Elderly Sex Study

Washington Post staff writer Rob Stein was online Thursday, Aug. 23 at 11 a.m. ET to discuss the findings of the the first detailed examination of sexuality among older Americans. He was joined by the study's lead author, Stacy Tessler Lindau, assistant professor of obstetrics, gynecology and of medicine-geriatrics at the University of Chicago.

The survey, published in The New England Journal of Medicine, found that many people maintain rich, active sex lives well into their 80s and that there is a close link between sex and health, with healthier people reporting the highest rates of sexual activity.

A transcript follows.

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Takoma Park, Md.: What do similar studies say about people under 40?

Rob Stein: A previous study conducted in 1992 among those ages 18 to 59 found similar levels of sexual activity.

Stacy Tessler Lindau: The last national study of sexuality in the U.S. was conducted in 1992. We have not had data generalizable to the U.S. public since then. There is a tremendous need for updated information.

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Brookfield, Mo.: Why should anyone really care about the sex habits of anyone else? Isn't it just voyeuristic drivel?

Rob Stein: Among other things, researchers say this kind of data provides crucial information to doctors, reminding them that it is important to talk to their patients about these issues and providing the kind of data they need to counsel their patients.

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Washington, D.C.: How many of these people are having unprotected sex with multiple partners? How familiar are they with various safe sex methods?

Is the percentage difference between Men and Women having sex indicative of a larger female population? Or are the men active with multiple partners?

Stacy Tessler Lindau: Condom use appears to be very uncommon among older adults. In order for the male condom to be used properly, it requires a full erection. Many older men do not experience full erection until after intercourse has occurred. We need to understand better how best to prevent sexually transmitted diseases among older couples.

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Knoxville, Tenn: You people are dancing around the obvious.

Seniors are sexually active because their Cardiovascular systems are perking. It's all about the blood! And not the other way around like you say.

Why are you so surprised that Seniors want to talk? Seniors need all the information they can get. But they need good and accurate information. Our society has become too Conservative? And they do not share and interact any more. Jerry

Rob Stein: The researchers did find seniors very willing to discuss these issues. Many said they had never talked about sexuality even with their doctors.

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New York, N.Y.: What percentage of the sexual experiences recorded by the research were heterosexual, and what percentage homosexual? I've seen no mention of this vital statistic in any of the press reports.

Stacy Tessler Lindau: As little as we have known about sexuality in later life in general, we know less about lesbian, gay, bisexual, transexual relationships in later years. In our study, we report on the number of men and women who said they had a same sex partner in the prior 12 months. Very few indicated they had. This should not be construed as a measure of homosexuality in the older population. We do have additional data, yet unpublished, that may shed more light but we did not explicitly ask people to identify their sexual orientation. More work needs to be done to understand sexual identity and orientation in later life.

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Rockville, Md.: Who knew?

I guess we can conclude that those who can - do and those who can't - talk. Or something like that.

Stacy Tessler Lindau: I don't think we can conclude this for women as many are capable physically of engaging in sex and interested in doing so, but find themselves without a partner. Women outlive men and in the later years, particularly the 8th and 9th decade, quite a few women find themselves without an opportunity for a relationship.

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Dagsboro, Del.: How do you explain the statistical anomaly that in the 75 to 85 age group, 38.5 percent of men and only 16.7 percent of women claim to have had sex in the last 12 months when "sex" is defined as having contact with another person?

Stacy Tessler Lindau: Men, on average, have relationships with women who are younger than they.

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New York, N.Y.: Did the study include the degree to which different fetishes are practiced?

Stacy Tessler Lindau: The study asked about common sexual activities like vaginal intercourse, oral sex and masturbation. We asked about activities like hugging and cuddling. We also assess non-sexual physical intimacy, such as hugging a grandchild or greeting another adult with physical contact.

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Arlington, Va.: Did Viagra or the other drug companies help fund your study as a way to help sell more perscriptions?

Stacy Tessler Lindau: The funding for this study is detailed in the New England Journal of Medicine publication and comes primarily from the National Institutes of Health. Pharmaceutical companies were not involved in funding this study. As is described in the publication, one of the study co-authors has conducted sexuality research with support from Pfizer.

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Washington, D.C.: They did NOT survey my husband and I. After almost 30 years of marriage, we maybe have sex 1-2 times a month, maybe! Not that we don't love each other but honestly as you age (I guess only in our case), it's just not as exciting as it had been. Can it be exciting? Sure, just take us out of our every day lives, routine, routine, routine and if we're on vacation, we have it more often and it is great. But on a regular, day-to-day basis, it's just not a big deal. A hug and a kiss is about all I need these days. And I'm only 49.

Rob Stein: Actually, that's about the level of sexual activity that the researchers found through this survey.

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If Doctor's aren't Talking about it...: And they're not using condoms...are they testing older patients for STDs? Sounds like a dangerous situation.

Stacy Tessler Lindau: Most older adults in our study say that they have not discussed issues related to sexuality with a physician since age 50. Although all available data suggest that most sexually transmitted infections are quite uncommon among older adults as a whole, there certainly are some populations at increased risk. Our study suggests to physicians that there is an opportunity to do better in terms of talking to patients about sexual matters both in terms of promoting sexual function and preventing transmission of infection. It suggests to the public health community that we should include older adults in messages and strategies to help prevent sexually transmitted infection.

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Washington, D.C.: Is it true that women take longer to get aroused the older they get? Given what you wrote earlier about male erection issues in older ages, what does both of those things say about the quality of intercourse in later years? Or are some active seniors replacing intercourse with other forms of mutual arousal and satisfaction?

Rob Stein: The survey found that between about 44 and 49 percent of the women surveyed reported a lack of interest in sex, between about 36 and 44 percent reported difficulty with lubrication and between about 34 and 38 percent reported an inability to climax. Also, between 18 percent and 12 percent reported pain during intercourse and about 24 percent reported that sex was not pleasurable.

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Oxford, Miss.: Regarding the rhetorical question made by another chatter "Why should anyone really care about the sex habits of anyone else?" I'd have this to say:

It's important for us to know about the sex habits of other people in order to understand our own feelings and urges. I'm only 33 years old but I'm glad to know that people in their 80s are often still sexually active if only so that when I'm 85 and still, um, raring to go, I won't feel like some sort of freak.

Stacy Tessler Lindau: In medical school, we learned that one way to assess the normalcy of another person's vital signs - say, their heart rate, was to compare it to our own. Given modern technology and information, this usually isn't necessary. Data such as those presented in our study give individuals a reference point for understanding and interpreting their own sexual experiences. Because sexuality in general, and particularly in later life has been a taboo subject, some people don't know whether what they're experiencing is typical or "normal," or whether it might represent a health problem that could benefit from treatment. Some older people never had a chance to discuss matters of sexuality with anyone - not their parents, not in school, not with their spouse, and not with their physician. People experiencing sexual problems can feel very isolated, ashamed and embarrassed. We hope the findings of our study might help some people feel less isolated or maybe even more hopeful. We also hope the study will help physicians provide useful information to patients about sexuality.

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Bethesda, Md.: Have there been studies about older populations in other part of the world? And if so, how does that compare with the the American results?

Stacy Tessler Lindau: There have been studies that include older populations in other parts of the world and our study is informed by those. With regard to male sexuality in later life, our findings are very consistent particularly with regard to sexual function and problems. Remarkably little has been known at a population level about older women's sexuality in the U.S. or elsewhere.

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Stacy Tessler Lindau: An interesting aspect of sexuality in later life is that the physiology of the male and female sexual response become more similar. As men age, they tend to be less responsive to visual stimuli alone and, like women, often times benefit from more foreplay and touch. Arousal and orgasm can take a bit longer to occur. Some older couples comment that, as a result, they find themselves in better synchrony and with more sexual satisfaction. Other couples, often those who are not aware of this, may feel distressed by these changes.

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Stacy Tessler Lindau: A question for chatters - we find in our study that some people (women more so than men) engage in sexual activity despite physical pain with intercourse and finding sex unpleasurable. I have some ideas about why this is, but I wonder what ideas others have.

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Washington, D.C.: I think those old codgers are bragging, is that statistic with or without ED medication?

Stacy Tessler Lindau: Although one in seven men reported ever using a medication to improve sexual function, most were not using these medications at the time of the study. There are many indications in the data that men and women are telling the same story. Furthermore, the data are very consistent with what we see clinically. I don't think there's a lot of bragging going on here.

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Glenn Dale, Md.: Thank you for such an enlightening study. My grandparents are sexually active. They are in their eighties, but their love and connection inspires us all to have the same in our marriages as we age too!

Stacy Tessler Lindau: My grandparents were an inspiration for me, too.

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Rob Stein: Stacy: The findings about health and sexuality were interesting, showing that healthier people were more likely to be sexually active. Do you think that only reflects the fact that illnesses can interfere with sex? Or do you think that remaining sexually active may promote health?

Stacy Tessler Lindau: Our study reports on people at one point in time. Although we see a strong association between sexuality and overall health, we don't know which causes which. As a physician, I certainly know that illness and medications or surgery used to treat illness can interfere with sexual functioning. But, I also see that treatment of illness can also make people feel better and therefore more able to engage sexually. Does a good sex life promote good health? I suspect it does. But to answer this scientifically, we would ideally follow people over time to better understand why and how this is.

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Rob Stein: Stacy, I was wondering what might be known about generational differences in attitudes about sexuality. With the Baby Boom generation aging, I was wondering they may bring different attitudes and expectations than earlier generations.

Stacy Tessler Lindau: The baby boomers bring a new face to aging in the U.S. and are influencing society in many ways. Baby boomers are the generation of the (first) sexual revolution and this is one influence that might mean they have different expectations with regard to sexuality than their older counterparts. Aging of the baby boomers demands that we take a fresh look at aging in the U.S., not just from the perspective of sexuality but more broadly. We have a lot to learn from older adults.

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To answer Stacy's Question: I'm a female in my thirties - but I wonder if it's because of a sense of duty to your spouse (especially older generations) - and through pure love - you want to please him.

My question back to you - did you find any situations where men found it uncomfortable but wanted to please their wife?

Stacy Tessler Lindau: Very few men reported pain with sexual intercourse as a problem. Our study only asked about specific sexual problems if a person was currently sexually active. Although we do have information about why people were not sexually active, we don't know specifically what kinds of sexual problems might have caused cessation of sexual activity. I wonder if men experiencing pain with intercourse are more likely to discontinue having sex altogether than women experiencing pain.

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NY, N.Y.: I may have been misreading, but did you say that you defined "sex" to the survey respondents as simply physical contact? So, could hugging or embracing then count towards the statistics you have documented?

Rob Stein: Sexual activty was defined as "any mutually voluntary activity with another person that involves sexual contact, whether or not intercourse or orgasm occurs."

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Rob Stein: One reaction I've heard to the findings was surprise that the rate of sexual activity did not change much with age. Is there a big difference between rates between those in their 20s versus their 30s or 40s or 50s?

Stacy Tessler Lindau: Likely, yes. Remember that the best data we have on sexual activity among younger adults in the U.S. are now nearly 15 years old. This, despite the fact that quite a bit has changed in those 15 years. Sexual behavior is at the root of many of the most important health issues in the U.S.and around the world - pregnancy, infertility, unwanted pregnancy, sexually transmitted infections including HIV/AIDS, even cervical cancer (a leading cause of cancer death among women in the developing world), sexual abuse and rape - yet we neglect to monitor sexual behavior in a rigorous and ongoing manner. If we look at the frequency of sexual activity by decade, we are sure to see that adults in their 20s with a partner have, on average, more frequent sex than adults in their 80s. This may be due to biological factors, social factors, logistical factors, etc.

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Tenafly, N.J.: Just a quick question on the methodology. How representative was your sample population with the demographic that is conventionally considered when we discuss "the elderly"?

Stacy Tessler Lindau: One of the major strengths of this study as compared to other studies of sexuality is that it involves a sample of U.S. adults ages 57-85 who were selected to be representative of the United States population of community-residing individuals in this age group. In addition, 75% of the people we approached agreed to participate. These are the first nationally-representative data available on sexuality in later life in the U.S.

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sexual activity despite physical pain: This describes my situation exactly, and I'm only 30! I engage in this activity for two reasons: 1. it is important to my partner, and 2. I realize that one must make sacrifices in one's relationship. I imagine that these are the same rationales for others.

Stacy Tessler Lindau: I hope that you might engage your physician in seeking evaluation and treatment of your pain.

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Maryland: In my situation, it's not a matter of wanting it or not wanting it, but a matter of medication that has caused my rather young (age 52) husband to lose interest and pretty much has gone into erectile disfunction mode. I'm sure since he can't "keep it up" (sorry for saying it that way but...), his interest just died. If on the very rare occasion I ask him to try, he will (bless his heart) but trust me, he can only last about a minute.

So, with that all said (how embarrassing?), he tried Viagra. He was scared because he didn't know what to expect...and neither did I. Within 20 minutes he was "up" (let's say) and actually performed very well. Unfortunately when he felt ready for the activity to be over, and I was in agreement, some 30 minutes later (remember we're use to once in a blue moon for about a minute), the erection just wouldn't go down. It took a few hours for it to subside.

Needless to say, we have not tried it again. Maybe for others it's a great help but for us, not our thing.

Stacy Tessler Lindau: I appreciate that you shared this experience. I think it probably resonates for many people out there. There are other alternatives to the particular drug you tried. I hope you and your husband, if interested, might engage your physician in seeking alternatives. Also, know that time away from intercourse can result in physical deconditioning, similar to lack of exercise. For women partners of men taking drugs to treat erection problems, resumption of sex may be improved with attention to vaginal moisturizing and lubrication products, exercises to regain hip and pelvic floor strength and flexibility, and sometimes even psychological preparation. We found that a large number of couples engaged in oral sex which may be one way to find sexual pleasure in addition to or as an alternative to vaginal intercourse.

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Washington, D.C.: Re: women having intercourse in spite of pain/lack of interest. Well, doesn't that happen at all stages of a woman's sexual life? Sometimes it's just a chore, or an obligation--such as after having a baby or when you're worn out from work and chasing the kids. He wants it, you don't especially, but you do it anyway. Is that the same thing going on for your study participants?

Stacy Tessler Lindau: Thank you for your thoughts. Yes, I suspect that many of the reasons older women engage in sex with their partners are very similar to the reasons younger women engage in sex with their partners. One way to think about aging is that older people are younger people later in life.

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Glenn Dale, Md.: (we find in our study that some people (women more so than men) engage in sexual activity despite physical pain with intercourse and finding sex unpleasurable. I have some ideas about why this is, but I wonder what ideas others have.)

I believe that women are willing to deal with mediocre sex lives because they are: (1) trying to spare his feelings; (2) "peer pressure" to maintain the image of a healthy relationship; or (3) he is a good provider, so they don't want to rock the boat. I personally know of women who hated sex with their spouses so they just dealt with it for these reasons. It's pretty sad.

Stacy Tessler Lindau: It's quite interesting to ponder what it might mean for women (or men) to engage in an activity as intimate as sex with their spouse and hate it at the same time. It's also interesting to me that in many places in the world, women almost never engage in sex for pleasure.

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Rob Stein: Thanks very much to everyone for you great questions and valuable comments. And thanks to you, Dr. Lindau, for taking the time to lend your expertise to this discussion.

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Stacy Tessler Lindau: I want to thank the Washington Post for an opportunity to interact with readers about this new study. I've learned a great deal today. Goodbye!

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