Healthy sexual aging: A mixed-method study of sexual function and sexual well-being in older European adults

Various aspects of healthy sexual aging were studied in representative populations of 60-75 year-olds in Norway, Denmark, Belgium, and Portugal (n=3820). In men, the percentage of sexually active participants in the past year ranged from 83% (Portugal) to 91% (Norway). In women, the percentage of sexually active ranged from 61% (Belgium) to 78% (Denmark). Regarding frequency of sexual intercourse during the past month, men in Norway, Denmark, and Belgium most often reported 2-3 times per month, whereas most men in Portugal reported 1-3 times per week. Masturbation was most commonly reported among Norwegians, and least commonly in Portugal. Concerning sexual satisfaction, across all countries, 40% - 60% reported that they were sexually satisfied. Having a partner was the most important predictor of sexual activity and sexual satisfaction. In partnered participants, across countries, important predictors of partnered sexual activity were positive attitudes toward sex, previous sexual activity, and relationship happiness. Positive attitudes towards sex correlated with less change in sexual interest and enjoyment, and with increased frequency of intercourse and masturbation. Dissatisfaction with appearance appeared to be an equally important aspect of sexual satisfaction in older as in younger adults. Across countries, health status was the most important predictors of change in sexual interest and sexual enjoyment in men. Change in sexual interest and enjoyment among women was best predicted by interpersonal factors. Good health, an active sex life throughout the lifespan, relationship duration and feeling emotionally close with the partner during sex are important factors in maintaining sexual interest and enjoyment among partnered older adults in Europe. We investigated whether the association between perceived discrepancy in sexual interest and sexual satisfaction was mediated by the frequency of sexual activity and emotional closeness during sex. We found the increased discrepancy in sexual interest was associated with low sexual intercourse frequency and low emotional closeness affected sexual satisfaction negatively for both genders. In men, we found a high prevalence of sexual problems lasting 3 months or longer across countries, but many men with sexual problems experienced minimal or no distress about these problems. Portuguese men reported significantly more distress to sexual problems compared with Danish and Norwegian men. A majority of women (72%-81%) reported having experienced at least one sexual problem lasting 3 months or longer in the past year, but many of them reported only mild or no distress about these problems. The most common sexual problems reported were lack of interest in sex, inability/taking a long time to experience an orgasm, and having an uncomfortably dry vagina. Partnered women reported significantly higher levels of sexual avoidance during the previous. The main reasons for sexual avoidance reported by women in a committed relationship were related to health problems, partner?s sexual difficulties, and lack of interest in sex. The reasons committed men had avoided sex were related mainly to partner?s sexual difficulties, their own sexual difficulties, and health problems. Older adults often face barriers when seeking help for sexual difficulties. More men (12%) than women (7%) had sought professional help for a sexual difficulty in the past 5 years. The main reason for help-seeking was that sex was important to the participant and/or their relationship. The main source of professional help was the primary-care physician. The main reasons for not seeking professional help included not being distressed by the symptoms or thinking that the difficulty would clear up on its own. Significant correlates of seeking professional help was level of distress about the sexual difficulty. Significant relationships between successful aging and sexual satisfaction were found for both male and female partners across countries. Among women, retrospectively assessed change in sexual interest over the past 10 years was consistently associated with sexual satisfaction. Partner effects were gender-specific: male partners? successful aging was significantly related to their female partners? change in sexual interest, which was linked to male partners? sexual satisfaction. Controlling for sociodemographic characteristics, higher successful aging scores were consistently related to lower reduction in sexual interest/enjoyment among female and male participants across the four countries. Given an increased life-expectancy and focus on healthy aging in many countries, the findings about the associations between sexual expression, quality of life and aging well are valuable to professionals working in the area of healthy sexual aging. The findings from this study point out that sustained sexual interest and sexual enjoyment are linked to successful aging in both genders.

The members of the research team has developed strong bonds which is promising for future cooperative projects. By November 2020, one doctoral thesis is defended, and two more are expected next year. An important aspect of the project was to develop interventions for health personnel and older adults. A cooperation between the Norwegian research team and Likestillingssenteret, Sex og Politikk, FRI and Likestillingssenteret KUN was established in 2020. The purpose of the cooperation was to conduct a national competence development boost to develop and implement an intervention for health personnel who work with the target group older adults, and the older adults themselves. The project is funded by the Norwegian Directorate of Health.

In Europe, older adults are a growing group of citizens that is thought to have more sexual difficulties with increasing age. While sexuality is long believed to be unimportant for older men and women, there are reasons - due to for instance cultural changes - to believe that current and future older adults will value their sexual health more than those from previous generations. Health authorities in European countries are gradually realizing that a growing number of older adults will regard their sexual health and sexual well-being as an important issue, even as a human right. Currently, there is a lack of empirical data about how older adults experience and cope with the physical, psychological, and relational changes that affect their sexual health. The present project aims to provide in culture-specific knowledge that will enable policy makers and health professionals to better react to the challenges associated with older adults' sexual health and well-being. In addition, we propose to design evidence-based education and intervention programs for: (a) health professionals in geriatric care; and (b) older individuals and couples struggling with sexual health-related issues. It is known that European countries differ in terms of sexual cultures and the social organization of sexuality, and these differences are historically rooted. For example, North- and South European countries strongly differ in sexual norms, attitudes and behaviours based on sociocultural differences in terms of gender roles and gender equality. The current project contains a qualitative in-depth interview component, and quantitative component in terms of probability-based survey that will be carried out in six participating countries representing the diversity in Northern, Southern and Central European societies.