AGEISM AND THE STIGMA OF SENIOR SEXUALITY
Recently, I attended a workshop about sexual well-being for seniors, and it was a real eye-opener. Although my practice specializes in human sexuality, I was surprised to learn just how much the healthcare system fails older folks when it comes to sex. Neglect in attending to their sexual needs increases their risk of both physical and emotional disorders. . Here are some things to think about:
Senior Citizens: A Growing Population
For those who wonder why be concerned about seniors, it is important to understand that their population is growing. Currently, almost 1 in 5 are over 65 and 1 in 4 is over 60. In terms of numbers, there are over 86 million Americans aged 65 or older. Get the Facts on Older Americans. Given this trend, the number of folks affected by the problem will only increase
AGEISM
Let’s face it, our youth-oriented culture is ageist, especially when it comes to sex. Ageism is a stereotypical discrimination toward individuals based solely on advanced age. For example, seniors are often believed to be asexual, because they’re “just “too old.
Ageism also involves more than individual discrimination. It also affects physician education and institutional structures. Indeed, many medical school curricula often make learning about the sexual well-being of older folks optional.
Even worse, Institutions fail to provide policies or structures that allow or promote physical intimacy for their residents. Many assisted living facilities do not recognize the sexual rights of their older residents and actively discourage any sexual behaviors by separating residents who pair off.
Sadly, many nursing homes do not provide basic safe-sex information or encourage them to get help with sex-related problems. Not surprisingly, senior citizen facilities report high rates of HIV and other sexually transmitted infections.
Sexual Stigma
Sexual stigma is another aspect of ageism. While many folks feel embarrassed about sex, what seniors experience goes way beyond embarrassment. To be clear, stigma is a profound, unfair mark of disapproval or shame imposed on individuals by society due to specific attributes like health conditions, behaviors, or appearance.
This stigma permeates not only younger people’s attitudes but also healthcare professionals’ as well. Not only are doctors poorly trained regarding geriatric sexuality but many express emotional discomfort with the subject and thus are not emotionally supportive to their older patients, Don’t ask, don’t tell: Silence in the medical encounter when sexual problems, aging, and health conditions meet | British Geriatrics Society
Sadly, ageism and sexual stigma not only affect seniors’ healthcare, but also their sense of their sexual legitimacy. Often, disapproval and shaming from others result in an internalized guilt and disgust about their natural wants and desires. As a result, many older folks fail to seek help for sexual issues, and, often, health care providers don’t inquire about sex-related concerns during regular check-ups.
For example, less than 40% of elderly women talk to their doctors about sexual concerns and less than 25% of men do. Studies reveal that sexual stigma even occurs in the doctor’s office, Bottom line: many suffer in silence and go without effective treatment.
The Historical Context of Sexual Stigma
For those who wonder where all of this negativity came from, the answer is obvious. Most Americans of whatever age have always had a problem with sex. Frankly, Christianity was a major factor in creating what has been called our culture’s erotophobia. Erotophobia
From its inception, the church struggled with sex. Early Christians believed that Christ’s Second Coming would spiritualize life and eliminate all of the problems of the flesh. ( “In Christ there is no male or female” Gal. 3.28,) But that didn’t happen, and early church leaders, who lived in a time of Roman sexual depravity, did not know what to do with sex, specifically sexual pleasure.
Unfortunately, the dominant church leader, the Bishop of Hippo, St Augustine, declared sexual pleasure (lust) sinful. Of the Good of Marriage (De bono coniugali, c. 401) and On Marriage and Concupiscence (De nuptiis et concupiscentia, c. 419). **
Although the church accepted sex, it was only under strict limitations, i.e., between husband and wife, and for the purpose of having a child. The implications for the elderly are obvious and explain why the church ignored the sexual issues of the elderly.
What Needs to be Done
Raise Public Awareness about Sexual Ageism
Much of the ageist attitudes toward seniors and sex stem from the persistent myth that sexual feelings fade away with age. In fact, given good emotional, physical, and relational health, it doesn’t. Accurate information can push out false ideas and beliefs.
75% of couples aged 64 report having regular sex. Likewise, 55% at 74 and 25% at age 85. Health, more than age, determines one’s experience of sex. In fact, given good health, sex is a lifelong entitlement. Of course, the physical effects of aging influence sexual experience but they do not eliminate it. Sexuality and Intimacy in Older Adults | National Institute on Aging
Going forward, we need to provide accurate information by expanding sex education programs to include aging issues.
Update our Understanding of Sex and Sexuality
Another crucial update is to change how we understand sex. It is more than something we do; sexuality is also part of who we are. Rather than viewing sex as a peripheral aspect of life, sexuality needs to be understood as an integral part of one’s identity. Likewise, the lifelong aspect of sexual desire needs to be emphasized.
Ussuage Guilt/Shame and Endorse Sex Positivity
Most sexual guilt and shame can be overcome by reminding folks that sexual feelings are normal and nothing to feel bad about. Guilt and shame need to be explained as the consequence of false and abusive negative beliefs and undeserved condemnation. Folks need to know that thoughts and behaviors, like fantasies and masturbation, are completely normal and healthy. SEX & SHAME | Pastoral Counseling Syracuse NY
Advocate for Mandatory Sex and Aging Training for All Healthcare Professionals
Professional health organizations, as well as state and federal licensing agencies, need to step up their requirements to include adequate training in the areas of sex and aging.
Advocate for Senior Sexual Rights
Seniors need reassurance about the legitimacy of their sexuality and their right to express it. Likewise, they need to be encouraged to assert their sexual needs and seek help when they are having problems.Sexual Rights For Seniors | American Sexual Health Association
Finally, senior living facilities need to change and accept that their residents are sexual people. They need to abandon puritanical attitudes that allow sex only between married couples.
To end on a positive note, change is slow, but it can happen. Over 30 years ago, in 1995, the Hebrew Home in Riverdale, New York, established what’s recognized as the nation’s first Sexual Expression policy for residents of a retirement community. Let’s keep the ball rolling.
Rev. Michael Heath, LMHC, Fellow, AAPC 4 15 2026
