Sex and Sexuality After 60: What the Research Actually Shows, What Changes Biologically

Editorial team, drugs-canada.com — Updated January 2026.

The most persistent and damaging myth about sexuality in later life is that it ends. The data say otherwise. The National Social Life, Health, and Aging Project (NSHAP) — one of the most rigorous population studies of sexual activity in older adults — found that 40% of people aged 65 to 80 were sexually active, and among those who were sexually active, 73% reported being satisfied with their sex lives. An AARP survey found that more than half of adults over 60 consider a satisfying sexual relationship important to their quality of life. A growing body of research also links continued sexual activity in later life to better cardiovascular health, improved mood, stronger immune function, and higher overall life satisfaction.

What does change after 60 is the biological and psychological context of sexuality — changes that are real, that affect both men and women differently, and that are manageable in the vast majority of cases with appropriate information, communication, and where indicated, medical support. This article covers the physiology of sexual change in aging men and women, the psychological and relational dimensions of later-life sexuality, the substantially underrecognised issue of STI risk in older Canadians, and practical approaches to maintaining a fulfilling intimate life after 60.

What the Biology Actually Does — Men After 60

Testosterone Decline and Late-Onset Hypogonadism

Total testosterone levels in men decline at approximately 1–2% per year after age 30, with free testosterone (the biologically active fraction) declining somewhat faster due to age-related increases in sex hormone-binding globulin (SHBG). By age 60–70, a meaningful proportion of men have testosterone levels that fall below the clinical threshold for hypogonadism (generally defined as <300 ng/dL total testosterone, or <6–8 nmol/L in Canadian laboratory reporting).

Late-Onset Hypogonadism (LOH) — the clinical syndrome resulting from age-related testosterone decline — produces a recognisable constellation of symptoms that are often attributed to "normal aging": reduced libido (the most consistent symptom), decreased morning erections, fatigue, reduced lean muscle mass, increased adiposity, mood changes, and reduced sense of wellbeing. The challenge for both patients and clinicians is that these symptoms are nonspecific and overlap substantially with depression, thyroid dysfunction, sleep apnoea, and the effects of multiple medications. A fasting morning testosterone measurement (repeated if borderline) is the appropriate screening test when LOH is suspected.

Testosterone replacement therapy (TRT) is available in Canada through Health Canada-approved formulations (gels, patches, injections) and can substantially improve libido, energy, and body composition in men with confirmed biochemical hypogonadism. TRT is not without risks (haematocrit elevation, effects on prostate, lipid changes) and requires monitoring — appropriate prescribing requires physician assessment rather than self-administration.

Erectile Function Changes — What Is Normal and What Is Treatable

The physiology of erection changes substantially with age even in the absence of organic disease. Changes that are normal and expected in men over 60 include: longer time required to achieve erection after stimulation; erections that are less firm at maximum than in younger years; longer refractory period (the interval before another erection is possible after ejaculation) — which can extend from minutes in youth to hours or more in older men; and greater dependence on direct physical stimulation rather than psychogenic arousal alone.

These changes do not constitute erectile dysfunction — they constitute the normal physiology of erectile aging. However, they create a substrate in which pathological erectile dysfunction (where erections are inadequate for sexual activity) is more likely to develop. Erectile dysfunction affects approximately 40% of men at age 40, rising to approximately 70% of men at age 70. The primary underlying mechanism in the majority of cases is vascular — the same endothelial dysfunction that drives cardiovascular disease reduces nitric oxide availability in cavernosal smooth muscle.

For Canadian men over 60 with erectile dysfunction, PDE5 inhibitors remain highly effective — but with an important pharmacokinetic consideration. Aging substantially alters the metabolism of all three major PDE5 inhibitors :

The most important clinical insight for older men: daily low-dose tadalafil (5mg) is arguably the most appropriate PDE5 inhibitor for men over 60. The 36-hour therapeutic window eliminates the anxiety of "timing" sex — a significant burden at any age but particularly when spontaneity is already reduced by physical changes, joint pain, or partner health issues. Daily tadalafil also treats benign prostatic hyperplasia (BPH) and its associated lower urinary tract symptoms simultaneously — relevant for the majority of men in their 60s and 70s. Discuss with your GP or through Canadian telehealth services.

Benign Prostatic Hyperplasia and Prostate Cancer

BPH affects approximately 50% of men in their 60s and up to 90% of men in their 80s, producing urinary symptoms that can indirectly affect sexual function. Alpha-blockers used to treat BPH (tamsulosin, doxazosin) can cause retrograde ejaculation, which is harmless but alters the ejaculatory experience. 5-alpha reductase inhibitors (finasteride, dutasteride) used for BPH reduce sexual desire and erectile function in a meaningful subset of men — an effect worth knowing before starting treatment.

Prostate cancer treatment — radical prostatectomy or radiation therapy — has significant effects on erectile and urinary function. Nerve-sparing radical prostatectomy preserves erectile function in approximately 65% of men with bilateral nerve-sparing technique, though recovery typically takes 12–24 months and early penile rehabilitation with PDE5 inhibitors is now standard practice. Radiation therapy has a delayed erectile function impact that becomes apparent over years rather than months post-treatment.

What the Biology Actually Does — Women After 60

Genitourinary Syndrome of Menopause (GSM) — The Most Common and Underreported Female Sexual Health Issue

Genitourinary Syndrome of Menopause (GSM) — previously called vaginal atrophy or atrophic vaginitis — affects approximately 45% of postmenopausal women and is the most important biological factor affecting female sexuality after menopause. Unlike vasomotor symptoms (hot flashes, night sweats) that typically diminish over years after menopause, GSM symptoms progressively worsen over time without treatment.

GSM results from oestrogen deficiency causing changes to the vulvar, vaginal, and lower urinary tract tissues: the vaginal epithelium becomes thinner and less elastic; vaginal pH increases from the normal acidic 3.5–4.5 to 5.0–7.5, making infections more likely; vaginal lubrication diminishes substantially during sexual arousal; the vaginal introitus may narrow; and the urethra becomes more vulnerable to trauma and infection. The clinical consequences are dyspareunia (painful intercourse) — reported by up to 45% of postmenopausal women — recurrent urinary tract infections, urinary urgency, and vaginal dryness and burning during daily activities.

Critically, GSM is both underreported and undertreated. Many women accept dyspareunia as inevitable with aging and do not raise it with their healthcare provider. Many healthcare providers do not ask. The result is that a highly treatable condition significantly impairs sexual function and quality of life unnecessarily.

Effective treatments for GSM available in Canada include :

• Vaginal moisturisers (Replens, K-Y Liquibeads) — available without prescription; provide non-hormonal hydration; used 3× weekly regardless of sexual activity for baseline tissue health
• Lubricants (water-based, silicone-based) — used during sexual activity; water-based are condom-compatible; silicone-based provide longer-lasting lubrication but are not compatible with silicone sex toys
• Topical vaginal oestrogen (cream, ring, tablet) — highly effective with minimal systemic absorption; available on prescription; the Society of Obstetricians and Gynaecologists of Canada (SOGC) affirms that vaginal oestrogen is safe for the vast majority of women including most breast cancer survivors, and represents the most effective pharmacological treatment for GSM
• Ospemifene (Osphena) — oral selective oestrogen receptor modulator (SERM); non-hormonal oral treatment for moderate-to-severe dyspareunia; available by prescription in Canada
• Vaginal DHEA (prasterone/Intrarosa) — intravaginal DHEA that locally converts to oestrogen and testosterone; Health Canada approved; effective for dyspareunia and sexual function
• Systemic menopausal hormone therapy (MHT) — treats GSM systemically along with vasomotor symptoms; SOGC guidelines (updated 2022) support MHT for symptom management in appropriate women under 60 or within 10 years of menopause

Female Sexual Response Changes After Menopause

Beyond GSM, several aspects of sexual response change after menopause due to oestrogen and androgen decline: the arousal phase lengthens — more stimulation is required to achieve equivalent lubrication and engorgement; orgasms may be less intense or take longer to achieve; the uterine contractions of orgasm may occasionally be uncomfortable rather than pleasurable in women with uterine conditions. None of these changes are inevitably distressing — many postmenopausal women report greater sexual freedom and satisfaction due to absence of pregnancy concern, more time, and deeper partner intimacy.

Medications That Affect Female Sexual Function

Multiple medications commonly prescribed to older women significantly reduce sexual function. Antidepressants — particularly SSRIs and SNRIs — reduce libido and impair orgasm in a substantial proportion of women. Beta-blockers prescribed for hypertension reduce libido. Antihypertensives including thiazide diuretics and centrally acting agents reduce arousal. Antihistamines reduce vaginal lubrication. Aromatase inhibitors (breast cancer treatment) dramatically worsen GSM symptoms. Reviewing medications with a GP or clinical pharmacist for sexual side effects is often worthwhile — alternatives may be available.

STI Risk After 60 — The Underrecognised Canadian Problem

One of the most clinically concerning patterns in Canadian sexual health data is the substantial rise in STI rates among adults over 50. The Public Health Agency of Canada's surveillance data consistently shows year-over-year increases in chlamydia, gonorrhoea, and syphilis in the 50+ age group — a demographic that public health messaging has historically neglected.

The reasons are multiple and logical: older adults entering new sexual relationships after divorce or widowhood are less likely to use condoms (the pregnancy concern that drove condom use in youth is no longer present); many older adults and their healthcare providers do not perceive older adults as an STI risk population; and the dating landscape for older adults increasingly includes digital platforms that facilitate meeting multiple partners.

Specific considerations for older Canadian adults :

• HIV risk is real for older adults — older adults are less likely to be tested and more likely to receive a late diagnosis, partly because healthcare providers may not consider HIV in older patients. Late diagnosis means worse outcomes. The Canadian HIV/AIDS Legal Network advocates for routine HIV testing across all ages.
• HPV can affect older adults — while the HPV vaccine is most effective before first sexual exposure, older adults re-entering sexual activity after years in monogamous relationships may encounter new HPV exposures. The vaccine is available for adults up to age 45 in Canada.
• Herpes simplex (HSV) — highly prevalent across all age groups and manageable with antiviral therapy; many older adults have longstanding HSV-1 or HSV-2 infection that re-activates with reduced immune function associated with aging
• Condom use — remains the most effective barrier against STI transmission and should be used consistently with new partners regardless of age; water-based lubricants should be used alongside condoms for older women with GSM-related dryness to reduce condom breakage risk

Canadian adults over 60 entering new sexual relationships should discuss STI testing with their GP or through anonymous testing services available in most Canadian cities. Testing is straightforward, accessible, and largely stigma-free in the Canadian healthcare context.

Psychological Dimensions of Sexuality After 60

Body Image and Aging

Body image concerns do not disappear with age — they transform. The cultural preoccupation with youth-associated physical appearance creates real psychological barriers to sexual expression in older adults, particularly women. Research by Tiggemann and Lynch (2001) found that older women's body dissatisfaction — while shifting somewhat from weight and shape toward concerns about skin texture, visible aging, and functionality — remained a significant predictor of sexual self-consciousness and avoidance.

The psychological counterweight to body image concerns in later life is perspective — a resource that genuinely increases with age. Many older adults report that acceptance of physical change and reduced self-consciousness about appearance allows greater focus on pleasure and connection during sex than they experienced in younger years. This is consistent with longitudinal data showing that sexual satisfaction does not decline linearly with age — many adults report their most satisfying sexual relationships in their 50s and 60s.

Partner Loss — Bereavement and Divorce in Later Life

Partner loss through death or divorce creates complex intersections between grief and sexuality. Widowhood rates increase substantially in the 60s and 70s, with women significantly more likely to be widowed than men due to both longer life expectancy and the tendency for women to partner with older men. The grief associated with partner loss encompasses sexual bereavement — the loss of a long-established intimate partner creates a specific form of grief around physical intimacy that is rarely acknowledged in healthcare settings.

Re-entering dating and sexual relationships after long periods of monogamy is emotionally complex for older adults — combining excitement, anxiety about changed bodies, comparison to previous partners, and practical concerns about STI risk with new partners. These emotional realities are legitimate and deserve acknowledgment rather than dismissal. Counselling support — available through Canadian telehealth platforms and community mental health services — can provide useful guidance for older adults navigating these transitions.

Performance Anxiety in Older Men — An Accumulation Problem

Performance anxiety around erectile function becomes a particular challenge in older men because it combines with the genuine physiological changes described above. A man in his 60s who experiences his first erectile difficulty — perhaps after a period of illness, medication change, or simply a stressful period — may respond with the same performance anxiety that drives failure in younger men, compounded by the correct understanding that erectile physiology does change with age. The challenge is distinguishing between "this is normal physiological change that I can adapt to" and "this is treatable erectile dysfunction." In practice, both may be true simultaneously, and both the physiological and psychological dimensions require attention.

The Critical Role of Communication

Research consistently identifies communication as the single most important factor in sexual satisfaction across all ages — and its importance increases in later life when biological changes make adaptation necessary. A landmark study published in the Archives of Sexual Behaviour (Kleinplatz et al., 2009) — based on interviews with older adults who described "optimal" sexual experiences — found that the defining characteristics of great sex in later life were not physical performance measures but rather: being present and focused; deep connection and intimacy; genuine communication about needs and preferences; vulnerability and trust; and exploration and curiosity.

Studies consistently show that couples who are able to discuss their sexual needs and concerns openly have significantly higher sexual satisfaction — with some research showing 3× higher satisfaction scores than couples who do not discuss sex. For older couples navigating physical changes, explicit discussion of what feels good, what is uncomfortable, what needs to change, and what remains highly pleasurable is not just helpful — it is likely the most important single intervention for maintaining sexual satisfaction.

Practical Adaptations for Better Sex After 60

The following approaches are supported by clinical evidence and the practical experience of sexual medicine specialists working with older adults :

Canadian Resources for Sexual Health After 60

• Sex Information and Education Council of Canada (SIECCAN) — sieccan.org — evidence-based sexual health resources including specific guidance for older adults
• Society of Obstetricians and Gynaecologists of Canada (SOGC) — sogc.org — patient-facing resources on menopause, GSM, and sexual health for women
• Canadian Menopause Society — menopause.ca — resources on all aspects of menopause including sexual health impact
• Prostate Cancer Canada — prostatecancer.ca — sexual function support resources for men after prostate cancer treatment
• Maple / Tia Health / Dialogue — Canadian telehealth platforms providing accessible physician consultations for sexual health including prescriptions for PDE5 inhibitors, topical oestrogen, and STI testing requisitions

Conclusion

Sexuality does not end at 60 — it evolves. The biology changes in ways that require adaptation rather than abandonment. Men experience slower arousal, greater dependence on physical stimulation, and erectile changes that are both physiologically normal and, in many cases, amenable to effective treatment. Women encounter GSM — a highly prevalent, undertreated, and highly treatable condition — and hormonal changes that alter but do not eliminate sexual response. Both genders carry psychological dimensions of aging sexuality that are real but navigable, particularly when communication between partners is open and honest.

The Canadian healthcare system — including an accessible primary care system, telehealth platforms, evidence-based sexual medicine specialists, and provincial mental health resources — provides genuine support for older adults who want to address sexual health concerns. The primary barrier is rarely availability of resources; it is the persistence of the myth that sexual health is not relevant after 60. The data show it is. The 73% of older adults who report satisfaction with their active sex lives in population studies are not exceptional — they are representative of what is achievable with good information, open communication, and appropriate support.

References

• Lindau ST et al. (2007). "A study of sexuality and health among older adults in the United States." New England Journal of Medicine, 357(8), 762–774.
• Kleinplatz PJ et al. (2009). "The components of optimal sexuality: A portrait of 'great sex'." Canadian Journal of Human Sexuality, 18(1–2), 1–13.
• Portman DJ & Gass MLS (2014). "Genitourinary syndrome of menopause: New terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and The Menopause Society." Menopause, 21(10), 1063–1068.
• SOGC (2022). "Menopause and Sexual Health — Updated Clinical Practice Guidelines." Society of Obstetricians and Gynaecologists of Canada.
• Public Health Agency of Canada (2023). "Reported cases and rates of notifiable STI by age group and sex, 2023 preliminary data." PHAC surveillance report.
• Tiggemann M & Lynch JE (2001). "Body image across the life span in adult women: The role of self-objectification." Developmental Psychology, 37(2), 243–253.
• Bacon CG et al. (2003). "Sexual function in men older than 50 years of age: Results from the Health Professionals Follow-up Study." Annals of Internal Medicine, 139(3), 161–168.

This article is for educational and informational purposes. Sexual health concerns deserve medical assessment — consult your Canadian GP or access telehealth services for personal advice. drugs-canada.com — January 2026.