Sexuality and Sexual Dysfunctions in Later Life

  • Ana Hategan
  • James A. Bourgeois
  • Tracy Cheng
  • Julie Young


Sexual needs appear to be similar in adult life and late life, with variations in mode of expression, frequency, and intensity. However, for older adults, there are a number of factors that can create barriers to achieving sexual expression. Older adults experience multiple age-related physiological changes in sexual functioning. During the aging process, it can be common for both males and females to experience sexual dysfunction relating to any issue that arises during the four stages of the sexual response cycle (excitement, plateau, orgasm, and resolution). Inappropriate sexual behaviors in institutionalized settings are more likely to occur in patients with major neurocognitive disorders. Clinicians working with older adults need to remain knowledgeable of legal and ethical issues related to the right to consensual sexual activity, which are discussed in this section. Assessment, diagnosis, and management of sexual dysfunction in older adults are also reviewed.


Sexuality Sexual dysfunction Geriatric sexuality Late-life sexual expression Sexual disinhibition 


  1. 1.
    Masters WH, Johnson VE. The sexual response cycle of the human female. III. The clitoris: anatomic and clinical consideration. West J Surg Obstet Gynecol. 1962;70:248–57.PubMedGoogle Scholar
  2. 2.
    Kibble JD, Halsey CR. Medical physiology: the big picture. New York: McGraw-Hill; 2015.Google Scholar
  3. 3.
    Wu FC, Tajar A, Beynon JM, et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med. 2010;363(2):123–35.CrossRefPubMedGoogle Scholar
  4. 4.
    Araujo AB, Esche GR, Kupelian V, et al. Prevalence of symptomatic androgen deficiency in men. J Clin Endocrinol Metab. 2007;92(11):4241–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Lochlainn MN, Kenny RA. Sexual activity and aging. J Am Med Dir Assoc. 2013;14(8):565–72.CrossRefGoogle Scholar
  6. 6.
    Basaria S. Reproductive aging in men. Endocrinol Metab Clin N Am. 2013;42(2):255–70.CrossRefGoogle Scholar
  7. 7.
    Rheaume C, Mitty E. Sexuality and intimacy in older adults. Geriatr Nurs. 2008;29(5):342–9.CrossRefPubMedGoogle Scholar
  8. 8.
    McMahon CG. Erectile dysfunction. Intern Med J. 2014;44(1):18–26.CrossRefPubMedGoogle Scholar
  9. 9.
    Chow E, Hategan A, Bourgeois J. When its time for “the talk”: Sexuality and your geriatric patient. Current Psychiatry. 2015;5(14):13–30.Google Scholar
  10. 10.
    Annon JS. The PLISSIT model: a proposed conceptual scheme for the behavioral treatment of sexual problems. J Sex Educ Ther. 1976;2(1):1–15.CrossRefGoogle Scholar
  11. 11.
    Ambrosini DL, Chackery R, Hategan A. Sexuality and sexual dysfunction in later life. In: Hategan A, Bourgeois JA, Hirsch CH, Giroux C, editors. Geriatric psychiatry: a case-based textbook. Berlin: Springer. In Press.Google Scholar
  12. 12.
    White CB. A scale for the assessment of attitudes and knowledge regarding sexuality in the aged. Arch Sex Behav. 1982;11(6):491–502.CrossRefPubMedGoogle Scholar
  13. 13.
    Hajjar RR, Kamel HK. Sexuality in the nursing home, part 1: attitudes and barriers to sexual expression. J Am Med Dir Assoc. 2004;5:S43–7.CrossRefGoogle Scholar
  14. 14.
    Kuhn D. Intimacy, sexuality, and residents with dementia. Alzheimer’s Care Quart. 2002. Accessed 17 Oct 2017.
  15. 15.
    Morley JE, Tariq SH. Sexuality and disease. Clin Geriatr Med. 2003;19(3):563–73.CrossRefPubMedGoogle Scholar
  16. 16.
    La Torre A, Giupponi G, Duffy DM, et al. Sexual dysfunction related to psychotropic drugs: a critical review. Part III: mood stabilizers and anxiolytic drugs. Pharmacopsychiatry. 2014;47(1):1–6.PubMedGoogle Scholar
  17. 17.
    Tucker I. Management of inappropriate sexual behaviors in dementia: a literature review. Int Psychogeriatr. 2010;22(5):683–92.CrossRefPubMedGoogle Scholar
  18. 18.
    American Association of Retired Persons. Modern maturity sexuality study. Washington: AARP; 1999.Google Scholar
  19. 19.
    McCracken AL. Sexual practice by elderly: the forgotten aspect of functional health. J Gerontol Nurs. 1988;14:13–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Waite LJ, Flicker L, Hankey GJ, et al. Sexuality: measures of partnerships, practices, attitudes, and problems in the National Social Life, health, and aging study. J Gerontol B Psychol Sci Soc Sci. 2009;64b:i56–66.CrossRefPubMedCentralGoogle Scholar
  21. 21.
    Gregorian RR, Golden KA, Bahce A, Goodman C, Kwong WJ, Khan ZM. Antidepressant-induced sexual dysfunction. Ann Pharmacother. 2002;36:1577–89.CrossRefPubMedGoogle Scholar
  22. 22.
    DeLamater J. Sexual expression in later life: a review and synthesis. J Sex Res. 2012;49(2–3):125–41.CrossRefPubMedGoogle Scholar
  23. 23.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Fifth ed. Arlington, VA: American Psychiatric Publishing; 2013. p. 423–59.CrossRefGoogle Scholar
  24. 24.
    De Giorgi R, Series H. Treatment of inappropriate sexual behavior in dementia. Curr Treat Options Neurol. 2016;18:41.–016–0425–2.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Helgason AR, Adolfsson J, Dickman P. Sexual desire, erection, orgasm, and ejaculatory functions and their importance to elderly Swedish men: a population based study. Age Ageing. 1996;25:285–91.CrossRefPubMedGoogle Scholar
  26. 26.
    Hyde Z, Flicker L, Hankey GJ, et al. Prevalence of sexual activity and associated factors in men aged 75 to 95 years: a cohort study. Ann Intern Med. 2010;7:693–702.CrossRefGoogle Scholar
  27. 27.
    Herring J, Wall J. Capacity to consent to sex. Med Law Rev. 2014;22:620–30.CrossRefPubMedGoogle Scholar
  28. 28.
    Perlin M. “Everybody is making love/or else expecting rain”: considering the sexual autonomy rights of persons institutionalized because of mental disaibility in forensic hospitals and in Asia. Washington Law Rev. 2008;83:481–512.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Ana Hategan
    • 1
  • James A. Bourgeois
    • 2
    • 3
  • Tracy Cheng
    • 4
  • Julie Young
    • 5
  1. 1.Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonCanada
  2. 2.Department of PsychiatryBaylor Scott and White Health Central Texas DivisionDallasUSA
  3. 3.Department of PsychiatryTexas A&M University Health Science Center, College of MedicineTempleCanada
  4. 4.St. Joseph’s Healthcare Hamilton, McMaster UniversityHamiltonUSA
  5. 5.Mercy San Juan Medical CenterFarmingtonUSA

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