Sexual health of older adults

Introduction

Relationships, sex, sexuality, and sexual health remain important to older people and should be recognised as an important part of their overall care.

Sexual health advice should not exclusively target young people as people remain sexually active into older age, including having new partners (especially for men), which means that STI risk continues and indeed, rates of some STIs are increasing in older people. 

Regrettably, sexual health can be surrounded by stigma, prejudice and discrimination which makes it a taboo subject.  It can therefore be difficult to access information and openly discuss issues of a sexual nature which may present as both physical and psychological.

On an emotional level, good quality relationships are important to all people at all stages of their life: they are a source of practical care and emotional support, and have also been shown to protect physical and mental health.  As people age, and are at greater risk of isolation and depression, relationships are essential to provide a good quality of life.

Key inequalities

The National Survey of Sexual Attitudes and Lifestyles (NATSAL-3) records:

  • Gender - 1 in 6 men and women said they had a health condition that affected their sex life and fewer than one in four of these men and one in five  of these women said that they had tried to get help or advice from a healthcare  professional
  • Health status - people in poorer health were less likely to have had sex recently, and less likely to say that they were satisfied with their sex life
  • Sexual function - People with a lower sexual function were more likely to report relationship breakdowns, STI diagnosis and riskier sexual practices such as paying for sex (men only) and having more partners (women)
  • Income - Women were more likely to lack confidence than men and older people on lower incomes were less confident about forming new relationships than those who were better off

Facts, figures and trends

The NHS Choices website has a wide range of information on sex in older age, sexual health and issues that older people face which impact on their emotional and sexual wellbeing in later life such as menopause and impotence (erectile dysfunction).  The Relate report (Who Will Love Me When I’m 64) explores how different types of relationship affect older people’s emotional health and wellbeing.

The importance of couple relationships

Intimacy and sex are important features of good couple relationships, and remain important as people get older. Two thirds of over-65s in a 2012 Age UK survey thought it was important to have a romantic companion, and one in ten was seeking a new relationship.

However, one in five people over 50 who participated in Relate research with Ipsos MORI survey said they lacked the confidence to form new friendships and relationships - equating to four million people across the population of Great Britain. Women were more likely to lack confidence than men and older people on lower incomes were less confident about forming new relationships than those who were better off. This places older people at greater risk of social isolation.

Divorce, bereavement and loss

The Relate report also highlighted that relationship breakdown is an increasing feature of older age. Like bereavement, the break up of relationships represents the loss of an intimate partner and therefore has an impact on emotional wellbeing.

In addition, divorce and remarriage can have lifelong implications on the structure of family relationships.  Children from previous relationships and stepfamilies can create emotional divides, ambiguity and resentments around family obligations.  Although the research is unclear, this fracturing of family relationships nevertheless places older people at greater risk of emotional isolation.

Sexual activity

The UK’s largest sexual health study, the National Survey of Sexual Attitudes and Lifestyles (NATSAL)  included adults aged 60 and older in the 2010/12 survey for the very first time in its 25-year history. The English Longitudinal Study of Ageing (ELSA) which began in 2002, also for the first time, included questions about sex.

For the NATSAL survey, 15,162 men and women aged 16-74 were interviewed between September 2010 and August 2012. It highlighted that people continue to have sex at all ages, but the frequency and range of sexual practices decrease with age:

Sexually Transmitted Infections (STI)

The rate of new STI diagnosed has increased year on year for people aged 45-64 and aged 65+.  Although the numbers of people affected are relatively small compared to other age groups, there was, nevertheless, a 25% increase for people aged 45-64 age group and 38% in older people aged 65+ between 2010 and 2014:

As to the different types of STI, the smallest increase between 2010 and 2014 has been seen in syphilis in both age groups.  The most common STIs are warts and herpes in people aged 65+ and chlamydia and warts in people aged 45-64, although rates of gonorrhoea have more than doubled:

Certain circumstances that increase higher risk sexual behaviours and potential STI acquisition in older populations have been proposed in research literature. These include:

  • increased numbers of new partners due to longer life (particularly men)
  • better overall health and higher rates of divorce
  • lack of awareness of healthcare professionals regarding issues of sexuality and sexual activity in older people with a consequent lack of communication about sexual health and HIV risk
  • omission from STI prevention and health promotion programs
  • decreased condom use and lower rates of STI testing (Poyntena et al., 2013). 

Embarrassment is a key barrier to accessing STI information and testing.  NHS Choices has a helpful web page about visiting an STI clinic to help people understand the process and overcome anxiety.

Sexual health information and advice

Seeking help is less likely in older people than younger people which presents a barrier to good sexual health in older age. Where these are important, sexuality and the ability to perform sexually are important elements of a person’s identity.

A study by the University of Sheffield reported that doctors were unlikely to be proactive when it came to the sexual needs of their older patients, leaving it instead for the patient to raise the issue.  Conversely, older adults preferred it if the health professional initiated a discussion about sex.   It concluded that “if doctors leave it to older adults to ask about their sexual concerns, and older adults leave it to their doctors to raise the issue, then a clear unmet need exists”.  Health and social care practitioners also failed to consideration the impact of diagnosis, treatment and management of illnesses and long-term health conditions on older people’s sexual health needs.

The Family Planning Association has published a comprehensive booklet called People over 50: Relationships and sexual health for people and professionals to help address such issues.

Factors affecting good emotional and sexual health

Menopause

The menopause is the time when women stop having periods and can no longer get pregnant naturally. Menopausal symptoms will affect most women and which can range from mild to severe and have a significant impact on everyday activities.  Common symptoms can affect emotional, mental, and sexual health and include hot flushes, night sweats, vaginal dryness and discomfort during sex, difficulty sleeping, low mood or anxiety, reduced interest in sex and problems with memory and concentration.

The NHS Choices website continues to outlines how menopause can also affect physical health:

  • Osteoporosis – changes in the balance and production of certain minerals needed for bone strength lead to weaker bones.  One in three women over 50 has osteoporosis (compared with only one in 12 men). Weaker bones increases the risk of breaking bones, particularly in the wrist, hip or spine. One in seven British women breaks a hip after the menopause.
  • Cardiovascular disease is any disease of the heart or blood vessels, including heart attacks and strokes, usually caused by blocked arteries. It is the most common cause of death in women over 60, and there is evidence to suggest that women are more likely to get blocked arteries after the menopause.
  • Breast changes – hormonal changes cause physical changes to firmness, shape, size and density.  Women also become more prone to certain abnormal lumps.  They’re usually cysts, which are harmless lumps filled with fluid but a GPs should be contacted when they are discovered. Mammogram screening for breast cancer is currently offered on the NHS to women aged 50-70 in England. Women over 70 who stop receiving screening invitations through the post can request screening by appointment.

This short video explains what happens when you have a mammogram:

Go to NHS Choices homepage

Impotence (erectile disfunction)

Erectile dysfunction (ED) is the inability to get and maintain an erection and is a very common condition, particularly in older men. It is estimated that half of all men between the ages of 40 and 70 will have it to some degree.  Physical causes include narrowing of the blood vessels going to the penis (commonly associated with high blood pressure (hypertension), high cholesterol or diabetes), hormonal problems (e.g. thyroid) or surgery or injury.  ED can be caused by and made worse by poor mental health including anxiety and depression.  Impaired sexual function can have a significant impact on mental and emotional wellbeing.

Prostate health

Prostate Cancer UK explains that the prostate is usually the size and shape of a walnut but grows bigger with age. Located under the bladder, it wraps around the urethra and problems can lead to impaired sexual and urinary function. 

The most common prostate problems are an enlarged prostate (growth), prostatitis (inflammation or infection) and prostate cancer.  It is important to note that one does not necessarily lead to the other, however, effects can be physical discomfort and impaired sexual function.  A lack of willingness to talk about genito-urinary problems combined with increased fear and anxiety can impact existing close relationships or thoughts about starting one.

Lesbian, Gay, Bisexual and Transgender people (LGBT)

Older LGBT people have similar needs to that of the wider older person population, however, service commissioning and provision overlooks needs specific to this group.

The emotional and sexual health support needs of LGBT people are comprehensively addressed in the Lesbian, Gay, Bisexual and Transgender section of the JSNA.

Men who have sex with men (MSM), Women who have sex with women (WSW)

People in these groups do not identify as gay or lesbian and would not consider themselves to be part of the LGBT community, but because of similar health inequalities and health risk factors, issues relating to their sexual health are covered in the in the Lesbian, Gay, Bisexual and Transgender section of the JSNA.

Want to know more?

There would be great value in promoting strategies that reduce the stigma associated with asking for sexual health advice. This is essential in helping young people to take responsibility for making informed decisions, and there are a number of resources to help achieve this.

Berkshire Sexual Health Needs Assessment (Berkshire Public Health Shared Service, 2013) – the background, national contexts, epidemiology of sexual health covering populations at risk, projections and the corresponding sexual health services relevant to various STI and reproductive issues in Berkshire.

Framework for Sexual Health Improvement in England (Department of Health 2013) – highlights the rising trend of STIs in older people and the increase in chronic illness which may affect sexual health as well as late diagnosis for HIV in the 50+ age range. Interventions in HIV testing and increased awareness about the dangers of poor sexual health in older people are the key actions presented.

Family Planning Association (FPA, 2016) – help, advice, guidance and resources for older people regarding their sexual health and wellbeing.

Hepatitis B and C; Ways to promote and offer testing to people at increased risk of infection (NICE 2012) – guidance for NHS, local authorities, prisons, immigration removal centres and drugs services, and for voluntary sector and community organisations working with young people at increased risk 

People over 50: Relationships and sexual health (FPA, 2010) – a significant resource for older people and professionals supporting older people with their sexual health and relationship needs covering sex and relationships, STI and prevention, men and women’s sexual health and the impact of illness and long-term conditions on sexual health and wellbeing.

Sexual and reproductive health profile – Bracknell Forest data and additional information about STI, HIV, reproductive health, teenage pregnancy and association wider determinants of health.  This tool replaces the earlier Sexual Health Balanced Scorecard

Safer Sex (British Association for Sexual Health and HIV, 2012) - a guide to safer sex to improve sexual health and reduce spread of HIV.

Safer sex guide for men who have sex with men (Public Health North East) – a guide targetted at men to develop awareness, promote safe sex and support emotional and physical wellbeing.

Safer sex guide for women who have sex with women – an informative guide for women to inform and reduce rates of STI and HIV infection.

STIs - age no barrier (Royal College of Nursing, 2010) – sets out the parameters for action to address the increased prevalence of STI in older people and the deficit of preventative measures to counter the problem.

Who will love me when I’m 64 (Relate, 2013) – Sets out the importance of couple, family and social relationships in later life and their impact on physical and emotional wellbeing.

 

This page was created on 1 July 2014 and updated on 28 June 2016.

Cite this page:

Bracknell Forest Council. (2016). JSNA – Sexual health of older adults. Available at: jsna.bracknell-forest.gov.uk/ageing-well/keeping-well/sexual-health-older-adults (Accessed: dd Mmmm yyyy)

 

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