Sexual activity in middle to later life

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c850 (Published 10 March 2010) Cite this as: BMJ 2010;340:c850
  1. Patricia Goodson, professor
  1. 1Department of Health and Kinesiology, Texas A&M University, 4243 TAMU, College Station, TX 77843-4243, USA
  1. pgoodson{at}hlkn.tamu.edu

    Better health leads to frequent, good quality sex in older adults

    A cursory search of the BMJ’s archives using the terms “sexuality” and “older adults” yields one study report and one editorial, both published in the past decade.1 2 Using the terms “sexual activity” and “elderly” yields only two additional citations, which focus on gynaecological and epidemiological topics.3 4 If for no other reason than that of filling a glaring void, the linked study by Lindau and Gavrilova (doi:10.1136/bmj.c810) represents a refreshing addition to the BMJ’s sexuality and ageing repertoire.5 The study is equally refreshing because it offers a health enhancing, health promoting perspective: most human sexuality studies—especially those informing healthcare professionals—centre on outlining problems, diagnosing illnesses, and managing treatments. To unearth positive news amid the rubble of a trouble focused literature is just as refreshing, stimulating, and invigorating as good healthy sex.

    Lindau and Gavrilova examined data from two cross sectional surveys of ageing populations in the United States (national survey of midlife development in the United States (MIDUS) and national social life, health and aging project (NSHAP)). They used two representative samples of more than 3000 adults to calculate a “sexually active life expectancy” estimate for men and women in various age groups. Defined as the “average number of years remaining spent as sexually active,” this measure represents a “new health expectancy indicator for clinical and public health application.” As far as can be determined, Lindau and Gavrilova are the first to propose such a measure. Despite the novelty in content, however, the study presents both good and bad news. The good news highlights prevention: men at age 55 can expect 15 additional years of sexually active life, and women, 10.6 years. The measure helps project and predict the “population structure of sexual activity” and the upcoming “need for public health resources, expertise, and services” and will help address the sexual health of one of the fastest growing demographic groups worldwide.6

    More importantly, the study bears good news in the form of hope: given the manner in which “second adulthood” has been redefined in recent years, the availability of sexual performance enhancers, the widespread use of the internet for social support, as well as improvements in overall health and better access to care, the news that adults in the US can enjoy many years of sexual activity beyond age 55 is promising.7 8 In fact, Lindau and Gavrilova document increases in sexual interest among older men in their samples, and a strong association between overall health and sexual partnering and activity in later life for both sexes.

    Despite the spotlight this study shines on the sexual health of older adults in the US, less good news lies dormant in the shadows. Take the gender gap in sexually active life expectancy, for instance, which favours men: for men at age 55, sexually active life expectancy was eight to nine years less than demographic life expectancy, whereas for women this difference was 17 to 18 years. Or consider how the new measure provides little detail about the quality of life during these added years. For example, the measure sheds no light on the intriguing—and still poorly understood—question of why, even though they enjoy fewer years of a sexually active life, many women do not perceive this as a “problem.”9 Neither does the measure provide details on how women and men manage, attempt to enhance, or deal meaningfully (and uniquely) with their ageing sexuality. Sadly, even Lindau and Gavrilova attest that, “particularly little has been known about the quality of older women’s sexual lives.”

    Also lying within the shadows of a sexually active life expectancy measure is the great void in what is currently known about older adults outside of the cultural, geographical, economic, and political contexts seen in the US. Researchers and providers have a poor understanding (often misunderstanding) of how cultural and structural factors such as familism (the needs of the family as a group), social class, machismo (male dominance), or marianismo (female dominance) affect the ageing process and sexual health in many of these contexts.10 Meanwhile, as understanding lags, projections estimate that by 2030 the proportion of people 65 and older worldwide will have grown from 59% to 70%.6

    Other elements—such as problems with measurement (an old nemesis of sexuality research) and silence regarding the sexual health of ageing homosexual, bisexual, or intersexed people—also linger in the shadows. They stand as dim reminders of the limitations inherent in applying science to the study of complex human realities, and the cultural values shaping the topics we choose to study.11

    Thanks to Lindau and Gavrilova we now have a better sense of how much sexually active life lies ahead as we age. How well equipped, willing, and prepared sexuality researchers and healthcare providers are to help foster optimal quality, meaning, agency, and purpose in those added years remains a challenging question for health care and public health.


    Cite this as: BMJ 2010;340:c850


    • Research, doi:10.1136/bmj.c810
    • Competing interests: The author has completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declares: (1) No financial support for the submitted work from anyone other than her employer; (2) No financial relationships with commercial entities that might have an interest in the submitted work; (3) No spouse, partner, or children with relationships with commercial entities that might have an interest in the submitted work; (4) No non-financial interests that may be relevant to the submitted work.

    • Provenance and peer review: Commissioned; not externally peer reviewed.