Elizabeth Loder: The sex lives of older people

Elizabeth Loder A recently published BMJ paper on sex at 70
attracted the attention of the medical columnist for the New York Times. It also caught the attention of NYT readers, as evidenced by the 100+ responses to the article that have so far been posted online.

The Swedish study reported on the results of four surveys done every 10 years beginning in 1971. In each survey, a representative sample of 70-year old Swedish men and women were queried about the quantity and quality of their sex lives. Over the years the questions stayed the same but the answers did not.

In general, with each successive survey, more seniors reported they were sexually active. Levels of reported satisfaction also increased over the years. Whenever a paper inspires this much interest from the public, we’re interested.

We published the paper because we were persuaded that it would improve doctors’ awareness of sex in the elderly. We were also persuaded that they probably need reminding. The editor in charge of research recounted the view of a patient advocate she’d once heard talk who “memorably said that doctors when they are looking at people with Parkinson’s Disease look above the waist and what patients care about is below the waist.”

At least some NYT readers agreed that the reminder was needed: “…younger people don’t seem to believe that those who are 50, 60 or 70+ years old still WANT to have (and ENJOY having!) sex regularly. Newsflash to the younger generation: plenty of older people have sex – good sex and often great sex! – despite wrinkles, arthritis and hip replacements!” But another reader raised the possibility that this emphasis on sexual activity might just be a new way to make old people feel inadequate: “… the media is more consistently reporting on seniors’ wonderful sexual lives … Since I am supposed to still feel sexual, as well as sexual pleasure, according to the current info out there, I am all the more alone in frustration, and feeling inadequate in my inability to compete with the rest of all these youthful, sexually active people.”

I compared NYT readers’ appraisals of the study with those of the BMJ editorial staff who saw it before publication. Like readers, editors were uncertain about the accuracy of self-reported information on sexual activity and its consistency over time. As one NYT reader asked, “Are more seniors having sex, or is it just that more seniors are willing to talk about it? … we are the product of the sixties when discussions about sex were more acceptable.” A like-minded BMJ editor commented that “It’s impossible to know whether the survey results reflect actual increases in sexual activity and satisfaction, or just an increase in the number of 70-year old people who are willing to report on it.”

But as our clinical epidemiology editor noted at the manuscript meeting, this is a limitation inherent to the subject: “What else are you going to do other than self report?” We settled on making sure that the authors were candid about these limitations and would prominently acknowledge that “it’s just a survey of what people are willing to say.”

The fact that a larger percentage of 70-year old men than women reported being sexually active did not escape the notice of either readers or editors either, but it was readers who came up with the best explanation. They pointed out that 70-year old men are likely, on average, to have partners who are younger than they are, while 70-year old women are more likely to be without partners or to have partners who are older. A small but vocal group of more cynical NYT readers, though, suggested that men might also be more likely to lie, use Viagra, or pay for sex.

Interestingly, readers didn’t discuss one aspect of the study that bothered a number of editors, which was the absence of any questions about masturbation, erectile dysfunction, and orgasm in men. Those omissions mean that the study does not provide information about important aspects of sexual activity. Editors and readers alike recognized that the reported changes may result from improvements in seniors’ health or societal attitudes towards sexual activity in seniors. Before we published the paper, our statistician asked the authors to account for some of these changes in their analysis. She noted, for example, that in addition to improved health in elderly people, rates of cohabitation and divorce had also changed over the years, perhaps providing more opportunities for sexual activity.

Ultimately, we can never know for sure what the long term impact of a paper will be. In this case, though, the lively discussion that followed its publication makes clear that it’s had the intended effect of sparking discussion. The message was a predictably cheering one for older readers, and possibly too for younger ones who, after all, may someday be old. One mischievous 32-year old, bemoaning his own waning sex life, commented that he now hoped “…I’ll make it to seventy to get some.”

Elizabeth Loder is Clinical Editor (secondary care), BMJ.