James Warner and colleagues are right to argue that older people are less reticent in discussing their sexual activity and problems than doctors believe.1 In a randomised controlled trial of health promotion with patients aged 65 years and over recruited through general practice, we asked 1090 responders the question: ‘How often have you experienced sexual problems in the last month?’ The choice of answers was ‘never’, ‘seldom or sometimes’ and ‘often or always’. One thousand and-fifty-three (93.6%) answered the question, of whom 72 (6.8%) answered ‘seldom or sometimes’ and another 72 (6.8%) answered ‘often or always’. Among men, 121 (25%) reported that they had a sexual problem, while only 23 (4%) women did so. Sexual problems were reported by 17% of those aged 65 to 74 years, 21.5% of those aged 75 to 84 years, but only 4% of those aged 85 years and over. We do not know what the sexual problems were, and can only speculate that the predominance of men suggests that prostatic hypertrophy, medication adverse effects, or diabetic neuropathies were major causes. Further investigation is needed here. We do know that there was no association between having sexual problems and self-rated health; 33.5% of those rating their health as good to excellent also reported sexual problems, compared with 30% of those describing their health as fair or poor. Our sample was self-selected and relatively well (those with significant disabilities were excluded from the trial), so we may be under-estimating the prevalence of sexual problems in later life. The clinical implications for GPs are that sensitive discussion of sexual problems with men, up to the age of 85 years, is likely to reveal a significant burden of morbidity, but it is not clear whether it will be tractable. If our findings are typical, few older women will report sexual problems.
- © British Journal of General Practice, 2008.
