed. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2007:1-54.