Biological sexual ageing: Myths and realities

Sexuality is both a human right and a meaningful parameter for the quality of life at any age but with significant individual variations. For the elderly, a sex life continuing into old age often contributes positively to their well-being, and in maintaining a satisfying affective and relational life. These basic notions are too often ignored due to preconceived ideas and beliefs concerning the "sexual presbybiology'': (a) sexuality stops with ageing and "it is just as well'', (b) ageing impairs the biological response globally and in the same way for all subjects of same gender but with important differences between sexes, (c) sexual ageing is unavoidable. In the popular imagination, sexuality usually ends for women in their fifties with the menopause, and for men in their sixties with erectile impairment. In reality, the situation is totally different. Although it is true that age remains a factor of vulnerability making sexual biological performance more vulnerable, sexual biology remains compatible with the continuation of sexual activity for many old people. In fact, the current limit for biological ageing seems to be somewhere around 75-80. The impairment of both sexual reactions and sensations related to ageing occurs progressively but with wide variations from one subject to another, without any difference between genders. Reproduction is the biological exception, but it is of little concern to senior citizens. In brief, sexual disorders in men are more closely correlated to biological and mainly pathological ageing, and in women to both the environment (partner and sociocultural) and previous sexual life. Male erection appears as the main fragile point for sexual biological ageing of the couple owing to its high prevalence and to its specific impact on sexual satisfaction for the couple, reflecting the different sexual representations between genders. To prevent or slow down sexual ageing is not a superficial or utopian view but a real challenge for the 21st century that requires a holistic approach because maintaining an adequate sexual physiology is necessary but not sufficient for successful sexual ageing. This recent concept implies: (a) a strategy for both learning and adaptability owing to the changes undergone in biological sexual performance in elderly people, (b) a policy of prevention against both biological and pathological ageing. (C) 2008 Elsevier Masson SAS. Tous droits reserves.