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Men and women are increasingly likely to stay sexually active into later life, but research shows that sexual United Kingdom mature woman for sex and satisfaction decrease with increasing age. Ill health and medical treatments may affect sexual activity but there is little research on why some older people with a health problem affecting their sexual activity are satisfied with their sex life, and others are not. Overall, Among this group, women were less likely than men to be sexually active in the 6 months In follow-up interviews, participants sometimes struggled to tease out the effects of ill health from those of advancing age.

Where effects of ill health were identified, they tended to operate through the inclination and capacity to be sexually active, the practical possibilities for doing so and the limits placed on forms of sexual expression. In close relationships partners worked to establish compensatory mechanisms, but in less close relationships ill health provided an excuse to stop sex or deterred attempts to resolve difficulties.

Sex in later life

Most fundamentally, ill health may influence whether individuals have a partner with whom to have sex. When dealing with sexual problems in older people, practitioners need to take of individual lifestyle, needs and preferences. This is an open access article distributed under the terms of the Creative Commons Attributionwhich permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

The sponsors played no role in the study de, data interpretation, data collection, data analysis or writing of the article. Competing interests: The authors have declared that no competing interests exist. Attitudes towards, and experience of, sexual activity in later life have changed in recent decades.

Many men and women remain sexually active well into later life [ 1 — 5 United Kingdom mature woman for sex, and the proportion who do so is growing. Surveys show an increase over time in the proportion of 70 year olds who are sexually active, who see sexuality as a positive force in life and express satisfaction with their sex lives [ 6 ]. Several trends help to explain this. Men and women today live longer and reach older age in better health [ 7 ]; and—perhaps most notably—social attitudes towards sex in later life have relaxed. Today, sexual expression is increasingly recognised as important throughout the life course, in maintaining relationships, promoting self-esteem and contributing to health and well-being [ 8 — 10 ].

There is, nevertheless, evidence that sexual expression changes with increasing age. Studies have shown a decline in sexual function with advancing years [ 251112 ] and, more equivocally, a lessening of desire among women [ 613 ].

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Age-related decreases in sexual activity and satisfaction have been shown in a large of studies for both men and women [ 1351113 — 16 ]. The decline in sexual activity and satisfaction can be attributed to various factors including the loss of a long-term sexual partner; deterioration in a continuing relationship; changes in hormonal status; and alteration in physical appearance impacting on self-esteem and response [ 12616 ].

A key factor is the impact of declining health and medications for ill-health on sexual function [ 11115 ]. The list of conditions with the potential to impact on sexual activity and satisfaction is long and includes diabetes, cardiovascular disease, prostate cancer, chronic airways disease, musculo-skeletal disorders and neurological impairment, and some cancers [ 125131517 — 20 ]. Depression has also been shown to be associated with poorer sexual function, although cause and effect are not easily established [ 9121621 United Kingdom mature woman for sex.

The growing body of literature has been partly stimulated by the advent of phosphodiesterase-5 PDE-5 inhibitors i. With rare exceptions [ 2223 ], research on health and sexual dysfunction reflects a predominantly biomedical perspective, potentially overlooking key aspects of function such as the relational context and patient appraisal of whether a problem exists [ 24 ].

Many studies are clinically based, proximate to the recent experience of ill health, and document physician-based remedies rather than patient-centred solutions.

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There is little research on how older people themselves see their health as impacting on their sexual expression and how they respond to this. Empirical evidence is also lacking on why some older people who report having a health problem affecting their sexual activity are dissatisfied with their sex life, while others are not, or how the sexual response is influenced by relationship status and quality. As a result, there is little to guide practitioners in helping to improve sexual satisfaction and experience among older men and women with health concerns.

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This study had two aims: to explore how older people see their health status as having influenced their sexual activity and satisfaction; and secondly, to further understanding of how they respond and deal with the consequences. We carried out a mixed method study that integrated data from the third British National Survey of Sexual Attitudes and Lifestyles Natsal-3 with follow up in-depth interviews drawn from a sub-sample of participants aged 55—74 years who reported in the survey having a health condition which affected their sex life in the last year.

We describe the prevalence of sexual activity and satisfaction among this group, and draw on in-depth interviews to explore ways in which health can impact on sexual activity and satisfaction. In combining qualitative and quantitative data we sought to exploit synergies between different approaches to examining the same phenomena.

United Kingdom mature woman for sex qualitative data were used to illuminate associations found in the survey data and findings from the qualitative research were, in turn, used to shape analysis of the survey data. Natsal-3 is a probability sample survey of men and women aged 16—74 years living in private households in Britain.

Overall, 15, adults were interviewed, of whom 3, were aged between 55—74 years at interview. The response rate for Natsal-3 was Full details of Natsal-3 methods have been reported elsewhere [ 2526 ]. Body mass index BMI was calculated from self-reported height and weight, and mobility was assessed by asking about ease of walking up a flight of stairs.

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United Kingdom mature woman for sex variables included whether participants had vaginal intercourse, oral sex or genital contact without intercourse in the last six months and satisfaction with the current amount of sexual activity. The prevalence of having had a health condition or disability, or taken any medication, in the last year which affected sexual activity or enjoyment was estimated among Natsal-3 participants aged 55—74 years.

Among the sub-group of participants reporting health conditions, disability or medication affecting their sex life, we estimated sexual activity in the last six months, and satisfaction with current sex life, in relation to selected lifestyle, health-related and relationship factors. Regression analysis was used to adjust for age and relationship status. Analyses were carried out using the complex survey functions of Stata version 14 and were weighted to adjust for the unequal probabilities of selection and for differential non-response. Participants eligible for the qualitative study were the men and women aged 55—74 years who reported in Natsal-3 having had, in the last year, a health condition or disability, or taken any medication, affecting their sex life.

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A sample was drawn, guided by: the recency with which Natsal-3 interviews had been conducted; the need for roughly equal s of men and women; and a geographical spread across Britain reflecting the quantitative survey. Governing the final sample size was the need to achieve sufficient variation in individual experience to explore the issues of interest and ensure saturation of themes.

Letters were sent to participants inviting them to take part in a further interview, followed by a phone call from a researcher to explain the purpose of the interview, check on willingness to take part and arrange interviews. Participants gave ed consent and were provided with an information sheet and a list of agencies from which they could seek advice on topics raised.

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The United Kingdom mature woman for sex, age and relationship status of the participants are shown in Table 1. The topic guide, refined during fieldwork, explored: perceptions of the relationship between health status and sexual activity and enjoyment; how health issues affected sexual activity; the relationship context; and action taken by participants in response to health-related sexual problems.

We undertook a thematic analysis drawing on principles of grounded theory e. Key themes emerged from close reading of transcripts, and open coding of transcript portions, focusing on excerpts that illuminated the relationship between ill-health and sexual frequency and satisfaction. The coding frame emerging from this exploratory phase included higher order e. Grouping of higher order and lower order themes was guided by the need to explore the nature of the association between health and sexual activity and enjoyment, the ways in which participants saw health conditions impacting on their sexual activity and enjoyment, and their responses to this.

Among Natsal-3 participants aged 55—74 years, roughly one in four men The prevalence was considerably higher among women with a cohabiting or steady partner compared with those without, a difference which was less marked among men. Those with lower self-rated health and mobility, with higher BMI men onlywith more self-reported chronic conditions, or with reported longstanding illness or disability were more likely to report having a health condition affecting their sexual activity or satisfaction.

Among the sub-group of those participants aged 55—74 years who had a health condition, The proportion reporting recent sexual activity was higher among men and women aged 55—64 years compared with those aged 65—74 years but there were no age-related differences in sexual satisfaction.

The proportion reporting recent sexual activity was more than four times as high, and the proportion who were satisfied with their sex lives was nearly twice as high, among those who were cohabiting or in a steady relationship compared with those were not Tables 3 — 6. Among this sub-group, self-reported general health was still strongly associated with recent sexual activity, especially for men. For men, but not women, a similar association was found for longstanding illness; the adjusted odds for recent sexual activity for men reporting a limiting longstanding illness was 0.

Individuals were more likely to report recent sexual activity if they reported no mobility difficulties men and women ; normal weight compared with being obese men only ; having no depressive symptoms men only ; or being employed compared with retired.

Sexual activity in the past six months was associated with the use of medication to aid sex men only ; seeking help regarding their sex life men and women ; and finding it easy to talk to their regular partner about sex women only. By contrast, after adjustment for age and relationship status, satisfaction with sex life showed no ificant association with self-reported general health or with any other physical health variables.

Satisfaction was most strongly associated with sexual activity in the past 6 months. Adjusted odds United Kingdom mature woman for sex satisfaction with sex life were much higher among both men and women reporting sexual activity in the past 6 months compared with the sexually inactive with adjusted odds of 3.

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The magnitude of the difference was considerably greater for having vaginal intercourse compared with oral sex or genital stimulation, particularly among men. Men and women were also much more likely to be satisfied with their sex life if they felt that the frequency of sex was about right with adjusted odds of 8. Experiencing depressive symptoms was ificantly associated with lower odds of sexual satisfaction in men, but not women, and those who found it easy to communicate with a partner about sex were more likely to be satisfied.

For women but not men in a steady or cohabiting relationship, after adjusting for age, satisfaction with their sex life was associated with feeling happy in the relationship.

While the associations between age, health and sexual activity observed in the survey data were also evident in the in-depth s, many participants found it difficult to separate the effects of declining health from those of increasing age. Ill health was seen as accelerating an inevitable decline in sexual activity with age which made it easier to accept:. Participants often found it difficult to elaborate on the link between ill health and sexual activity in the in-depth interviews.

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Establishing cause and effect required them to retrieve information on two aspects of the association: first, specific health conditions to which changes in sexual activity might be attributed, and second, the sequence in which these events had occurred.

Both posed challenges.

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For some, the multiplicity of ailments, and variation in timing of onset and severity, created problems for attribution and recall. Rarely were symptoms of ill-health experienced in isolation from one another, and it was hard for participants to isolate their effect.

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But likes of nowyou knowbeing with the combination of maybe being oldermy TIA [transient ischaemic attack] may have had an effect. With regard to timing, it was not always possible to recall the sequence in which health-related events had occurred, particularly where the onset of ill health had been gradual and symptoms intermittent.

Similarly, where the onset of ill health occurred simultaneously with life events such as bereavement M3it was difficult to disentangle the influences and assert attribution. Despite the uncertainties around the order of events and precise causes of sexual difficulties, most participants were able to describe specific ways in which they felt aspects of their health had affected their sex lives.

For some, the health condition impacted directly on the capacity to have sex.

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Nine of the 11 men M1, M2, M3, M4, M6, M7, M8, M10, M11 United Kingdom mature woman for sex one woman M13 in relation to her partnersaw illness or medication as having led to erectile problems, making penetrative intercourse difficult or impossible to achieve. For two women, conditions that caused sex to be painful, such as cystitis W8 and severe back pain W2had a direct bearing on sexual frequency and enjoyment. As conventionally practised, sexual activity requires a degree of agility, and musculo-skeletal deterioration, accidental damage, or the aftermath of surgical procedures were reported in more than one as restricting mobility W2, W9.

Medication and procedures aimed at alleviating health conditions were also seen as having had a direct and detrimental effect on sexual enjoyment M2, W1, W4, W8. Complicated treatment regimens interrupted the spontaneity of sex. One woman described the impact of remedies for her gynaecological problems—a vaginal ring for uterine prolapse and sanitary p for her weak bladder:.

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For others, health-related factors were less direct. Changes to sleeping arrangements, initially intended as temporary, sometimes became permanent. A woman who had recently undergone a hysterectomy asked her husband to move to a separate bed because she was afraid he would knock her stitches and he had never moved back in W1.