Sex in later life: the subject nobody brings up

“At our age, people don’t talk about that any more, do they?”

It is a sentence anyone in their seventies might say. Picture a couple who have been together for almost fifty years. They talk about the grandchildren, about the daughter who moved away, about the silence that settled into the flat after retirement. In passing, they mention that for a few years now they have slept in separate rooms because he snores. She says it as a joke. He looks out of the window. Neither of them says that it hurts. But neither of them says that it doesn’t.

Sex in later life is one of the few subjects about which almost everyone stays silent at once: older people themselves, their children, doctors and often therapists too. That silence is not neutral. It tells people that their wish for closeness is something that should have passed long ago — and if it hasn’t, something must be wrong with them. In this post I want to loosen that silence a little. Not because older people ought to have a sex life, but because they are allowed to.

What the research says

One of the most widely cited studies on this subject was published in 2007 in the New England Journal of Medicine. Stacy Tessler Lindau and her colleagues looked at sexuality and health in the second half of life in a representative sample of Americans aged 57 to 85. In the previous year, 73 per cent of people aged 57 to 64, 53 per cent of those aged 65 to 74 and 26 per cent of those aged 75 to 85 had been sexually active with a partner.

These figures say two things at once. First: sexual activity really does decline with age. Second: it is far from disappearing. A quarter of people over 75 were sexually active — and this is the group about whom most people simply assume that “all that is over”.

The study showed something else, too. In every age group women were less often sexually active than men, and to a large extent this was because they were more often left without a partner — on average women live longer and are more often widowed. So it was not mainly a matter of fading desire, but of there being nobody there. Among those who were sexually active, about half reported at least one problem that bothered them. And perhaps most telling of all: since the age of fifty, only 38 per cent of men and 22 per cent of women had discussed sex with a doctor.

Why we stay silent

If so many older people are sexually active, and so many of them have difficulties, why is it hardly ever talked about? There are several reasons, and they reinforce one another.

Prejudice about age. In our culture sex is closely tied to youth, beauty and fertility. When all of that is “gone”, it seems as though sex should be gone too. An older man who wants sex quickly becomes a joke; an older woman becomes almost invisible. People internalise this message and begin to feel ashamed of their own desire.

Upbringing. Many of today’s retired people grew up at a time when sex was not discussed at home and only sparingly at school. They were never given words for it. It is hardly surprising that they struggle to find them now, at seventy — especially in front of a doctor half their age.

Children. Adult children rarely imagine their parents as people with bodies and desires. When a father meets a new woman after the mother’s funeral, or when a mother at seventy mentions that she has a “friend”, children often react with unease, mockery or even anger. Parents sense this and prefer to say nothing.

Doctors. Doctors often don’t ask either. Partly because of time, partly out of embarrassment, partly because they too assume it no longer matters. And so a vicious circle forms: the patient doesn’t ask because they are waiting for the doctor to ask, and the doctor doesn’t ask because the patient hasn’t mentioned anything.

The body changes — and the doctor comes first

I want to be clear here: I am neither a sexologist nor a doctor. When it comes to physical changes, the first port of call is always a doctor — your GP, a gynaecologist or a urologist. The body really does change with age, and a good deal of that can be eased.

In women after the menopause the vaginal tissue changes, which can lead to dryness and pain. You can read more about what genuinely changes at this stage and what is myth in the post Menopause and sexuality: what really changes and what is myth. In men, erection problems become more common and may be linked to cardiovascular disease, diabetes or medication. Medication is a chapter of its own: blood pressure drugs, antidepressants and some others can affect desire or the body’s response, which is covered in more detail in Medication and sex: antidepressants, contraception and blood pressure.

Because talking to a doctor about this feels awkward for many people, prepare your questions in advance and write them down. The template in the knowledge base, Questions for your doctor, can help. It is perfectly fine to begin an appointment with: “I’d like to ask about something I find embarrassing.” Doctors have heard this many times, and if you come across one who brushes you off with “that’s normal at your age”, you have every right to ask again or to seek a second opinion.

One more important point: a sudden change in sexual desire or response can also be a sign of something else — heart disease or depression, for example. So talking to a doctor is worthwhile not only for your sex life but for your health in general.

Intimacy is broader than intercourse

One thing research on sex in later life often shows is that its meaning changes over time. At the start of this century, Merryn Gott and Sharron Hinchliff interviewed older people in the United Kingdom about how important sex was to them. The answers varied a great deal — for some it was still very important, for others less so — but one idea kept returning: sex is not only intercourse. It is touch, a hug, sleeping side by side, a hand on the shoulder while watching television.

When the body can no longer do everything it once could, couples often adapt. Some discover that tenderness without a goal is more pleasant than sex ever was under the pressure of “will it work this time”. Others slowly drift apart, because neither dares to touch the other in case it is taken as an invitation that cannot be followed through. That second pattern is common, but unnecessary. Touch that invites nothing can be a form of closeness in itself.

A long marriage: when a couple renegotiates

In long marriages sex often stops quietly. Someone falls ill, someone takes a long time to recover after an operation, someone says “not tonight” a few evenings in a row — and then nobody asks again. The years pass and the subject becomes so closed that opening it would feel almost dangerous. What if the other says they don’t want it any more? What if they say they do, and I don’t?

In another study, in which they spoke with older people in long-term marriages, Hinchliff and Gott described exactly this: couples dealt with change through adaptation and commitment to each other, and many saw sex as part of a closeness worth keeping, even in a different form. What mattered was being able to talk about it.

Such a conversation might sound something like this (a composite, not a real person):

“It’s been a long time since I held you before we fell asleep.”
“I thought it didn’t matter to you any more.”
“I thought it didn’t matter to you.”
“After the operation … I didn’t know whether I was even allowed to ask. You know not everything works any more.”
“I’m not asking for everything. I’m asking you to lie down next to me again.”

This conversation is not about technique and not about how often. It is about two people who have both kept quiet for years out of consideration, each believing they were protecting the other. For many couples this is the first step: realising that the silence was built by care, not rejection. If you don’t know how to begin, How to start a difficult conversation with your partner: the first three minutes decide offers concrete steps. And when partners’ desires differ — which is common at every age — When your desires don’t match: sex in a long relationship can help.

New love after being widowed

A chapter of its own belongs to people who, after the death of a partner or a divorce in later years, meet someone new. Many emotions tend to intertwine here at once.

The first is guilt towards the one who died. “As if I were betraying him.” Many people wonder whether they are allowed to love again, whether it is too soon, what he or she would have said. How to find yourself again after a partner’s death is the subject of When a partner dies: who are you now without them. A new love does not erase the old one. They can exist side by side.

The second is shame about your own body. After forty years with one person, undressing in front of someone else can feel deeply vulnerable. The body is not what it was, and the new partner never knew it when it was different. It helps to know that the other person is in exactly the same position — and that shame is an emotion that shrinks once it is spoken. You can read more about how shame works in the knowledge base under Shame.

The third is how others react. Adult children who won’t accept the new partner, neighbours who comment, friends who are taken aback. Yet often it goes the other way: people who have lived alone for a long time describe a new relationship bringing them back to life. Loneliness in later life is not just unpleasant; it is linked to poorer physical and mental health. Closeness, including physical closeness, is part of what keeps a person upright.

The fourth is practical: with new partners it makes sense to think about sexually transmitted infections as well. This is not a topic only for the young, and your doctor will be able to advise you.

Self-image and a body that is no longer the same

When we talk about sex in later life, we cannot avoid how a person experiences their body. Wrinkles, scars from operations, changed weight, dentures, a hearing aid. For many people this is a source of shame that gets in the way of closeness far more than physical ability itself.

What is interesting is how differently people experience this. Some say that in later life they felt more at home in their bodies than ever before — because they no longer had to prove anything to anyone. Others grow increasingly estranged from their bodies. How self-image shifts as the body and our roles change is the subject of Self-image and ageing: when your body and roles change.

From relational family therapy, in which I am training, I bring one more perspective. How a person feels in their body is not only a matter of their relationship with the mirror. It is also a matter of how others have looked at them — parents, partner, the people around them. If someone has heard all their life that their body is something to be hidden, that message will often be even louder in old age. And the reverse: a partner who has looked at you with tenderness for years can gradually change how you see yourself, too.

Exercise: the conversation you haven’t had yet

If you are in a relationship and feel that the subject of closeness between you has been shut away, you can try this exercise. It doesn’t need to end in anything other than a conversation.

1. Write down for yourself what you miss. Not what you are supposed to want, but what you genuinely miss. Perhaps a hug in the morning, perhaps sleeping in the same bed, perhaps sex, perhaps simply your partner taking your hand on a walk.
2. Write down what you are afraid of if you were to say it. That the other will be hurt? That they will turn you down? That they will think you expect something they can’t give?
3. Choose a calm moment — not right before sleep and not after an argument. Begin with something you appreciate: “I love being with you when …”
4. Say one wish, not a list. “I miss us curling up together in the evening.” And add that it is not a demand.
5. Ask the other how it is for them. And listen without immediately defending your side. You may hear something you didn’t know.

If old resentments surface, or the conversation keeps sliding into an argument, that may be a sign that you would both benefit from a space where you can talk about it with a third person present. In couples therapy, intimacy is often one of the themes, whatever your age. But when it comes to sexual difficulties in the narrower sense, the right place to go is a doctor or a specialist in sexual medicine.

Where this post does not apply

Having spent this whole post saying that sex in later life exists and makes sense, I would now like to give the other side too.

There is no duty to be sexually active. If in later life you no longer want sex and it doesn’t bother you, there is nothing wrong with you. One of the traps of today’s talk about “active ageing” is that it turns a right into a new commandment: now older people are supposed to be sexually vital as well. Some people are entirely content with the calm that has come. A problem arises only when partners differ on this and don’t talk about it.

It is not always about the relationship. Loss of desire can also be a sign of depression, which in older people is often overlooked because we mistake it for ageing itself. If you are also noticing that nothing brings you joy any more, that you are withdrawing from people and that you are tired all the time, read Depression in older people: when we mistake it for age itself and talk to your doctor about it.

Consent remains essential. With people who have advanced dementia, the question of sex becomes very complicated, because it is uncertain whether the person can still consent. Sex without consent is violence, no matter how long two people have been married. This applies at every age. If there is violence at home, in Slovenia you can call the SOS helpline for women and children victims of violence on 080 11 55, and in an emergency 112, or the police on 113.

Therapy does not replace a doctor. Talking can open the subject, ease shame and help a couple find each other again. It does not, however, resolve physical problems. So always check first what is going on with the body.

What to remember

• Sex changes with age but does not disappear: according to Lindau and colleagues, a quarter of people aged 75 to 85 were still sexually active.
• In women, the main reason for the decline is often being left without a partner, not reduced desire.
• Take physical changes to a doctor first — your GP, a gynaecologist or a urologist. Prepare your questions in advance.
• Intimacy is broader than intercourse; touch without a goal can be a form of closeness in itself.
• Sex in later life is a right, not a duty — the problem arises when nobody talks about it.