(Antique sex image)
ABSTRACT: Studies regarding sexuality have generally overlooked the growing population of older adults over 50. In this article, we discuss and elaborate on what information we do have regarding intimacy and sexuality post-50 including sexual behaviors, sexual satisfaction ratings, and how the policies within long-term care facilities (LTC’s) and elderly housing impact sexual expression later in life. All these facets of aging and sexuality are also examined in the context of aging LGBT individuals who often benefit from specialized methods of treatment by their healthcare professionals.
One of the most common comments today about people over 50 is that each decade is somehow ten or more years younger now than it used to be. It is not our task here to marshal evidence to the truth or fiction of this assertion, but intuitively, it seems right. As we look at aging today, it does appear true that age is enacted differently than it was in previous older generations and that vitality—asserted in longer careers, second and third marriages, and late child rearing—has changed the face and felt experience of the last quartile of life.
One cannot discount the impact of culture and cohort. Much of what we have to say will hinge on the fact that the Baby Boom generation, born between 1945 and 1964, have reinvented each phase of their lives. Being the largest generation, they turned the spotlight on themselves in adolescence and at every phase thereafter. It is not surprising then that the leading edge of this group (now in their early 70s) have remained a center of attention, refusing to retire to previous stereotypes of aging such as being content to center their lives purely around their grandchildren, serving as handmaidens to their adult child’s needs. They are not only working longer — either be-cause of economic need or professional fulfillment — they are changing the way they use their recreational time, even opting for world travel or discovering new interests, and perhaps even building new careers (see Miller, 2017). They are also researching supplements and healthy foods, using creams that promise rejuvenation, lifting weights, and dressing in contemporary modes. Gyms are now full of exercising oldsters doing Yoga and Pilates. A gener-ation whose parents would never have been caught anywhere but on a farm in jeans, wear leggings and work-out clothes on the street. Elderly men and women are frequently doing a number of things out of with sync with “traditional” values and behaviors. For example, having multiple marriages (many in old age), living together without getting married, and being open and proud of their sexual identity—often declaring late in life that they are gay, lesbian, or transsexual.
The ubiquitous media in our culture supports and celebrates youthfulness but is beginning to integrate more and more programs featuring older actors retaining their vitality. Dating sites show large numbers of people over 60 in their membership with some sites such as SeniorFriendFinder and HowAboutWe openly recruiting older men and women as their clientele. Pharmaceutical ads show youthful retirees, workers, and grandparents enjoying life in physically demanding ways and, of course, ads for Viagra and Cialis are predicated on older men wanting, as well as needing, medications for sexual intercourse.
Here, however, we come to a point that has been much less discussed or changed in the reframing of a more vital longevity: the role sexuality plays in the revitalization process. As a nation that would much rather have sex than talk about it, there is precious little discussion about a particularly squeamish subject, sex among the aging and elderly. But despite the awkwardness surrounding the subject of sexuality in later years, we know that sexuality continues to play a part in people’s lives at any point in the life cycle. This is something we want to address so that we all can be more knowledgeable about people’s needs and desires. Though there is much to be said about the topic, in our brief coverage we will address key aspects of aging and sexuality such as the frequencies of sexual encounters, how satisfying sex can be in later life, the influence that having an intimate relationship can have on this population, which major illnesses or physical impairments have the potential to dampen sexuality, especially for seniors, and how long-term care facilities (LTC’s) can both promote and interfere with resident’s sexual longevity. It is worth noting that this is not a complete picture, but rather a review of curated information. Because of this, we emphasize the need to take the findings presented as a partial contribution in a complex narrative.
A (Sexually) Active Population
There is certainly evidence that older and elderly people have liberalized their ideas about sex. An AARP study (Fisher et al., 2010) showed that attitudes about sex among older populations have continually gotten more accepting and approving. Whereas 73% of people affirmed the statement “there is too much emphasis on sex in our culture today” in 1999, by 2004 only 65% of respondents felt that way. We believe this shows an increasing comfort with and desire for sexuality as a core ingredient to happiness in later life as well as in young adulthood and middle age. Even with the tabooed nature of elderly sexuality, many Baby Boomers refuse to be inhibited.
Part of this may be due to a reluctance to give up on any of the joys and perks of their youth but it also may be part of their attachment to healthy living. There is certainly some evidence that exercise helps people connect to their bodies, and allows more use of those bodies longer. Pilates, for example, strengthens the core and pubic muscles and has even been suggested as a way of strengthening orgasms (see Herbenick, 2015). Additionally, research shows that having a sexual life is correlated with many components of leading a healthy lifestyle including (but not limited to) relationship satisfaction, overall happiness, and mental health (Blanchflower & Oswald, 2004; Fisher et al., 2010; Mcfarland, Uecker, & Regnerus, 2011; Schwartz & Velotta, 2018; Zeiss & Kasl-Godley, 2001)—and so, the re-emergence of sexuality as a positive good for older people could have important ramifications for health and happiness.
Given that the preponderance of sexuality research focuses on the desires, frequencies, and satisfactions of heterosexual men and women in their reproductive years, there have been few reviews and studies that tap into the over-50 population. Even so, there are some that reveal quite a bit about this growing populace. In the 2009 AARP study mentioned earlier, for example, 75% of respondents believed “a satisfying sex life is important”. A recent literature review found that the older population is very interested in remaining sexually viable even with harsh social barriers impeding access to this desire (Schwartz, Diefendorf, & McGlynn-Wright, 2014). Whether that attitude comes from being more active in general, feeling more entitled to have a thriving sexual life, or liberalized notions of masturbation (with more access via online to vibrators or sex aides) is not clear, but there certainly has been more conversations about sex among the elderly. AARP has published columns on sex for the last few decades and movies and TV programs like Netflix’s Grace and Frankie (starring Lilly Tomlin, Jane Fonda, Martin Sheen, Sam Waterston, and Tom Selleck), Amazon’s Transparent (with Jeffrey Tambor as a transwoman), It’s Complicated (with Meryl Streep, Alec Baldwin, and Steve Martin), and Mamma Mia! (with Julie Walters, Stellan Skarsgård, and Meryl Streep again) are rare but still support the theme that having sex, passion, and romance over 60 is not ridiculous.
It’s not just a Hollywood fantasy, however. The current literature confirms this message of sexual and romantic engagement at older ages. Men and women over 60 continue to live sexual lives with or without partners (Schwartz & Velotta, 2018). According to a 2009 AARP survey on midlife and older adults, nearly 40% of married older adults are having sex at least once a week, and 60% of partnered older adults report sex at least once a month (Fisher et al., 2010). The survey also found that almost 50% of older singletons who are dating or engaged reported having sex once a week. So, although it is true that sexual frequency reduces over time—both with older age and longer duration of relationships—much of what determines sexual activity has to do with psychosocial factors like internalized ageism and stigma, poor body image, poor relationship quality, or absence of a partner (these last two are especially true for women). Thus, the reduction in sexual frequency is not as closely linked to the biological effects of old age as many people may think.
If we look not just at frequencies but also at sexual satisfaction, the data show that a high percentage of older people are enjoying their sexual lives. There are many factors that make sexual satisfaction fluctuate, but the potential for pleasure from sexual activity does not diminish with age (Penhollow, Young, & Denny, 2009). In his study with older adults currently in relationships, Gillespie (2016) found that sexual communication (partners speaking about their needs from sex) and more variety in sexual encounters (e.g. trying new positions, locations, or sex toys) were major predictors of both high sexual satisfaction and high sexual frequency. For older adult partners who are married or cohabitating, sexual satisfaction ratings remain around the 50% mark (Fisher et al., 2010). Unfortunately, it does seem that individuals post-45 have a harder time remaining sexually satisfied if they are not paired, or do not actively date. AARP’s data showed only 10% of older men and women who are single and are not currently dating report being sexually satisfied (Fisher et al., 2010). More encouraging, that number jumps to 60% for those over 45 who are actively dating.
Research on older people makes it clear that having some kind of relationship, however casual, is closely tied to having any sexual activity and increasing both sexual and personal satisfaction. However, the research literature notes that younger adults often see romance among the elderly— and especially among postmenopausal women—as unnatural or unnecessary (Bouman, Arcelus, & Benbow, 2007; Hinchliff & Gott, 2008). In the senior author’s large university class on human sexuality, sex education videos showing older men and women often get reactions of disgust and discomfort. If the senior men and women are merely holding hands or kissing, they receive a more positive reception but this reception seems to categorize the couple as “adorable” or “cute”. Both response types dehumanize men and women over a certain age who are genuinely interested in love, romance, and yes, sex. Older adults are, of course, quite capable of finding love, enjoying one-night flings, or reigniting the flame with a high school sweetheart at a 50th reunion, and take umbrage at not being taken seriously. If professionals in the helping and medical specialties who work with older populations show that they do not think these men and women have sexual thoughts or urges or behaviors, it follows that their clients, advisees, or patients will feel that the full scope of who they are is unseen and denigrated.
LGBT Sexual Activity
We also think it is important to include the special needs of older LGBT population in our discussion. Though the data is sparse (almost non-existent for bisexual and transsexual individuals) we will briefly touch on these populations’ frequencies and satisfaction ratings. Before continuing it is important to note that in combining several types of sexual minorities into one section we are not attempting to portray homogeneity in their needs or behaviors. Our more general approach to these populations is simply due to the paucity of scholarly data on older sexual minorities.
Regarding gay male sexuality post-50, we find that having a stable partner does not impact sexual frequency nearly as much as it does for heterosexuals. When asking gay men (n = 24,787) about their most recent sexual encounters, Rosenberger et al. (2011) found that the majority of sexual acts in all age brackets surveyed were with a partner that participants labeled an acquaintance. About 30% of sexual encounters in the 60-year-old-and-up brackets were with a boyfriend, significant other, or someone the respondent was dating. Over 60% of sexual encounters happened within the past week for this population. And with around half the gay population post- 40 reporting that they are currently partnered (Lyons, Pitts, & Grierson, 2013) it is likely that many of these frequent acquaintance hook-ups reflect a non-monogamous culture among gay men—something that has been observed in other literature (Lyons et al., 2013; Northrup, Schwartz, & Witte, 2012). Alongside their high frequency rates, gay men over 60 also have relatively high sexual satisfaction ratings, with around 40% saying they are “very satisfied” (Lyons et al., 2013). Overall the older gay male population, when given the right environment, seem very capable of maintaining long-term sexual functioning and satisfaction.
Factors that are influential for female sexuality such as: relationship quality, presence of a partner, and emotional fulfillment are especially vital for lesbians. Perhaps the most significant predictor of sexual longevity in the partnered lesbian population is relationship quality which is positively correlated with arousability, sexual functioning, pleasure, and satisfaction (Henderson, Lehavot, & Simoni, 2009; Tracy & Junginger, 2007). Some early literature on the sexual frequencies of older lesbians found that there is a decline over the course of their relationships (Blumstein & Schwartz, 1983; Loulan, 1987). Unfortunately, we simply lack empirical, contemporary evidence on average lesbian sexual frequencies as they stand today. Some have explored whether the parameters used to measure such frequencies should be modified for lesbian samples in order to reflect the fluid, less episodic nature of lesbian sexuality (Meana, Rakipi, Weeks, & Lykins, 2006). It is important to observe, however, that lesbians value the companionate qualities of their partnerships, and do not necessarily feel that the relationship is less intimate if they have low sexual frequency (Averett, Yoon, & Jenkins, 2012). That said, lesbians engage in more masturbatory behavior than their heterosexual female counterparts and are more inclined to integrate masturbation into partnered sex (Hurlbert & Apt, 1993; Laumann, Gagnon, Michael, & Michaels, 1994) as well as have more positive attitudes towards masturbation in general than heterosexual women (Writer, 2012).
The most unstudied sexual minority group, especially in terms of sexuality in old age, is bisexuals. From the sparse data we have, it appears that older bisexual men are very likely to have had their last sexual encounter with an acquaintance rather than a partner (Rosenberger et al., 2011) and may be more generally cut off from positive social or intimate relationships. Some indication that this is true is that research has shown higher rates of internalized stigma and smaller social networks for male bisexuals and a higher likelihood for them to live alone (Fredriksen-Goldsen et al., 2013). Additionally, because bisexuals are seen as emotionally or sexually dangerous by both heterosexuals and homosexuals, bisexuals are likely to keep their sexual lives private, undiscussed or remain “in the closet”. They may only identify by their current sexual behavior, which may give less than the whole picture to professionals trying to help them or place them in a comfortable housing or community environment. We feel this is a very under-researched population and therefore our understanding of what this population needs later in life is very limited.
Illness, Impairment, And Sexuality Later In Life
Even with many older adults living longer, more sexually fulfilling lives, sundry health-related conditions impact the ability of some seniors to perform sexual acts. Here we have devoted space to discuss a few select ailments that are known to effect sexuality for older men and women.
Though technological advances and increased awareness have allowed many cases of cancer to be detected earlier than in previous generations, breast and prostate cancer remain a prevalent problem for many older individuals.
Breast cancer is a serious risk for women post 40 who comprise around 95% of those diagnosed, with older age brackets experiencing an even higher risk of developing the disease (American Cancer Society, 2016a; National Cancer Institute, 2015). Chemotherapy, which is still regularly used in the treatment of breast cancer, has a host of negative physiological side effects that are temporary, but many effects can be quite severe and carry on months after ending chemo (Biglia et al., 2010; Boswell & Dizon, 2015; Malinovszky et al., 2006). Reported sexual consequences include reductions in: sexual desire or interest, arousability, sexual functioning, and the overall quality of relationship with partner (Biglia et al., 2010; Knobf, 2001). Another treatment method, radiation therapy (RT), has shown less clear links between onset of treatment and sexual dysfunction (it is often used in conjunction with other techniques, making it difficult to isolate how RT specifically affects sexual health). That said, Boswell and Dizon (2015) suggest that the locoregional impairments that RT can cause (e.g. pain in breasts and loss of flexibility) could contribute to the reductions in sexual functioning we see in women exposed to it.
The most severe of treatment for breast cancer is surgical removal of tissue. There are various types of breast surgery, ranging from mastectomy-only (with no following breast reconstruction) to lumpectomy (removal of only cancerous tissue) and mastectomy with reconstruction, but a common theme in literature suggests that mastectomy-only (MO) patients have worse sexual consequences than patients who elect for the other surgeries.
Studies find that those treated with MO operations are more likely to experience low levels of sexual desire, arousal, perceived sexual attractiveness, sexual functioning, and encounter greater difficulties in achieving orgasm (Aerts, Christiaens, Enzlin, Neven, & Amant, 2014; Al-Ghazal, Fallowfield, & Blamey, 2000). And yet another aspect that MO patients have to face is the loss of their breasts—something that can alter body image significantly. Of those women who get any of the three cancer removing surgeries listed, MO patients report significantly worse body image than their peers (Engel, Kerr, Schlesinger‐raab, Sauer, & Hölzel, 2004; Markopoulos et al., 2009). This low body image implies that even for those with high sexual functionality after surgery, some older women may feel too self-conscious to engage sexually, a disappointing finding to discover.
For men, the risk of developing prostate cancer increases exponentially with age and about one in seven men is diagnosed in their lifetime (American Cancer Society, 2016b; Prostate Cancer Foundation, 2016). And along with concern for one’s survival, prostate cancer can have devastating effects on sexual functioning and satisfaction.
As is the case for breast cancer, most male cancer patients must undergo radiation therapy to treat their prostate. This technique, though effective for treating prostate cancer, has been associated with low levels of sexual desire, decreased frequency of erections, lowering importance of sex life post treatment, reduced orgasm intensity, and an uptick in ejaculation dysfunctions (e.g. no ejaculate during orgasm or pain during ejaculation) (Helgason, Fredrikson, Adolfsson, & Steineck, 1995; Incrocci, 2002, 2006, 2015; Incrocci & Slob, 2002; Incrocci, Slob, & Levendag, 2002; Olsson, 2015).
For patients with worse prognoses, doctors may choose to perform a radical prostatectomy and that procedure results in erectile dysfunction for 60-70% of patients (Chung & Gillman, 2014). Some additional post operation difficulties with radical prostatectomies include: incontinence during sexual activity, less or no sperm emission at orgasm, changes in penile appearance (e.g. length and curvature), and decreased pleasure during orgasm (Ambruosi et al., 2009; Chung & Gillman, 2014; Dubbelman, Wildhagen, Schröder, Bangma, & Dohle, 2010). And although Dubbelman et al. (2010) found there are nerve-sparing procedures that doctors can follow in order to reduce damage to orgasmic functioning, being over the age of 60 was one of the strongest predictors associated with the inability to achieve climax post-radical prostatectomy.
There are various treatment methods that can help men who experience difficulty after their prostate cancer treatment, ranging from highly effective sildenafil citrate (i.e. Viagra) (Incrocci, Koper, Hop, & Slob, 2001) to intracavernosal injections administered into the base of the penis prior to sex. Other non-pharmaceutical methods are discussed by authors Canalichio, Jaber, and Wang (2015) in their review of hormonal and non-hormonal based treatments for sexual functioning post-prostate cancer surgery.
The Centers for Disease Control and Prevention’s National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States (2014) found that 25.9% of Americans 65 years of age and up were diabetic, men making up a significant majority of this population. Erectile dysfunction (ED) is commonly comorbid in male patients with diabetes due to a combination of various blood circulation difficulties and can often be alleviated with the use of oral medications such as Viagra (Hatzimouratidis & Hatzichristou, 2014). With treatment for diabetes induced ED available, it is somewhat surprising that men with diabetes are more likely to see their ED as severe and permanent when compared to their non-diabetic counterparts (Eardley, Fisher, Rosen, Nadal, & Sand, 2007). Perhaps showing the value of a medical staff who can initiate conversations about sexual functioning with their diabetic male patients.
The effects of diabetes on older women is relatively unclear. The disorder impacts vascular and neurogenic functioning which may be associated with lowered desire and reduced lubrication but these symptoms are also present in many non-diabetic post-menopausal women, making it harder to discern if the root cause is diabetes or other, more general aging processes (Zeiss & Kasl-Godley, 2001).
Of the 35 million-plus Americans over 65, more than 6.5 million are impacted by depression (Reyers, 2013). We do not have room in this paper to discuss all the concomitants of this all too common problem, but suffice it to say that depression can, and frequently does, wipe out both the desire for sex and arousal when having sex. Often patients are so severely impacted that a medical professional will not think twice about giving a high dosage anti-depressant or anti-anxiety medication that affects sexual functioning since they are far more worried about their patient’s mental state than their sexual life. Still, this disregard for the concomitant impact of anti-depressives and anxiolytics can worsen the situation for the suffering patient. Often patients are not even told about the impact the medication will have on their sex life or simply don’t bring up the sexual side effects they are experiencing when with their pre-scribing doctor (Ferguson, 2001). This dynamic impedes possible discussion on how a lower dosage or a different drug might affect their sexual life less. As important, there may also be an impact of these drugs on the patients ability to love and feel affectionate (Marazziti et al., 2014). This, of course, complicates the couple’s life together and may result in a partner feeling unloved or appreciated, not realizing that some of the flat affect is drug induced.
Long-Term Care Facilities
One of the most important decisions that older people (and often their families) must make is whether or not they will require long-term caregiving in a facility or home. As we have illustrated, sexual activity remains an important aspect of many aging men and women’s quality of life. However, the facility and policies of nursing homes often contain negative views toward sexual behavior in the aging population (Bauer, Mcauliffe, & Nay, 2007; Bouman et al., 2007; Hinrichs & Vacha-Haase, 2010; Parker, 2006). Desexualization of this population may serve as a convenience for caretakers, allowing them to escape uncomfortable and complex discussions about elderly sexuality. They may also simply lack knowledge and feel unqualified to speak with residents. Issues such as these are especially poignant for LGBT individuals who find it difficult to express their sexuality in LTC settings due to assumed heterosexuality and homophobic dispositions within the staff (Hinrichs & Vacha-Haase, 2010).
LGBT residents may conceal their sexual orientation as well as other pertinent information (e.g. HIV status) to reduce stigmatic treatment by health workers (Griebling, 2016). A recent study using lesbian transgendered participants found that although this population felt that they had aged successfully, major concerns still plagued them about late-life events and legal difficulties (Witten, 2015). Given that many in the LGBT community rely on “chosen families” for social support (networks of non-biological family members), when judgments must be made on whether someone is capable of giving sexual consent (for example, when a person has fading cognitive abilities or has dementia), a lack of proper documentation of who is entitled to claim a family or spousal relationship, may make it difficult for those closest to the client to protect his or her interests. Legal complications and negative attitudes found in caregivers and family members, surely contribute to LGBT nervousness in regards to their sexual freedom being honored when living under institutional care in hospitals, long-term care facilities, or other kinds of senior communities.
One solution for older LGBT patients nervous about sexual restrictions imposed within heterosexual LTC communities are homes built exclusively for sexual minorities which have staff trained in facilitating the specialized needs of its members. In addition to expanding LGBT-specialized communities, a broader message to healthcare providers treating LGBT patients can be to develop a strong sense of trust with minority clients. Trust often enables LGBT patients to be open and honest about personal matters pertaining to their sexuality (Dibble, Eliason, Dejoseph, & Chinn, 2008) and will likely increase sexual liberties for minority members within primarily heterosexual facilities. This is especially important for less experienced and younger staff members who show higher rates of sexual restrictiveness towards patients than more experienced, senior faculty (Bouman et al., 2007).
Regardless of sexual orientation, the recognition of sexual rights within LTC’s is meaningful to many. Unfortu-nately, residents have reported feeling that their providers care little about fostering an intimate environment for couples and few facilities even permit double-beds (Bouman et al., 2007). Additionally, the atmosphere of nursing homes can be quite open and indirectly oppose residents’ desires to have private moments with partners (Fran-kowski & Clark, 2009). It is not difficult to imagine how unlocked-door policies, community-based activities, and restrictions on sharing sleeping quarters may negatively impact tenants’ ability to engage in sexual activities.
Roach (2004) describes the conduct and actions that caregivers and staff take to restrict sexual contact between residents as the guarding discomfort paradigm. This is because the incentive for preventing such behaviors is to “guard” against the discomfort that seeing older men and women in sexual or intimate situations would cause staffers. After her interviews with nursing and LTC staff, Roach concluded that the staff’s restrictive actions are not only a product of their individual predispositions towards sexuality but also a product influenced by the general “ethos of an organization” (p. 174).
Should a resident have a cognitive disability, the nursing home’s restrictiveness may be even more inhibiting. Individuals who display inappropriate sexual behavior (ISB), for example, are regularly removed from ISB-triggering stimuli or given distractive tasks. And— in cases where such actions do not reduce patients’ ISB—practitioners may medicate the individual often with prescriptions used off-label (Dominguez & Barbagallo, 2016). Some research on inappropriate sexual behavior among the cognitively impaired indicates however that ISB is rarely motivated by sexual urges. Usually the patient’s intentions are to communicate something entirely appropriate, but their actions are observed as a sexual act (Dominguez & Barbagallo, 2016).
In our brief review on aging and sexuality we have drawn a problematic picture that indicates that western culture still stigmatizes and/or ignores sexual desire and sexual relationships among older men and women. A review of the literatures available, indicates that there is a lack of recognition of older people’s sexual needs, and that professionals who are supposed to be working in behalf of people in late middle or old age as caretakers, medical and mental health professionals, or as social workers and para-professionals, may not accord older people the same sexual rights as they do to younger populations. This may be especially true for older gays, lesbians, bisexuals, and transsexuals. Older men and women trying to stay vibrant as an individual, and sexually attentive to them self or with a partner, deserve more conscious concern and support for their sexual lives.
However, translating research findings into useful policies and practices can be quite complicated for the administrator overseeing a large residence community or the clinician cycling through many patients a day. Therefore, we would like to offer some of the more pragmatic steps that professionals who work with older individuals may take in order to reduce potential barriers to their clients’ ability to enjoy thriving sexual lives well past the age of 50. Firstly, care facilities may want to review their unlocked-door and single-bed policies which can be clear obstacles for the residents looking to enjoy private, intimate time with one another. Having activities where residents can partake in pairs (as opposed to as a group) is another measure that can enable more opportunities for residents to experience intimate, romantic connections with one another. For the LGBT population, facilities may explore having staff specialized in serving older LGBT residents. This could enable their clientele who are in the sexual minority to develop more trusting bonds with a group of care staff that is specifical-ly trained for providing aide to their unique concerns later in life.
For clinicians who require knowledge about sexual activity, conscious efforts to assess implicit biases could be helpful in reducing issues related to assumed heterosexuality (for LGBT patients) and presumptions of sexual inactivity later in life (for all older patients). For example, Aging Life Care Professionals may want to ask whether their patient has a male or female partner prior to discussing any sexual activity to avoid the use of inaccurate pronouns or non-applicable sexual behaviors that may make their patient uncomfortable to answer (e.g. asking a gay male how frequently he engages in vaginal intercourse with his partner). It may also benefit practitioners to foster open dialogs about their patients’ sexual frequencies and satisfaction—topics often left untouched by doctors treating older patients who are also less likely to seek help with sexual needs when their doctors do not ask about their sexual behavior during visits (Hinchliff & Gott, 2011). Doctors and medical professionals should consider administering an annual questionnaire during their patients’ check-ups that covers sexual issues as areas that the patient might like to discuss. Among the potential areas of concern, patients could answer items (as appropriate) about: the presence of erectile dysfunction, pain during intercourse or other penetrative sexual behaviors, genital pain in the absence of sexual behavior, undesired loss of sexual interest or arousal, and the desire to hear about medications that affect sexual behavior or get a referral to see a doctor who specializes in sexual medicine. Of course, there are many more actions that care workers can take to better their clientele’s sexual autonomy later in life, but these are a few good starting points. With the recent medical innovations in sexual health it is important to keep the above-50 population informed as to what their options are to increase their sexual longevity, and in so doing increase their sexual agency for the rest of their life.