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Sexuality is a basic human need that exists throughout life in one form or another and is a significant component to quality of life of many older individuals. Although 70% of adult patients in a large sample study considered sexual matters to be an appropriate topic for a general clinician or geriatrician to discuss, sexual problems are noted in less than 2% of primary care physicians' notes. It is not easy to find physicians and other health care providers who are knowledgeable about sexuality in general and sexuality among the aging population in particular. Sexuality and sexual function in the aging female is addressed in Chapter 47. Sexuality, sexual function, and dysfunction in the aging male will be addressed in the first part of this chapter, with the second part being devoted to androgen replacement therapy in the older man.

Sexual Behaviors

Idealized societal concepts of older people do not include sex or the facility for sexual function. A poll conducted by the National Council on Aging, regarding attributes of people aged 65 years or older, reported that older persons were frequently thought of as being “warm and friendly” (74% of respondents) or “wise from experience” (70% of respondents), but being “sexually active” was only attributed to older persons by 5% of the survey respondents. Yet epidemiologic studies of sexuality and aging, such as the Duke Longitudinal Studies, the Massachusetts Male Aging Study, and, most recently, the University of Chicago study, report many older adults are sexually active. Sexual expression can encompass many forms, including sexual intercourse, oral sex, masturbation, intimacy, physical appearance, erotic stimuli (reading, movies) and fantasies (daydreams), but most study data involve the first three components.

Figure 49-1 depicts the prevalence of male sexual activity with a partner based on a probability sampling of 3000 U.S. adults aged 57 to 85 years. The likelihood of sexual activity with a partner declined with age, but nearly 39% of men aged 75 to 85 years reported sexual activity with a partner within the previous 12 months, with 54% of these sexually active 75- to 85-year-old men reporting sex at least two to three times a month.

Figure 49-1.

Prevalence of male sexual activity with a partner in previous 12 months as obtained from a survey of a probability sample of 3000 U.S. adults aged 57 to 85 yrs. Data are presented by age group and self reported health status. Data from Lindau ST, Schumm LP, Laumann EO, et al. A study of sexuality and health among older adults in the United States. N Engl J Med 357:762, 2007.

In addition to partner availability, there are other factors that affect sexual activity in older adults. Health status has a strong influence. Diseases such as arthritis, especially when it involves the hips and pelvis, can affect sexual positions, endurance, ...

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