Factors Associated With Sexual Health and Well Being in Older Adulthood

Maria Kleinstäuber


Curr Opin Psychiatry. 2017;30(5):358-368. 

In This Article


The current review demonstrates that previous research of factors associated with sexual health in older adulthood has already revealed several meaningful studies. In many of these studies, the role of psychosocial, health-related and demographic variables in sexual well being in later phases of life has been examined. However, these previous findings have to be interpreted cautiously as in many cases the analyses have not been adjusted for confounding variables. Moreover, for several factors that have been evidenced to be associated with sexual health, the relationships seem to be more complex than expected. A typical example is the relationship between age and sexual health, which has been examined in numerous studies. Age itself, however, does not present an appropriate predictor. For example, it seems to be strongly moderated by sex and aspects of physical health. Thus, for many of the previously investigated factors, moderators and mediators of their relationship to sexual well being have to be understood and researched in more depth. Most recent studies have done this – for example for variables such as marital characteristics,[47**] depressive symptoms[42] and religion.[46*]

Another important point lacking in previous but also in most recent studies is that sexuality is a field that is strongly influenced by cultural aspects. In future, more transcultural research in order to understand differences between ethnic groups in the perception and experience of sexuality in older adulthood is needed. In addition, in studies applying mixed samples including individuals from different ethnic groups, ethnicity should be paid attention to as an important variable for adjusting analyses.

Our review also strongly demonstrates that the associations of specific factors vary strongly between different facets of sexual health in older adulthood. Therefore, in future research, it is important to distinguish between sexual activity, satisfaction and functioning. For example, many of the above cited studies show a decline of sexual activity with age in both sexes (Figure 1). However, sexual satisfaction or sexual desire does not necessarily decline with increasing age, especially not in women (Figure 2 and Figure 3). This complex relationship could be possibly explained by results from a cross-sectional study by Gebauer et al..[52] The authors demonstrated that in men the satisfaction principle (a high level of sexual activity decreases sexual desire) accounted for sexual desire over the whole lifespan. However, in women, it accounted for sexual desire only until their mid 30s. From this age on, the sexual desire in women was rather explained by the adaptation principle (higher levels of sexual activity increase sexual desire). However, there are also other aspects that can probably explain this complex relationship: for example affection becomes more and more important for sexual satisfaction with increasing age,[28] or sex-related changes in body image show that women seem to be more successful in dealing with age-related changes of the body and body function than men.[53]

Although previous research has already considered various factors and their associations with sexual health in older ages, there are variables that have been strongly neglected. For example, research of LGBT samples[14] and of the influence of modern media and the role of pornography[54] on the sexual health in older people should be paid more attention in future research. In addition, it would be important to focus more on protective factors of sexual health in older adulthood instead of the risk factors of sexual decline only.[55]

The current review also provides important insights for clinical work. Studies demonstrated that for health-care providers[56,57] as well as older patients,[9,58] there are high barriers to talking about sexuality. Consequently, older adulthood patients have generally little knowledge regarding aspects of sexuality in older age. Thus, communication training for health-care providers to older people is very important and should include information about risks as well as protective factors associated with sexual health in older adulthood. Previous studies have already demonstrated that such training can improve the communication regarding sexuality between old persons and their clinicians.[56] In summary, the conclusions from the current review encourage and emphasize the importance of research in the field of factors associated with sexual health in older age groups. A good example of a future study that will bring more insight into adults' understandings and practices relating to sexual health is the Sex, Age and Me nationwide Australian study.[59]