Sex. There. I said it.

In the U.S. we have a weird fascination with sex. Why ‘weird?’ Well, it seems to be an all-consuming subject of interest and an impolite subject of discourse. More than 30 years ago, I coined this statement: “Sex? It is dirty, wrong, sinful, and disgusting. Save it for the one you love.”  It seems people in the U.S. would rather watch pornography than talk about sex. Never mind what this limited communication does to one person or another. What it does to us all is debilitating. Only a month ago I was shocked to hear that in my university class the majority of my students – all juniors and seniors – understood the word sex to refer only to penetrative vaginal or anal behavior. Kissing, touching, sucking, rubbing, masturbation – mutual or otherwise? Nope.

It is against this backdrop, in this context of still being generally unskilled in talking and thinking about sex, that people over 55 must try to make sense of their sexual and relationship experiences and goals. Research over the past 20 years fairly consistently shows that about half of all Americans over 60 are sexually active. (Of course, how much shared meaning over what constitutes sex is unknown). Forty percent of those having sex would like to have sex more often. Two out of three older men and women also state that they are as satisfied, if not more, than when they were in their 40s. Still, too often sexually active and sexually interested older adults are socially viewed as inappropriate, predatory, or derisive.

Community development that truly engages older adults as whole people must account for our sexuality, both its maintenance and its challenges. Unresolved health issues like sexuality grate on older adults, too often privately, too often alone. With these issues sapping our psychic reserves, I believe our social contributions are similarly truncated. Add these issues of sexual functioning to our feelings of dwindling sexual attractiveness as we age, and corporate profits for companies that trade in this arena soar. We know that sexual issues are commonplace because there are enough media ads hawking products that address issues that we cannot name. Viagra will eliminate erectile changes in men’s aging lives, but we cannot talk about the changes themselves. We know this stuff; we just don’t talk about it.

It appears that we also know some things that seem to contribute to challenges in maintaining satisfactory sexual functioning after 60. Medications for blood pressure, psychosis, depression, sleep, and stomach upset can all trigger problems with sexual functioning and sexual desire. Alcohol and watching lots of pornography can as well. While the impact of pornography on sexual functioning is not well understood, the size of the porn industry has been receiving much attention for a while. Given these factors, why are not people talking about sex after sixty more often? Are primary care doctors having these discussions with their patients? Does anyone even ask about sexual goals of people over 60?

For over a decade we have known that video pornography was larger than the revenue collected by the N.F.L. or the N.B.A. But, when we add the estimated $10 billion to $14 billion associated with pay-per-view, web sites, hotel movies, print, and sex toys, the porn business becomes bigger that the ticket sales for all performing arts combined or purchases of all bottled water in a year. I am not suggesting changes in the legal protections of people’s right to access porn. I am wondering about why and how this industry became so large and how its impact on older adults can be addressed.

On the reverse of this, healthy lifestyle and the absence of chronic disease has a positive impact on sexual functioning. For example, men who exercise at least three hours per week have one-third less risk of sexual dysfunction than those who exercised very little. This factor might be associated with reduced chance for obesity, tobacco use, and an excessively sedentary lifestyle, all of which have been associated with risk.

For several years I led the sexuality education programs of a Planned Parenthood affiliate. I later served as national consultant in a program aimed at increasing the number and quality of sexuality education mandates for public schools. While I am proud of the work I did and the gains that we made, I confess I don’t see the impact I would have liked. I don’t see robust, commonplace discourse on human sexuality, discourse that could increase happiness and unleash greater potential for social good from the contributions of older adults.