Sexual health in an aging world: a global call to action for more resilient services for older and disabled adults

The global population is aging. By 2050, over 1.5 billion people worldwide will be aged 65 or older, which is 26% of the population and more than double the number in 2019.¹ As adult health spans increase, more people will have sex in their later years of life. One population-representative study in England² and other data from Europe³ suggest that many people aged 60–69 years old have sex. Older adults (ages 60 years and above) represent a wide array of backgrounds, experiences, and attitudes towards sexuality. Many, but not all, older adults have disabilities that directly impact sexual health and well-being. As a result, older adults often face ageism, ableism, and related intersectional problems when seeking sexual health services.² Addressing these challenges requires an understanding of the interconnected aspects of physical, emotional, and social well-being in older adults’ sexual lives.⁴ Healthy sexual activity is not isolated, but linked with overall health, relationship satisfaction, and quality of life.⁵

Unfortunately, most sexual health services fail to serve the unique needs for older adults, especially people with disabilities.⁶ The health systems of most countries fail to adequately address the needs of the aging population, despite their contribution to society.⁷ Discriminatory healthcare practices often neglect older adults,⁸ excluding them from sexual health discussions.⁹ In addition, few older adults are involved in the development of health services. Existing sexual health services have largely been tailored for young people and designed by middle-aged people.¹⁰ Healthcare providers infrequently discuss sexual health with their older patients.¹¹

Older adults’ sexual well-being requires an understanding of sexual health needs, health and long-term care services tailored to these needs, health providers and caregivers willing to engage, accessible information and resources, and a society that validates older adult sexual rights and needs.

Older adults are often excluded from population-based sexual health research studies. A review of STI treatment clinical trials found that 72.7% of risk-reduction clinical trials excluded participants over the age of 50 years and 88.8% excluded those over the age of 65 years.¹⁰ In order to generate more responsive sexual health services, researchers need to include older adults in cohort studies, trials, community engagement and other research. Growing the evidence base for sexual health services among older adults will allow us to better understand the diversity of needs and opportunities for collective action. For example, aging is accompanied by a variety of physiological changes, with increasing risks for decline in physical and mental capacities (e.g. through visual impairment, hearing and mobility loss) as well as increasing risks for chronic disease. Over 46% of adults over the age of 60 years report at least one disability,¹² making the voices of older adults and those with disability or chronic conditions important, including in low- and middle-income countries (LMICs).⁶ By 2050, 80% of these older adults with a disability will be living in LMICs. While wheelchair ramps and accessibility planning have been introduced in some high-income country sexual health clinics, these essential components are missing from most LMIC sexual health clinics.⁶

Integration of health and long-term care services in sexual health services is also important. Many older adults live in assisted living, skilled nursing homes, or other care homes. These communities could increase the risk of abuse and neglect,¹³ but also provide an opportunity for community-based research and action. Given that many countries are decentralizing sexual health services, greater attention to community-based provision of self-care interventions (e.g. self-testing, self-sampling) could enhance the sexual health of older adults in diverse care settings.

Supporting caregivers, partners, and health professionals is another important consideration in this field. A typical clinical interaction between a physician and an older patient often has a third person in the room. This third person could have substantial implications for discussing a sensitive topic such as sexual health, completing a comprehensive history and physical examination, and carrying forward recommendations for care. Little research has focused on caregiving in the context of older adults accessing sexual health services.

Older adults also need tailored information to ensure their sexual health and well-being.¹⁴ HIV/STI and sexual health campaigns often focus on young people, neglecting some older adults who are at risk for STIs.¹⁵ Sexual health campaign materials should be provided in ways that reach older adults, recognizing that some people may have disabilities and some do not have disability. Educational materials can be distributed where older and disabled adults can access them, such as senior centers, independent living facilities, and community organizations. Focusing messaging on topics relevant to older adults (e.g. intimacy after the loss of a partner) may be particularly useful. Making sexual health information accessible and relevant to older individuals, affirming sexuality across the health span, and expanding the spectrum of ability are critical. Open discussions that center the perspectives of older adults to better address their needs are important.

Breaking down stigma and social taboos present another key area of sexual health for older adults.¹⁶ Public engagement and participatory methods may be useful to increase public understanding on the topic and gradually decrease stigma.¹⁷ For example, the Sexual Health in Older Adults Research¹⁸ team used co-creation and related participatory approaches to solicit feedback from older adults in the United Kingdom to improve sexual health services.¹⁹ This included co-creation workshops, a crowdsourcing open call, and community advisory board that were tailored to focus on people older than 45 years old and those with disabilities. Co-creation refers to an iterative interaction between researchers and community members for mutual benefit.²⁰ Crowdsourcing has a group of people solve all or part of a problem, then share solutions back with the community.²¹ A community-engaged research agenda developed in partnership with older adults could help to decrease stigma associated with sexual health among older adults.

To better support sexual health and well-being for the aging population, we need to actively involve older adults and disabled individuals in research, policy making, and programs. Research should be used to identify gaps in sexual health services and embrace the diversity of sexual health needs among older adults. Policymakers need to develop laws, policies, and programs to decrease ageism and increase resilient services. Sexual health policymakers should prioritize the needs of an aging population, ensuring sexual health services receive funding for accommodating older adults, including those with disabilities. Anti-discrimination training in health services should root out the persistent effects of ageism and ableism.⁹

There is an urgent need to improve sexual health services for older adults around the world. Older adults should be included as key partners in sexual health research and health promotion. Their insights are indispensable for innovation to make better sexual health services. Recognizing the diversity of older and disabled adults is important for designing sexual health messages tailored for these groups. Older adults have rich wisdom and insight that can help to develop more resilient sexual health services and programs. This Special Collection in Sexual Health will focus on sexual health and well-being among older adults. We welcome all related research on this topic, but are particularly interested in manuscripts related to sexual functioning and co-morbidities (e.g. interactions of medications for chronic conditions with sexual desire), menopause and related topics, sexual health service utilization, research that links sexual activity and health, perspectives from LMICs, and community-engaged research on sexual health among older adults. The deadline for submissions is 1 April 2025.