Self reported sexual activity among married and unmarried 70 year olds in Gothenburg, Sweden increased from 1971 to 2001. At the same time among elderly people attitudes to sexuality became more positive, and the proportion reporting a very happy relationship increased. Furthermore, the proportion reporting high satisfaction with sexual activity and that sexuality was an important factor in life increased, whereas those with sexual dysfunctions (erectile dysfunction among men, orgasmic dysfunction in women) decreased. Consistent with population studies of younger samples of later born cohorts1 2 3
the median age of sexual debut decreased and the proportion that had their sexual debut before age 20 increased. The one year prevalence of intercourse in the two earliest birth cohorts was similar to that among septuagenarians reported from studies in the 1950s and 1980s.4 6
The prevalence in the two younger birth cohorts is similar to a European study in 2001-216
and a US study in 2005-6.5
The main reason for men to cease intercourse was self reported as personal reasons, mirroring reports by women that the reason for cessation of intercourse was due to their partner. Whether elderly couples continue to be sexually active seems to a large extent to be determined by men.17
This pattern, which did not change over time, was also reported in studies in the 1950s8
and in 2005-6.5
In agreement with previous reports self reported sexual activity was more common in men, regardless of marital status.5 6 8 9 16 18 19 20
Differences between the sexes in self reported sexual behaviour, however, decreased from 1971 to 2001 among the 70 year olds in our study. Overall, men reported an earlier age of sexual debut and a higher proportion of premarital sex than women in the 1970s, but this sex difference diminished among those in later born samples. Recent studies on adolescents report that women experience first sexual intercourse at a younger age than men.1 2 3
Finally, whereas 70 year old men in the 1970s more often reported positive attitudes to sexuality than women, there were no sex differences in attitudes in 2000-1. Thus attitudes to sexuality cannot entirely explain observed differences between the sexes in sexual activity. Women were less likely to be married or in other intimate relationships than men, as reported by others.5
As in other studies,5 6 8
the proportion of elderly people reporting sexual activity was higher among married participants than among unmarried participants, especially in women. Sexual activity was reportedly rare among unmarried women in the 1970s.
In 2000 around two thirds of men and women reported high sexual satisfaction, a substantial increase from 1976, especially in women. The proportion of women who reported no or low satisfaction decreased, whereas the proportion of men with low satisfaction increased. It could be speculated that it has become more permissible for men to admit failure in sexual matters or that a real difference exists. The percentage of men reporting erectile dysfunction decreased during the study period. We have no data to examine whether the advent of new drugs in 1998 to treat erectile dysfunction may have contributed to this phenomenon. Premature ejaculation is one of the most common sexual dysfunctions among men aged 40-80.16
The prevalence of premature ejaculation in our study was relatively low. This is in line with observations that the proportion of men with premature ejaculation decreases with age.21
The proportion of women reporting anorgasmia decreased, which may further support a better quality of sexual interactions in later born cohorts. Our results for sexual problems are lower than those reported in a US study,5
despite a similar prevalence of sexual intercourse in the studies.
It was beyond the scope of this study to examine in detail the reasons for self reported secular changes in sexual behaviour over 30 years. It could be speculated that the changes reflect higher educational levels and better socioeconomic status in the later birth cohorts. Furthermore, cohabiting and living apart became more common. The proportion never married decreased and the proportion divorced increased in the later born samples. The later born samples also experienced better general physical health,22
possibly reflected by an increasing average life expectancy in Sweden during the study period (72.2 to 77.4 in men, 78.1 to 82 in women).23
When several of these factors were taken into consideration in a logistic regression analysis, birth year was still related to sexual activity, suggesting that several yet unidentified factors might be important. Other factors that may have influenced public attitudes to sexuality during the 20th century relate to changes in legislation. For example, between 1911 and 1938 Swedish law prohibited information about and the sale of contraceptive devices. In 1946, pharmacies were required to sell contraceptives (condoms and diaphragms) to anyone requesting them; however, homosexuality was still prohibited until 1949. General sex education became compulsory in elementary schools in Sweden in 1955. By the end of the 1950s condoms were available in vending machines in public places. The “sexual revolution” followed in the 1960s, with the contraceptive pill and, later on, intrauterine devices.24
Strengths and limitations
Major strengths of this study are that it is based on four general population samples examined using identical methods over a 30 year period, and that the interviews were part of a comprehensive investigation on ageing and people were not recruited explicitly to talk about their sexuality. Furthermore, the interviews were carried out by doctors and nurses experienced in asking sensitive questions.
Despite the strengths of the study, possible limitations need to be mentioned. Firstly, although the response rate in this sample is higher than in most studies on sexual behaviour, it did decline from 80% in the first sample to 65% in the fourth sample. Comparisons between responders and non-responders identified no differences for several factors, including three year mortality rate, indicating that non-responders were similar to responders. Furthermore, the secular trends in reported sexual behaviour over the 30 year study period were so pronounced that declining response rates could not explain the differences between the samples of 70 year olds. We cannot, however, exclude the possibility that those who declined had more sexual problems than those who participated. Secondly, studies of elderly people include a survival bias—we examined only those who reached age 70. Thus we cannot draw any conclusions on sexual behaviour before this age. Thirdly, sexual behaviour is a sensitive matter to report to strangers. Semistructured interviews were, however, done by doctors or experienced psychiatric research nurses. It might be easier to report sexual behaviour to a professional within the context of an examination on different aspects of ageing. Most reports indicate that people are reasonably open about their sexual behaviour when the observer is objective and comfortable with the topic of inquiry.7
In line with this, the Duke studies7
reported a high correlation among married couples regarding answers on the frequency of sexual intercourse. Fourthly, the first three cohorts were examined by psychiatrists and the fourth by psychiatric research nurses. The large differences in results were, however, observed between the first two and the latest two cohorts, not between those examined by psychiatrists and research nurses. Fifthly, changes in evaluations of responses over time may have influenced the results. One researcher (IS) was trained by those who carried out the examinations in the 1970s, who in turn trained those doing the examinations in 1992 and 2000. Inter-rater reliability between the researcher and examiners in the 1970s and 1990s was high, ensuring consistency in the interviews over time. Sixthly, the study is based on self report, which lends itself to reporting bias. Two qualitative studies indicated that participants from later born cohorts reported that they had learnt to speak more openly about sexuality25
and that many welcomed the opportunity to talk about sex and discuss issues they had never talked about before.26
More positive attitudes to sexuality in 70 year olds in later born cohorts might have resulted in more participants reporting sexual intercourse. Changing attitudes affect both interviewers and participants. It is possible that our results reflect a more open minded attitude in society to sexual matters rather than real changes in sexual behaviour. Seventhly, the definition of sexual activity was limited to intercourse between heterosexuals. Questions on homosexual behaviour and masturbation were included in the original study but then withdrawn in 1976-7, as they evoked strong reactions and many refused to respond to the questions. Thus we cannot generalise our results to other types of sexuality than intercourse between heterosexuals. As we aimed to describe secular trends, we were limited to those questions used in the 1970s. Finally, depression is common in elderly people and is well known to affect sexual activity. Our results for prevalence, however, did not change when we excluded depressed participants, and year of birth was still related to sexual activity in 70 year olds when depression was controlled for in logistic regression analyses including all four samples.
Self reported quantity and quality of sexual experiences among 70 year olds improved over a 30 year period. At the same time, a relatively large proportion of participants had ceased having intercourse. Our study, however, shows that most elderly people consider sexual activity and associated feelings a natural part of later life. It is thus important that sexuality is taken into consideration when dealing with elderly people.
What is already known on this topic
- Secular trends in elderly people’s sexual behaviour is unclear
What this study adds
- The quantity and quality of sexual experiences among 70 year olds in Sweden improved over a 30 year period
- Attitudes to sexuality have become more positive in this age group