Sexual intimacy, experiences, identity, and behavior are important for well-being and health across the life span. Research with adults in middle and later life demonstrates the continuing importance of sexual intimacy, but there remains much to understand about older adults’ experiences of sexuality ( Lodge & Umberson, 2016). A brief historical search of works published in The Gerontologist reveals little attention to sexuality until recently. The first mention of sexuality appears in 1967, in two articles that included comments on the loss of sexual identity or prowess as features of aging ( Lowy, 1967; Schonfield, 1967). These now cringeworthy comments occurred a year after Masters and Johnson first published their landmark study of human sexuality ( Masters & Johnson, 1966), and it was not until 1971 that two articles in The Gerontologist identified such negative conceptions of sexuality as ageist myths ( McTavish, 1971; Palmore, 1971). Articles exploring the sexual experiences and behavior of older adults were still scarce in the following two decades. Two articles in the early 1980s addressed late life (hetero)sexual experiences: from a literary perspective ( Loughman, 1980) and in a review ( Ludeman, 1981). Articles exploring experiences of sexual minorities, particularly gay men ( Kelly, 1977; Laner, 1978), emerged almost a decade after uprisings and outrage followed a violent police raid on the Stonewall Inn in New York; Stonewall marked the beginning of a decades-long cultural shift in legal and public attitudes that has undoubtedly altered the lives of the current cohorts of LGBTQ+ (lesbian, gay, bisexual, transgender, queer, or questioning) older adults ( Kimmel et al., 2015). In the 1990s, articles noted the sexual concerns and/or interests of persons with dementia ( Lichtenberg & Strzepek, 1990; Litz et al., 1990) and older adults’ sexual activity and satisfaction ( Matthias et al., 1997), but it was not until well into the 21st century, with seminal work by Fredriksen-Goldsen et al. (2013, 2014; 2015), that we have seen consistent appearance of topics related to human sexuality in The Gerontologist. We are now beginning to see scholars tackle the complex intersections of sexual behavior with other aspects of identity (e.g., Goldsen et al., 2017; Nevedal & Sankar, 2016) and recognize older adults, including those with cognitive impairment, as active agents in control of their sexuality (e.g., Syme et al., 2020). The articles in this special issue of The Gerontologist continue these important trends.
Across the life span, access to high-quality information enables people to explore and understand sexuality and sexual expression while promoting health and protecting against sexually transmitted diseases. Dalmer and Marshall (2023) review research on how older adults access information about sexuality and note that information science as a field has neglected the needs of older adults in this realm. For example, in the United States and elsewhere, older adults are frequent users of public libraries, but libraries’ collections may neglect older adult sexuality. Dalmer and Marshall argue for collaboration between gerontologists and information science professionals to create inclusive information hubs within public libraries, and to generate joint research that expands our understanding of older adult sexuality and information use.
Consistent with conclusions by Dalmer and Marshall (2023), a scoping review by Gewirtz-Meydan et al. (2023) found that older adults use the internet to find information about sex. Just as stereotypes about older adult sexuality abound, so do stereotypes about older adults’ use of digital media; this review addressed how digital media portrays sexuality in older adults, and how older adults use digital media for reasons of sex and love. Their review reveals that negative stereotypes about sexuality and aging are prevalent in digital media and may prevent older adults from disclosing sexual interests beyond companionship or prevent researchers from studying these interests. The authors also conclude that portrayals in the digital media do not reflect diversity among older people with respect to race and ethnicity, or with respect to physical ability.
Depictions of older sexuality on television may be similarly constrained. Exploring two British sitcoms, Röber (2023) demonstrates how portrayals of older adult sexuality reflect contemporary societal tensions about whether and how older people should be seen as sexual beings. Recognizing that, at least in United States and European mainstream, sexual expressions by older adults may be increasingly accepted, her analysis also shows that there are limits to how these sexual expressions may be portrayed that reflect perspectives of heteronormality and stereotyped gender roles. Furthermore, while addressing new themes for older adult sexuality, the programs she analyzes are cautious in how or whether to show actual sexual behavior; sex is often implied or hidden rather than overt. In other words, even as older adult sexuality is allowable on prime-time television, it must still be presented with delicacy.
One way that stereotypes or popular depictions of sexuality in aging can affect older people is in shaping their expectations about sex in later life, which in turn could affect their sexual and relationship satisfaction. Schafer and Upenieks (2023), using the Midlife Development in the U.S. data set, found that participants’ expectations about the quality of their sexual lives 10 years in the future, measured at mid-life, predicted sexual frequency and satisfaction 4 years later, controlling for health and demographic covariates. Positive expectations diminished the negative impact of functional changes, especially for women. The study focused only on different-sex couples who remained in the same partnership for the two waves of data collection. Similarly, Skoblow et al. (2023) report that among different-sex married and cohabiting couples in the English Longitudinal Study, perceptions of aging were associated with men’s and women’s sexual satisfaction and frequency of partnered sexual activity. That is, those individuals who had a negative view of aging reported poorer sexual satisfaction and less sexual activity. This study did not find partner effects: participants’ reports of sexual satisfaction and activity were unrelated to their partners’ perceptions of aging.
The article by Chai et al. (2023) addresses how stress, sexual motives, and mental health may be interrelated, focusing on middle age as a time in development with elevated stressors and growing awareness of physical changes associated with aging. From the perspective of Self-Determination Theory ( Deci & Ryan, 2000), intrinsically motivated activities should be more beneficial to our well-being than extrinsically motivated activities, and, according to Chai et al., this should be the same for sexual motivation. They did find that married people with more intrinsically motivated sexual intimacy reported fewer depressive symptoms, but this article also reminds us of the dangers of generalizing across couples or individuals within couples. Comparing different-sex married couples to same-sex married couples, they found that motivation interacted with gender, couple type, and stress levels in relation to depressive symptoms. This article challenges us to pay close attention to inclusion and definitions in samples. It also highlights the importance of longitudinal research because their cross-sectional analysis could not sort out temporal relationships among stress, depressive symptoms, and sexual intimacy motivations.
One article that does use a longitudinal data set is that by Henning et al. (2023). In the Health, Aging, and Retirement Transitions in Sweden sample, they looked at changes in sexual satisfaction before and after retirement. They found that sexual satisfaction was related to higher relationship satisfaction preretirement. Participants with higher relationship satisfaction preretirement had a greater decline in sexual satisfaction after retirement, but they did not decline to the level of those who had lower relationship satisfaction to start with. There was considerable stability from preretirement to postretirement, and postretirement declines in satisfaction were primarily found among men.
If we take a life course perspective on sexuality and intimacy, we expect outcomes in later life to be associated with partner experiences across the life span. Kong et al. (2023) demonstrate that adverse experiences in childhood can affect the quality of relationships in the seventh decade of life. In their study of respondents to the most recent wave of the Wisconsin Longitudinal Study, they found that sexual abuse in childhood was related to sexual and marital satisfaction in later life. Their hypothesized mechanism, experiencing intimate partner violence, mediated the effect of other types of childhood abuse on later life relationship satisfaction, especially for women, but this mediation did not explain the life-long impact of childhood sexual abuse. A gerontological perspective on late life sexuality requires that we consider outcomes in the context of life-long experiences.
One common experience in later life, changing cognitive capacity, may be reciprocally related to sexuality in later life. Slayday et al. (2023) examined the prospective relationship of men’s sexual functioning and satisfaction with their cognitive functioning after approximately 12 years. They hypothesized that vascular changes in mid-life that lead to poor erectile function and low sexual satisfaction could exacerbate the cognitive decline. Using the Vietnam Era Twin Study of Aging of U.S. military veterans, they found partial support for their hypotheses in that baseline erectile function was related to the rate of cognitive decline over the study period. This study illustrates the importance of considering sexual functioning as a component of health evaluation. Shen and Liu (2023) used the National Social Life, Health, and Aging Project data set to evaluate the longitudinal, reciprocal relationship between cognitive capacity and individuals’ reports that they had engaged in sexual activity out of a sense of obligation or duty. Having cognitive impairment above the established cut score for a dementia diagnosis on a screening measure, at the first time of measurement, predicted the likelihood of reporting feeling obliged to have sex 5 years later, even accounting for the sense of obligation reported at Time 1. There are limitations related to extrapolating about dementia based on a survey screening measure and the accuracy of reporting for people with significant memory impairments, but this study raises questions for further research. Claes and Enzlin (2023) offer a longitudinal framework that can help us begin to address these questions. Their framework offers a way to understand how couples may progress through phases as cognitive changes emerge, are diagnosed, and result in increasing impairment. At each phase, there are new challenges that require the sexual relationship to be renegotiated, between the partners and with increasing involvement of people outside of the partnership: family, health care providers, and formal caregivers. While describing how emerging cognitive impairment introduces new problems for sexual intimacy, these authors recognize the agency of people living with dementia and their intimate partners; their framework provides a nice starting point for further research on how couples negotiate this process.
The notion of other people being involved in our sexual lives as we age is also a focus of the article by Wallach et al. (2023), a qualitative study of palliative care professionals’ views of sexual expression and how those perceptions relate to communications with the older adults at the end of life. Providers’ views of patients’ sexuality were either inclusive or specific. Those with inclusive views saw all forms of closeness as forms of sexual intimacy, whereas those with specific views limited sexual intimacy to genital physical contact and saw this as not available or not relevant to their older palliative care patients. Regardless of viewpoint, though, the majority did not raise sexuality with patients. Although based on a small sample, this study suggests the need for additional training and resources to allow older people at the end of life to discuss their intimacy needs and challenges with palliative care professionals.
The studies reviewed in the previous paragraphs primarily include different-sex couples. Four articles in this collection address loneliness and well-being among same-sex couples. People who have a sexual minority identity may be at greater risk for social isolation or loneliness. Lam and Campbell (2023) used data from the longitudinal Household, Income, and Labor Dynamics in Australia (HILDA) Survey to track loneliness from age 50. They expected to find a loneliness disadvantage for individuals who identified as LGB (lesbian, gay, and bisexual), but in fact, there were no differences in loneliness trajectories among individuals identifying as heterosexual, gay, or lesbian. Only men who identified as bisexual or changing sexual orientation over time were at a disadvantage with respect to loneliness: they were lonelier at age 50, and became increasingly lonely after age 70. Differences in social connectedness, education, or socioeconomic status did not explain these differences. Buszak-Stec et al. (2023) used a German sample to examine the relationship between sexual orientation and well-being, similarly framed with Minority Stress Theory. They found that individuals who identified as LGB reported greater loneliness but not worse well-being, taking into account other demographic and health variables. This sample grouped all sexual minority-identifying individuals into one category, which could explain the difference in finding from the Lam and Campbell (2023) study.
Detwiler et al. (2023) also used Minority Stress Theory as a framework to study the experiences of older individuals who identify as sexual minorities. They selected participants for their study based on their having a sexual orientation “anywhere along a continuum … other than attracted exclusively to the opposite sex” (p. XXX), so sexual orientation was not an independent variable. Rather, the researchers were interested in within-group mechanisms posited by Minority Stress Theory, including exposure to ageism and heterosexism as distal stressors, and whether social support and in-group contact moderated the relationship of exposure to heterosexism and ageism with psychological well-being. This study is also notable for assessing gender identity in a nonbinary fashion, allowing gender to vary on a continuum. Although experiencing more heterosexism was related to loneliness, quality of life, and psychological distress, supporting the Minority Stress framework, the moderation hypotheses were not fully supported. In-group contact exacerbated the relationship between heterosexist experience and psychological distress, whereas the authors found the opposite effect for experiences of ageism. As the authors note in their title, “it’s complicated.” This could also be the conclusion of the study by Peterson et al. (2023), who further parse social relationships as they relate to sexual orientation in a large sample of older- and middle-aged adults. As in the German sample ( Buszak-Stec et al., 2023), LGB participants reported higher loneliness. In the whole sample, the diversity of social communication was related to greater loneliness, while the diversity of social support was related to less loneliness. However, the social communication moderation effect was the opposite for LGB participants: those with high social communication diversity had lower loneliness.
The articles in this special issue give us insight into the ways that older people negotiate sexual intimacy and expression across the second half of life, and how societal stereotypes about older sexuality continue to influence satisfaction with our intimate lives. They suggest the promise of expanding access to information, in libraries, in the digital world and media, and within health care settings. They also demonstrate that much more work is needed. With one exception ( Detwiler et al., 2023), the quantitative articles have relied on existing large data sets in which measures of sexual behavior, partnership, sexual orientation, and gender identity are limited or outdated. Incorporating contemporary and nonbinary definitions of gender and sexual orientation will expand our understanding of the experiences and perspectives of older sexual minority individuals who are currently invisible in our samples. Furthermore, these articles present a perspective that is almost exclusively White and European in origin (although the authors and samples stretch across the globe). We can learn nothing from this collection about the sexual experiences of older people of color, or those from developing countries, or those from cultures that are not Westernized. One way to incorporate missing perspectives is to expand the use of qualitative research methodologies. Qualitative studies that privilege the voices of diverse older people will enrich our understanding and drive future research questions. I suspect if we hear directly from older people, the focus of the research will shift substantially.
In the final Forum article of this collection, Fredriksen-Goldsen (2023) offers a new framework for studying late-life sexuality, the Sexual Equity Framework, which recognizes the heterogeneity of older adults and their sexual experiences, changes over the life span, and the intersections of age, sexual orientation, gender identity, race, and ethnicity. This framework further recognizes the historical and sociocultural structures that influence the life-long development of sexual expression and satisfaction, and the potential harm these structures can cause. Fredriksen-Goldsen calls for the study of sexuality to be fully integrated into gerontology. The articles in this collection represent an important movements in that direction; they also show how much additional work there is to be done.