How to support the sexual wellbeing of older patients

Dear Editor

It is now well established that the world’s population is ageing, and has been doing so rapidly in the last century. Ageing will have a significant impact on health and social policies, and the older people (both men and women) will likely be among the policy-making priorities in the next few decades. Sexual and reproductive health and rights (SRHR) issues in older adults remain a “taboo” among individuals and in many societies at large, a “topic of minimal interest” for health professionals and researchers; and a “blind spot” in the broader policy dialogue. (1)

At any age we can talk about any disease freely but when it comes to sexual and reproductive health for seniors, the conversation doesn't flow as freely. In a recent National Poll on Healthy Aging by the University of Michigan, most respondents (76%) agreed that sex is a vital part of a romantic relationship at any age. Yet only 17% of older adults had brought up the subject of sexual health with their healthcare providers in the past two years.

Sexual activity is an important marker of quality of life in older adults, associated with mental and physical well-being, satisfactory relationships, and reduced risk of chronic diseases. As global health policy prioritizes the relevance of promoting well-being in older age by implementing a person-centered approach, the inclusion of sexual health as an intervention tool may be particularly relevant.(2) In conclusion, findings from this review suggest that programs that aim at promoting well-being may benefit from encouraging a fulfilling sexual life in older age.(3) The World Health Organization (WHO) and the World Association for Sexual Health acknowledge the important positive influences of fulfilling sexual experiences on well-being throughout the life span, including at older ages (4, 5). Research suggests that sustained sexual desire and being sexually satisfied may contribute to successful aging (6, 7).

We are so tight-lipped about sex after 50 because sexual health tends to be a taboo topic. The topic of sex is even more sensitive in underdeveloped and developing countries. Not only that, it’s often surrounded by feelings of fear and anxiety. We need to bring the topic of sexual health out of the dark into the light by getting closure to the older people and try to know their sexual problems which they hesitate to discuss.
We need to design different algorithms that better describe the sexual conditions of subjects from different geographical locations like India, China, Europe, Australia, USA and other countries which have different socio-economic cultures and beliefs. Future research may help us understand which physiological and psychosocial factors are negatively or positively associated with sexual behavior, to improve future research on aging and sexuality, to develop educational and assistance strategies to improve sexual health, and to devise sex-related social interventions and services for older adults.

We also need to change mindset of general physicians attending geriatric clinics and train them to initiate the dialogue about sexual health life of any individual at their own. This will remove the initial taboo from older subjects. Normally we see the advertisement for any sex related products like Viagra, condoms, and other devices used for sexual pleasure and find very young brand ambassadors. This creates a misconception in most of the populations as if these products are designed only for young people. However if we "replace these young ambassadors with the older ones", it may change perceptions along the public. This will also remove hesitancy of older people to discuss the sexual issues with physicians of any age. In this way we can improve not only sexual life of elderly but also improve quality of life as a whole and decrease the disease burden of the world.

1. Saka S, Oosthuizen F, Nlooto M. National policies and older people’s healthcare in Sub-Saharan Africa: a scoping review. Annals of global health. 2019;85(1).
2. Allen MS, Desille AE. Personality and sexuality in older adults. Psychology & Health. 2017; 32(7):843-59.
3. Vasconcelos P, Paúl C, Serruya SJ, Ponce de León RG, Nobre P. A systematic review of sexual health and subjective well-being in older age groups. Rev Panam Salud Publica. 2022;46:e179.
4. World Association for Sexual Health. Declaration of sexual rights. Minneapolis (MN): World Association for Sexual Health;2008.
5. World Health Organization. Sexual health, human rights and the law. Geneva: World Health Organization; 2015.
6. Štulhofer AH, Hinchliff S, Jurin T, Carvalheira A, Træen B. Successful aging, change in sexual interest and sexual satisfaction in couples from four European Countries. Eur J Ageing. 2019;16(2):155-65.
7. Štulhofer AH, Hinchliff S, Jurin T, Hald GM, Træen B. Successful aging and changes in sexual interest and enjoyment among older European men and women. J Sex Med. 2018;15(10):1393-402.