Sex and aging

Sex does not stop

The English Longitudinal Study of Ageing (Lee et al., 2016, Archives of Sexual Behavior, over 6,200 adults aged 50+) found 54 percent of men and 31 percent of women aged 70 and over reported being sexually active. The US National Social Life, Health and Aging Project (Lindau et al., 2007, NEJM, n = 3,005) found 73 percent of 57–64 year olds, 53 percent of 65–74 year olds and 26 percent of 75–85 year olds were sexually active, with most of the sexually active reporting sex two to three times a month or more.

The most consistent predictor of continued sexual activity in later life is not age or health but partner availability and partner health — which is why the drop is steeper for women, who on average outlive male partners.

Physical changes with menopause

Falling oestradiol produces the genitourinary syndrome of menopause (GSM): thinner, less elastic vaginal tissue, reduced lubrication, raised pH, shortening and narrowing, and increased urinary frequency and UTI risk. GSM affects roughly 50–70 percent of postmenopausal women, is progressive without treatment, and — unlike hot flushes — does not resolve on its own.

What the evidence supports:

• Vaginal moisturisers used regularly (two to three times weekly), distinct from lubricants used at the time of sex. Both help; they do different jobs.
• Local vaginal oestrogen (cream, pessary, ring). Cochrane review evidence supports efficacy for GSM. Systemic absorption is very low, and major bodies including NAMS/The Menopause Society and the British Menopause Society state that the standard breast-cancer "black box" warning is not supported by the evidence for low-dose vaginal preparations.
• Vaginal DHEA (prasterone) and ospemifene are alternatives where oestrogen is unsuitable.
• Systemic HRT treats vasomotor symptoms and helps GSM, though local treatment is often still needed. The 2002 Women's Health Initiative results were widely over-generalised; subsequent re-analysis by age group (Manson et al., 2013, 2017) found a substantially more favourable risk-benefit profile for women starting therapy under 60 or within 10 years of menopause.
• Testosterone for postmenopausal hypoactive sexual desire disorder has meta-analytic support (Islam et al., 2019, Lancet Diabetes & Endocrinology) for a modest but real improvement in desire and satisfying sexual events; it is endorsed by the Global Consensus Position Statement, 2019.

Physical changes with male ageing

Testosterone declines gradually — roughly 1 percent a year after 30 — but symptomatic hypogonadism is far less common than the "low T" marketing implies. What changes reliably:

• Erections need more direct physical stimulation and are less reliably spontaneous.
• The refractory period lengthens, often substantially.
• Ejaculation volume and force decrease; orgasm intensity may change.
• Benign prostatic hyperplasia and its treatments affect function. Finasteride and dutasteride carry sexual side effects; tamsulosin commonly causes retrograde ejaculation.

Erectile difficulty in older men is more often vascular than hormonal. PDE5 inhibitors (sildenafil, tadalafil) work in roughly 60–70 percent of cases and are contraindicated with nitrates. Persistent new erectile dysfunction is a cardiovascular red flag — the Princeton Consensus recommends cardiac risk assessment.

Medication and illness

Common contributors to sexual difficulty in later life: SSRIs and SNRIs, beta blockers, thiazide diuretics, finasteride, anti-androgen therapy for prostate cancer, opioids, and treatments after breast or gynaecological cancer. Diabetes, cardiovascular disease, arthritis, Parkinson's and neuropathy all have direct effects. Almost all of these are worth raising with a prescriber; alternatives frequently exist and are rarely offered unprompted.

STIs after 50

STI diagnoses in over-50s have risen substantially in the UK and US over the last two decades. Contributing factors: post-menopausal loss of pregnancy concern removing the motive for condoms, thinner vaginal tissue increasing transmission risk, new partnerships after divorce or bereavement, and clinicians who do not ask. Testing and barriers are not age-limited.

What improves with age

Longitudinal and survey research consistently finds older adults report better communication, less performance anxiety, more accurate knowledge of what they like, and — in several studies — higher sexual satisfaction despite lower frequency. Frequency and satisfaction are different measures and diverge with age.

Sources

• Lindau ST et al. "A study of sexuality and health among older adults in the United States." NEJM, 2007.
• Lee DM et al. "Sexual health and well-being among older men and women in England." Archives of Sexual Behavior, 2016.
• The Menopause Society (NAMS). Position statement on genitourinary syndrome of menopause, current edition.
• Lethaby A et al. "Local oestrogen for vaginal atrophy in postmenopausal women." Cochrane Database of Systematic Reviews, 2016.
• Manson JE et al. "Menopausal hormone therapy and long-term all-cause and cause-specific mortality: the Women's Health Initiative randomized trials." JAMA, 2017.
• Islam RM et al. "Safety and efficacy of testosterone for women: a systematic review and meta-analysis." Lancet Diabetes & Endocrinology, 2019.
• Nehra A et al. "The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease." Mayo Clinic Proceedings, 2012.
• UK Health Security Agency. Sexually transmitted infections annual data tables, current edition.

Last reviewed: August 2026.