Unapologetically Ita, page 13
I think it’s the word ‘old’ that causes so much confusion, especially among people who are not old, and this includes family members, many of whom have some romantic view of how their parents should behave. ‘Old’ is a word most people fear, because it’s associated with slowing down, even breaking down; with mental fragility, being tossed on the scrap heap, failing faculties and ill-health; with no longer being valued.
Ageing is an unknown world to which, if we live that long (and not everyone makes it), all of us must travel, but because it obviously represents change – a change in lifestyle, a change in the things we are still able to do, a realisation that one day we might be dependent on others – people fear it.
As a person grows older, every day is a learning experience, like the time I took a jacket to Rita, my dressmaker, to have the sleeves shortened. I put the jacket on and Rita walked behind me looking at something. She didn’t speak.
‘What are you doing?’ I asked.
‘Just checking your elbows haven’t dropped,’ Rita replied.
‘Oh no! Elbows drop?’
‘It’s okay,’ said Rita. ‘Yours haven’t dropped.’
I felt such a sense of relief at Rita’s pronouncement.
I never really understood what it meant to be older until I got older and truly understood the expression: ‘Only the elderly appreciate the brevity of life.’ I never thought much about being on my own until my children left home. I never thought about older old age until I cared for my father when he was in his eighties and battling vascular dementia.
I never thought much about my sexual desires until I read an article about Jane Fonda, which reported that when she realised her libido wasn’t as good as it used to be, she started to take testosterone. It worked. Jane’s libido became lusty again. The only problem was she started getting acne again too. Poor Jane, what a dilemma. Good sex with pimples or give up testosterone.
Kate Winslet takes testosterone too. In a podcast she did in 2024 Kate revealed that, like Jane, she had suffered a loss of libido and had turned to testosterone replacement therapy (TRT) to bring her hormones back to a ‘normal’ level. She told listeners that TRT had certainly made her ‘feel sexy’ again. She did not mention anything about pimples.
For some unexplainable reason, older people are usually excluded from surveys on sexual activity. I found an interesting one done with 100 senior citizens in Brisbane, comprising eighty-four women and sixteen men. Fifty-four per cent were widows; 28 per cent were married; the rest were divorced, single or separated. All but four of them were on the pension. Thirty-eight per cent thought people regarded the elderly as a group beyond sexual relationships and couldn’t indulge even if they wanted to; the elderly were seen as not interested in sex. What’s more, 28 per cent said their families would not approve of them having an intimate sexual relationship. Only 5 per cent said their families would react favourably. What spoilsports families can be – and actually, their parents’ sex lives are none of their business.
The fact of the matter is that older women and men enjoy being sexual. Most of them have been having sex for a long time, and they probably would have countless pieces of sexual wisdom that might just benefit younger people. For instance, the forever beautiful Dame Joan Collins, when asked by The London Daily Mail what was the secret of her successful relationship with her husband Percy, who is thirty-two years younger, didn’t hesitate: ‘Sex, sex and more sex.’ The esteemed American journalist and broadcaster Barbara Walters told the viewers of the top-rating TV show The View: ‘You know what [my vibrator] is called? A selfie!’
It is often concerns about safety, coupled with ageism, that deny older people in care what is often one of their few remaining pleasures. Sexual relationships are a basic human right and a normal and healthy part of ageing. Older people usually continue to enjoy a happy sexual relationship while they are at home, but once they move into residential care, such relationships, although lawful and consensual, are often not permitted.
All sorts of obstacles get in the way, such as duty of care, safety fears, lack of privacy, and reactions from relatives. But the fact is sexuality and intimacy are important as people grow older and are important for their health and wellbeing. The sexual needs of residents cannot be overlooked or dismissed once they are in aged care facilities. Health care professionals need to ask people about their sexual needs. If such things are not talked about beforehand, they can become difficult to handle later. Often residential facilities lack formal policies or guidelines, and appropriately trained staff to address this.
Not allowing individuals, including those with dementia, to express their sexual needs, possibly in the mistaken belief that they need to be ‘protected’, is denying them their fundamental right to be recognised as a person before the law and, I think, a significant failure of duty of care. Of course, if their expression of sexual needs is inappropriate and adversely impacts others, that is a different matter, and a GP might declare someone can no longer have sex. But what if the person in question does not feel like giving up sex, or what if a person with dementia thinks otherwise? How are such decisions best handled?
The dementia caseload continues to grow. More than 50 per cent of residents in Australian government-subsidised aged care facilities have dementia. Almost half of permanent residents with dementia also have a diagnosis of a mental illness. As the caseload increases, people who provide residential care and community care to people at home will be confronted with situations they might not have encountered before.
For instance, the issue of consent: when does a person with dementia cease to have capacity to give consent? This is different for every case. The counsellors at Dementia Australia often have to deal with this issue and have to make an assessment as to whether a person with dementia is no longer able to give consent, but at what stage do they intervene and discuss this with the partner/carer who still wishes to have sex?
Dementia causes many changes in a person’s life and one area in which there are often changes which are seldom discussed is that of sex and intimate relationships. Everyone has the right to express their sexuality without fear of judgement, and that includes people with dementia. The onset of dementia does not mean the end of a happy sex life. It may lead to changes, but all relationships change over time, and intimate relationships can take many different forms. The behaviour of a person with dementia can change dramatically. They can suddenly want more sex, or lose interest entirely, which presents all kinds of challenges in a relationship, especially in the initial stages. Some people with dementia may become aggressive if their sexual demands are not met. This is often the time to call in a GP or other health professional.
I am aware of cases where children have intervened to stop their mother or father in care having sexual relationships with other residents. But whose call is it? The same with partners who discover their partner of many years who is in care has partnered up with someone else in care, even of the same sex. These stories present all kinds of challenges to staff and families. When should someone intervene, if at all?
And then there are simple pleasures to consider. People in care often miss out on the many simple pleasures of day-to-day intimacy. The shower is perhaps the only time they may be touched and this is likely (appropriately) to be in a matter-of-fact fashion. But there are other ways that touch can be appropriate and be soothing. A gentle arm around a shoulder or holding a hand as you walk along a corridor; a calming hand rub; head massages when shampooing; warm foot baths; brushing someone’s hair; or perhaps even arranging massages for clients. All easy things to do and organise. The gentle power of touch can never be underestimated. I remember in the early days of the HIV/AIDS crisis one young, good-looking Melburnian man who had AIDS telling me: ‘No one touches me or hugs me anymore.’
Much rests on the shoulders of the medical profession. They need to communicate better with their patients. From a personal perspective, no doctor has ever discussed sex with me. But doctors do have an important role to play. This was reinforced in an article published in the esteemed medical journal The Lancet in March 2023, which said that doctors must be prepared to discuss older patients’ sexual needs.
Sexual activity is an important part of health and wellbeing and it correlates with greater enjoyment of life for older adults. People do not become asexual with age, although they might modify their sexual activity as a consequence of physiological changes. Given the substantial proportion of the global population over the age of sixty-five years and the availability of drugs and devices to enhance their sexual function, physicians must be willing and prepared to both initiate discussions with older patients about sexual concerns, and to make sexual health a routine part of general health care for older adults.
Discussions about sex are infrequent, partly because physicians might unwittingly accept misconceptions about the sexual function of older adults.
The first misconception is that older adults are neither sexually active nor interested in sex, so there is no reason to ask them about their sexual health. However, although the frequency of sexual activity tends to decline with age, older adults are still sexually active.
In 2023 AARP (formerly the American Association of Retired Persons) conducted a survey, ‘Ageless Desire: Relationships and Sex in Middle Age and Beyond’, which showed that 61 per cent of people surveyed believe sexual activity is a critical part of a good relationship. Interestingly, it also revealed that the Covid pandemic had an impact on how people viewed their relationships. Forty-one per cent of older adults wanted an increased connection with their significant other, and 70 per cent said they believed quality time and strong connections were more important now than before Covid-19.
They were more conscious of the importance of relationships with friends, family, spouses or romantic partners, and the need to spend time with each other to keep the romance in the relationship. Couples even volunteered information on how they do that:
63 per cent make a point of saying ‘I love you’
57 per cent celebrate special days like birthdays and anniversaries
35 per cent take a vacation or romantic trip annually
32 per cent set aside time to enjoy each other’s company
30 per cent buy each other gifts or flowers.
The ARRP survey contained some fascinating information. The response to ‘Are sexual fantasies among older adults common?’ was a resounding yes; 83 per cent of those surveyed admitted they had sexual thoughts, fantasies or erotic dreams. Having sex with a stranger was the most common fantasy for both genders, while men’s fantasies included having sex with more than one person at a time. Women were more likely to say that they fantasised about having sex with someone of the same sex or having sex in different locations. The survey explored how frequently older adults masturbate and found that 55 per cent of people reported pleasuring themselves in the past six months. Among those who did masturbate, 61 per cent had done so within the past week. About one in four pleasure themselves weekly, but that number decreases as age rises: only 11 per cent of people aged seventy and older reported masturbating in the previous week, compared with 40 per cent of those aged forty to forty-nine. ‘Masturbation is natural and shouldn’t produce feelings of guilt or embarrassment,’ say the researchers.
Worryingly, in the past few years there has been a rise in the rates of sexually transmitted infections (STIs) among Australians aged 60 years and older. Rates of gonorrhea have more than doubled and rates of chlamydia have also risen and coincide with an increase within this age group of online dating. These results suggest that older people need to know more about safe sex practices and sexually transmitted diseases.
In January 2025, Australia’s Seniors Magazine carried an article titled ‘STIs and playing it safe in older age’. It included research from the University of Melbourne which revealed that while most new STI cases in Australia occur in young people, the rates among older people are rising faster. This may be partly because older people falsely think they do not have to worry about STIs. Many of them are ignorant about their level of risk and lack knowledge about STIs and the importance of safe sex and using condoms.
The assumption that older people know about safe sex is widespread. Yet many of them grew up in a time when sex education was not provided at school, and because many older people have enjoyed long-term, monogamous relationships, using condoms is not something they have ever thought about. Older people might also have unique or different safe sex needs to their younger counterparts. For example, how does one negotiate condom use and an ageing body? How can issues around increased friction and pain that can be associated with condom use (particularly for postmenopausal women) be managed?
Older Australians need different types of information at various stages of their life, and those re-entering the dating or casual sex scenes might benefit from a refresher on safe sex. As ARRP research confirms, recognition that sex is a vital component of a good relationship, coupled with older people’s predominantly sex-positive attitudes, underscores the significance of intimacy in later life. Additionally, the continued engagement in sexual behaviours and the near-universal prevalence of private sexual fantasies and thoughts among older adults highlight the ageless nature of desire.
Older people cannot continue to be routinely excluded from research on sex and relationships. They need to be educated about their sexual health care as do health professionals, especially as all the evidence suggests that older Australians are happily engaging in sexual activity and associate a happy sex life with better health as they age.
But even though all the evidence shows that older people are contentedly sexually active, there is an unwillingness to accept this shift. Many in the community continue to cling to old-fashioned and ageist assumptions that older people are asexual. Consequently, GPs often don’t bother to talk to their older patients about sex. Like the general population, many GPs think sexual health is not relevant to older people and therefore don’t discuss it with their older patients. Like so many others, they presume older men and women are no longer sexual.
Research carried out by the Victorian Primary Care Practice-Based Research Network suggests that older patients want to talk about sexual health but are reluctant to initiate these discussions with health practitioners. While all GPs recognise the importance of sexual health in relation to the overall health of patients, most suggested they did not consider it a high priority for their older patients, and they did not routinely discuss it with them. Most believe the responsibility for initiation of sexual health discussions rested with patients.
One of AARP’s contributors is Joan Price, a fabulous 82-year-old, author of five books including Naked at Our Age: Talking Out Loud about Senior Sex. She calls herself an advocate for ageless sexuality. America’s media call her a ‘senior sexpert’. Joan believes ‘ageing is a precious gift. Those of us who age did not die young.’ She encourages older adults to see themselves as sexual beings and to care for their sexual health and says: ‘Sexual pleasures have no expiration date.’ If I were still running Cleo, I would hire her immediately.
Sex as people age is not without certain challenges, however. Joints are not as supple as they once were. Couples need to work out positions that minimise joint stress and they need to be honest with one another. If you have arthritis (many older people do), explore ways to reduce discomfort. Listen to your body. If you feel pain, stop and try to reposition. Many older people have mobility issues. Maybe lying side-by-side could help. Enjoy exploring new positions.
According to AARP, many older women prefer casual sex, especially after a divorce or the death of their partner. This is understandable, and it is okay too. One of the many benefits of older years is not having to ask permission to do anything, and that includes having casual sex.
For most people, sex is a very private matter and some people find it difficult to talk about their sexual feelings to their partners, let alone anyone else. In communal living the notion of privacy is one that constantly requires attention. It is easy to forget the need for personal space, and the need to have a sense of ownership and control over it. Another need is the right to select and maintain social and personal relationships with any other person without fear, criticism or restriction.
People lose many things as they grow older. They may lose their vision, they lose their youthfulness, and they often lose their agility. They lose some of their friends. They may lose the ability to live independently. However, they do not lose their legal rights, and a key entitlement is the right to privacy. What a person does in the confines of their own space is deemed to be the person’s own business, the proviso being that it does not compromise others, or inflict damage to property.
Older people, including those who are living with dementia, have the same right to intimacy as everyone else, and the various ways in which they express their sexuality needs to be respected by their families, their carers, and aged care workers, without judgement.
Chapter Seven The Many Challenges of HIV
There was a time when David Polson thought that he would not live to be an old man. In 1984, he was one of the first 400 men in Australia to be diagnosed with HIV/AIDS. He was twenty-nine. In 1984, I was appointed chair of the National Advisory Committee on AIDS (NACAIDS), charged with implementing Australia’s AIDS education campaign.
Neither of us knew that our lives would be so profoundly influenced by a remarkable man, immunologist Dr David Cooper, an HIV/AIDS researcher at St Vincent’s Hospital and the Kirby Institute at the UNSW Sydney. He and Professor Ron Penny, the deputy chair of NACAIDS, and the inaugural Director of St Vincent’s Hospital’s Centre for Immunology in Sydney, diagnosed the first case of HIV in Australia.
