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Sex and the over seventies – what the research really said

July 9th, 2008

Dr Petra

You’ll have probably seen the big press fuss over the latest research showing that sex is important for seniors. The study, (rather catchily) entitled “Secular trends in self reported sexual activity and satisfaction in Swedish 70 year olds: cross sectional survey of four populations, 1971-2001” will be published later this week in the British Medical Journal along with an editorial discussing issues of seniors and sex.

The research looked at a selection of Swedish participants who were aged seventy and over – beginning in the 1970s and ending in early 2000. Meaning that participants who were seventy at different points in time were studied to see how their views of sex and sexual experiences varied. The participants were questioned as part of a larger study about health and ageing.

The study indicated sex was an important aspect of people’s lives as they got older, and highlighted some key issues around sex/relationships for our aging populations.

Media coverage has stuck to this, although a lot of coverage has focused on the ooo-isn’t-it-shocking-that-wrinklies-are-having-sex angle, and in many places misquoting or misunderstanding the study data. This is probably because most journalists didn’t read the original research or editorial, and based their stories on the press release. Of the journalists I spoke to who were writing their coverage yesterday the majority were not interested in getting reportage of the study right, but simply wanted me to find them a seventy year old couple who didn’t mind talking about their sex lives or having their photograph included in the paper.

So, to help you get through the hype, here’s a summary of the research and critique of the study.

What did the study do?
The study design’s a bit complex, so bear with me. The research was based on a cross-sectional survey with a sample of 1506 Swedes (946 women and 560 men) who all aged seventy when interviewed in 1971-2, 1977-7, 1992-3 and 2000-1. In all four samples participants underwent a psychiatric exam and were asked to report on sexual intercourse, attitudes to sex (particularly in later life), sexual dysfunction, and relationship satisfaction.

The researchers found over the thirty year study period respondents reported an improvement to their sex lives – in both the amount of sex they were having and the quality of their sexual experiences. So people who were seventy in the 1970s weren’t reporting as good sex lives as participants who were seventy in 2000.

For the earlier study groups participants were more likely to be widowed or never married, while in the later study groups participants were more likely to report being divorced or cohabiting with a partner.

People in the later study groups (those who were aged 70 in the 1990s/2000s) were far more likely to report enjoying a happy relationship. They were also more likely to have had sex in the past year, to have more frequent sexual activity and view sex as an important part of life. Sexual satisfaction was rated as important by participants who were in their 70s during 2000 – particularly for female participants.

Perhaps unsurprisingly some participants did report sexual problems, although importantly women who were 70 in 2000 were more likely to report sexual satisfaction – something that is often neglected in sexual functioning research. Reasons for not having sex or sexual problems were mostly attributed to health problems on the part of the respondent or their spouse. While participants explained sex was pleasurable and important to them, most also indicated they were not having as much penetrative sex as in the past.

What are the strengths and weaknesses of this research?
The study is useful as it is a large scale piece of research that has tracked people’s sexual experiences over time. It flags up the importance of relationships, not just sex, and has moved the discussion of sex and ageing from the usual focus on sexual dysfunction to include pleasure, satisfaction and happiness. Most importantly it highlights that sex for seniors is an important fact of life for many folk.

However, as with any study there are limitations to this research – which, predictably, most media coverage did not pick up on.

The key drawback with this study is the way the researchers defined ‘sex’. They described sexual activity as “having had intercourse during the past year”. Intercourse was defined as “sexual contact between individuals, most often with penetration.”

This means that sex was defined in a very narrow fashion and in a problematic way. It ignores solo or mutual masturbation, oral sex, using sex toys or other erotic activity. If the definition of sex had been more flexible the reported sexual activity may well have been far higher than this study indicates.

The inclusion of sexual activity meaning having intercourse within the past year also affects the results since it includes folks who have had sex once during the year with those who’ve had regular sex and increased the amount of reported sexual activity.

The researchers did ask about sexual satisfaction, but did not appear to ask about pleasure relating to sexual activity – meaning we don’t know how much people were enjoying each sexual encounter they had. Participants in this research could be reporting sexual or relationship satisfaction, but not necessarily experiencing said satisfaction through intercourse alone.

Some participants refused to answer certain questions (either due to sensitivity or because another party was in the room at the time of interview), meaning there is missing data on some of the more sensitive questions. This is further compounded by the researchers dropping questions on homosexuality and masturbation as participants were offended by these questions in the 1970s. It means key aspects of people’s sex lives went unrecorded.

The number of respondents dropped from 80% to 65% in the study groups (meaning there were fewer respondents aged 70 in 2000-1). This may have some bearing on the research, as might the fact that the study was conducted in Swedish so some key issues may not necessarily translate.

What do these findings mean?

These findings seem to capture changes in society over the last few generations. Greater availability of contraception and sex education, improvements in people’s quality of life, changing cultural views on aging and feminism have all led to making it possible for older people to be seen as sexual beings.

This is all very positive, although the downside has also been that commercial organisations and the pharmaceutical industry in particular have made a point of highlighting how sex for seniors should be mandatory.

In the editorial accompanying this research and Swedish study suggests sex is an important issue for older people and is something that is reasonable for doctors to ask patients about. While I would agree that asking male patients about erectile function is important within healthcare (since erectile dysfunction can be an indicator of heart disease or diabetes) there are issues around practitioners raising the issue with patients.

We know that patients do feel it’s acceptable for doctors to ask them about their sex lives, but only within certain contexts. And we also know that many doctors feel uncomfortable raising the issue due to a lack of training and support – and limited time and resources. There’s very little point in asking a patient if all is okay sexually if you have a short consultation time, limited skills to tackle the problem and relatively few referral services available.

Perhaps a better suggestion would be for increased resources, education, support and services for older people – that way if someone has a sex question, problem or just wants to spice up their sex life then there’s someone to talk to – who may not always be their GP. It’s also worth noting that while sex is important to older people, so is housing, healthcare, tackling poverty and social exclusion. Because if you’re poor, hungry, cold, or feel isolated you’re not exactly going to be feeling sexy.

The general message from this research should be that sex is important for older people, and we shouldn’t forget this or allow ageist views to prevent us from talking about sex, pleasure and desire for seniors. However, we shouldn’t do this at the expense of sexual variation and choice – so not everyone over seventy is going to be into penetration and not everyone is going to want sexual activity at all. Comfort, skin contact, hand-holding and affection can be equally valid forms of sexual expression. It’s all about choice – not making people feel their only option is a meaningful glance over a cup of cocoa, nor suggesting if they’re not at it each night then there’s something amiss.

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