Wisconsin Public Television University Place  Is There Sex After 60? John Delamater  2/13/13 UP839  cc >> Welcome, everyone, to Wednesday Nite at the Lab. I'm Tom Zinnen. I work here at the UW Madison Biotechnology Center. I also work for UW Extension Cooperative Extension, and on behalf of those folks and our other organizers, Wisconsin Public Television, Wisconsin Alumni Association, and the UW Madison Science Alliance, thanks again for coming to Wednesday Nite at the Lab. We do this every Wednesday night, 50 times a year. It's your chance to experience science as exploring the unknown. Tonight it's my pleasure to be able to introduce to you Professor John DeLamater who brings a broad bio... Oh, I almost said biophysical. Biopsychosocial perspective to the study of sexuality through the life course. His recent work has focused on changes in sexual functioning associated with age. 

He has published papers on sexual desire and sexual behavior in persons aged 45 to 75 and more, and a paper on sexual satisfaction using data from the Wisconsin Longitudinal Study, and those folks are now ages 62 to 67. He has been invited to review the literature on sexuality and aging for Current Psychiatry Reports. DeLamater was awarded the Alfred E Kinsey Award for Distinguished Contributions to the field of sex research by the Society for the Scientific Study of Sexuality. He is the co-author of a primary text in social psychology and another on sexuality. Usually I don't ask Wednesday Nite at the Lab presenters to change their title, but Professor DeLamater's original title was Is There Sex After 50? Since I know the answer to that question, I thought I would ask a more hopeful question. [LAUGHTER] Is There Sex After 60? [LAUGHTER] Please join me in welcoming Professor DeLamater to Wednesday Nite at the Lab. [APPLAUSE]  >> Thank you for that wonderful introduction. That's a hard act to follow. I've been studying sexuality for about 40 years. I am a sociologist, a social psychologist by training, which means that I focus on social interaction and social relationships. 

And when I began to study sexuality there was very little research on the topic. There's a little more now. Although, we know much less about sexuality, particularly from a social science point of view, than we do about many other things. And so, I've been continuing to work on expanding the social scientific understanding of human sexuality, and I really appreciate the opportunity to come tonight. Tom and I had lunch together back, I think, last September, and he discovered I was studying and he said, oh, you've got to come to the talk at Wednesday Nite at the Lab. And we decided that Wednesday, February 13th was about the best possible day to schedule talk. So, that's why I'm here tonight. As Tom said, my perspective is a biopsychosocial one. I use that intentionally to emphasize that I think we need to take into account biology, biological processes; psychology, people's thoughts, emotions; and sociology, people's attitudes and people's relationships when we think about sexual behavior and sexual expression. I think they all contribute to sexual functioning. 

Obviously, the relative contribution of each of those varies over the life course so that at puberty and at menopause, for example, the biology is probably more important, but I think all three of those contribute throughout the life course to people's sexual functioning. I got interested in this topic about 10 years ago for no apparent reason. [LAUGHTER] And I went to the literature, the published literature on sex after 50 or 60, and what I found were about 700, this is in 2002 or 2003, 700 medical articles, and they were about how various diseases, various illnesses, various kinds of accidents, and various kinds of medications would ruin your sex life. And I thought, well, that's probably all true. I mean, each of those things probably does have a negative impact, but how common are those things in the population, and what other things might be related to people's sexual functioning as they get older? So that was kind of the starting point for this research. Now, the basic observation that we've known for at least 40 years, actually since Kinsey first did his research 60 years ago, is that frequency of sexual activity declines with age. Kinsey documented that there's a slow decline from 20 to 30, the 20 to 30 age range to the 60 to 70 age range. So that's been known for a long time. In the social science there was some debate about what it was that caused that, but there was not much recognition that it might be biological or aging related. The idea was it had to do with psychological and social. 

And we have two national studies that have been done in the last 15 years that have clearly documented that decline. On the left here, we have data from the National Health and Social Life Survey. This is face to face interviews with 3400 people, 18 to 59. And you can see, I don't know if the colors show up very well, but the little red boxes are men and the little blue boxes are women. So the top line here on the left-hand side is men. The bottom line is women. And what you notice is that until about age 45, over 90% of both men and women are sexually active, and this is regardless of marital status or relationship status. And then, starting at about age 50, we see some decline in women but not necessarily in men. In 2005 and 2006, the National Social Health and Age Project interviewed 3,000 people, ages 57 to 85, and we have that on the right side beyond the dotted line. And you see there that starting at age 57, these are smoothed averages by the way, starting at age 57 the men decline steadily and the women decline steadily, and consistently there's about a 20% difference between the frequency of sexual activity for men and the frequency of sexual activity for women. 

Most of that difference is explained by the availability of a sexual partner. This is partnered sexual activity. Most studies of sexual activity have asked strictly about heterosexual vaginal intercourse, which is a serious limitation in the data. Given that that's what you ask, then obviously one has to have a partner available in order to engage in that. And as some of you may recognize, men tend to marry younger women, and so those younger women lose their husbands. And so, as people age, more and more women do not have sexual partners available, and that tends to account for that 20% gap that we observed there between men and women. So, why do we care about that? Why do we care that sexual activity declines in later life? What difference does it make? You can get older, we focus on other things, right? We focus on the spirit and the mind, and not the body. Well, we're getting more and more evidence that indicates there are tremendous benefits from regular sexual activity throughout life. The physical health benefits of sexual intercourse and orgasm include increased longevity for men. This has now been documented in two or three longitudinal studies. 

Men who engage in sexual activity regularly live longer than men who don't. Reduced incidence of coronary events in both men and women. Regular sexual activity is associated with less likelihood of various coronary events for both men and women. And there is a reduced risk of prostate cancer for men. And all of these things have been document by a number of researchers and put together in a document that Planned Parenthood published in 2007 on the physical health benefits of regular sexual activity Moreover, we know that there are mental health benefits of sexual intercourse and orgasms. So now we're getting more specific. These people have actually looked at engaging in sexual intercourse and experiencing an orgasm. Those benefits include an increased quality of life among both men and women. Men and women who report these activities on a regular basis are more satisfied with their quality of life and more satisfied with their relationships. There is an increased personal happiness among men and women, and this was documented by both of the studies that I showed you those curves on the frequency of sexual activity from. 

And most recently, a very interesting study has documented that sexually active men and women as old as age 85 show lower rates of depression controlling for other characteristics that we know are associated with depression. So there are clearly a number of good physical health and mental health benefits of regular sexual activity throughout the lifespan or the life course. Furthermore, and from my point of view perhaps one of the most important, a declining frequency of sexual activity apparently leads to relationship instability. There is a good study that shows that sexual satisfaction with the relationship overall is associated with partners sexual activity. So people who are engaging in sexual activity are more satisfied with their relationships. And a second study that shows that declining sexual frequency over time is associated with relationship dissolution, with people breaking up. And that's true for people who are married. It's also true for people who are cohabiting, and cohabiting includes people of the same gender. You don't have to be of two different genders to live together. So, there are relationship aspects to regular sexual  activity as well. 

So, it seems to me that there are a number of very positive benefits associated with maintaining regular sexual activity in one's relationships. One of the things that most people who study sexuality have noticed, and you may have noticed too, is that in the last 30 or 35 years, our thinking about sex in the United States has gotten more and more medicalized. This is not a new trend. We medicalized childbirth about a hundred years ago. But it's been gradually expanding to the point where we now medicalize what I would call regular sexual functioning. Although, the medical experts would obviously disagree with that. And so the implication of that is that if we see something like declining sexual activity it must be associated with medical problems, must be associated with declining health, and that's why people's sexual functioning is declining over time. And, of course, health problems increase with age, and so that, from the medical point of view, explains that finding that we started with, that the frequency of sexual activity declines over time. And this, of course, is what is documented in those 700 articles that I found a decade ago, all the individual illnesses, accidents, and medications that can lead to problems of sexual functioning, and, therefore, people discontinuing engaging in sexual activity. So I said, well, let's actually look at that. 

Okay, so, clearly, diabetes is associated with a decline in sexual activity, but how common is diabetes in the population? And for this I turned to the National Social Health and Aging Project. This is the survey, interviews with people 57 to 85. One of the things that they did was asked them what illnesses they had been diagnosed with. And this is a report of, well, some illnesses obviously can impair sexual functioning, and there's a large medical literature on that, but that literature involves small samples. These are mostly samples of less than a hundred, and they're mostly patients who are suffering from the illness and seeking treatment from medical personnel. And my concern was that may be a very small percentage of the population. Yes, the disease in that group may be impairing their sexual functioning, what about other people who have the same illness but are not seeking medical treatment? This is from the National Social Health and Aging Project. I apologize for the complexity of it. But we have, on the left here, people 57 to 64, in the middle, people 65 to 74, and on the right-hand side, people 75 to 85. And then we have separate columns for men and women. 

You'll see that in general there are about 500 people in each of those categories. So 500 men in each age group, 500 women in each age group. The national representative sample, 75% response rate for those of you who know about that. What you see is that by far the most frequently reported illness was hypertension. Hypertension clearly is associated with restricted blood flow, restricted blood flow to the genitals. And so, restricted blood flow to the genitals can cause certain sexual problems, certain sexual functioning problems. In men, it causes erectile problems. In women, it causes problems with lubrication. So that would be clearly an illness that could affect one's sexual functioning. Notice that the incidence of that doesn't really increase with age, particularly; although, it does a little bit more so among women than men. 

About 50% of both men and women, 57 to 64, report that they've been diagnosed with hypertension. The percentage of men remains about the same, even as they get older. There's some increase in the percentage of women who are diagnosed with that problem. The second most commonly reported is arthritis, and the reports of arthritis diagnoses do increase, linearly with age. Arthritis could obviously affect sexual functioning in terms of the amount of physical discomfort or pain that one experiences with various kinds of movement. And so that is a serious consideration that could lead to difficulties in sexual functioning. These are in order of report. So, diabetes, about 20% of the population not related to age. Thyroid, less. Skin cancer and so on down the line. 

Stroke was reported by less than 7%-8% of the people, except in the oldest group where it was reported by about 12% or 13%. So, the illnesses that we think might be associated with sexual functioning, with the exception of hypertension and arthritis, are not widespread in community samples, representative samples of adults in that age range in the United States. So, that has to do with diagnosed illness. There's a big debate, if some of you are in the health field, you know there's a big debate about how to measure this. Obviously there are people who have conditions that haven't been diagnosed. And so some people prefer to simply say do you suffer from a particular illness. I've gone here with things that have been diagnosed because that's a more carefully defined measure. And so we're a little bit more certain what that actually means. There also, of course, is the issue of medication. Obviously, a side effect of some medications could be impaired sexual activity. 

Again, if you look at the literature, you find that it's basically based on small samples of patients or people taking the medication or it's based on clinical trials. Clinical trials, of course, you have a large population of people taking a medicine, and you get relatively few reports of any particular side effect, but, of course, those reports are serious and some people will then say, well, this medication is leading to sexual dysfunction, although it might have been reported by only a small number. If you watch morning television and see the ads for all those drugs and then they list all those things that could kill you, right? Well, most of those are only reported by 1% to 5% in the clinical trials, but, of course, they have to report those as potential side effects. And so that's the problem with relying on that. The other big problem with the literature on medications is little follow-up. So people come in, they report a side effect, they go away, the physician or the FDA, depending on who the report was made to, generally does not follow up on those reports. So you have no idea actually what the outcome was or whether the side effect was long lasting or whether it was serious and so on. So, this is an area where we need a whole lot more research, I think. And, actually, I believe the AARP has been pushing for some better research on particularly side effects among older people. That clearly is something that we need. 

Here are the data from the National Social Health and Aging Project on medications. Cardiovascular agents were reported by anywhere from 50% to 75% of the people between 57 and 85. Clearly associated with the fact that so many people reported being diagnosed with hypertension. The second most common were central nervous system agents, reported by 35% to 55%. Notice there's less increase with age there. There's also less evidence, less clear evidence that these are associated with sexual difficulties in sexual functioning. They may be, although the literature, I think, is not clear on that. Analgesics are being taken by 30% to 50%. Again, there's not any evidence that those are consistently related to sexual problems and so on. So, again, we see that the most commonly reported medications being taken are not necessarily medications that are associated with sexual side effects. 

Which led me to the conclusion that a lot of the variances not being accounted for by the fact that we get older, we get sicker, we take more medication. There are other things going on there that account for that decline in sexual activity. So, in summary, I would say the health literature indicates that the illnesses that can impair sexual functioning are not common in persons 45 to 85 in these community surveys of representative samples. I've actually now seen surveys not only from the US but from Germany, Australia, Sweden, and a couple of other countries that show basically the same thing for people 45 to 85 years of age. So, this is not a culturally specific set of findings necessarily. And similarly, medications that may impair sexual functioning are not being commonly taken by people 45 to 85 who participated in these surveys. Medical literature is correct. If you are seeking treatment for a problem or if you are prescribed a particular medication, you may experience certain effects. The question from a sociologist's point of view is, how common are those in the population? And my reading of this data says that they're not that common to account for the kinds of declines that we see in sexual activity. So, here is some data on sexual activity in the past year by gender and age. 

Now, these are from studies, people have, in recent years, people, particularly people who study people over 50 have broadened their definition of sexual activity for purposes of population surveys. And so, increasingly, they say something like, sexual activity refers to any kind of genital activity that provides pleasure or satisfaction. Okay? So, it's a rather broader definition of sexual activity than is sometimes used. There are a number of qualitative studies that indicate that as people age they do shift to other activities besides penile/vaginal intercourse or penile/anal intercourse as means of sexual gratification, and so that broader question seems to be a more appropriate way to assess this. And again, here we have men in the three columns on the left-hand, women in the three columns on the right-hand. Same data. So about 500 men and women in each category. You see that sexual activity is reported by 83%-84% of the men 57 to 64, 67% of the men 65 to 74, and 39% of the men 75 to 85. So a clear decline in frequency of activity as we saw in that earlier chart. Among women, the percentages declined from 62% down to about 17% across those same ages. 

That's using that broad definition. One of the things that some of us said was, well, we need to take into account masturbation precisely because people are not partnered. Some people are not partnered. So let's look at masturbation. So we've got that here in the second line. And you see that men, 64% down to 28%. And women, 31% to 16%. So there are people who are reporting that activity. Men about twice as likely to report it as women. Oral sex almost the same percentages, interestingly, for men. 

More women reporting oral sex, relatively, than reported masturbation, for example, with age. The question that was then asked was, when you engage in sexual activity, do you usually or always engage in vaginal intercourse? And here we get 91% of the younger men, 78% of the men 65 to 74, 83% of the men 75 to 85. Among women, the percentages are 86% to 74%. So, among the sexually active, although the number or percentage of people is going down, most people who remain sexually active are engaging intercourse. Do you have a question? >> Yes. It's in the past year, does that mean just once in the past year? >> In the past year. Right, that's what they use. The standard is either the last three months or the last year, and people like the year because it captures the whole range of weather and whatever. [LAUGHTER] But at least it's constant. [LAUGHTER] >> [INAUDIBLE] >> Down here we have, do you always experience an orgasm when you engage in sexual activity? Do you always experience and orgasm? 76%, 57%, and 48% of the men. 

31%, 26%, and 25% of the women are reporting that they always experience an orgasm. That difference in experience of orgasm is present in data from 15- to 19-year-olds. It's across the age range. And I think what's going on there is that women are simply less likely to have an orgasm from the typical kinds of sexual activity that couples engage in. But that's a kind of different story. You'll have to invite me back for that one if you want to hear that one. >> Okay. [LAUGHTER] >> Okay, so, the research question from my point of view is, what is the relative contribution of several different things to the frequency of sexual activity in later life? One is age, which, unfortunately, is closely correlated with the duration of relationship. One of the dominate explanations for this decline with age is the habituation explanation, that we become habituated to a particular sexual partner, whoever or whatever that is, and it just loses its magic over time. So it's very difficult to separate out the independent effects of people getting older from the fact that the relationships that they're in is getting longer. 

Health, which we've already talked about, medications, which we've already talked about, but what I as a social psychologist are particularly interested in are relationship variables. What about the quality of the relationship that the people are engaging in? I have long believed that if you're absolutely furious with the person you sleep with, you probably don't want to have sex with them. [LAUGHTER] And vice versa. If you're very happy with the person that you sleep with, you'll be more interested in having sex with them. So I think we need to look at relationship variables to sexual activity in later life. To study this, we obviously need a survey that has measures of all of these variables for the same people. So we need data sets with measures of these diverse factors. And, fortunately, there have been several studies in the last decade. And, in fact, three of them, interestingly, have been conducted by the AARP. And I had the good fortune of getting access to two of the AARP's data sets. 

And the results that we're going to look at next come from a study that I did using one of their data sets. So, we looked at sexual activity. This is a sample of 1,384 people, age 45 and older. Now, this is a volunteer sample. They were sent letters, asked to participate, they agreed to participate. It's likely that a sample is biased toward people who were more healthy and people who were willing to answer questions about their sexual activity, because the letter said the survey includes questions about your sexual activity. So, there are those potential limitations on the data. And questionnaires were mailed out to those people who agreed to participate. This is a regression coefficient of the variables that were related to frequent sexual activity among women. And we have, up at the top, age was not significant, diagnosis of arthritis not significant, diagnosis of high blood pressure not significant. 

Those are the illnesses we saw, right? Hypertension and arthritis. Taking a medication for cholesterol was not significant, but attitudes about sex for themselves, this was a three-question scale, sexual activity is very important to my quality of life, I think sexual functioning is particularly important across life. So it's their personal questions about sexual activity. That was positively related to frequency of sexual activity. This was a question about attitudes about sex in relationship. Three questions. Sex is a very important part of my relationship, sex is a very important part of my relationship with my partner. The minus sign results from the way in which the variables were coded, but it was a positive relationship. So more positive attitudes about having sex, more positive attitudes about sex in your relationship are associated with more sex. This was a measure of sexual desire, how frequently you experience sexual desire are highly significant. 

Has sexual partner strongly, negatively related. This is what I talked about earlier. Women without sexual partners are generally not sexually active. The other was partner has sexual limitations. And, again, that's a self-report question and there are some problems with that, but we have to live with that. And then physical satisfaction with the partner which probably is related to the partner's sexual problem was also a significant contributor. So we see here that's it's not medications, it's not diagnosed illnesses. It's attitudes and it's relationship variables that are associated with women reporting sexual activity, ages 45 to 75. The same table for men. Same variables for men. 

Again, the attitudes about sex in their relationship were positively associated with frequency, sexual desire was positively associated with frequency, and that's about it. So, for men it was I'm still experiencing sexual desire and I believe that sex is an important part of my relationship with my partner. Oh, and then physical satisfaction with the partner, down at the bottom, was also important. Several people suggested in looking at this, okay, so there's declining frequency but then there are people who simply stop having sex, right? At some point people become no longer sexually active. And so we really ought to think about people who stop having sex, or what I'm calling sexual cessation. And we need to try and look at that separately from simply declining frequency. So that's what we've been doing most recently. Here we've been looking at the data from the National Social Life, Health, and Aging Project, which you've seen before. This is the 3,005 men and women aged 57 to 85. This was a nationally representative sample of non-institutionalized adults. 

Face to face interviews by trained interviewers, and the data was collected in the summer of 2005 into the spring of 2006. So it's only about six years old. And they have a 75% final response rate out of the people that were initially selected randomly to be in the study. There were still, among that 3,005, 1,502 were married and had completely marital and sexual histories so that we could use their data in this analysis. And so those are the people that we focused on here. Obviously, if you look at sexual cessation among people without partners, it becomes very difficult to tease out how much of it is having a partner. So we limited ourselves to those people who are married who we know have partners. So if they've stopped, presumably, it's obviously not because they don't have a partner. We used event history analysis. This is a technique for looking at a binary distribution. 

Either people do something or they don't do something, or they have something or they don't have something. And with longitudinal data, or data over time, you can look at when they shift from yes to no, in effect. So we did an event history analysis of when these people reported they had stopped having sexual activity in that marital relationship. And our specific dependent variable was the month and year that they last engaged in sexual activity, which they had been asked. Again, this study, as I said earlier, used this generous definition of sexual activity or broad definition of sexual activity. So when we say the last year you engaged in sexual activity, we mean genital activity that provided satisfaction or gratification involving sexual contact. Here's the curve. People in relationships that had lasted up to 400 months, more than 90% of them were sexually active. Ninety months is about 33 years. Then we get, again, a very steady decline down a very small percentage at 800 months. 

800 months is about 66 years. So, you see that for the first 33 years of relationships people maintained levels of sexual activity, then they decline, probably reflecting some of those factors that we talked about earlier as related to the decline. Then we looked at, again, we did regression analyses of some of these variables that might be associated with, in this case, ceasing to engage in sexual activity. This is the regression analysis for men. And, again, I apologize for the fact that these are rather small, but I'll tell you the most important variables here were, there were five variables that were particularly associated with the declining frequency, cessation for men. Obviously, relationships of longer duration, we have duration in years up here at the top, the far column on the right are odds ratios. If the odds ratio is more than one, the variable was associated with cessation. If it's less than one, it was associated with continuing to engage in sexual activity. So the odds ratio for duration in years was 1.26, meaning that for every year you were married, there was a 26% greater likelihood that you ceased to have sexual activity within the age range 57 to 85. You also see that a very significant variable was age. 

Again, we can't tease that out from duration particularly. Obviously it's important. Physical health here is self-rated physical health. Again, there's some debate about what the best measure is, but sociologists tend to use self-rated as a single best measure. It does highly correlate with diagnoses with medications and with other things. So that's related. Also, for men, notice that partner's physical health was reported. When the men reported their partner had poor physical health, they were more likely to have ceased engaging in sexual activity. And a very significant variable was marital happiness. People who reported low marital happiness were more likely to have ceased engaging in sexual activity. 

So, for men, it's duration, it's age, it's physical health, partner's physical health, and relationship satisfaction. Again, we don't see in this data particular illnesses or particular medications associated with, in this case, cessation of sexual activity. When we looked at the data for women, we found very similar results. Longer duration was associated with cessation. Older age was associated with cessation. And older partner, in this case, not for men but for women, an older partner was associated with cessation. And then again, poor partner's physical health and lower marital happiness. So for both men and women, one of the significant factors in cessation is marital happiness. As marital happiness declines, people are less likely to be engaging in sexual activity. The major difference between men and women in these event history analyses is partner's physical health. 

Men's reports of their partner's physical health are not associated with cessation. Women's reports of partner's physical health are associated with cessation. >> [INAUDIBLE] >> This is cross-sectional data. So from this data set, in particular, we can't make that distinction. But from some smaller scale longitudinal studies, it's the decline in health that precedes the decline in sexual activity. So, in conclusion, sexual inactivity is associated with longer marriages or relationships. We actually including cohabiting people in all of these analyses. There were relatively small numbers, less than a hundred, but they were quite consistent with the results for married people. So we can say people in relationships. The longer duration relationship, older age, your own health, your partner's health, but, importantly, as I said, the quality of the relationship. 

And I think that these results in association with other research that's been done recently has some very important implications. One, given the importance of own health and partner's health assessments in these data, clearly, maintaining good health will enable people to remain sexually active. So, maintaining people's health is a major prerequisite, it seems to me, for continuing sexual activity. That means that people need access to good quality healthcare. It also means that we need healthcare professionals who are knowledgeable about sexuality throughout the life. And, unfortunately, that is one of the things that we're lacking in our society. A recent survey, a 2010 survey of the 125 medical schools that graduate the most doctors in the United States found that only 10% of them have any sex education during the four-year medical curriculum other than urology and gynecology. And so, people who turn to their doctor's for questions about health and sexual functioning are generally not going to find what they need, and I think that's really unfortunate. Given that we've medicalized this, given that we have Viagra and all these drugs, that encourages people to go to their doctors. Unfortunately, their doctors don't have the information that they really need. 

I've been involved in three committees over 40 years on this campus to provide sex education to medical students. Every committee has come up with a program of anywhere from five hours to 20 hours, and in all three cases, the medical school curriculum committee shot it down. They said it wasn't important. Doctors don't need to know that. So what can you do? That's the problem that we're up against in getting trained medical professionals. The other implication here, I think, is we need to support good relationships. Good relationships clearly facilitate sexual activity, and sexual activity clearly facilitates good relationships. So, providing people with whatever it is they need to maintain good relationships is very important throughout life but as people age. Particularly because as people age, the partner becomes a major source of social support. And there's a huge literature in sociology that shows that quality of life, physical health, mental health, particularly as we get older, is very importantly associated with having social support available. 

So, it's in our interest to maintain these relationships, maintain them positively so that people get the kind of support from those relationships they need. And with that, I will say thank you very much, and I'll be glad to answer your questions. [APPLAUSE]