Sexuality and Ageing: Why Intimacy Still Matters Later in Life

Sexuality is a central part of being human and a persistent need throughout the lifespan — including for older adults. Sexuality isn’t just about sex itself. It also includes gender identity, sexual orientation, eroticism, pleasure, intimacy, affection, emotional connection, and reproduction.

Many older adults continue to value sexuality as an important part of their life and relationships. Sexual activity can continue well beyond the age of 60, with around 30% of adults remaining sexually active over 70. For many, sex strengthens marital bonds, enhances quality of life, and supports overall wellbeing.

And yet, sexuality in later life is often overlooked, ignored, or even shunned. This blog explores the unique biological, psychological, and social dimensions of ageing and sexuality, the challenges that older adults face, and the supports that can help nurture intimacy and connection at any age.

What Happens to Sexuality as We Age?

Biological Changes

Ageing brings biological changes that affect sexual function and satisfaction. Overall health, chronic illnesses, hormonal shifts, and the side effects of medications can all reduce sexual desire and function. For example, cardiovascular disease, diabetes, thyroid conditions, and certain medications (such as antidepressants) can impact sexual health.

• For men: erectile dysfunction is the most common difficulty. Testosterone gradually declines, erections may take longer or require direct stimulation, orgasm intensity may reduce, and prostate changes can further complicate sexual activity.

• For women: menopause brings significant changes due to declining estrogen, including vaginal dryness, thinning of vaginal tissue, pain during sex, and decreased lubrication. Changes in desire can also result from hormonal shifts, gynaecological conditions, or cancer treatments.

Sexual health is also impacted by awareness and safety. Older adults often lack education on HIV and STIs, which has contributed to rising rates of diagnoses in later life.

Psychological Changes

Psychological factors strongly influence how older adults experience sexuality. Positive sexual attitudes and optimism are linked with greater sexual activity and satisfaction. In contrast, depression, anxiety, dementia, negative body image, and internalised stigma can all reduce sexual interest and intimacy.

For some, ageing brings pressure from rigid sexual scripts: men feeling their masculinity tied to erections, women experiencing pressure to prioritise a partner’s satisfaction over their own, or internalised beliefs that sex is only for the young. These scripts can contribute to performance anxiety, avoidance, and low desire.

On the other hand, some older adults experience freedom and growth in later life. Freed from earlier pressures, they discover deeper intimacy, greater comfort with their bodies, and even more satisfying sexual relationships.

Social and Relational Changes

Relationships and social context shape sexual wellbeing in profound ways. A supportive, emotionally close partner is one of the strongest predictors of sexual satisfaction in older adulthood. Positive communication, shared history, and emotional intimacy often enhance later-life sexuality.

At the same time, there are unique relational challenges. Caretaking roles, fatigue, long-standing conflict, restrictive gender roles, and lack of open discussion about sexual needs can all reduce desire. Family members or cultural expectations may discourage intimacy or object to new relationships in older age.

For LGBTQ+ older adults, experiences of ageism combined with homophobia or transphobia can compound barriers, leading to isolation and reduced access to appropriate healthcare.

Societal stigma also plays a major role. Sexuality in older age is often dismissed or treated as abnormal, which leads to silence in healthcare, a lack of education for older adults, and under-recognition of their sexual needs.

Psychosexual Supports and Interventions

Medical and Biological Supports

• For men: testosterone therapy, PDE-5 inhibitors (Viagra, Cialis), vacuum devices, or penile implants can assist with erectile function.

• For women: vaginal estrogen, lubricants, moisturisers, and pelvic floor training can reduce pain and support arousal and satisfaction.

• For all genders: exercise, lifestyle changes, and managing chronic conditions can support sexual function and overall wellbeing.

Psychological and Therapeutic Supports

Sex therapy offers a confidential, non-judgemental space to explore the emotional and relational aspects of ageing and sexuality. Therapy may include:

• Reframing ageist sexual scripts and expectations.

• Addressing grief related to health changes.

• Expanding definitions of sex to include a broader range of pleasurable, intimate activities.

• Exploring behavioural adaptations for pain or mobility issues.

• Reducing shame and performance anxiety.

Couple-focused therapy is especially powerful in later life, as it strengthens communication, fosters mutual support, and helps couples approach intimacy as a shared journey.

Therapeutic approaches such as Good Enough Sex, sensate focus, mindfulness, compassion-focused therapy, narrative therapy, and cognitive-behavioural therapy all have strong applications in this area.

When to Seek Support

It may be time to seek support if:

• You or your partner are distressed by changes in sexual desire or function.

• Pain, shame, or anxiety interfere with intimacy.

• Health conditions or medications are affecting your sex life.

• You feel disconnected, pressured, or avoidant in your sexual relationship.

• You want to rediscover pleasure, confidence, and connection.

Taking the First Step

Sexuality does not have an expiry date. Older adults continue to value intimacy, connection, and pleasure — and yet these needs are often overlooked in healthcare and relationships.

If you are struggling, know that you are not alone. With the right supports, it is possible to adapt to biological changes, challenge ageist myths, and cultivate fulfilling, meaningful intimacy.

I offer online sex therapy across Australia and would be honoured to support you in navigating these changes. Together, we can explore ways to strengthen intimacy, reduce shame, and celebrate sexuality as a lifelong source of connection and joy.

Written by Justine

References:

Castaldo A, Leon Garcia JFJ, D’Amico A, Perrotta G, Eleuteri S. Barriers Related to the Identification and Satisfaction of the Sexual Needs of Nursing Homes’ Residents: A Narrative Review. International Journal of Environmental Research and Public Health. 2025;22(8):1163.

Lee DM, Nazroo J, O’Connor DB, Blake M, Pendleton N. Sexual health and well-being among older men and women in England: Findings from the English Longitudinal Study of Ageing. Archives of sexual behavior. 2016;45(1):133-44.

Pakpahan C, Castelo-Branco C. From Couplepause to Doublepause: Naming the Gap in Holistic Sexual Health Care for an Aging Group. Clinical and Experimental Obstetrics & Gynecology. 2025;52(8):41856.

Gambescia N, Weeks GR, Hertlein KM. A clinician's cuide to systemic sex therapy. . 3rd ed. New York Routledge; 2021.

McCarthy B, McCarthy E. Couple sexuality after 60: Intimate, pleasurable, and satisfying. New York: Routledge; 2022.

Kleinplatz PJ, Menard AD. Magnificent sex: lessons from extraordinary lovers. New York: Routledge; 2020.