Men's health care in old age: Facing sexual behavior and needs in old age

Sexual Behavior in Old Age

Due to a lack of accurate understanding and awareness of the sexual attitudes and interests of the elderly, sexual activity (sexual behavior) is often equated with sexual intercourse. In reality, certain emotional needs of the elderly can be satisfied through sexual activity, such as receiving caresses from the opposite sex; these needs do not disappear or cease with age. Therefore, sexual behavior in the elderly does not always have to be fulfilled through sexual intercourse.

I. Prejudice Regarding Sexual Life in the Elderly

When discussing sexual issues in the elderly, most people are extremely hesitant and reluctant to engage in sexual activity. Even today, many articles introducing "secrets to longevity" almost invariably mention strict control of sexual activity (their intention being "prohibition"). The phrase "avoid close contact with women" from Emperor Qianlong's longevity formula has been repeatedly published more than ten times in various newspapers and magazines. Ancient medical books, when discussing health preservation, also regard sexual activity in the elderly as a significant factor reducing lifespan.

Long-term societal values ​​and cultural influences, along with traditional teachings and social prejudices, have led to the belief that sex is no longer a part of marital life in old age, or is even unnecessary. The elderly themselves have developed distorted mindsets contrary to physiological function: "After 40, it's past noon; at 50, no more sleeping in the same bed; at 60, no more intimacy with a wife." This severely suppresses the sexual attitudes and interests of the elderly. To avoid being scorned as "promiscuous" or "improper," they desperately suppress their sexual desires, and dare not seek a new partner after widowhood, or even after remarriage, they are unwilling to establish sexual contact. This view is prevalent not only in China but also abroad. An author once conducted a survey of American university students, asking for their opinions on their parents' sex lives. About two-thirds believed their parents should no longer have sex, and one-third believed their parents should have sex at least once a month. In reality, their parents were generally only in their forties or fifties.

Indeed, decreased sexual function and libido are common physiological phenomena in old age. However, there are significant individual differences in the sexual attitudes, interests, and abilities of the elderly. Generally speaking, male sexual function declines later than female sexual function, and those who have always been healthy and have no serious illnesses in old age experience a much slower decline in sexual function than those who are frail and sickly.

II. The Need for Sexual Activity in the Elderly

Appropriate sexual activity is normal for the elderly and is a sign of health. Physiologists have concluded from years of work that "if a high level of sexual activity is maintained from an early age, and as long as there are no acute or chronic physical disabilities, then elderly men can often maintain some form of sexual activity until their 70s or even 80s." According to surveys and studies by many scientists at home and abroad, it is unanimously agreed that people maintain a considerable degree of sexual desire and function into old age. A survey of 4,246 elderly people aged 50 to 93 by the U.S. Consumer Association found that most elderly people can maintain active sexual lives until their 70s or older. According to their statistics, over three-quarters of women over 60 still have sexual intercourse with their husbands, averaging once a week; over half of women over 70 and three-quarters of men over 70 are still interested in sex. Some elderly couples over 70 still maintain normal sexual activity, averaging once every 10-11 days, much higher than people imagine. A Japanese study of 55 elderly men aged 65-80 found that only 12.7% had completely lost their sexual ability. A survey in Tokyo, Japan, showed that sexual ability varies among the elderly; some people at 80 can still maintain sexual intercourse twice a week, and some men even have sperm production at 90. Surveys in some Chinese cities indicate that libido gradually decreases with age, but 70% of men and 50% of women in the 70-year-old group still remember having good sexual ability. In Nanyang, Henan Province, a folk tale tells of the medical sage Zhang Zhongjing having a son late in life.

Zhang Zhongjing pioneered the principles, methods, prescriptions, and medicines of traditional Chinese medicine, emphasizing dialectical treatment. He authored works such as *Shanghan Lun* and *Jinkui Yaolue*, and is revered as the "Medical Sage" who saves the world and heals people. When he was 84 years old and serving as the Prefect of Changsha during the Eastern Han Dynasty, his last wife gave birth to a boy. His colleagues gossiped, speculating that the Prefect had been cuckolded. The Medical Sage, aware of the rumors, was not angry but instead wrote a humorous poem for everyone to see. The poem reads: "At eighty-four, I have a child, making everyone in the east and west offices laugh; if relatives and friends don't believe it, when he grows up, he will still be sitting in Changsha." According to reports, in the central Iranian city of Arak, a resident named Sandi, at the age of 106, his wife (40 years old) gave birth to a son named Muhammad. At birth, he weighed 3 kg, was 51 cm long, and was "in excellent health." Sandi himself was a coachman with over 60 years of experience (Reference News, November 13, 1991).

Due to complex physiological and psychological reasons, a decline in sexual function and libido is a general rule in old age, but this process is slow and varies greatly from person to person. However, although some elderly people still retain some sexual function, they are, after all, old age, and therefore should moderate their sexual activity until it naturally ceases.

III. Factors Affecting Sexual Life in the Elderly

As mentioned earlier, physiological changes with aging affect sexual function. In addition, there are other factors that also affect and suppress the sexual function that still exists in the elderly.

1. Physical Health. Elderly people inevitably have some chronic illnesses, but some illnesses will not necessarily be aggravated by sexual activity. Many people have a fear of illness and sexual activity, are embarrassed to seek medical help, or accept incorrect guidance from quack doctors, resulting in sexual dysfunction.

2. Marital Relationship and Quality of Sexual Life. If a couple has a good relationship and a harmonious sex life, and both understand and grasp each other's sexual desires and characteristics, their sex life will continue for a considerable period in old age. If their sex life has always been disharmonious and unsatisfactory, it will become even more awkward in old age.

3. Attitude towards marital sex life. If sex is seen as merely a release of desire, its quality will quickly decline; conversely, if it is seen as an emotional exchange, an essential source of psychological pleasure and joy, sexual activity will continue in various forms into old age.

4. Confidence in one's sexual ability. Physiologically, older adults are fully capable of sexual activity, but if they psychologically believe they are no longer able, it may affect the normal functioning of their sexual abilities.