Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Sexual dysfunction in older adults

Marc Agronin, MD
Section Editor
Murray B Stein, MD, MPH
Deputy Editor
Richard Hermann, MD


Clinicians are increasingly likely to encounter older patients seeking help with sexual dysfunction. More individuals are living into late life, a significant proportion of which remain sexually active.

The proportion of older adults that remain sexually active may be increasing. Openness and acceptance about the role of sexuality in late life has expanded. Medication and other treatments have been developed that enable individuals to maintain successful sexual functioning regardless of age.

This topic discusses the presentation, assessment, and management of sexual dysfunction in older adults, defined as individuals 65 years and older. Diagnosis and management of specific sexual disorders are discussed separately. (See "Overview of male sexual dysfunction" and "Evaluation of male sexual dysfunction" and "Treatment of male sexual dysfunction" and "Sexual dysfunction in women: Epidemiology, risk factors, and evaluation" and "Sexual dysfunction in women: Management" and "Female orgasmic disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis" and "Treatment of female orgasmic disorder" and "Approach to the woman with sexual pain" and "Differential diagnosis of sexual pain in women".)


The current model of normal sexual function across the lifespan is anchored in five stages of psychological and physiological changes: desire, arousal or excitement, plateau, orgasm, and resolution [1-3].

Desire (or libido) refers to psychological urges, thoughts and fantasies of sexual activity. It is centered in the hypothalamus and surrounding limbic structures and is stimulated by testosterone in both men and women [4].  

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Oct 2017. | This topic last updated: Oct 24, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Masters WH, Johnson VE. Human Sexual Response. Little, Brown & Company, Boston 1966.
  2. Kaplan HS. The New Sex Therapy. Brunner/Mazel Inc., New York 1974.
  3. Hock RR. Human Sexuality, 4th ed, Pearson, New York 2015.
  4. van Anders SM. Testosterone and sexual desire in healthy women and men. Arch Sex Behav 2012; 41:1471.
  5. Santoro N, Epperson CN, Mathews SB. Menopausal Symptoms and Their Management. Endocrinol Metab Clin North Am 2015; 44:497.
  6. Nappi RE, Cucinella L, Martella S, et al. Female sexual dysfunction (FSD): Prevalence and impact on quality of life (QoL). Maturitas 2016; 94:87.
  7. Dennerstein L, Guthrie JR, Hayes RD, et al. Sexual function, dysfunction, and sexual distress in a prospective, population-based sample of mid-aged, Australian-born women. J Sex Med 2008; 5:2291.
  8. Davis SR, Worsley R, Miller KK, et al. Androgens and Female Sexual Function and Dysfunction--Findings From the Fourth International Consultation of Sexual Medicine. J Sex Med 2016; 13:168.
  9. Stanworth RD, Jones TH. Testosterone for the aging male; current evidence and recommended practice. Clin Interv Aging 2008; 3:25.
  10. Jia H, Sullivan CT, McCoy SC, et al. Review of health risks of low testosterone and testosterone administration. World J Clin Cases 2015; 3:338.
  11. Bitzer J, Platano G, Tschudin S, Alder J. Sexual counseling for women in the context of physical diseases: a teaching model for physicians. J Sex Med 2007; 4:29.
  12. Graham CA, Mercer CH, Tanton C, et al. What factors are associated with reporting lacking interest in sex and how do these vary by gender? Findings from the third British national survey of sexual attitudes and lifestyles. BMJ Open 2017; 7:e016942.
  13. Jacoby S. Great sex. What’s age got to do with it? Modern Maturity 1999; www.aarp.org/press/1998/nr100198.html (Accessed on November 1, 2000).
  14. American Association for Retired Persons. Sexuality at Midlife and Beyond: 2004 Update of Attitudes and Behaviors. AARP: 2005. Accessed at: http://assets.aarp.org/rgcenter/general/2004_sexuality.pdf.
  15. Fisher LL. Sex, Romance, and Relationships: 2009 AARP Survey of Midlife and Older Adults.American Association for Retired Persons 2010. http://assets.aarp.org/rgcenter/general/srr_09.pdf (Accessed on April 25, 2013).
  16. Schick V, Herbenick D, Reece M, et al. Sexual behaviors, condom use, and sexual health of Americans over 50: implications for sexual health promotion for older adults. J Sex Med 2010; 7 Suppl 5:315.
  17. Fredriksen-Goldsen KI, Muraco A. Aging and Sexual Orientation: A 25-Year Review of the Literature. Res Aging 2010; 32:372.
  18. Agronin ME, Westheimer RK. Sexuality and Sexual Disorders in the Elderly. In: Principles and Practice of Geriatric Psychiatry, 2nd ed, Agronin ME, Maletta GJ (Eds), Lippincott Williams & Wilkins, Philadelphia 2011. p.603.
  19. Villar F, Celdrán M, Fabà J, Serrat R. Barriers to sexual expression in residential aged care facilities (RACFs): comparison of staff and residents' views. J Adv Nurs 2014; 70:2518.
  20. Roelofs TS, Luijkx KG, Embregts PJ. Intimacy and sexuality of nursing home residents with dementia: a systematic review. Int Psychogeriatr 2015; 27:367.
  21. Lester PE, Kohen I, Stefanacci RG, Feuerman M. Sex in Nursing Homes: A Survey of Nursing Home Policies Governing Resident Sexual Activity. J Am Med Dir Assoc 2016; 17:71.
  22. Stein GL, Beckerman NL, Sherman PA. Lesbian and gay elders and long-term care: identifying the unique psychosocial perspectives and challenges. J Gerontol Soc Work 2010; 53:421.
  23. Hinrichs KL, Vacha-Haase T. Staff perceptions of same-gender sexual contacts in long-term care facilities. J Homosex 2010; 57:776.
  24. Mahieu L, Gastmans C. Older residents' perspectives on aged sexuality in institutionalized elderly care: a systematic literature review. Int J Nurs Stud 2015; 52:1891.
  25. Tarzia L, Fetherstonhaugh D, Bauer M. Dementia, sexuality and consent in residential aged care facilities. J Med Ethics 2012; 38:609.
  26. Zeiss AM, Davies HD, Wood M, Tinklenberg JR. The incidence and correlates of erectile problems in patients with Alzheimer's disease. Arch Sex Behav 1990; 19:325.
  27. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2014. Department of Health and Human Services, Atlanta, GA 2015.
  28. Centers for Disease Control and Prevention. Sexually HIV Among People Aged 50 and Over. U.S. Department of Health and Human Services, Atlanta, GA 2015. http://www.cdc.gov/hiv/group/age/olderamericans/index.html (Accessed on December 03, 2015).
  29. Herbenick D, Reece M, Schick V, et al. Sexual behavior in the United States: results from a national probability sample of men and women ages 14-94. J Sex Med 2010; 7 Suppl 5:255.
  30. Lindau ST, Tang H, Gomero A, et al. Sexuality among middle-aged and older adults with diagnosed and undiagnosed diabetes: a national, population-based study. Diabetes Care 2010; 33:2202.
  31. Aronow WS. Peripheral arterial disease in the elderly. Clin Interv Aging 2007; 2:645.
  32. Crenshaw TL, Goldberg JP. Sexual Pharmacology: Drugs that Affect Sexual Function, W.W. Norton, New York 1996.
  33. Goodwin AJ, Agronin ME. A Women’s Guide to Overcoming Sexual Fear and Pain, Updated Edition, Echo Point Books and Media, Brattleboro 2015.
  34. Thomas DR. Medications and sexual function. Clin Geriatr Med 2003; 19:553.
  35. Montejo AL, Llorca G, Izquierdo JA, Rico-Villademoros F. Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction. J Clin Psychiatry 2001; 62 Suppl 3:10.
  36. Taylor MJ, Rudkin L, Bullemor-Day P, et al. Strategies for managing sexual dysfunction induced by antidepressant medication. Cochrane Database Syst Rev 2013; :CD003382.
  37. Kavoussi RJ, Segraves RT, Hughes AR, et al. Double-blind comparison of bupropion sustained release and sertraline in depressed outpatients. J Clin Psychiatry 1997; 58:532.
  38. Clayton AH. Recognition and assessment of sexual dysfunction associated with depression. J Clin Psychiatry 2001; 62 Suppl 3:5.
  39. Ambler DR, Bieber EJ, Diamond MP. Sexual function in elderly women: a review of current literature. Rev Obstet Gynecol 2012; 5:16.
  40. Brotto LA. The DSM diagnostic criteria for sexual aversion disorder. Arch Sex Behav 2010; 39:271.
  41. Lewis RW, Fugl-Meyer KS, Bosch R, et al. Epidemiology/risk factors of sexual dysfunction. J Sex Med 2004; 1:35.
  42. Feldman HA, Goldstein I, Hatzichristou DG, et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994; 151:54.
  43. Laumann EO, Waite LJ. Sexual dysfunction among older adults: prevalence and risk factors from a nationally representative U.S. probability sample of men and women 57-85 years of age. J Sex Med 2008; 5:2300.
  44. Lindau ST, Schumm LP, Laumann EO, et al. A study of sexuality and health among older adults in the United States. N Engl J Med 2007; 357:762.
  45. Porst H, Montorsi F, Rosen RC, et al. The Premature Ejaculation Prevalence and Attitudes (PEPA) survey: prevalence, comorbidities, and professional help-seeking. Eur Urol 2007; 51:816.
  46. Bitzer J, Platano G, Tschudin S, Alder J. Sexual counseling in elderly couples. J Sex Med 2008; 5:2027.
  47. Avis NE, Brockwell S, Randolph JF Jr, et al. Longitudinal changes in sexual functioning as women transition through menopause: results from the Study of Women's Health Across the Nation. Menopause 2009; 16:442.
  48. Szwabo PA. Counseling about sexuality in the older person. Clin Geriatr Med 2003; 19:595.
  49. Agronin ME. Sexuality and Aging. In: Principles and Practice of Sex Therapy, 5th ed, Binik YM, Hall KSK (Eds), The Guildford Press, New York 2014. p.525.
  50. Steinke EE. Sexuality and chronic illness. J Gerontol Nurs 2013; 39:18.
  51. Kaplan HS. The Evaluation of Sexual Disorders: Psychological and Medical Aspects, Brunner/Mazel, New York 1983.
  52. Principles and Practice of Sex Therapy, 5th ed, Binik YM, Hall KSK (Eds), The Guildford Press, New York 2014.
  53. Gareri P, Castagna A, Francomano D, et al. Erectile dysfunction in the elderly: an old widespread issue with novel treatment perspectives. Int J Endocrinol 2014; 2014:878670.
  54. Müller A, Smith L, Parker M, Mulhall JP. Analysis of the efficacy and safety of sildenafil citrate in the geriatric population. BJU Int 2007; 100:117.
  55. Kim E, Seftel A, Goldfischer E, et al. Comparative efficacy of tadalafil once daily in men with erectile dysfunction who demonstrated previous partial responses to as-needed sildenafil, tadalafil, or vardenafil. Curr Med Res Opin 2015; 31:379.
  56. Yafi FA, Sharlip ID, Becher EF. Update on the Safety of Phosphodiesterase Type 5 Inhibitors for the Treatment of Erectile Dysfunction. Sex Med Rev 2017.