The conversation the health system forgot to have

In more than two decades of clinical practice, I can count on one hand the number of patients over 60 who raised the topic of their sexual health with me unprompted. Not because they had no concerns. Not because intimacy had stopped mattering to them. But because nobody – not their GP, not their specialist, not the health system itself – had given them permission to talk about it.

That silence has consequences. And it is time we addressed it honestly.

A 2025 study from the University of New Hampshire found that many single adults aged 60 to 83 continue to prioritise sexual activity in their romantic relationships, with some participants describing a relationship without sex as feeling “more like a friendship.”

The findings were striking: adults aged 60 to 80 expressed not only a desire, but a need for sexual intimacy in a relationship, with some describing the absence of physical connection as a “deal breaker.”

A systematic review examining sexual activity in older adults revealed that 30 to 90 per cent of adults aged 60 and older reported being sexually active, with activity continuing for at least some people into their 90s.

These are not outliers. These are millions of people – your friends, your neighbours, your parents, possibly you – whose intimate lives continue to matter deeply and who are receiving almost no support, information or acknowledgement from the health system that is supposed to be looking after them.

Why does this topic make everyone so uncomfortable?

Let me be direct about the problem, because it is worth naming.

We live in a culture that is simultaneously saturated with sexuality and deeply uncomfortable with the idea that older people experience it. Young bodies are everywhere in advertising, entertainment and media. Older bodies are invisible – or, when they do appear in the context of intimacy, treated as a punchline rather than a reality.

Healthcare providers play a crucial role in promoting sexual health among older adults, yet it remains an important and often neglected aspect of ageing well. Although sexuality evolves beyond the reproductive years, it remains a meaningful part of life for many. Unfortunately, targeted interventions to support later-life sexuality are lacking, creating significant gaps in care. keyingredient

The result is a generation of Australians who have health concerns about intimacy that they are not raising with their doctors, questions about their changing bodies that they are not asking, and a sense that desire itself is somehow inappropriate at their age.

It is not inappropriate. It is normal, healthy and well-documented by research. And it deserves to be discussed with the same clinical seriousness as blood pressure, cholesterol and bone density.

What actually changes physically — and what doesn’t

The body at 60 is not the body it was at 30, and pretending otherwise is neither helpful nor honest. Understanding what changes – and why – makes it far easier to adapt rather than withdraw.

For women, the most significant changes are driven by menopause and the decline in oestrogen. Vaginal tissue becomes thinner, drier and less elastic – a condition called vaginal atrophy that affects the majority of postmenopausal women to some degree. This can make intercourse uncomfortable or painful, which understandably leads many women to avoid it entirely rather than seek treatment.

The important thing to know is that this is highly treatable. Vaginal moisturisers (used regularly, not just before sex) and water-based lubricants (used during sex) are available without prescription and make a significant difference. For more persistent symptoms, topical oestrogen – applied locally as a cream, pessary or ring – is effective, carries minimal systemic risk and is something your GP can prescribe after a straightforward conversation. Many women do not know this option exists because nobody has told them.

Arousal may take longer. This is a physiological change, not a psychological one. The nerve pathways and blood flow responses that drive arousal slow with age, which means what worked quickly at 35 may need more time at 65. This is not dysfunction. It is adaptation – and couples who understand this and adjust accordingly often report that their intimate lives improve rather than diminish with age, because there is less rushing and more attention.

For men, the most common change is erectile function. Erections may be less firm, less frequent and slower to achieve. This is influenced by vascular health, hormonal changes, medications (blood pressure drugs, antidepressants and prostate medications are common culprits) and psychological factors including performance anxiety, which tends to worsen the more a man worries about it.

Erectile dysfunction is extraordinarily common – estimates suggest it affects more than half of men over 60 to some degree – and it is treatable in the vast majority of cases. Medications like sildenafil (Viagra) and tadalafil (Cialis) remain effective for many men, and your GP can prescribe them after checking for contraindications, particularly if you take nitrate medications for heart conditions.

What is less commonly discussed is that erectile changes do not mean the end of a satisfying intimate life. Many couples discover that when the focus shifts away from penetrative sex as the sole measure of intimacy, the range of physical connection actually expands – and satisfaction often increases rather than decreases.

For both, desire itself does not disappear. It may change in character – becoming less urgent, more emotional, more connected to the quality of the relationship rather than purely physical drive – but the research is unambiguous. The vast majority of older adults who are in relationships continue to want and value physical intimacy, and those who are sexually active report higher life satisfaction, better mental health and stronger relationships.

The medications that quietly interfere

This is the section I wish more GPs would discuss proactively with their patients, because it is one of the most common and most fixable contributors to sexual difficulty after 60.

A significant number of medications commonly prescribed to older Australians have sexual side effects, including reduced desire, difficulty with arousal and difficulty achieving orgasm. The most frequent offenders include:

Antidepressants, particularly SSRIs, which can significantly reduce desire and delay or prevent orgasm in both men and women. Beta-blockers and some blood pressure medications, which can affect erectile function in men and reduce arousal in women. Antihistamines, which can cause vaginal dryness. Opioid pain medications, which suppress testosterone and can reduce desire in both sexes. Prostate medications, particularly finasteride and tamsulosin, which can affect erectile and ejaculatory function.

If you have noticed changes in your intimate life that coincide with starting a new medication, raise it with your GP. In many cases, an alternative medication with fewer sexual side effects is available – but your doctor cannot make that switch if they do not know the problem exists.

This is perhaps the single most important practical message in this entire column: if a medication is affecting your intimate life, tell your doctor. They will not be embarrassed. They will not be surprised. And in many cases, they can help.

The emotional landscape matters as much as the physical

Intimacy after 60 is not just about bodies. It is about vulnerability, trust, self-image and the willingness to be seen – truly seen – by another person at a stage of life when many of us feel less confident about how we look and how our bodies perform.

Body image concerns do not end at 30. Many older Australians feel self-conscious about weight changes, surgical scars, skin changes and the general effects of ageing on their physical appearance. These concerns can be powerful enough to prevent someone from pursuing intimacy at all – not because they do not want it, but because they cannot imagine being wanted.

This is where honest communication with a partner becomes the most important intimacy tool available. Talking about what feels good, what has changed, what you need and what you are anxious about is not always comfortable – but it is almost always transformative. Couples who talk about sex tend to have better sex. This is true at every age, and it becomes more important rather than less as bodies change.

For those who are single and dating – whether after divorce, bereavement or simply a long period alone – the prospect of physical intimacy with a new person can feel genuinely daunting. Take your time. A partner worth being with will understand that pace matters and that trust is built gradually.

What your doctor should be asking — and what you should feel free to raise

Sexuality in older adults is influenced by biological, psychological and social factors, and it deserves to be part of routine health conversations rather than something that is only discussed when a patient is brave enough to bring it up. keyingredient

If your GP does not ask, you can. You do not need to make it a big moment. A simple “I’d like to talk about some changes I’ve noticed” is enough. Any competent GP will take it from there.

Questions worth raising include: changes in desire or arousal, pain or discomfort during intimacy, concerns about the effect of medications on sexual function, vaginal dryness or discomfort, erectile changes, concerns about STIs (which are rising significantly in the over-60 population and deserve the same safe-sex conversation that younger people receive), and any emotional barriers to intimacy that you feel would benefit from professional support.

The bottom line

Intimacy after 60 is not a footnote. It is not an optional extra reserved for the young. It is a fundamental part of wellbeing – physical, emotional and relational – that the health system has been quietly neglecting for far too long.

The World Health Organisation estimates that by 2050, the world’s population of those aged 60 and older will double to 2.1 billion. Yet although representing a disproportionately large segment of the population worldwide, older people are under-represented in sexual health discourse. aol

Desire does not have a use-by date. Connection does not expire. And the need to be touched, held, seen and wanted by another human being is not something you are supposed to grow out of.

If you have questions, ask them. If you have concerns, raise them. If you have been avoiding intimacy because of physical changes that feel embarrassing, know that almost all of them are treatable – and that you are far from alone.

This is a conversation that should have started a long time ago. Consider it started.

This column is for general information purposes only and does not constitute personal medical advice. Always consult your GP about changes in your intimate health, particularly if you are taking regular medications.