Thursday 16th February sees the Greater Manchester Ageing Conference, held by the GM Ageing Hub, of which MICRA, the Manchester Institute for Collaborative Research on Ageing, is a part . To celebrate the conference, and to highlight the policy implications of living in an ageing society, MICRA have teamed up with Policy@Manchester to deliver a week of  highly relevant age-related blogs.

In their current review of sexual health and well-being in later life, Dr David Lee from the University of Manchester and Professor Josie Tetley from Manchester Metropolitan University, reflect on the fact that romantic love and relationships are something that most people want in their lives.  However, their current work also recognises that our experiences of love and relationships change across our life-course in both positive and negative ways, which are influenced by individual and social factors.  

When we consider society’s prevailing view of late-life sexuality, the predominant view is often that older people are not particularly sexually active or interested in intimate sexual relationships.  These preconceptions can be extreme, ranging from humour to disgust, or simply a refusal to believe that people in their 70s and 80s have sexual interests or needs at all.  Increasingly, positive intimate sexual relations are recognised as a key aspect of health at all ages.  Here it is argued that practice and policy need to change to better support the sexual and intimate lives of older adults.

• Many older people over the age of 50 remain sexually active and sexual health is a concern for men and women beyond the reproductive years
• A wide range of physical and psychological health conditions, the drugs used to treat them, and chronic disability can adversely affect sexual activity and satisfaction
• Conversations around sex and older people need to be normalised – countering stereotypes and misconceptions can only improve public health
• Health professionals need to proactively engage with older people to better manage problems that impact on both individuals and couples sexual health and function
• Positive sexuality and intimacy throughout the lifecourse is linked to higher levels of happiness and well-being, irrespective of age
• Older people have a right to good sexual health care and should be able to easily access joined up services to help them meet their needs

Our work is also featured in the recent Chief Medical Officer’s annual report ‘Baby Boomers: Fit For The Future’, where Professor Dame Sally Davies highlights that improving the sexual health and well-being of the over 50s continues to be hindered by stereotypes and taboos.  The sexual health problems in this age group may well be underestimated because of their reluctance to seek help, due to embarrassment or stigma.  This underlines the need to raise awareness to support adults in this age group seeking help for problems related to sexual activity and function, which may have important impacts on quality of life.

We’ve considered some of the key issues surrounding sexual health and well-being in later life using data from the Sexual Relationships and Activities Questionnaire (SRA-Q) included in wave 6 of the nationally representative English Longitudinal Study of Ageing (ELSA).

Challenges and changes: sexual health and satisfaction in later life

In ELSA, we found that half of men and almost a third of women aged 70 and over were still sexually active.  Sexual problems were relatively common, however, with a third of sexually active women reporting difficulties becoming sexually aroused or achieving orgasm.  For men difficulties getting and maintaining an erection was the most common problem, reported by 40% of those who were sexually active.  Chronic health conditions and poor self-rated health seemed to have more obvious negative impacts on the sexual health of men compared to women.

Examining the written quotes from ELSA participants describing their sexual health and problems in more depth, it became clear that key areas of concern focused on arousal problems, vaginal dryness and/or pain among women and erectile difficulties among men.  A common theme which emerged for both men and women was that irrespective of the sexual problems they were facing, whether due to the menopause or the presence of long-term health conditions, there was a feeling of not knowing who to turn to for advice and of the awkwardness and embarrassment of approaching health care professionals for help.

We were very aware that sexual health and sexual well-being has most commonly been looked at from an individualistic, as opposed to a partnered, perspective.  Given that for most people intimacy and sexual relations is a “coupled” activity, the partnership aspect of a couple’s sexual relationship should not be overlooked in either research or clinical practice.  Some couples in ELSA reported that changes in their health led to them being more likely to engage in non-penetrative sexual activities, and it was the quality of the relationship that was of primary importance.  Other couples, however, reported mismatches between themselves and their partners with respect to their individual desires and expectations concerning their sexual relations and overall relationship.

Around two-thirds of men and over half of women in ELSA thought ‘good sexual relations were essential to the maintenance of a long-term relationship’ or ‘being sexually active was physically and psychologically beneficial to older people’.  This was backed up when we looked at the associations between sexual health and measures of well-being and quality of life.  On the one hand, more frequent partnered sexual activities (kissing, fondling and petting; sexual intercourse) and higher levels of overall sexual satisfaction were related to higher well-being and quality of life scores in both men and women.  However, reported concerns about sexual desire and sexual function, and a reduced ability to achieve orgasm were linked to lower well-being and quality of life scores in men only.  That certain ‘functional’ sexual problems are more strongly connected with well-being among men may have implications for the management of individual sexual health.

How to go forward?

The findings from ELSA illustrate the need for more proactive discussions around changes that impact on sexual activities, which also take account of long-term health problems.  There is also a need to fund and support work that moves society away from the negative stereotypes and assumptions that continue to impact on how older people experience sexuality and relationships in later life.  We particularly recommend that more work is focused on improving positive ways of maintaining sexual intimacy in later life.  This could be achieved by developing sexual health support encompassing physical, psychological and relationship changes, i.e., a more holistic approach could make a real difference to both the sexual and general health of older people.  When problematic issues are identified, support for psycho-sexual support has to go beyond the use of prescribed medications; signposting to relationship and lifestyle support also has the potential to improve intimate and sexual relationships and psychological health outcomes.

Even though penetrative and non-penetrative sexual activities may change overtime, partnerships can remained satisfying, caring and rewarding.  However, mutual respect, management of health conditions and good communication clearly impact on how couples ultimately experience their intimate sexual relationships.  As the partnership aspects of sexual relationships are under researched, support and funding for work that explores partnered sexual and intimate relationships, particularly focused on negotiation and non-penetrative sexual activities, are warranted.  There is also a need to challenge how people perceive ‘normative’ sexual relationships in later life and recognise diversity and change over the lifecourse.

The sexual health of older people should not be overlooked by health care professionals in the broader context of maintaining well-being during ageing.  Recognising that sexual health may be an unspoken quality of life issue for older individuals could also improve the relationship between physician and patients, with better outcomes for the latter.  With respect to health care policy, if one argues that the well-being of older people is an important objective, both from a health perspective and by extension economically, then it seems reasonable that sexual health, and resources to maintain it, should be extended a higher priority within broader health policy.

Our work, therefore, reflects the reality that while some people are enjoying an active sex life, for others there are challenges as they experience difficulties in their sexual relationships.  In recommending solutions, we are not advocating a ‘one size fits all’ model of sexual ageing.  Our ongoing research is increasingly highlighting the diversity of late-life sexualities, and trying to impose youthful norms of sexual health on older people seems over-simplistic and even unhelpful.  We hope our research will also encourage a more open discourse about late-life sexuality and health, and foster wider intergenerational understanding that sex doesn’t stop at 50.