For a harmonious full-blooded existence, the complex nature of human beings requires a whole range of factors. Those may include good health conditions, proper living environment, adequate social status, satisfying work, and many other possible elements. Among those, the significance of such factor as satisfaction with one’s sexual functioning cannot be overestimated. Initially designed as reproductive method, sexual functioning has developed a meaning for people that equals sometimes to personal success and competence. Ability to realize one’s sexual potential and to receive the corresponding sexual satisfaction defines one’s sexual function as successful and significantly raises personal self-esteem, which in its turn has an impact on one’s social standings and image.
Traditionally, active sexual functioning is closely connected with age limits and ascribed to relatively young generations of human beings. The interest to and participation in sexual functioning traditionally begins at teenage years, with the onset of pubescence, develops throughout the next several decades, and gradually tails away as the person enters the elderly age. Due to this biological rhythm, there exists a tendency towards a stereotype on the sexuality and sexual functioning of the elderly as a nearly taboo theme that is irrelevant to a healthy society. Involving into sexual activity at an older age is barely discussed, since it is nearly unthinkable of and is generally perceived as abnormal or pervert. By and large, everything connected to sexual behavior is left for the young and active, and such attitude literally ostracizes the elderly from engaging into any form of sexual activities. However, recent research has shown that despite all the myths that exist about sexual functioning of the elderly, there is an urgent necessity to understand and promote sexuality among the aged so that their quality of live and demands of healthy existence are satisfied to the fullest.
The traditional perception of sexuality among the elder generation is based on a series of myths that exclude any possibility of sexual functioning of the aged. Due to the stereotypical opinion of the older people’s sexuality, it is not infrequent that general public openly devaluates elderly sexuality and negatively comments on any of its manifestations employing even sarcasm and ridicule. Generally speaking, the widespread myths on elderly sexuality are mainly based on the premise that “sexuality is only the province of a youthful society” (MacRae, as cited in Low et al., 2005). Youth, outward attractive appearance, physical capacities, agility, energy, — all those qualities are traditionally the realm of the young, and since they are standardly connected to the sphere of sexual activities, the elder generations are automatically shunned away from sexual functioning as being incongruous with the basic criteria of sexuality. What results from physical withering away and losing standardly accepted attractiveness is that the elderly are no longer viewed as desirable and attractive, and consequently give up the idea that they can also desire and attract. The aged generation therefore become a kind of asexual beings with no physical attractiveness and no desires or needs to involve in any form of sexual activities. Such is the standard social norm, and those who dare to break it appear to contradict the normal social expectations and therefore become socially inacceptable deviants. By labeling the sexual behavior of the elderly as socially inappropriate, disgusting, and anomalous, the general publish actually neglects the needs of the elderly and dismiss their sexual demands as irrelevant, which is in itself scandalous and intolerable.
In order to dismiss the outrageous social discrimination of the elderly on the ground of their sexual behavior, it is vital to gain sufficient understanding of the ways sexual functioning in the elderly occurs. Until quite recently, research on elderly sexuality used to concentrate mainly on sexual dysfunctions, mainly among the males, and covered such areas of interest as erectile dysfunction, capacity for sexual intercourse, and sexual interest (DeLamater & Karraker, 2009). However, a genuine understanding of sexual functioning includes a much broader scope of relevant matters that define the quality of sexual functioning among the elderly. DeLamater and Karraker (2009) suggest enlarging the definition of sexual functioning with such factors as a broader scope of sexual activities which encompasses not only standard direct intercourse but such practices as oral sex and masturbation. Additionally, the researchers emphasize the significance of reckoning with a range of objective and subjective factors of sexual activities, such as presence of a partner and the partner’s individual characteristics (DeLamater & Karraker, 2009).
Attempting to present a possibly complete understanding of sexual functioning, DeLamater and Karraker (2009) categorize all the factors that significantly influence this aspect of human life into four major groups. The first group, biological determinants, includes mostly chronic medical conditions, lifestyle, and biological processes that lead to hormone changes in the body. For example, aged people who undergo substantial medical treatment, no longer consider themselves fit and capable of involving into sexual activities. The second group, psychological determinants, features emotional and interpersonal motivation that drives the elderly in their sexual behavior and attitudes. A significant part in forming one’s sexual motivation belongs to self-perception and self-image of the elderly, which is not infrequently negative in relation to sexual behavior. In addition, the situation can be worsened by prolonged medication and treatment that causes depression. The third group of factors defining sexual functioning is connected with the social context, and the researchers consider its role to be crucial for the elderly (DeLamater & Karraker, 2009). Provided that social context used to be a factor largely neglected in medical research literature, DeLamater and Karraker (2009) emphasize the importance of studying it in more detail and taking it into account when dealing with the issue of sexual functioning of the elderly. Firstly, the availability of a partner becomes a key issue for the elderly, since the average lifetime of females is standardly longer than that of males. Secondly, individual partner characteristics and the partner’s fitness and readiness for involving into sexual relations plays a decisive role for sexual functioning among the aged. Last but not least, the cultural expectations of the community appear to be crucial for defining the sexual standards of the elderly. Perceptions of appropriate marriage age, attitudes to cohabitation, and out-of-wedlock children change throughout the time and entail revision of sexual behavior standards by the new generations of elderly people. (DeLamater & Karraker, 2009)
With such variety of factors influencing sexual functioning among the aged, it appears reasonable to gain an understanding of the medical changes that occur to the body as it ages and result in altering psychological perceptions of sex among the elderly. A widely discussed issue of elderly male anatomy that hinders normal sexual activities is loss of erectile function. Among the normal anatomical and physiological changes in the female body, researchers enlist decreased hormone levels after menopause, which in their turn entail atrophy of labia majora, shortening and loss of elasticity of the vagina barrel, and decrease in vaginal secretions (Gelfand, 2000). As a consequence of those changes, women after menopause may experience a whole range of sexual response alterations, including “muscle tension, distention of the urinary meatus, lack of breast size increase during stimulation, delay in reaction time of clitoris, […] delayed or absent vaginal lubrication, decreased vaginal expansion in length and transcervical width, […] and fewer and occasionally painful uterine contractions with orgasm” (Gelfand, 2000, p. S-16). Naturally, such changes do not add much pleasure and satisfaction from sexual act to women, who choose to give up their former sexual practices completely rather than engage in activities for which they consider themselves unfit. In addition to natural body changes, sexual function of both men and women may be heavily distorted by such medications as antihypertensive agents, antipsychotics, and antidepressants (Gelfand, 2000). Long treatment courses may lead to irreversible changes in the body, but the more troubling consequence is that the patients stop perceiving themselves as capable of involving in sexual activities in their traditional understanding and thus close the door on sexuality in general.
Despite the cheerless medical perspectives on the aging body, there still exists an endless range of opportunities for the elderly to engage in sexual activities at a qualitatively different level than the standardly stereotyped ones. Along with traditional intercourse, research on older people in residential care has shown that such practices as masturbation, caressing and touching, kissing foreheads, hugging, petting or holding hands are not infrequent among older generations who thus realize their need for love, care, and tenderness (Low, 2005). It is revealing that practices involving less physical contact were more popular among the female patients than among the male ones, and thus reflect the typical female approach to sexuality as a manifestation of one’s being special, loved, and attractive.
Since in general perceptions, the elder generations are standardly denied any sexual activity as being asexual and disinterested in this sphere of human life, several studies have been carried out recently in order to find out the actual level of the elderly involvement into sexual activities. Confronting the popular opinion of the elderly disinterestedness in sexual sphere, research has yielded convincing evidence of sexual activity among the older adults. A fundamental study carried out by Lindau et al. (2007) involved a national probability sample of over three thousand US adults aged fifty-seven and older, and focused on the sexual activities, behaviors and problems of the aged people. The general trend observed among the adults who take part in the research was a gradual decline of sexual activity with the age, but not its total disappearance (Lindau et al., 2007). Throughout all the age subgroups, the male respondents were generally more likely to engage in sexual practices than the female ones, and this difference between male and female willingness to perform sexual functioning increased dramatically with the age (Lindau et al., 2007). In addition to the age element, another factor determining the level of sexual activities of the elderly was involvement in spousal or another intimate relationship. Those aged adults who were not involved in such kind of relationship showed significantly lower sexual activities: only 22% of men and 4% of women were sexually active outside of a spousal or intimate relationship (Lindau et al., 2007). And again, the percentage of sexually active men prevailed over that of sexually active women. Despite the fact that the levels of sexual activity lowered with the age, still even in the oldest age subgroup, between seventy-five and eighty-five years old, the frequency of sexual activities stayed as high as two to three times per month, reported by 54% of the sexually active sample, to once and more per week, reported by 23% of the sexually active sample (Lindau et al., 2007).
In regard to the alternative forms of sexual activity, the responses provided by the representatives of the elder generation showed that the aged do not avoided those forms either. Thus, for example, in Lindau et al. (2007) study, 58% of the youngest age-group respondents (57–64 years old) reported engaging in oral sex, against 31% of respondents in the oldest age group (75–85 years old). Masturbation was a common practice among almost half of the male respondents and a quarter of the female respondents, regardless of the availability of a spouse or another intimate partner. The frequency of engaging in this alternative sexual practice varied rather negatively depending on the health condition of respondents (Lindau et al., 2007).
The aforementioned results obtained by Lindau et al. (2007) correspond by large to the findings of a previous study conducted by Holden et al. (2005) in a telephone survey among Australian men. Holden et al. (2005) report that although sexual activities decrease with the time, out of those elder men who maintained their sexual functioning around 95% had a regular sexual partner, and over 90% found sexual relationship with their partner physically pleasurable (p. 3431). At the same time, around half of the respondents managed to find a compromise between their ideal and real frequency of sexual intercourse, and one-third of the respondents would prefer engaging into sexual activity more often (Holden et al., 2005). In a later research on sexuality among the aged, Lindau and Gavrilova (2010) confirm the earlier findings that sexual activity, interest in sexual life, and its good quality are more relevant and significant for elderly males than females, and that this gap widens with the age: by the age of seventy-five, only 16.8% of women were sexually active, as opposed to 38.9% of men (p. 4). Likewise has the research confirmed that positive views and rates of sexual life are positively related to the health conditions of the respondents (Lindau & Gavrilova, 2010). The novel results yielded by the research have emphasized that while men generally demonstrate longer duration of sexually active life, poor health conditions shortened that sexually active life expectancy of men much more than that of women (Lindau & Gavrilova, 2010).
For the elderly, one of the crucial reasons for decreasing or even ceasing their sexual activities is a certain medical condition that hinders or prevents such activities. As reported by Lindau et al. (2007):
“Among men, the most prevalent sexual problems and the corresponding percentages of those who were bothered by them were difficulty in achieving or maintaining an erection (37% and 90%, respectively), lack of interest in sex (28% and 65%), climaxing too quickly (28% and 71%), anxiety about performance (27% and 75%), and inability to climax (20% and 73%). For women, the most common sexual problems and the percentages of those who were bothered by them were lack of interest in sex (43% and 61%, respectively), difficulty with lubrication (39% and 68%), inability to climax (34% and 59%), finding sex not pleasurable (23% and 64%), and pain (most commonly felt at the vagina during entry) (17% and 97%).” (p. 769)
Apart from medical conditions, among the established factors that lowered sexual functioning of the female elderly adults were higher educational level and status, lack of constant partner, and white race (Addis et al., 2006).
Researchers have also established significant changes in sexual attitudes and practices among the elderly that have occurred within the recent decades. Thus, for example, a comparative study of a sample that included 70-year-olds from Sweden in a time period from 1971 to 2001 has emphasized a sufficient increase in self-reported sexual activity among the elderly (Beckman, Waern, Gustafson, & Skoog, 2008). While reports on own sexual activity were generally higher with men than with women, which corresponds to the previous research results, Beckman et al. (2008) have discovered that by the early 2000s male and female respondents demonstrated no significant difference in their overall positive attitude to sexuality, and around two thirds of men and women reported high sexual satisfaction. Additionally, fewer complaints on premature ejaculation with men or anorgasmia with women have been reported, which may be partially explained by launching new medical treatments for the problems (Beckman et al., 2008).
In spite of the reported declining sexual activity among aged people as compared to younger generations, the current research results show that a great proportion of the elderly would like to increase the quantity and quality of their sexual functioning. These findings have two significant implication on further research on the one hand and on the social policies on the other hand. Provided that physical changes and medical conditions of the elderly are frequently a defining factor for their sexual activities, studies should be conducted in order to work out medical treatment strategies that would not suppress but boost sexual functioning of the elderly and provide them with a chance to sexual satisfaction and fulfillment. In addition, modern society at the present progressive stage of its development has to reconsider the standard stereotyped perceptions of the elderly sexuality and recognize the right of the aged people to enjoy a proper sexual functioning. Thus, for example, Low (2005) examines the situation in residential care establishments and concludes that the attitude of the residential care staff towards the manifestations of sexual behavior among the aged is far from positive. Instead of creating appropriate friendly environment for the elderly to feel at ease when they need to realize their need for intimate affection and physical connection, members of residential care staff expressed major concern for any sexual expressions classified as inappropriate (Low, 2005).
Improvement of the existing negative attitude of the society towards sexuality among the aged is naturally easier to launch at institutions of greater concentration of the elderly and those who promote that negative attitude. Thus, residential care establishments provide an excellent location to start promoting a positive view of the elderly sexuality. In order to eliminate the shock and horror staff members demonstrate at sexual behavior of the elderly, and to implant an understanding that not only loving and caring but also erotic attitudes are not unusual and abnormal for elderly people, there are several possible steps to undertake. On the one hand, staff awareness of elderly sexuality should be increased through proper educational programs (Low, 2005). Although elderly sexuality is a mysterious terrain for younger generations who often do not wish to delve into the issue, increasing residential care staff awareness of the topic would benefit both the elderly and the staff members themselves. They would not have to feel lost or simply disgusted witnessing manifestations of erotic behavior, and they would gain knowledge and guidelines for action and reaction to certain situations connected with the elderly sexual functioning.
On the other hand, promotion of open, tolerant, and understanding attitude of the staff to elderly sexuality would comprise a significant step towards creating a positive environment for elderly sexual activities. Since residential care establishments initially represent quite an obscure, if not hostile, terrain for the elderly who possess various sexual backgrounds, it is vital that the staff are open-minded and willing to easily discuss the elder people’s individual sexual needs and to provide adequate advice and information on how to resolve certain sexual issues (Low, 2005). For the purpose of creating such friendly environment, it is also vital to conduct further research on of the meaning and essence of sexuality for the elderly and on the basis of research findings establish an understanding attitude that would promote discussion and practice of sexuality among the aged.
The issue of sexuality among the aged is relatively new to the society which has shunned away this crucial question for centuries. Sexual functioning of the elderly used to be a terra incognita both for the society and for the elderly, since the latter were shunned away from open discussion or practice of their sexual needs as inappropriate and shameful. However, recently launched research has shown that despite certain medical problems, the elderly are a sexually active group and their demands should be considered and reckoned for. With the new progressive attitude to the issues of sexuality in general, and of elderly sexuality in particular, the elder generation receives the chance of promoting their sexual wellbeing and improving the overall quality of life.
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Beckman, N., Waern, M., Gustafson, D., & Skoog, I. (2008). Secular trends in self reported sexual activity and satisfaction in Swedish 70 year olds: Cross sectional survey of four populations, 1971-2001. British Medical Journal, 337: a279.
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