.jpg)
In the Netflix series Grace and Frankie, two of the main characters own and operate a sex toy business whose main product, a vibrator, is designed and marketed to older women. Despite this sex-positive depiction of older adults in this popular series, society is still marginalizing later-in-life sexuality. Sex among older adults is often stereotyped in a way that elicits repulsion, amusement, or disbelief. Despite society's exclusion of sexually active older adults from mainstream media, research shows that older Americans enjoy a range of sexual activities (Levy, 2019).
In other words, older adults are having sex. They are having every kind of sex—heterosexual sex, same-sex sex, sex with multiple partners, and sex with themselves. They are having sex in nursing homes and retirement communities, and they are having more of it than expected. A U.S. study reported that, of sexually active people between the ages of 75 and 85, 54% reported having sex two or three times per month, and 23% reported having sex one or more times per week. The American Association of Retired Persons' Healthy Aging Poll of Individuals aged 65-80 showed that two-thirds of individuals were interested in sex, and more than 50% stated that sex was essential to their quality of life.
Society still depicts older people as asexual, undesirable beings isolated from the youthful, beautiful people of society. Ageism, discrimination, prejudice, and stereotyping based on one's age play a significant role in the misconceptions and attitudes toward the sexuality of the elderly and aging, specifically people aged 65 and older (Flesia et al., 2023). This article aims to describe how ageism can affect the sexual health and well-being of older people, dismantle mistaken beliefs and stigma regarding older adults' sexuality, and explain how sex can improve with age.Â
For this article, the concept of sexuality has many dimensions, including identity, need and desire, and relationships and behavior, which develop through aging and life experiences. There is great diversity among older people in terms of age, sexuality, ethnicity, and culture, including sexual feelings, thoughts, attractions, and behaviors toward people. Sexuality is not about who you have sex with or how often you have sex. There are standard terms to describe sexuality (i.e., heterosexual, homosexual, bisexual, etc.), but one does not have to adopt a label, significantly as sexuality can change over time (BetterHealth, 2012).
At the University of Illinois Urbana-Champaign, Professor Liza Berdychevsky conducted a study with more than 270 young adults ages 18-35. More than 25% of those in the survey believed that seniors were at a greater risk of heart attack from having sex. They also believed that disinterest in sex was a normal part of aging. On the contrary, sexual activity later in life can include health benefits such as improved cardiovascular function, improved relaxation, and decreased symptoms of pain and depression. Despite ageist societal views that growing older kills one's sex life, studies have shown that most adults enjoy sex into their 80s and 90s. Regardless, ageism continues to put older adults' sexual rights at risk of marginalization and neglect (Forrest & Forrest, 2024).
Ageism can be directed towards older adults institutionally or interpersonally, or it can be self-directed (internalized ageism). Ageism is associated with poorer health outcomes, worse mental health, and a shorter life span. It hinders successful aging by causing higher rates of loneliness and isolation and a poorer quality of life, including decreased sexual well-being.
According to the World Health Organization (WHO), sexual well-being is "the absence of disease and coercion and draws attention to sexual rights and the possibility of sexual pleasure (Flesia et al., 2023). Since older people are often stereotyped as non-sexual beings, ageism hinders the representation of older people's sexual health. Because of this, older people's sexual needs go unaddressed, which increases sexually transmitted diseases (STDs) and causes overall worse sexual and reproductive health (Flesia et al., 2023). Society typically depicts older adults' sex lives as non-existent because they are viewed as too frail, sick, or feeble to desire sex or engage in sexual activities. Ironically, when older people do express their sexuality, they are often viewed as deviant and perverse (i.e., "the dirty old man") (Levy, 2019).Â
Liberal beliefs concerning sexuality among older adults are strongly correlated with sex as a leisure activity. Organizations such as the World Health Organization (WHO) and the World Association for Sexual Health have also embraced and underscored the leisure aspects of sex, including sexual pleasure, autonomy, self-determination, and sexual rights for all (Forest & Forest, 2024). However, the Geriatric Sexuality Breakdown Syndrome (Kaas, 1981, as cited by Flesia et al., 2023) describes a seven-step process that explains how societal ageism is still interfering with and causing sexual problems for older adults.
Sex Lives of the Aging
The process begins with:Â
·       being prone to identifying with stereotypical sexual issues for older adults, such as sexual dysfunctions and body changes
·       relying on society's myths and stereotypes in the absence of sex-positive older age role models
·       labeling of older adults as dirty, shameful, or asexual (i.e., internalized societal attitudes)
·       direct labeling of older adults as asexual or indecentÂ
·       adopting behaviors and skills to avoid feeling shame and/or guilt (e.g., denying sexual desire, underreporting sexual dysfunction)
·       losing sexual enjoyment, interest, and performance skills because of distancing and shame
·       self-identifying with stereotypes such as the "dirty old man."Â
When internalized, these societal attitudes and myths negatively affect the behaviors and sexual satisfaction of older adults (Flesia et al., 2023). Unfortunately, later-in-life sexuality is underrepresented, and older adults' sexual needs are rarely addressed (Flesia et al., 2023). Moreover, policies and practices, at a societal level, affecting healthcare services reflect the stigma consistent with ignorance or ambivalence toward older adults' sexuality. Recent trends show an increase in rates of STIs, such as HIV, among older adults. Sexual risks are not surprising among this generation of older people who came of age when sex education in school was absent, HIV was almost unheard of, and sexual protection meant preventing pregnancy.
Today, older adults are more likely to engage in hook-up culture and condomless sex fueled by the increased use of dating apps for seniors (Steckenrider, 2023). Although the U.S. Center for Prevention and Disease Control (CDC) suggests routine STI screenings until age 64, with accommodations for subgroups that are currently sexually active, have new partners, and other health risks, healthcare providers need to ask older adults about their sexual practices to determine their risk. This is not happening. Older adults rarely receive comprehensive health screens (Syme & Cohn, 2015).
According to the CDC, of the nearly 1.1 million people diagnosed with HIV in the U.S. in 2021, over 53% were 50 years old or older. Unfortunately, older adults are often identified as having chlamydia, syphilis, herpes simplex virus, and gonorrhea. Still, they go untested and untreated until later stages of the illness, resulting in a poorer prognosis. Misinformation and lack of education regarding the aging process, especially among the medical community, contribute to the myths and stereotypes that result in outcomes such as depression, anxiety, infections, and other chronic health conditions. Furthermore, when ignored, sexual dysfunction or lack of interest in sex can also indicate or lead to underlying illnesses (Tupy et al., 2015).
At the provider level, stigma is evident through the reported lack of knowledge concerning older patients' sexuality, avoidance and/or embarrassment of the topic, and the assumption that older patients are no longer having sex. When this structural stigma intersects with internalized stigma, assessment and treatment of sexual health issues for older adults declines (Syme & Cohn, 2015). Older adults do not bring their concerns to their provider since sex past a "certain age" is often disparaged or because sexual dysfunction has become an expectation. Furthermore, many older adults believe that sexual dysfunction is untreatable (Tupy et al., 2015).
Older people are often reluctant to discuss sexual issues with their doctors for fear of being met with disapproval and embarrassment. Internalized ageist stereotypes and myths regarding later-in-life sexuality promote dysfunctional beliefs and influence personal self-perceptions of sexual desire and sexual arousal. More specifically, stereotypes regarding aging and sexuality have been internalized since childhood, reinforced throughout adulthood, and became believable in older age. One study (Heywood et al., 2019, as cited by Flesia et al., 2023) discovered that internalized ageism was more frequently reported by those 60 years of age and older who had not had sex in the past two years and were uncertain about sex in the future as opposed to their sexually active counterparts (Flesia, 2023).
Not surprisingly, sexual orientation is rarely included in the already scant research on sexuality and aging. The lesbian, gay, bisexual, transgender, and queer (LGBTQ) community experiences their own structural, interpersonal, and individual stressors. Ageism, interacting with other forms of discrimination towards this population, exacerbates the negative impact on their personal health and sexual well-being. LGBTQ older adults experience a double stigmatization process of aging and being a part of a non-normative sexual minority. Moreover, LGBTQ older adults often hide their identity from their healthcare providers due to fear of discrimination in healthcare provisions and assumptions by their providers that their older patients are not only asexual but also heterosexual (Flesia et al., 2023). It is also a common misconception that sex refers to partnered sex and intercourse.
For many older adults, they have made adaptations to their sexual activities due to their age. For instance, chronic health conditions, issues with mobility, arthritis, etc., may interfere with penetrative sex. Many older adults consider various expressions of physical and emotional intimacy as having sex. Furthermore, this misconception does not consider those whose sex partner has passed away or older people in the LGBTQ community having non-heterosexual sex. Providers need to consider various forms of sexual activity outside of penetrative sex, such as oral sex, fondling, and masturbation (Steckenrider, 2023).
*Read Part 2 for the rest of the article.
Warm Regards,
Bryan Hutchison
Bryan Hutchison is a licensed professional counselor and Certified Clinical Anxiety Treatment Professional (CCATP) who recognizes the privilege to partner with individuals and families struggling with anxiety, depression, stress management, life transitions, and self-esteem. She understands the complexity of LGBTQiA issues, and also provides affirmative counseling that recognizes all parts of your identities and experience. Bryan uses an integrative approach to therapy that includes Cognitive Behavioral Therapy, Motivational Interviewing, Acceptance and Commitment Therapy, and mindfulness.
Comments