As a medical student in the recent past I remember being told: “not asking an elderly patient about his or her sex life is simply ageism”. A few weeks later a colleague informed me he had at that point resolved to cast aside his queasiness, which was really just prejudice, and put the advice into practice.
The problem was, he said, many of the patients he spoke to had similar prejudices. “It must be their Victorian upbringing,” he said.
Some health professionals take a great interest in the topic of sex and sexuality in the elderly. Big Pharma has also expressed its concern (perhaps a more acute concern of late, with the falling rates of prescription for erectile dysfunction (ED) drugs such as Viagra). The media of course, are perennially interested. Last year the world heard Michael Douglas’s endorsement of the little blue pill. Recently the New York Times reported on rising rates of cosmetic surgery among those over 65. The clear message from their interviews was that looking and feeling sexy was important in that age group.
Is it really? If so, for how many? And more importantly, why?
All of these questions are difficult to answer. But reflecting on the third question could shed some light on some of the proposed answers to the first two (for instance, that 60 percent of the elderly population are interested in maintaining sexual activity).
Without entering into debates about the definition of “elderly” and “sexual activity”, and taking the liberty of lumping “desire to look and feel sexy” (as opposed to the “desire to look good”) with “desire to have sex”, we could begin this reflection by asking “why not?” Why shouldn”t those in the golden years be interested in sex and sexiness?
There is an argument, in fact, that such an interest is healthy and aiding that interest could be therapeutic. Undoubtedly, there is truth in this, albeit surrounded by a significant cloud of grey. But there is something suspicious about a urology journal publishing a global survey of sexual attitudes and behaviours in those aged up to 80. And the idea that a breast augmentation in an octogenarian can be beneficial for self-esteem is about as credible as the idea that alcohol is a good cure for stress or nervousness.
Therapeutic claims aside, isn’t the increased openness in the discussion of sex and sexuality in the elderly a triumph of Freudian psychology and the sexual revolution? Isn’t it a sign of a liberated society, traducing Victorian values and an antiquated morality?
Possibly. But there is an alternative view, one that argues that our own society’s approach to sex is distorted. We have heard a good deal about the sexualisation of the young. Could we also be witnessing the sexualisation of old age? Could the culture of cosmesis and the popularity of ED drugs be phenomena foisted upon our forebears by a society that places far too much emphasis on sexuality and sexual performance?
The effect of such a society on children is of great concern, since it bears out on them before they have reached an age of sexual development, and sometimes even before the are able to reason. But the effect on the elderly ought not be overlooked.
If sex at 60 is considered to be the norm, then anything less could be pathological, and a cause of significant anxiety. It is worth noting that 40 to 50 percent of men receiving a first script of Viagra do not refill it. It is unlikely that this is because they have all been “cured” of their “disease”. A more plausible interpretation is that they were made to think they had a disease in the first place.
Similarly, if cosmetic surgery at 70 becomes a social necessity, older people, especially women, could feel compelled go under the knife at considerable risk and for questionable gain. No one needs to be convinced that there are less scrupulous surgeons out there willing to take the risk for the benefit of their clientele. 
So the question is, have the elderly been sexually liberated or are they the unwary victims of sexual hyperinflation? If the latter, what is the way forward?
A well-intentioned but ultimately inadequate solution to this question is the idea that sex is not just about physicality, rather, it is a complete physical, emotional and spiritual experience. This argument is a valid reaction against the predominant presentation of sex in our society, but it doesn’t really transcend it. For the “herbal sex” crowd, sex is still supreme.
A truly revolutionary idea is not that there is more to sex than physics, but that there is more to love, and to life, than sex. Therefore, it is no great disaster when sex ceases to be a part of a relationship. To the unlikely bedfellows Big Pharma and neo-Freudian psychology, this may be ageism. But to many it is just part of growing up. Phillip Elias is a Sydney doctor.