The full content of Annals is available to subscribers

Subscribe/Learn More  >
Original Research |

Prevalence of Sexual Activity and Associated Factors in Men Aged 75 to 95 Years: A Cohort Study

Zoë Hyde, MPH; Leon Flicker, MBBS, PhD; Graeme J. Hankey, MD; Osvaldo P. Almeida, MD, PhD; Kieran A. McCaul, MPH, PhD; S.A. Paul Chubb, PhD; and Bu B. Yeap, MBBS, PhD
[+] Article, Author, and Disclosure Information

From Western Australian Centre for Health and Ageing, Centre for Medical Research, Western Australian Institute for Medical Research, School of Medicine and Pharmacology, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Crawley; Royal Perth Hospital, Perth; and Fremantle Hospital, Fremantle, Western Australia, Australia.

Acknowledgment: The authors thank Tricia Knox and the staff of the Departments of Biochemistry, PathWest, Royal Perth and Fremantle Hospitals, Western Australia, Australia, for their assistance in performing the hormone assays; Peter Feddema, DPC-Biomediq, Doncaster, Victoria, Australia, for his assistance with sourcing hormone assay kits and reagents; and the staff and management of Shenton Park Hospital, Shenton Park, Western Australia, Australia, for providing space in which to conduct follow-up clinics. The authors especially thank all the men who participated in the study and the research assistants who helped with data collection.

Grant Support: By grants 279408, 379600, 403963, 513823, and 634492 from the National Health and Medical Research Council of Australia and grant DS 080608 from the MBF Foundation of Australia. Ms. Hyde is supported by a National Health and Medical Research Council Biomedical Postgraduate Scholarship. Hormone assays were funded by a Clinical Investigator Award to Dr. Yeap from the Sylvia and Charles Viertel Charitable Foundation, New South Wales, Australia.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-1542.

Reproducible Research Statement:Study protocol and data set: Not available. Statistical code: Available from Ms. Hyde (e-mail, zoe@sexologyresearch.org)

Requests for Single Reprints: Zoë Hyde, MPH, Western Australian Centre for Health and Ageing (M570), University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia; e-mail, zoe@sexologyresearch.org.

Current Author Addresses: Ms. Hyde and Drs. Flicker, Almeida, and McCaul: Western Australian Centre for Health and Ageing (M570), University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia.

Dr. Hankey: Royal Perth Hospital, GPO Box X2213, Perth, Western Australia 6001, Australia.

Drs. Chubb and Yeap: Fremantle Hospital, PO Box 480, Fremantle, Western Australia 6959, Australia.

Author Contributions: Conception and design: Z. Hyde, G.J. Hankey, O.P. Almeida, K.A. McCaul, B.B. Yeap.

Analysis and interpretation of the data: Z. Hyde, L. Flicker, K.A. McCaul, B.B. Yeap.

Drafting of the article: Z. Hyde, G.J. Hankey.

Critical revision of the article for important intellectual content: Z. Hyde, L. Flicker, G.J. Hankey, O.P. Almeida, K.A. McCaul, S.A.P. Chubb, B.B. Yeap.

Final approval of the article: Z. Hyde, L. Flicker, G.J. Hankey, O.P. Almeida, K.A. McCaul, S.A.P. Chubb, B.B. Yeap.

Provision of study materials or patients: L. Flicker, B.B. Yeap.

Statistical expertise: Z. Hyde, L. Flicker, K.A. McCaul.

Obtaining of funding: L. Flicker, G.J. Hankey, O.P. Almeida, B.B. Yeap.

Administrative, technical, or logistic support: L. Flicker, K.A. McCaul, S.A.P. Chubb, B.B. Yeap.

Collection and assembly of data: Z. Hyde, L. Flicker, O.P. Almeida, S.A.P. Chubb, B.B. Yeap.

Ann Intern Med. 2010;153(11):693-702. doi:10.7326/0003-4819-153-11-201012070-00002
Text Size: A A A

This article has been corrected. For original version, click "Original Version (PDF)" in column 2.

Background: Knowledge about sexuality in elderly persons is limited, and normative data are lacking.

Objective: To determine the proportion of older men who are sexually active and to explore factors predictive of sexual activity.

Design: Population-based cohort study.

Setting: Community-dwelling men from Perth, Western Australia, Australia.

Participants: 3274 men aged 75 to 95 years.

Measurements: Questionnaires from 1996 to 1999, 2001 to 2004, and 2008 to 2009 assessed social and medical factors. Sex hormones were measured from 2001 to 2004. Sexual activity was assessed by questionnaire from 2008 to 2009.

Results: A total of 2783 men (85.0%) provided data on sexual activity. Sex was considered at least somewhat important by 48.8% (95% CI, 47.0% to 50.6%), and 30.8% (CI, 29.1% to 32.5%) had had at least 1 sexual encounter in the past 12 months. Of the latter, 56.5% were satisfied with the frequency of activity, whereas 43.0% had sex less often than preferred. In cross-sectional analyses, increasing age, partner's lack of interest, partner's physical limitations, osteoporosis, prostate cancer, diabetes, antidepressant use, and β-blocker use were independently associated with reduced odds of sexual activity. Living with a partner and having a non–English-speaking background were associated with increased odds. In longitudinal analyses, higher testosterone levels were associated with increased odds of being sexually active. Other factors were similar to the cross-sectional model.

Limitations: Response bias may have influenced findings because sexuality can be a sensitive topic. Attrition may have resulted in a healthier-than-average sample of older men.

Conclusion: One half of elderly men consider sex important, and one third report being sexually active. Men's health problems were associated with lack of sexual activity. Key modifiable risk factors include diabetes, depression, and medication use. Endogenous testosterone levels predict sexual activity, but the role of testosterone therapy remains uncertain.

Primary Funding Source: National Health and Medical Research Council of Australia.


sex behavior


Grahic Jump Location
Figure 1.
Study flow diagram.

The study spans 14 y, from 1995 to 2009. W = wave.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Proportion of men who engaged in sexual activity in the 12 months before survey wave 3 (2008 to 2009), by age group.

Based on data from 2783 men; of these, 1145 were aged 75 to 79 y, 1120 were aged 80 to 84 y, 436 were aged 85 to 89 y, and 82 were aged ≥90 y. Errors bars indicate 95% CIs.

Grahic Jump Location
Grahic Jump Location
Figure 3.
Importance of sex at survey wave 3 (2008 to 2009), by age group.

Based on data from 2930 men; of these, 1192 were aged 75 to 79 y, 1194 were aged 80 to 84 y, 453 were aged 85 to 89 y, and 91 were aged ≥90 y.

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Thoughts on about article on sexual activity for older men.
Posted on December 7, 2010
Steven W. Belcher
No Affiliation
Conflict of Interest: None Declared

Like most in my age and sex cohort in the US, I assumed that sexual activity would decline along with other aspects of my body. I was a competitive swimmer as a adolescent, and have always been very physically active (hiking, martial arts, skiing, etc.). At 66 years of age, I am increasingly and incrementally less flexible, strong, and my physical endurance is noticeably reduced. I think I am very realistic about this particular life stage and accept aging as part of the wheel of life.

I have been living in Thailand for the year and have a 34 year old Thai girlfriend. Throughout my adult life, I have had sex roughly once a week. There were long stretches between marriages or when my wife had cancer, where I had little sex with another. I have been utterly flabbergasted that I am now have sex sometimes every day of the week. Honestly, once a week is fine with me, but living with a younger woman requires compromise. I am deeply appreciative to the gods above, but I had no idea that this was possible.

I guess I am writing to you because I feel that I have to share and I can't think of an appropriate forum (telling my friends would be too much like bragging). However I think it is important to inform other old men that the possibility exists. Maybe there is a study there. Sincerely, Steve Belcher

Conflict of Interest:

None declared

Male Sexuality and the Role of Society Expectations
Posted on December 16, 2010
Daniel G. Arkfeld
USC Keck School of Medicine
Conflict of Interest: None Declared

It is with great interest that I read the article on the prevalence of sexual activity and associated factores in men age 75 to 95 years by Hyde et al. As a younger doc 20 years ago I remember a female patient at the age of 93 trying to have sex despite physical limitations due to her age and high level of osteoarthritis. It took me some time to give her proper advice. Thus reading this article on men spark a similar interst in me especially after seeing an elderly male patient with migratory polyarthritis for which gonnorrhea was suspected. The use of erectile dysfuncion medications which are accepted by society may lead to a much higher expectation of sexual response in elderly males. Additionally this study was performed on Australian men and it would be of keen interest to evaluate men in other countries. Cultural and society values may certainly change one's expectation of sexual frequency.

Conflict of Interest:

None declared

Sexual activity and rejuvenation
Posted on December 16, 2010
Hernando Rafael
Universidad Nacional Autonoma de M?xico
Conflict of Interest: None Declared

TO THE EDITOR.I was very interested in the article by Hyde and colleagues(1)on the sexual activity in men over 75 years of age.The authors informed that 85% of men provided data on sexual activity.In my opinion, these findings were due,essentially,to a partial function of the hypothalamic-pituitary-testis(HPT)axis by the following.FIRST,the aging process is initiated in the producing hypothalamic nuclei of growth hormone-releasing hormone(GHRH),caused by progressive ischemia(2,3).SECOND,the arcuate nucleus. main producing hypothalamic nucleus of GHRH is constituted by small cells such as dopamine,GHRH, luteinizing hormone-releasing hormone(LHRH),vasoactive intestinal peptides(VIP),proopiomelanocortin (POMC) and neuropeptide Y(NPY) neurons,as well as ependymal cells and tanacytes.THIRD,The unmyelinated axons of GHRH and LHRH neurons terminate directly in the median eminence.FOURTH,through the LHRH,the adenohypophysis secrete luteinizing hormone(LH) and follicula-stimulating hormone(FSH),and both of them acts in the testis.FIFTH,the revascularization of the arcuate nucleus produces rejuvenation and improvement the sexual activity (4).SIXTH,the arcuate nucleus,through the fornix,receives excitatory impulses from the hippocampal formation (5). For these reasons,I believe that the sexual activity into the men reported by Hyde and associated were due to a partial function of the HPT axis.Likewise,it suggest that the rejuvenation is related with the sexual activity.


1.Hyde Z,Flicker L,Hankey GJ,Almeida OP,McCaul KA,Chubb P,Yeap BB.Prevalence of sexual activity and associated factors in men age 75 to 95 years:A cohort study.Ann Intern Med 2010;153:693-702.

2-Rafael H.Therapeutic methods against aging.Turk J Geriatri 2010;13(2):138-144. www.geriatri.dergisi.org

3-Rafael H.Effects of ghrelin in the hypothalamus.Med Sci Monit 2010;16(12):LE20-21.www.medscimonit.com

4-Rafael H.Rejuvenation after omental transplantation on the optic chiasma and carotid bifurcation.Case Rep Clin Pract Rev 2006;7:48-51.

5-Reichlin S. Neuroendocrinology.In Wilson JD,Foster DW(eds).Wiliams texbook of endocrinology.Chapter 17,Seventh edition.Philadelphia,WB Saunders 1985.

Conflict of Interest:

None declared

Submit a Comment/Letter

Summary for Patients

Sexual Activity in Men Aged 75 to 95 Years

The full report is titled “Prevalence of Sexual Activity and Associated Factors in Men Aged 75 to 95 Years. A Cohort Study.” It is in the 7 December 2010 issue of Annals of Internal Medicine (volume 153, pages 693-702). The authors are Z. Hyde, L. Flicker, G.J. Hankey, O.P. Almeida, K.A. McCaul, S.A.P. Chubb, and B.B. Yeap.


Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.