The notion of sexual health, as with physical health, is not simply the absence of sexual dysfunction or disease, but rather, a state of sexual well-being that includes a positive approach to sexual relationships and anticipation of a pleasurable experience without fear, shame, violence, or coercion. The complexity of stigma and ageism prevalent in many societies often leads to older people’s hesitancy to seek consultation with a professional on sexual health issues. This deepens the reality of the unique biological, psychological, and social challenges faced by older adults seeking advice or treatment around sexual health issues, which require correspondingly unique and appropriate responses from healthcare professionals, including openness, knowledge, and competence to promote an open, accepting environment in which sexual issues can be discussed.

Health care providers can introduce sexual topics by asking whether there are any difficulties with intimacy as part of routine reviews or examinations. In this way, a comfortable environment can be created in which sensitive issues may be discussed. The responsibility does not fall solely on general practitioners. Many different healthcare professionals should be familiar with the differential diagnoses of male and female sexual dysfunction. 

It is important for older men and women who are interested in preserving their sexual capabilities to avoid, as much as possible, allowing chronic illness to interfere with sexual functioning. Carrying on this aspect of an older person’s life improves self-image and, hence, often improves the medical prognosis for a patient. Knowledge about sexuality at older ages among health care professionals should improve patient education and counselling, as well as the ability to clinically identify a highly prevalent spectrum of health-related and potentially treatable sexual problems. 

Moreover, health professionals can dispel some myths about health risks of sexual intercourse. For instance, the oxygen used in intercourse is roughly equal to that used in climbing a couple of flights of stairs (Butler & Lewis, 1988). Except in cases of unusual severity, the danger of a coronary attack during sexual activity is slight and can be minimised by taking nitroglycerin tablets prior to sexual encounters. It is conservatively estimated that less than 1 % of sudden coronary deaths occur during intercourse (Walbroehl, 1988). In fact, anxiety and tension caused by restricting sex are considered to be greater risks than is the physical risk from participating in intercourse (Butler & Lewis, 1988). Health professionals have an integral role in helping older adults to remain sexually healthy and to express their sexuality in whatever manner they choose, regardless of age.

At the same time, it is important to note that there is commonly a misconception that older adults are not at risk of sexually transmitted diseases, and therefore there is no need to ask about sexual history or discuss sexual behaviours. Indeed, the rate of sexually transmitted infections (STIs) among those aged 55 years or older has consistently increased and has more than doubled over the past decade (Steckenrider, 2023). Furthermore, STIs may not be investigated adequately in this population and thus may go untreated for long periods of time or be mistaken for other illnesses that better fit the ‘age’ expectations (Bodley-Tickell et al., 2008). Given the past and current sexual experiences of this generation of older adults, their sexual risks should come as no surprise. Many older people rarely consider using protection because they came of age at a time when sex education in schools did not exist, HIV was virtually unheard of, and their main concern in seeking protection was to avoid pregnancy. Today, older adults are more likely to participate in the hook-up culture of casual encounters and condomless sex, which might be further encouraged by the availability of drugs for sexual dysfunction, and the increased use of dating apps for older people.