Nearly half of men aged 75–95 say that sex is still important to them, and nearly a third have had a sexual encounter in the past year, according to a community-based study from Australia.1 Although sexual activity was lower among the oldest respondents than among the youngest, 40% of men aged 75–79 and 11% of those aged 90–95 had had sexual contact with another person in the past 12 months. Men had reduced odds of being sexually active if their partner lacked interest in sex, if they or their partner had health problems, or if they were taking medications that may affect sexual function.
The data are from a longitudinal study of community-dwelling men in Perth, Australia. Participants were recruited in the mid-1990s for a large-scale aneurysm screening trial of men 65 or older; 12,203 completed a study questionnaire (Wave 1). In 2001–2004, some 5,585 of them completed a follow-up questionnaire (Wave 2). Finally, 3,274 men completed another questionnaire in 2008–2009, when they were aged 75–95 (Wave 3). At Waves 2 and 3, the men provided a range of information about their health; further information about their medical history was obtained from state hospital, cancer and death registries. In addition, at Wave 3, the men answered questions about their sexual activity, sexual satisfaction and partners. Sex was defined as any sexual encounter with another person, regardless of whether intercourse was involved or orgasm resulted, and men were considered sexually active if they had had sex at any time in the past year. Levels of sex hormones were measured using blood samples taken at Wave 2.
The investigators conducted two logistic regression analyses to identify factors associated with sexual activity. The first was a cross-sectional analysis of all 2,758 men with complete data at Wave 3. The second, a longitudinal analysis, examined the relationship between men’s characteristics at Wave 2 and their sexual activity at Wave 3; it included only the 1,500 men whose sex hormone levels had been measured at Wave 2 and who did not have prostate cancer, had not undergone androgen deprivation therapy or supplementation, and had responded to all relevant questions.
At Wave 3, three-quarters of participants were married or in a marriage-like relationship, and most were aged 75–84 (81%). Many had health problems, including hypertension (61%), coronary heart disease (41%), benign enlargement of the prostate (34%), diabetes (20%) and prostate cancer (16%). Some were taking beta blockers (25%) or antidepressants (8%), both of which may affect sexual function or interest.
Eighty-five percent of the men provided information about their sexual activity in the past year; 31% of this group had had sex at least once during that time. Among those reporting sexual activity, 54% were satisfied with the frequency of their sexual encounters, but 41% had had sex less often than they desired; the remainder either did not answer the question or had had sex more often than they liked. Almost half (49%) of the men who answered a question concerning the importance of sex in their lives said that it was at least somewhat important; 13% reported it was very or extremely important.
Sexual activity and the importance of sex in men’s lives were both lower among the oldest respondents than among the youngest. Forty percent of men aged 75–79, but only 11% of those aged 90–95, had had sex in the past year. Similarly, the proportion who said that sex was at least somewhat important to them was 59% among the youngest men, but just 21% among the oldest. Reasons for lack of sexual activity included physical problems (48%), lack of interest (41%), partner’s lack of interest (40%), partner’s physical problems (23%) and lack of a partner (21%).
In the cross-sectional regression analysis, several characteristics were associated with sexual activity at Wave 3. The likelihood that a man had had sex in the past year declined with age (odds ratio, 0.9 per year). In addition, he was less likely than his peers to have been sexually active if his partner lacked interest in sex (0.1) or had physical limitations (0.4); if he had diabetes (0.7), osteoporosis (0.6) or prostate cancer (0.4); or if he was using antidepressants (0.5) or beta blockers (0.7). Respondents were more likely than other men to have had sex if they lived with a partner (3.6) or if English was not their first language (1.4).
Most of these variables (the exceptions were osteoporosis and beta blocker use) were also associated with sexual activity in the longitudinal analysis—that is, their value at Wave 2 predicted sexual activity at Wave 3. The odds ratios were generally similar to those of the cross-sectional analysis. In addition, the higher a man’s testosterone level at Wave 2, the greater the likelihood that he was sexually active at the following wave (odds ratio, 1.2 per standard deviation increase in level).
The authors acknowledge a number of study limitations, including response bias (participants with less liberal attitudes may have been reluctant to report sensitive activities), survivorship bias (respondents may have been healthier and more sexually active than nonrespondents) and recall bias. Still, the findings refute "the stereotype of the asexual older person," according to the authors. The investigators note that the proportion of men who considered sex at least somewhat important was greater than the proportion who were sexually active, "suggesting that a substantial proportion of older men may have unmet sexual needs." Although addressing health problems may help some elderly men continue or resume sexual activity, research is needed "to explore how older men can achieve sexual fulfillment when they are widowed or when their partners are incapable of or uninterested in sex."—P. Doskoch