Sexual Activity of Older Adults: A Systematic Review of the Literature

Abstract

Objective: The goal was to conduct a literature review of studies that examined sexual activity in older adults. Method: A systematic search was conducted to identify studies that had examined sexual activity in adults aged 60 years and older. The main characteristics of each study and results were examined and reported according to PRISMA guidelines. Results: Sixty-three articles were found. These articles were classified into three main groups based on the results they presented: percentage of older adults that were sexually active; frequency of sexual activity; and type of sexual activities. The results show that older adults are sexually active, engage in frequent sexual activity, and participate in a wide variety of activities. Conclusions: Although older adults remain sexually active, differences in the way sexual activity is assessed limit the drawing of firm conclusions and our understanding of the sexual activity of older adults. We propose a series of recommendations to gain a better understanding of this topic.

Despite popular conceptions, people both engage in and enjoy sexual activities well into older adulthood (Bortz & Wallace, 1999; Choi et al., 2011; Fischer et al., 2020). Due to the cultural stereotypes that older people are asexual or that sexuality in later life is undesirable (Hillman, 2012; Ussher et al., 2015), sexuality research has excluded older adults from analysis and research about sexual activity in this population is lacking. However, increasing health, wellness, and longevity in developed nations is making it increasingly important to understand how older adults engage in and experience sexual activity. Therefore, the goal of this study was to conduct a literature review of studies that examined the sexual activity of adults aged 60 years and older.

It is important to understand the sexual lives of older people given that they are known to remain sexually active (DeLamater & Moorman, 2007; Lindau et al., 2007) and are making up an increasing large subsection of the population (United Nations Department of Economic & Social Affairs, 2022). Although much research has already been conducted on this topic (see Bell et al., 2017), our understanding of the sexual activity of older adults remains unclear. One of the main limitations is that, currently, there is no agreement about how to operationalize and assess sexual activity in the elderly. This is a problem because different operationalizations impede the comparison of results across studies. Even similar operationalizations can lead to different results when different time frames are used in the assessment of sexual activity. Furthermore, disagreements about how to best operationalize sexual activity has also impeded the development of standardized measures of the sexual activity of older adults. Meanwhile, the vast majority of researchers have simply resorted to creating their own questionnaires, which can introduce bias in the results as well as make it difficult to replicate studies.

A second limitation typically found in the literature is that intercourse is overemphasized as the so-called ‘de facto’ sexual activity. That is, most research on sexual activity focuses on sexual intercourse only, ignoring that older adults have broad and varied sexual repertoires that encompass multiple forms of sexual expression (Santos-Iglesias et al., 2016). Studies have also tended to ignore that older adults engage in non-genital sexual activity more frequently than in genital activity. Therefore, there is potentially a great spring of information available about the sexual activity of the older adult population that has been left uncovered. This is important to correct because an over-focus on sexual intercourse may not adequately represent the benefits elderly people receive from other sexual behaviors, since a broad sexual repertoire is associated with greater sexual satisfaction (Gillespie, 2017).

The present study

More efforts are needed to understand how older adults engage in sexual activity. This can only be accomplished by understanding how past and current researchers have defined and measured sexual activity within this population. Such an understanding of sexuality will inform about the strengths and limitations in past research and how to move forward to further our understanding of sexual activity in older adults. Therefore, the aim of this study was to conduct a literature review of studies that examined the sexual activity of adults aged 60 years and older.

Method

Literature search

This study was conducted according to the PRISMA statement (Page et al., 2021), which is a set of criteria used to maintain transparency and standardization across systematic reviews. A literature search was conducted from August 2021 to August 2023 through PsycINFO, PsycARTICLES, PubMed, and Google Scholar. The literature search was limited to the title and abstract of original, empirical, and quantitative journal articles (excluding literature reviews) that were published or in-press in English. No date restriction was imposed on this search. Different, comparative synonyms were used for the key terms of older adults (elderly, geriatric, geriatrics, aging, senior, seniors, older people, aged 65, 65+), sexual activity (sexual behaviors), and sexual frequency. The Boolean operator “AND” was used between the key-term older adults (and related terms, indicated above) and each of the other key-terms. That is, the first search was older adults AND sexual activity, followed by older adults AND sexual behaviors, and thirdly older adults AND sexual frequency. After completing this initial search, the comparative synonyms for older adults listed above were used in a similar procedure. That is, we then searched for elderly AND sexual activity, elderly AND sexual behaviors, elderly AND sexual frequency etc. for each of the older adult synonyms identified. This procedure was replicated in each of the four databases. Two reasons were behind this search strategy: (1) To reduce the large number of initial search results to a smaller, more manageable pool of studies and (2) to retain publications that focused on the sexual activity of older adults specifically, rather than those of middle-aged adults or any other age-defined demographics.

Screening, inclusion criteria, and data extraction

Once the initial search had been completed, the abstracts of the articles were screened to ensure that they met the inclusion criteria. If this information was unclear after having read the abstract, then the full text was reviewed. This was done by the first author of the article (Joshua Cameron). Articles were included if they met the following inclusion criteria: (1) empirical study published in a journal article in English; (2) the authors assessed sexual activity quantitatively and provided results about sexual activity within the article; (3) the article indicated collecting informed consent from participants or used data that had been collected with informed consent; and (4) the sample included adults aged 60 or older; studies including younger samples were included as long as the results were stratified by age and results were presented separately for those 60 years of age or older (in this case, only results from older adults are reported). Once an article was marked as meeting these inclusion criteria, the following information was extracted from each article (whenever possible): author name(s); publication year; sample size (including a breakdown by gender); age range, mean and standard deviation; information about how sexual activity was assessed, including any standardized measures used, operationalization of sexual activity, response scale used, time frame used, and any data transformation that was used (e.g., recoding, summing scores, etc.); and main results about sexual activity, including age and gender differences. This was done by the first author (Joshua Cameron) and later reviewed by the second author (Pablo Santos-Iglesias). Any discrepancies were discussed by the authors and decisions were made based on mutual agreement.

Results

A total of 2,712 articles were initially retained after having systematically searched the databases described above. Out of them, 2,133 articles were removed as either duplicates or after having screened the study title to see if the paper met our inclusion criteria, leaving 579 articles for further analysis. Next, we screened the abstracts to see if the paper met the inclusion criteria. An additional 492 articles were excluded after completing this procedure, leaving 87 candidate studies. Finally, we read the entire article to determine whether the study met the inclusion criteria. 24 articles were removed in this stage, leaving a final of 63 articles to be included in the literature review. Please see Figure 1 for a visual representation of this article exclusion process.

Figure 1.

A visual depiction of our exclusionary procedures and number of articles excluded at each step.

The sample sizes of these studies varied widely, ranging between 40 and 4,111 participants. The year of publication for these studies ranged between 1981 and 2022. All of the studies used a cross-sectional design, except for one longitudinal study (Ekström et al., 2018), and three birth cohort studies (Beckman et al., 2008; 2013; Twenge et al., 2015). Most of the studies assessed sexual activity using ad hoc methods. Among them, many did not define sexual activity clearly to participants. Instead, they asked participants to simply report their “sexual activity”, “sexual acts”, “sexual behaviours”, etc., without providing a clear definition of these terms to participants. When sexual activity was defined to participants, most often it was operationalized as a list of different sexual activities (e.g., masturbation, anal sex, and oral sex) or as sexual intercourse (more details will be provided in the Results section). There is only one study (Flynn & Gow, 2015) that used a standardized measure, the Sexual Behavior Frequency Scale (Ginsberg et al., 2005). Overall, the results of these studies were grouped into three major categories according to the way they operationalized, assessed, and reported sexual activity: (1) Percentage of older adults that were sexually active (n = 28), (2) frequency of sexual activity (n = 26), and (3) type of sexual activities (n = 17).

Percentage of older adults that were sexually active

A total of 28 studies examined sexual activity as a dichotomy by asking their participants whether they were sexually active and/or by dichotomizing responses into active vs. non-sexually active. All the studies within this group used ad hoc questions to evaluate sexual activity. Out of these studies that examined sexual activity as a dichotomy, most (n = 17, 60.7%) assessed sexual activity by asking participants whether they participated in sexual relations, practiced sex, were sexually active, had sex, etc., without providing a definition of these terms. Six studies of the 28 in this category (21.4%) provided operational definitions of sexual activity by referring to a list of several sexual activities. Among them, one study included only a couple of activities (e.g., intercourse and masturbation) (Hsu et al., 2016), whereas other studies included a more comprehensive list of sexual activities (e.g., masturbation, intercourse, oral, and anal sex) (Alzona et al., 2013). Finally, five studies of the 28 assessing sexual activity as a dichotomy (17.9%) operationalized sexual activity exclusively as sexual intercourse.

The results show that older adults remain sexually active. However, there was a wide diversity in the percentages reported across studies (see Table 1). Some studies reported that only 13% of the sample were sexually active (Thompson et al., 2011) whereas other studies found that around 90% of the sample had engaged in sexual activity (Fischer et al., 2021; Træen et al., 2017). This wide range depends on the methodology used to assess sexual activity, as well as the age and gender of participants. For example, among the studies that did not provide operational definitions of sexual activity, the percentage of sexually active older adults ranged between 13% and 60% for women (Mardi et al., 2019; Thompson et al., 2011), and between 26% and 74% for men (Freeman & Anglewicz, 2012; Trudel et al., 2014); a disparity of almost 50% between the lowest and highest estimates. Among the studies that provided operational definitions of sexual activity, estimates were lower for studies that included narrower definitions (Hsu et al., 2016; Smith et al., 2007) than for those that included broader definitions (Palacios-Ceña et al., 2012; Træen et al., 2019). For example, Smith and colleagues defined sexual activity as ‘sexual intercourse and other activities involving stimulation of the genital region’ and found that 18% of women and 41% of men were sexually active. Conversely, Palacios-Ceña et al. (2012) defined sexual activity as kissing and hugging, vaginal intercourse, oral sex, or masturbation and found that 37.4% of women and 62.3% of men were active.

Table 1.

Results from studies that examined whether older adults were sexually active or not (n = 28).

Authors (year)	Sample	Age	Assessment of Sexual Activity	Results
Alencar et al. (2016)	N = 235 (224 women)	60 years and over	Participants indicated whether they practiced sex (n.d.).	32.3% (73 women and 3 men) indicated that they practiced sex.
Almeida et al. (2015)	N = 1,649 men	M = 83.9 (SD = 3.0) Range = 80-93	Participants were considered sexually active if they had sex (n.d.) at least once during the past year.	64.7% (n = 1067) of participants reported no sexual activity in the past year.
Alzona et al. (2013)	N = 104 (63 women)	M = 68 Range = 60-84	Participants were considered sexually active if they reported any sexual act in the past three months. Sexual acts were defined as masturbation, intercourse/coitus, oral or anal sex.	(1) 24% (18 men and 7 women) were sexually active. (2) Those sexually active were between 60-74 years old; older women and men were more likely to be non-sexually active.
Beckman et al. (2008)	N = 1,509 (946 women)	70 years and over	Whether they had intercourse in the last year. Intercourse was defined as sexual contact between individuals, most often with penetration.	(1) Intercourse was more common among men than among women. (2) The proportion of 70-year-olds reporting that they were sexually active increased during the study period. (3) Among those reporting intercourse, the proportion that had intercourse at least once a week increased over the 30-year period.
Beckman et al. (2013)	N = 1,407 men and women	70 years old	Whether they had intercourse (n.d.) during the last year.	(1) 38% (n = 529) were sexually active. (2) 55% of men (n = 528) and 27% of women (n = 879) were sexually active.
Chen et al. (2007)	N = ,2453 (1,206 female)	M = 69.7 (SD = 3.4)	Whether they participated in sexual activity (n.d.).	(1) 31% (n = 766) indicated being sexually active. (2) 42% of men (n = 527) and 20% of women (n = 239) were sexually active.
Cismaru-Inescu et al. (2022)	N = 511 (297 female)	70 years and over Range = 70-99	Whether they were sexually active or indicated physical tenderness. Sexual activity was not restricted to sexual contact with penetration, but also included masturbation, oral sex, etc. Physical tenderness was defined as cuddling and hugging.	(1) 31.3% (n = 160) were sexually active. (2) 47.3% (n = 166) of those sexually inactive reported engaging in physical tenderness in the prior 12 months. (3) Sexual activity was positively associated with younger age.
Egbewale and Adebimpe (2020)	N = 491 (385 female)	M = 66.9 (SD = 7.3)	Whether they had sex within the past 12 months. Sex was defined as intercourse.	(1) 15.9% (n = 78) indicated that they had sex within the last 12 months. (2) Men were about 9.9 times more likely to have had sexual intercourse compared to women. (3) Men were 2.6 times more likely to be sexually active compared to women.
Ekström et al. (2018)	N = 798 (372 female) at T1 N = 511 at T2 (2-year follow-up)	M = 76.4 (SD = 5.8) at T1	Whether they were sexually active (n.d.).	(1) 28.7% (n = 229) were sexually active at T1. (2) 25.6% (n = 131) were sexually active at T2 (two years later).
Freeman and Anglewicz (2012)	N = 465 (256 women)	65 years and older	Whether they had sex (n.d.) during the past year.	(1) 26.7% (n = 68) of the women and 73.8% (n = 154) of the men had sex during the past year.
Freak-Poli et al. (2017)	N = 2,374 (1,399 female)	65 years and older	Whether they were sexually active (n.d.) within the last six months or whether they engaged in physical tenderness in the last six months. Physical tenderness was defined as fondling or kissing.	(1) 44.8% of men (n = 437) and 20.9% of women (n = 292) were sexually active. (2) 75.7% of men (n = 738) and 45.4% (n = 635) of women engaged in physical tenderness. (3) Men were more likely to engage in sexual activity than women. (4) The younger group (65-75 years) engaged in more sexual activity and physical tenderness than the older group (75+ years).
Fischer et al. (2020)	N = 1,354 (677 dyads)	M = 67 Range = 60-75	Whether they engaged in sexual intercourse, masturbation, petting, or fondling within the last year.	(1) 89% (n = 574) of men and 86.7% (n = 541) of women were sexually active.
Howard et al. (2006)	N = 234 women	Range = 60-79	Whether they were involved in sexual activity (n.d.).	(1) 51.6% (n = 63)a of the 60–69-year age group were sexually active (2) 20.5% (n = 23)a of the 70–79-year age group were sexually active
Hsu et al. (2016)	N = 1,705 men	Aged 70 and older	Whether they had sexual activity over the last month. Sexual activity was defined as engaging in intercourse or masturbation.	(1) 56% (n = 682) were sexually active.
Knodel and Chayovan (2001)	N = 920 (134 women)	Aged 60 and older	Whether they were sexually active (n.d.) during the previous month and year. Frequency of coitus in the previous month.	(1) Between 0%b and 40.2% of both married and unmarried men were sexually active in the past month, and between 5% and 73.4% were active in the past year. (2) For women, between 1.8% and 25.8% were active in the past month and 12.4% to 53.2% were active in the past year.
Mardi et al. (2019)	N = 380 women	M = 71(SD = 6.8) Range = 60-87	Whether participants had sexual relations (n.d.) during the last 4 weeks.	(1) 60% (n = 228) were sexually active. (2) Sexually active women were on average 12 years younger than sexually inactive women. (3) Most sexually active women were in the group of 60-69 years whereas the sexually inactive women were in the group above 80 years.
Marsiglio and Donnelly (1991)	N = 807 men and women	60 years and older	Whether they had sex (n.d.) at least once over the past month.	(1) 52.4% (n = 423) were sexually active (2) 54% (n = 427) of men and 51% (n = 380) of women were sexually active. (3) 65.3% (n = 221) of those 60-65 years old and 43.8% (n = 202) of those 66 years and older were sexually active.
Momtaz et al. (2013)	N = 1,046 (403 women)	M = 67.31 (SD = 6.06) Range = 60-92	Whether they had intercourse (n.d.) during the last year.	(1) 62.1% (n = 399) of men and 50.6% (n = 204) of women indicated that they were sexually active. (2) Female gender and older age were significantly negatively related to sexual activity.
Olatayo et al. (2015)	N = 100 (24 women)	M = 66.42 (SD = 5.77) Range = 60-83	Whether they engaged in sexual activity (n.d.).	(1) 53.9% (n = 41) of men and 29.2% (n = 7) of the women engaged in sexual activity. (2) More men than women engaged in sexual activity.
Palacios-Ceña et al. (2015)	N = 1,939 (1,118 women)	Women M = 74.5 (SD = 6.3). Men M = 73.5 (SD = 6.2)	Whether they had a sexual practice with a partner during the past 12 months. Sexual practice was defined as engaging in kissing and hugging, vaginal intercourse, oral sex, or masturbation.	(1) 62.3% (n = 512) of men and 37.4% (n = 418) of women reported being sexually active. (2) More men than women were sexually active.
Smith et al. (2007)	N = 50 (28 women)	M = 81 (SD = 6.0)	Whether they were currently sexually active. Sexually active was defined as engaging in sexual intercourse including penetration, as well as other sexual activities involving stimulation of the genital region of oneself or one’s partner.	(1) 41% (n = 9) of the men and 18% (n = 5) of the women were sexually active.
Stentagg et al. (2021)	N = 1680 (959 female)	60 years and over Range = 60-96 Median = 78	Whether they were sexually active within the last year (n.d.). Response scale was ordinal (no; yes sometimes (occasionally); yes, about once a month (regularly); yes, about once a week or every day (often)) and was dichotomized to sexually active vs. not active.	(1) 46% (n = 654) were sexually active (2) Sexual activity was more commonly reported by men (55%, n = 334) than by women (40%, n = 320). (3) There was a decline of sexual activity with age.
Thompson et al. (2011)	N = 1,235 women	M = 73.6 (SD = 7.2) Range = 60-89	Whether sex (n.d.) was a part of their life during the past six months.	(1) 51.7% (n = 201) of women aged 60-69, 32.6% (n = 184) of women aged 70-79, and 13.5% (n = 38) (of women aged 80-89 said that they were sexually active. (2) These differences are significantly significant, indicating a significant decline of sexual activity with age.
Træen et al. (2017)	N = 1270 (676 men) from Norway N = 1,045 (530 men) from Denmark N = 990 (318 men) from Belgium N = 509 (236 men) from Portugal	Range = 60-75	Whether they engaged in sexual activity within the last year. Sexual activity was defined as engagement in intercourse, masturbation, or petting/fondling.	(1) Between 60.9% (n = 453) and 78.4% (n = 458) of women and between 82.9% (n = 210) and 90.6% (n = 615) of men were sexually active. (2) Older men in Norway and Belgium were less likely to be sexually active than younger men. (3) Older women were less likely to be sexually active than younger men in Portugal and Denmark.
Trudel et al. (2014)	N = 788 men and women	Women (M = 73.30) Men (M = 75.90)	Whether they had sexual activity (n.d.).	(1) 67.8% (n = 534) engaged in hugging/caressing at least once a week. (2) 26.1% (n = 47)a of men and 28.1% (n = 54)a of women reported sexual activity over the last year.
Tsatali and Tsolaki (2014)	N = 265 (140 women)	M = 72 (SD = 1.7) Range = 60-85 years	Whether they were sexually active (n.d.) during the last year.	(1) 30.5 % (n = 43) of women and 50.4% (n = 63) of men were sexually active.
Wang et al. (2008)	N = 616 (204 women)	M = 72.49 65 years and older	How many times they engaged in sexual activity (n.d.) over the last year. Masturbation was also assessed, but no details are provided.	(1) 35.71% (n = 220) were sexually active. (3) 19.55% (n = 43) of the sexually active participants also masturbated.
Wong et al. (2009)	N = 1,561 men	M = 75.5	Whether they had intercourse (n.d.) over either the previous 4 weeks or the previous 6 months.	(1) 18% (n = 283) had sexual intercourse within the past 4 weeks. (2) An additional 12.3% (n = 192) had sexual intercourse over the past 6 months.

Note: n.d. indicates that the meaning of this term was not defined to participants. ^aThese numbers were not provided by the original authors, instead they were calculated for this literature review; ^b Sample size not reported in the article.

Estimates of the number of older adults that are sexually active also varied by gender and age. Regarding gender, older women appear to be less sexually active compared to older men, which was found to be well-supported by multiple studies (Beckman et al., 2008; Chen et al., 2007; Egbewale & Adebimpe, 2020; Momtaz et al., 2013; Olatayo et al., 2015; Palacios-Ceña et al., 2012; Papaharitou et al., 2008). Beckman et al. (2008) showed that intercourse was significantly more common among men than women. Other authors indicated percentages of those sexually active by gender that were much closer to being equal (Fischer et al., 2021) or percentages that were not tested for statistical significance (Smith et al., 2007). One study found no differences between men and women; Trudel et al. (2014) found that 73.9% of men and 71.90% of women reported no sexual activities over the past year. Regarding age, results show that sexual activity amongst the older adult populations decreases with increasing age. For example, Mardi et al. (2019) reported that most sexually active women (48%) were in the age group of 60-69 years, and that sexually inactive women (44%) were in the age group of above 80 years. Thompson et al. (2011) found similar results, and the results of studies with a mixed-gender sample corroborate the results from the female-only sample studies (Howard et al., 2006; Papaharitou et al., 2008). This indicates evidence that the proportion of sexually active men and women is larger in younger groups than in older groups.

Frequency of sexual activity

A total of 26 studies presented results on the frequency of sexual activity. Among these, 42.3% (n = 11) assessed the frequency of sexual activity, sexual relations, etc., without providing definitions of these terms (Bortz & Wallace, 1999; DeLamater et al., 2008). Eleven studies out of the 26 assessing sexual activity as frequency (42.3%) operationalized sexual activity as either a list of sexual activities (e.g., vaginal intercourse, oral sex, or stimulation by hand) (Kontula & Haavio-Mannila, 2009) (n = 9, 34.6%) or by providing an actual definition (n = 2, 7.7%). For example, (Heywood et al., 2018) assessed the frequency of sex and defined sex as “any contact the participant felt was sexual, not just intercourse” (p. 298). Finally, three studies in this category (11.5%) assessed the frequency of sexual intercourse exclusively (Leigh et al., 1993) and one (3.8%) study assessed the frequency of masturbation only (Malakouti et al., 2012).

These studies also varied in the time frame used to assess sexual activity. Of these 26 studies, most assessed the frequency of sexual activity either during the last month (n = 11, 42.3%) (Štulhofer et al., 2019) or over the past year (n = 9, 34.6%) (DeLamater et al., 2008). One study of the 26 (3.8%) assessed the frequency of sexual activity in the past week (Bortz & Wallace, 1999) and another (3.8%) assessed the frequency of sexual activity in the past six months (Flynn & Gow, 2015). A final group of studies assessing sexual activity as frequency (n = 4, 15.4%) combined different time frames in their response scale. For example, Choi et al. (2011) assessed the frequency of sexual activity using the following scale: At least once a week; 2-3 times/month; 2-3 times/six months; 2-3 times/year.

Overall, the results vary greatly from study to study (see Table 2). Several studies showed lower frequencies of sexual activity among older adults. For example, in a study conducted by Spector and Fremeth (1996) the average frequency of dyadic sex (kissing, hugging, touching/caressing, or intercourse) was only 0.2 for men and 1.6 for women (out of 18 points). However, the authors attributed these low frequencies to living in long-term care facilities. Although not as low, Das (2017) also found that, on a scale from 0 (none at all) to 5 (once a day or more), the frequency of sex was only 1.1 for both men and women. Other studies reported moderate frequencies. Kolodziejczak et al. (2019) found the average frequency of sexual activity (defined as intercourse, exchanging caresses, and body contact) as being 2.37 on a scale from 0 (never before) to 4 (at least once per week). Fischer et al. (2020) found that, on average, older men and women in their study engaged in sexual intercourse (defined as vaginal, anal, or oral sex) between once a month and two to three times in the last month. Similarly, Heywood et al. (2018) found that more than 50% of the older men and women in their study had sex between 3-5 times and more than 6 times per month. Finally, there is also a reduced group of studies reporting high frequency of sexual activity. Bortz and Wallace (1999) found that up to 55% of the older adults in their sample between 60 and 69 years and up to 42% of those older than 70 years engaged in sex in the last week.

Table 2.

Results from studies that examined the frequency of sexual activity (n = 268).

Author(s)	Sample size	Age	Assessment of sexual activity	Results
Bortz and Wallace (1999)	N = 668 (213 women)	60 years and older	Times per week that they engaged in sexual intimacy (n.d.) or sexual intercourse (0, < 1, 1-2, 3+).	Sexual intimacy: (1) In the 60-69 years group, the percentages for women were 39% (0 times), 20% (< 1 time), 27% (1-2 times), and 14% (3+ times), and 16%, 28%, 33%, and 22% for men, respectively. (2) In the 70+ years group, the percentages were 62%, 10%, 15%, and 13% for women, and 21%, 25%, 35%, and 18% for men, respectively. Sexual intercourse: (3) In the 60-69 years group, the percentages were 42, 27, 24, 7 for women, and 21, 36, 35, 7 for men, respectively. (4) In the 70+ years group, the percentages were 64, 20, 10, 6 for women, and 29, 35, 32, 3 for men, respectively.
Choi et al. (2011)	N = 156 (40 women)	M = 71.47 (SD = 4.64) Range = 65-70	Frequency of sexual relations (n.d.). (At least once a week; 2-3 times/month; 2-3 times/six months; 2-3 times/year)	(1) 77.6% (n = 121) had sexual relations. (2) 19% (n = 23) had sexual relations at least once a week, 45.5% (n = 55) 2–3 times per month, 17.4% (n = 21) 2-3 times per six months, and 18.2% (n = 22) 2-3 times per year.
Das (2017)	N = 1,708	Range = 60-90	Frequency of sex (n.d.) (0 = none at all − 5 = once a day or more) and masturbation (0 = not at all − 9 = more than once a day) over the past 12 months.	(1) The frequency of sex was low for both males (M = 1.16) and females (M = 1.13). (2) Frequency of masturbation was very low for males (M = 2.03) and females (M = 1.08).
DeLamater et al. (2008)	N = 4,111 (1,955 women)	M = 64.3 (SD = 0.72) Range 62-67	How many times they had sex (n.d.) over the last 12 months. (Once a day or more, 3 to 6 times per week, once or twice a week, 2 to 3 times a month, once a month or less, and not at all).	(1) The average mean frequency of sex was 1.72 (SD = 1.12).
Fischer et al. (2021)	Norway N = 1,270 (594 women) Denmark N = 1,045 (515 women) Belgium N = 990 (672 women) Portugal N = 509 (273 women)	Range = 60-75	How many times they had or attempted sexual intercourse over the past month. Sexual intercourse was defined as vaginal, anal, or oral sex and definitions of these terms were given to respondents. (1 = none − 7 = more than once a day)	(1) For men, 27% of respondents form Norway, Belgium and Denmark reported a frequency of two or three times a month, whereas 30% of Portuguese men reported that they had sexual intercourse once a week. (2) For women, 27% of Norwegian and Belgium women and 20% of Danish women had sexual intercourse two to three times a month, whereas almost 25% of Portuguese women had sexual intercourse only once in the past month.
Fischer et al. (2020)	N = 2,695 (1303 women)	M = 67; Range = 60-75	How many times they had or attempted sexual intercourse over the past month. Sexual intercourse was defined as vaginal, anal, or oral sex and definitions of these terms were given to respondents. (1 = none − 7 = more than once a day)	(1) On average, men and women had sexual intercourse between once a month, and two to three times in the past month (M = 2.8 and 2.7, respectively). (2) Approximately half of the men had engaged or attempted sexual intercourse 2 or 3 times in the past month (25.5%) or once a week (20.3%). (3) Approximately 40% of the women had engaged or attempted sexual intercourse 2 or 3 times in the past month (23.8%) or once a week (18.1%).
Flynn and Gow (2015)	N = 133 (62 women)	M = 74 (SD = 7.1)	Sexual Behavior Frequency Scale (Ginsberg et al., 2005). Frequency of touching/holding hands, embracing/hugging, kissing, mutual stroking, masturbating and intercourse in the past 6 months. (0 = not at all − 4 daily). Six items summed to calculate total frequency of sexual behaviors.	(1) Men participated in an average of 10.23 (SD = 5.26) sexual behaviors in the prior 6 months, while females participated in an average of 8.85 (SD =4.67).
Glaude-Hosch et al. (2015)	N = 1,429 (47.4% women)	60 years and older	Frequency of sex (n.d.) over the previous year. (none, monthly or less, 2 or more times per month)	(1) 17.1% (n = 224) reported engaging in sex monthly or less, and 32.3% (n = 462) reported engaging in sex 2+ times per month.
Heywood et al. (2018)	N = 1,583 (456 women)	Aged 60 years and older	Frequency of sex during the past four weeks. Sex was defined as engaging in any contact the participant felt was sexual, not just intercourse. (0 – 6+ times)	(1) Most men had sex between 3-5 times (26.7%) and 6+ times (31.6%) in the past month. (2) Most women had sex between 3-5 times (25.3%) and 6+ times (29.1%) in the past month.
Hyde et al (2010)	N = 2,783 men	Range = 75-95	Frequency of sex (n.d.) during the past 12 months. (did not have sex, ≥ 1 time per week, 2 to 3 times per month, or ≤ 1 time per month)	(1) 5.2% had sex ≥ 1 time per week, 7.7% had sex 2-3 times per month, and 13.3 had sex ≤ 1 time per month.
Keil et al. (1992)	N = 2,283	Aged 65 and older	Frequency of sexual relations (n.d.) with a partner or sexual activities (n.d.) without a partner. (dichotomized at 3 or more times/month)	(1) Age was negatively related to the frequency of sexual activity.
Kim and Jeon (2013)	N = 3,360 (1,347 women)	Men: M = 67.34 (SD = 0.17) Women: M = 66.86 (SD = 0.20)	Frequency of sex (n.d.). (None, 1-2 per 6 months, 1-2 per 3 months, 1-2 per month, over 1 per week)	(1) For men, the most common frequencies were 1-2 per month (34.8%) and none (34.2%), whereas for women they were none (59.7%) and 1-2 per month (20.7%). (2) Male participants had more sexual activity than female participants (X2 = 40.66, p < 0.001)
Knodel and Chayovan (2001)	N = 920 (134 women)	Aged 60 and older	Whether they were sexually active (n.d.) during the previous month and year. Frequency of coitus in the previous month.	(1) On average men had coitus between 2.0 and 2.1 times in the past month, and women had coitus an average of 1.6 to 1.8 times.
Kolodziejczak et al. (2019)	N = 1,514 (757 women)	M = 68.15 (SD = 3.68) Range = 60 to 82	Frequency of sexual activity in the past 12 months. Sexual activity was defined as sexual intercourse, sex without intercourse, exchanging caresses, and body contact. (0 = never before − 4 = at least once per week).	(1) The average frequency of sexual activity was 2.37 (SD = 1.07) (2) Older age was associated with less frequent sexual activity (r = −.10, p < .01) (3) Women reported less frequent sexual activity than men (B = .19, p < .01).
Kontula and Haavio-Mannila (2009)	N = 373 (221 women)	Range = 65-74	Frequency of sexual intercourse over the last 30 days. Sexual intercourse was defined as vaginal intercourse, oral sex or stimulation by hand. (1 = not at all − 8 =every day or more frequently).	(1) 23% of men and 10% of women had sexual intercourse in a week. (2) Men had a higher frequency of sexual intercourse than women.
Kvalem et al. (2020)	Norway (n = 957) Denmark (n = 846) Belgium (n = 612) Portugal (n = 367).	Range 60-75	How many times they had or attempted sexual intercourse over the last month. Meaning of sexual intercourse defined as engaging in vaginal, anal, or oral sex. (1 = None, 2 = Once in the past month, 3 = 2 or 3 times in the past month, 4 = Once a week, 5 = 2 or 3 times a week, 6 = Once a day, and 7 = More than once a day)	(1) Average frequency of sexual intercourse was 2.58 (SD = 1.38) in women and 2.75 (SD = 1.38) in men.
Leigh et al. (1993)	N = 214	60 years or older	Frequency of sexual intercourse (n.d.) over the last 12 months. (Never, 1 time/month, 2 times/month, 1-2 times/week, 3-4 times/week, daily)	(1) In the 60-69 years group, 15.8% never had sex, whereas the majority had sex between once a month (25.8%), twice a month (28.8%), or 1-2 times a week (22.6%). Only 0.4% said daily (2) In the 70+ group, 31.1% never had intercourse, and 32.1% had sex one a month. Nobody reported having sex daily.
Lindau et al. (2007)	N = 1,985 (1,058 women)	Range = 65-85	Frequency of sex or sexual activity over the past twelve months. Both sex and sexual activity were defined as any mutually voluntary activity with another person that involves sexual contact, whether or not intercourse or orgasm occurs. (dichotomized to ≥ 2-3 times per month)	(1) 65.4% of the men and women in the 65-74 years group had sex ≥ 2-3 times per month. (2) 54.2% of the men and 54.1% of the women in the 75+ years group had sex ≥ 2-3 times per month.
Malakouti et al. (2012)	N = 384 (188 women)	Female: M = 64.6 (SD = 4.6) Male: M = 66.1 (SD = 5.3)	How many times they masturbated in the past month. (Not at all, rarely, usually, mostly)	(1) 25% of men (n = 49) and 8% of women (n = 15) have masturbated in the month preceding this study. (2) 7.2% of men and 5.3% of women masturbated ‘rarely’, 12.4% of men and 2.1% of women masturbated ‘usually’, and 3.1% of men and 0% of women masturbated ‘mostly’ in the past month.
Marsiglio and Donnelly (1991)	N = 807 men and women.	60 years and older	Frequency of sex (n.d.) with their husband/wife over the past month. (0,1,2,3,4,5,6,7,8,9,10, 11-19, 20-35)	(1) 8.7% reported engaging in sexual activity once in the last month, 11.1% said they had two encounters, 6.9% said three, 11.6% said four, 2.6% said five, 4.0% said six, 0.7% said seven, 2.8% said eight, 0.4% said nine, 1.6% said ten, 1.4% said between 11-19, and 0.9% said between 20-35. (2) Age was negatively associated with sexual frequency.
Palacios-Ceña et al (2012)	N = 1,939 (1,118 women)	Women: M = 74.5 (SD = 6.3) Men: M = 73.5 (SD = 6.2)	How many times they engaged in sexual practices with a partner during the past 12 months. Sexual practices were defined as engaging in kissing and hugging, vaginal intercourse, oral sex, or masturbation. (Two or more times a week, 2-4 times a month, once a month or less)	(1) In the 65-74 years group, 9.7% of men had sex 2+ times a week, 57.8% 2-4 times a month, and 32.57% once a month or less. The percentages for women were 12.7%, 44.5% and 42.8%, respectively. (2) In the 75+ years group, 2.6% of men had sex 2+ times a week, 52.6% 2-4 times a month, and 44.7% once a month or less. The percentages for women were 4.8%, 28.6% and 66.7%, respectively. (3) Those greater than 75 years had lower rates of sexual activity (p < .05).
Rodrigues et al. (2019)	N = 1,129 (59.7% women)	Aged 60 and older	Frequency of sexual practice (n.d.). (2-3 times/week, once/week, 2-3 times/month, once/month)	(1) 37.4% engaged in sex once a month, 27.5% once a week, 20.6% 2-3 times a month, and 14.5% 2-3 times a week.
Shkolnik and Iecovich (2013)	N = 200 (101 women)	M =7 3 (SD = 6.65) Range = 61-94	Frequency of sexual activity. A sexual activity score was the summed frequency of hugs and kisses, holding hands, sexual caressing, and sexual intercourse. (0 = not at all − 4 = every day).	(1) The average frequency of sexual activity for men was 7.53 (SD = 5.19) and 8.09 for women (SD = 5.19) (p = .44).
Spector and Fremeth (1996)	N = 40 (23 women)	M = 82.5 (SD = 5.6) Range = 69-95	Frequency of sexual behaviors in the past month. Sexual behaviors included both solitary (reading erotic and romantic books and magazines, masturbation) and dyadic (kissing, hugging, touching/ caressing, or intercourse) behaviors. (maximum score for solitary = 12, and dyadic = 18)	(1) Frequency of solitary sex was low in both males (M = 0.1) and females (M = 0.3). (2) Frequency of dyadic sex was low for both males (M = 0.2) and females (M = 1.6). (3) No differences between men and women were found.
Štulhofer et al. (2019)	N = 677	Range = 60-75	Frequency of or attempted sexual intercourse over the past month. (1 = none − 7 = more than once a day).	(1) The average frequency of sexual intercourse ranged from 2.60 to 3.06 in men, and from 2.43 to 2.80 in women.
Twenge et al. (2015)	N = 5,197	60 and older	The number of times they had sex (n.d.) during the last 12 months. (0 = not at all − 5 = More than three times a week).	(1) Sexual frequency was measured using a 0-5 scale. Means (SDs) are reported as follows (60-69 years old | 70 and older) for different cohorts: − 1989-1994: 1.98(1.74) | 0.86(1.37 - 1995-1999: 2.02(1.74) | 0.95(1.45) − 2000-2004: 1.99(1.69) | 0.93(1.51) − 2005-2009: 1.90(1.76) | 0.88(1.36) − 2010-2014: 1.81(1.73) | 0.96(1.42)

Note: n.d. indicates that the meaning of these terms was not defined to participants.

The results also showed that older women reported less frequent sexual activity than older men, regardless of how sexual activity was defined. Kim and Jeon (2013) found that men reported greater frequency of sex than women (Bortz & Wallace, 1999; Kolodziejczak et al., 2019; Kontula & Haavio-Mannila, 2009; Malakouti et al., 2012). Only one study assessing sexual activity as frequency reported a difference by gender that opposes this pattern of results. Spector and Fremeth (1996) found that the frequency of dyadic sexual activity over the past month for females was similar for men and women. However, it is important to note that this study showed extremely low frequency of sexual activity for both men and women (as reported above). Like other studies, as older adults increase in age, they report less frequent sexual activity. Bortz and Wallace (1999) reported that the frequency of intercourse, as well as sexual intimacy, declined with increasing age. Interestingly, Bortz and Wallace (1999) indicated that the men in their sample nevertheless had a high frequency of sexual and intimate behaviors at all ages. Every study that measured age-based differences in sexual activity found differences in sexual frequency favoring the young-old (Keil et al., 1992; Kolodziejczak et al., 2019; Leigh et al., 1993; Palacios-Ceña et al., 2012).

Type of sexual activities

Seventeen papers fell into this category and examined and reported on several sexual activities. The number of sexual activities assessed in these studies ranged from two to eight different sexual activities. There was a lot of diversity in the activities that were included in these studies that ranged from more affectionate, non-genital activities (e.g., holding hands, kissing) to more genitally focused activities (e.g., sexual intercourse, oral sex). All the studies assessed sexual intercourse. Masturbation was assessed in 14 studies out of the 17 in this category (82.4%), and non-genital activities were included in 10 studies (58.8%). Interestingly, one study assessed whether older adults used objects (sex toys) (Yang & Yan, 2016) and another study assessed the frequency of both watching films and reading magazines of sensual content (Papaharitou et al., 2008).

Some of these papers assessed what sexual activities older adults engaged in during a certain time frame (see Table 3). Adams and Turner (1985) asked older adults between 60 and 85 years to check the sexual activities they had engaged in from a list of activities including petting, masturbation, sexual intercourse, and ‘other’ sexual activities not listed. They found that 80% of the men and 61% of women in their sample said they pet, 67% of the men and 58% of women had sexual intercourse, 26% of the men and women masturbated, and 0% of the men and 2% of women engaged in ‘other’ activities. Minhat et al. (2019) found in their sample that around 97% engaged in holding hands and hugging, 93% kissed, 75% had sexual intercourse, while only 16% masturbated.

Table 3.

Results from studies that examined the type of sexual activities that older adults engage in (n = 17).

Study Name	Sample	Age	Assessment of Sexual Activity	Results
Adams and Turner (1985)	N = 102 (62 women)	Range = 60-85	Whether they engaged in petting, masturbation, sexual intercourse, homosexual relations, or other. (Yes/No)	(1) 80% of men and 61% of women said they pet; 26% of men and 26% of women masturbated; 67% of men and 58% of women had sexual intercourse; 0% of men and 5% of women had homosexual relations; and 0% of men and 2% of women engaged in ‘other’ activities.
Alzona et al. (2013)	N = 104 (63 women)	M = 68 Range = 60 − 80	Whether they engaged in masturbation, intercourse/coitus, oral sex, or anal sex. (Yes/No)	(1) Sexual intercourse was the most common sexual activity (76%), followed by masturbation (8%), and oral sexa.
Beier et al. (2020)	N = 751 (486 women)	M = 68.18 (SD = 3.71) Range = 60-84	Frequency of body contact, exchange of touching, sex without intercourse, or sex with intercourse in the last 12 months (0= never, 1 = not at all, 2 = less than once a month, 3 = at least once a month, 4 = at least once a week).	(1) The most frequent sexual activities for men and women were exchange of touching (M = 2.74), body contact (M = 2.69), sex with intercourse (M = 1.95), and sex without intercourse (M = 1.75). (2) Men experienced more frequent sexual activity across all categories than women (p ≤ 0.001).
Bretschneider and McCoy (1988)	N = 202 (102 women)	M = 86.1 (SD = 5.0) Range = 80-102	Whether they engaged in touching and caressing without having intercourse, sexual intercourse, masturbation, petting, breast suckinga, and oral sexa.	(1) 83% of men and 64% of women engaged in touching and caressing at least sometimes. (2) 62% of men and 30% of women had sexual intercourse at least sometimes. (3) 72% of men and 40% of women reported masturbation at least sometimes. (4) 85% of men and 47% of women had masturbated at least sometimes. (5) More men than women engaged in touching and caressing, sexual intercourse, and masturbation.
Ginsberg et al. (2005)	N = 166	M = 76 (SD = 6.8) Range = 61-92	Frequency of touching/holding hands, embracing/hugging, kissing, mutual stroking, masturbating and intercourse in the past 6 months. (0 = not at all − 4 daily).	(1) Most engaged in touching/holding hands (60.5%), embracing/hugging (61.7%) and kissing (57%) with some regularity (daily to at least once a month). (2) Mutual stroking (82.1%), masturbation (84.9%) and intercourse (90.3%) were experienced not at all by most participants.
Glaude-Hosch et al. (2015)	N = 1,429	60 years and older	Whether they received/gave oral sex, engaged in intercourse, or engaged in foreplay over the past year.	(1) 49% engaged in intercourse, 48.4% reported foreplay, 22.5% gave oral sex, and 21.5% received oral sex.
Maharani et al. (2021)	N = 98 (50 women)	62 years and older	How often they engaged in intercourse, hugging, kissing, and masturbation. (Never, occasionally, routinely)	(1) Hugging and kissing were the most frequent sexual activities, with 100% engaging in hugging and 96.9% engaging in kissing routinely or occasionally. (2) 88.8% engaged in intercourse either routinely or occasionally. (3) All participants reported ‘Never’ engaging in masturbation.
Martin (1981)	N = 188 men	M = 68.7 Range = 60-79	Whether they engaged in coitus or masturbation. (Yes/No)	(1) 39.7% of the least sexually active men had intercourse during the last year and 17.5% masturbated. (2) 88.9% of the moderately active group had intercourse during the last year and 20.6% masturbated. (3) 93.5% of the most active group had intercourse within the last year and 32.2% masturbated.
Minhat et al. (2019)	N = 160 (69 women)	M = 65.33 (SD = 5.87)	Whether they engaged in sexual intercourse, holding hands, hugging, kissing, and masturbation. (Yes/No)	(1) 97.4% reported holding hands, 97.4% reported hugging, 93% reported kissing, 74.6% reported sexual intercourse with a partner, and 15.8% reported masturbation.
Mulligan and Moss (1991)	N = 206 men	Range = 60-99	Frequency of vaginal intercourse, touching or caressing, oral sex, and masturbation. (5-point scale from low to high frequency)	(1) On average, engagement in touching and caressing occurred monthly. (2) Those aged 60-69 indicated that they had vaginal intercourse monthly, while older individuals reported having it yearly. (3) On average, they did not engage in oral sex (4) Those aged 90-99 said that they did not masturbate, while participants aged 60-89 indicated that they masturbated yearly.
Papaharitou et al. (2008)	N = 454 (180 women)	M = 69.04 (SD = 6.5) Range = 60-90	Frequency of intercourse, masturbation, watching films with sensual content, and reading magazines with sensual content. (Response scale not described)	(1) 67.4% of those aged 60-68 and 38% of those aged 69 or older had sexual intercourse. (2) 25.3% of those aged 60-68 and 16.7% of those aged 69 or older watched films with a sensual content. (3) More men than women masturbated (14.2 and 1.1%, respectively), watched sensual films (88.5% and 11.5%), and read sensual magazines (82.8% and 17.2%) (p < .001)
Santos-Iglesias et al. (2016)	N = 188 (89 women)	Range = 65-75	Frequency of three non-genital (kissing, hugging, and cuddling) and four genital (touching breasts and/or genitals, oral sex, vaginal penetration/intercourse, and anal stimulation/penetration) activities, and masturbation in the previous three months. (0 = not at all − 6 = more than once a day; genital and non-genital frequency were defined as the most frequent genital and non-genitally sexual activities, respectively).	(1) Older adults engaged in non-genital sex once a day (M = 5.04, SD = 1.26), in genital activities around once a week (M = 3.34, SD = 1.40), and in masturbation alone around 2 or 3 times in the last three months (M = 2.14, SD = 1.48). (2) Men (M = 2.48, SD = 1.51) masturbated significantly more than women (M = 1.60, SD = 1.25). (3) Non-genital sexual activities were more frequent than genital sexual activities.
Shkolnik and Iecovich (2013)	N = 200 (101 women)	M =73 (SD = 6.65) Range = 61-94	Frequency of hugs and kisses, holding hands, sexual caressing, and sexual intercourse. (0 = not at all − 4 = every day).	(1) 85% of the respondents reported at least one kind of sexual activity. (2) 45.5% engaged in sexual intercourse at least once or twice a month. (3) 74.7% held hands, 78.3% did hug and kiss, and 62.6% engaged in sexual caressing.
Skałacka and Gerymski (2019)	N = 83 (50 women)	M = 66.4 (SD = 5.2) Range = 60-81	Whether they engaged in kissing, cuddling, touching intimate parts of the of the partner’s body, sex with penetration, or masturbation. (Yes/No)	(1) 55% engaged in kissing, 54% engaged in cuddling, 41% touched the intimate parts of the partner’s body, 34% had sex with penetration, and only 8% masturbated. (2) There were no significant differences between men and women.
Smith et al. (2007)	N = 50 (28 women)	M = 81 (SD = 6) 70 years and older	Whether they engaged in intercourse, masturbation, oral stimulation of the partner, and manual stimulation of the partner. (Yes/No)	(1) 18% of women and 41% of men engaged in sexual activity. (2) The most reported type of sexual activity was intercourse for men and masturbation for womena.
Træen et al. (2017)	N = 3,614 men and women from Norway, Denmark, Belgium, and Portugal.	Range 60 - 75	Frequency of sexual intercourse (vaginal, anal, oral sex) and masturbation in the past month. (1 = none − 7 = more than once a day).	(1) Men had or attempted sexual intercourse once a week in Portugal. Men had sexual intercourse 2 to 3 times a week in Norway, Denmark and Belgium. (2) Women had or attempted intercourse 2 to 3 times per week in all countries except Portugal (1/year). (3) Men masturbated 2 to 3 times per week, but women masturbated once a year.
Yang and Yan (2016)	N = 688 (380 women)	Mean = 68.46 (SD = 7.20) Range = 60-69	Whether they engaged in sexual intercourse, caressing, oral sex, orgasmb, use of objects (that is, ‘sex toys’) and initiating sexb. (Yes/No)	(1) The most common sexual activities were intercourse (44.26 %) and caressing (43.11%), followed by oral sex (14.85%) and use of sex objects (8.14%). (2) Men were more likely to report engaging in sexual intercourse, caressing, and oral sex. (3) Age was negatively correlated with the number of sexual activities they engaged in.

Note:

^a Data not reported in the article. ^bNot included in the results, as it is not a sexual activity. n.d. indicates that the meaning of this term was not defined to participants.

Other authors assessed the frequency with which participants engaged in these sexual activities. For instance, Santos-Iglesias et al. (2016) assessed the frequency of three non-genital (kissing, hugging, and cuddling) and four genital (touching breasts and/or genitals, oral sex, vaginal penetration/intercourse, and anal stimulation/penetration) activities, as well as masturbation. They found that older adults, on average, engaged in non-genital sexual activities once a day, once a week in genital activities, and masturbated between 2 to 3 times in the last three months. Beier et al. (2020) found that the most frequent sexual activities for older men and women were exchange of touching, followed by body contact, sex with intercourse, and sex without intercourse. Finally, Maharani et al. (2021) reported the number of participants that said they engage in kissing, hugging, intercourse, and masturbation ‘routinely’, ‘occasionally’, and ‘never’. Their results showed that hugging and kissing were the most frequent activities. Among their sample, 100%, 97%, and 88% engaged in hugging, kissing, and intercourse, respectively, either routinely or occasionally. All participants reported ‘Never’ engaging in masturbation (see Table 3). Overall, all these studies seem to confirm that non-genital sexual activities are the most frequent and prevalent ones, followed by genital activities. Other activities such as masturbation, use of objects, or using media materials seem to be far less frequent or prevalent comparatively (Santos-Iglesias et al., 2016).

Like the studies presented above, there were also gender and age differences in the frequencies of different sexual activities. Beier et al. (2020) found that men reported higher frequency across all the different activities than women. Bretschneider and McCoy (1988) showed that more men than women engaged in caressing, sexual intercourse, and masturbation (see also Papaharitou et al., 2008; Santos-Iglesias et al., 2016; Yang & Yan, 2016). The only exception is the study by Skałacka and Gerymski (2019) that did not found differences between men and women. Regarding age, Yang and Yan (2016) found that age was negatively associated with the number of sexual activities. Both Mulligan and Moss (1991) and Papaharitou et al. (2008) found that older people reported lower frequency across all different sexual activities.

Discussion

This study reviews the available literature about the sexual activity of people aged 60 years or older. A total of 63 articles assessing sexual activity in this population were found, which, upon analysis, showed that older adults remain sexually active well into older adulthood. Further, there was significant variation in the prevalence and frequency of sexual activity among older adults; we attribute this to the vast differences in the operationalization and assessment of sexual activity used in these studies. This limits our understanding of the sexual activity of older adults and hinders our ability to draw firm conclusions about the results.

Sexual activity of older adults

Overall, the results of this literature review were characterized by three main findings: (1) that large percentages of older adults continued to have sexual activity into old age, (2) that older women were less sexual activity than male older adults, and (3) that sexual activity declines with increasing age of participants. Regardless of how sexual activity was assessed and operationalized, we found that sexual activity nonetheless still occurs among older adults. A first group of studies showed that between 13 and 90% of the older adults were sexually active (Fischer et al., 2021; Thompson et al., 2011; Træen et al., 2017). Although this is a wide range, it indicates that people continue to remain sexually active as older adults. The differences in percentages reported by these studies are attributable to diverse methodologies, as well as to age and gender differences. For example, the lowest estimate found in these studies correspond to a sample of women in the 80-90 years age range (Thompson et al., 2011). Among them, only 33% were married or in an intimate relationship (compared to 67% in younger groups), which is known to decrease the likelihood of sexual activity (Freak‐Poli, 2020).

Not only do older adults remain sexually active, but they also engage in sex fairly frequently. The findings in our literature review showed that, depending on the type of activity and the time frame used to assess sexual activity, the average frequency of sexual activity can range from weekly to several times a year (Choi et al., 2011). A common finding was that non-genital activities can be as frequent as once a day, whereas genital activities tend to be less frequent, with averages ranging from once a week to several times a year for some older adults (Choi et al., 2011; Santos-Iglesias et al., 2016). Other activities, such as masturbation or using toys, are even less frequent. Younger samples also engage in non-genital activity more frequently than in genital activity (O'Sullivan et al., 2014). However, in a recent study conducted in the United States, the authors found that between 47% and 53% of men and women between 18-44 years had sex an average of weekly or more, which is higher than the frequencies found in this literature review for older adults. This is in keeping with the literature suggesting that sexual activity decreases with age (Herbenick et al., 2010; Lindau & Gavrilova, 2010). Finally, the results also show that older adults engage in a wide variety of sexual activities. From kissing and hugging, to masturbation, intercourse, or oral sex, different sexual activities were always present in a group of older adults. This is important because a diverse and varied sexual repertoire has been associated with sexual satisfaction (Gillespie, 2017). It could also be an indicator of the positive attitudes (Santos-Iglesias et al., 2016) and flexible schemas that older people have about sexual activity (Cameron & Santos-Iglesias, 2022).

A major finding across many of these studies was that sexual activity decreases with increasing age. This could be due to health and sexual problems limiting the sexual expression of older adults, as these issues are known to become increasingly likely with age (DeLamater & Karraker, 2009; Lindau & Gavrilova, 2010; Mitchell et al., 2013; Træen et al., 2017). Another major finding was that older women appear to be less sexually active than older men. A possible explanation for these findings is that women generally outlive men; the likelihood of a women being widowed compared to a man being widowed therefore increases with increasing age (DeLamater, 2012; DeLamater & Moorman, 2007). Because the likelihood of being in a sexual relationship is higher in married than single older adults (Minichiello et al., 2004; Wang et al., 2008), an explanation as to why older men appear to be more likely to remain sexually active compared to older women becomes readily apparent. Finally, it could be seen that despite the finding that remaining sexually active decreases with increasing age, many studies nonetheless found that a significant proportion of adults continue to engage in sexual activity well into older age.

Assessment of sexual activity in older adults

The wide range of estimates found in the results described earlier were mostly attributable to the wide diversity of methods used to assess sexual activity. Overall, we found two main issues which, in the end, result in very diverse estimates of the sexual activity. First, the way in which sexual activity has been operationalized and measured in these studies prevents a clear understanding of the sexual activity of older adults. In many cases, the authors used different terms (e.g., sexual activity, sexual relations, sex) without providing definitions of these terms. This is in keeping with Macleod and McCabe (2020), who found that out of 32 studies that examined sexuality in older adults, more than two thirds of those studies did not provide a definition of sexuality and relied on implicit definitions instead. This is especially concerning given that people of different ages have different and inconsistent definitions about sex and what constitutes ‘having sex’ (Cameron & Santos-Iglesias, 2022; Peterson & Muehlenhard, 2007; Sanders et al., 2010; Sanders & Reinisch, 1999). Even when operational definitions of sexual activity were provided, these were inconsistent and varied widely. Some studies referred to only a couple of sexual activities (e.g., sexual intercourse and masturbation), whereas other studies included a larger number. Several authors have recommended using behavior-based definitions of sexual behavior. Sanders et al. (2010) found that there was no universal agreement as to what behaviors constitute having sex (e.g., whereas almost all agreed that penile-vaginal intercourse constituted having sex, only 30% agreed that oral sex was sex) and suggested that researchers need to be cautious when they create measures to assess sexual activity and the need to use behavior-specific terminology. Even when sexual activities are assessed (e.g., intercourse), it is important to provide definitions about these terms, as slightly different interpretations can produce very different estimates of sexual activity. For example, whereas 77-90% of the older adults consider penile-vaginal intercourse sex, only 50% to 66% consider penile-anal intercourse to be sex. We add that it is important to assess a wide range of sexual activities in order to be comprehensive, inclusive and to not leave out people who might not be engaging in more stereotypical sexual activities (e.g., penile-vaginal intercourse). It is also equally important to have a better understanding of the activities older adults consider as having ‘had sex’, as this could help in designing more inclusive measures of sexual activity in older adults.

A second concern has to do with the variety of time frames used to assess sexual activity. In this study, the bracket ranged from one week to one year, which is very broad and leads to different results. For example, an additional 12% of older adults reported having intercourse when they reported on the last year compared to reporting on the previous four weeks (Wong et al., 2009). Researchers also need to consider that the accuracy of reports can decrease when excessively long time-frames are used. Can people remember how many times they had sex or whether they engaged in a specific sexual activity in the last 12 months? Graham et al. (2003) found that for vaginal intercourse, recall error increased significantly at three months. That is, after three months participants made significantly more errors in reporting the accuracy of vaginal intercourse. Jaccard et al. (2002) found that self-report accuracy for the frequency of sexual activity was fairly accurate at three and six months, but less accurate at one and 12 months. Finally, it is worth noting that some studies used response scales that are difficult to interpret and that prevent from having a clear understanding of the frequency of sexual activity in older adults. For example, it may be more useful to report how many times older adults were having sex (e.g., once a week, 2-3 times a month) rather than reporting that the frequency of sexual activity was moderate over the last month. Comparisons between studies mentioned within this review should therefore be considered in light of not only the various operational definitions of sexual activities employed, but also in terms of the equally myriad timeframes utilized.

Limitations and future research

Our literature review used a thorough search and documentation approach. However, it is possible that relevant articles might have been missed. Also, because our search was restricted to articles published in English, relevant literature written and published in other languages has been excluded. This limits the generalizability of our findings, making them only applicable to English speaking cultures. Furthermore, even though some studies were conducted in countries such as Malaysia, China, or Iran, most of the studies come from Western contexts, which limits our understanding of the sexual activities of older adults in non-Western cultures. Because culture has an impact on the sexual expression of older adults (Von Humboldt et al., 2020), it is likely that the results obtained in Western cultures do not reflect and cannot be compared to their non-Western based counterparts. For instance, two of the articles included in this review were completed in Muslim majority countries, where the sexual expression is organized by religious and conservative rules (Yaşan et al., 2009). This may have influenced the sexual activities experienced and reported by participants in these studies. This is further complicated by the lack of a standardized measurement of sexual activity, in that, a standardized method of assessing sexual activity would allow researchers to better grasp when/if societal factors are influencing one culture’s sexual activity compared to another. Nonetheless, more cross-cultural research is necessary to unravel the cultural, societal, and religious nuances present in studies assessing sexual variables. It should also be mentioned that the articles included in this review may demonstrate a geographical bias in measurement, as they have also been almost exclusively developed within the occidental context. This further complicates the unraveling of cultural/societal influences on the results of these studies. Likewise, this methodological hurdle may be remedied in the future thorough the promotion and development of sexual activity research in non-Western cultural contexts.

In this review, we found that non-genital activities (when assessed) tend to be the most commonly experienced sexual activities, followed by genital activities, and finally other activities such as masturbation and the use of toys (Choi et al., 2011; Santos-Iglesias et al., 2016). However, it is important to consider that the use of objects (sex toys, magazines, videos, etc.) have been only assessed in two studies included in this review. The use of other technologies, such as computers and telephones, may also be used by older adults but have not been assessed. It appears that, regardless of cultural and technological changes over time, these have not seen their way into the assessment of sexual activities, and studies focus, for the most part, on the traditional sexual script. Regardless, future research should aim to uncover the possible use of digital technologies concerning the sexual activity of older adults.

Finally, another significant limitation of this set of studies is that they have been almost exclusively done with data from heterosexual populations alone. Given that there is great variety of sexual activities within LGBTQ+ communities (Wainipitapong et al., 2023), the results derived from heterosexual older adults may not necessarily be generalizable to this population. Therefore, there is potentially a great wealth of sexual activity information available concerning this population that has, to date, been largely ignored and underreported. This is an especially important limitation to address in future research given the known association between increased sexual activity and positive outcome variables, such as sexual wellbeing (Santos-Iglesias et al., 2016).

Conclusions

This paper provides a summary of the literature about the sexual activity of older adults. In spite of the volume of studies uncovered in this review, our understanding of the sexual activity of older adults is still lacking due to the lack of a clear consensus on how best to operationalize and assess sexual activity. We recommend that sexual activity be clearly operationalized as a variety of different sexual behaviors in future studies. This will serve two main purposes. First it will capture the extensive sexual repertoires of older adults uncovered in this review better, especially compared to an operationalization based around sexual intercourse alone. Second, it will avoid the use of vague terminology (e.g., sexually active, sex) that may be interpreted differently by respondents. Additionally, given that different time frames also produce different results, we recommend using shorter timeframes that are less prone to recall biases. Finally, we recommend that future studies assess older adults from LGBTQ + populations and different cultural contexts, as these populations/cultures may have different norms compared to published research to date.

The results paint a positive picture about the sexuality of older adults, in that they remain active and engage in a wide diversity of sexual activities. These results are in stark contrast with common myths about the sexuality of older adults (Ussher et al., 2015) and should be used to change the public discourse and start recognizing the sexual lives of older adults. That is, we need to make sure that sexuality in later life is accepted and valued to, ultimately, avoid stigmatic beliefs and policies about sexuality in later life (Tsang et al., 2011).

Funding Statement

This research is part of a larger project funded by a Cape Breton University – RISE grant, granted to the second author.

Author contributions

All authors contributed to the study conception and design. The literature search and data collection were performed by Joshua Cameron. All analyses and summary of results were performed by Joshua Cameron and Pablo Santos-Iglesias. The first draft of the manuscript was written by Joshua Cameron and further revised by Joshua Cameron and Pablo Santos-Iglesias. All authors read and approved the final manuscript

Disclosure statement

No potential conflict of interest was reported by the author(s).