Lindau et al, in a study published in the New England Journal of Medicine, reported on a survey of 3005 respondents ages 57-85 who were queried as to prevalence of sexual activity, behaviors, and problems. The prevalence of sexual activity in this sample was 74.8%. Reported sexual activity declined with age; it was 73% for 57- to 64-year-olds, 53% for those 65-74 years old, and 26% for those 75-85 years old. Women were much less likely to report being sexually active than men. Half of the women and half of the men reported at least 1 bothersome sexual problem and were concerned about the impact of aging changes on sexuality. After the age of 50, 38% of the men and 22% of the women had discussed sex with a physician. Women's most prevalent problems were a lack of desire, difficulty with vaginal lubrication, and inability to experience orgasm. Older men's sexual concerns were focused primarily on erectile difficulties. Those elders in poor health were less likely to be sexually active and more likely to experience sexual problems.

DeLamater and Moorman reported on the Modern Maturity Sexuality Survey conducted by the American Association of Retired Persons in 1999. In 2013, Northrup et alrepeated the survey. Among the survey respondents, all 50 years or older, 59% of men and 56% of women reported that their partners were not fulfilling their needs. More than a quarter of the men said they are not having enough sex, and a quarter of the women reported not having the lifestyle they had hoped for. Thirty-one percent of couples have sex several times a week, 28% a couple times a month, 8% once a month, and 33% rarely or never. The happiest couples say "I love you" at least once a week. Interestingly, 90% of men and only 58% of women regularly say "I love you" to their partners.

A number of authors have reported on surveys of sexual desire, attitudes, behaviors, and function in older women and men. Ginsberg et al studied a sample of 166 lower-income older adults living in subsidized independent living facilities. Most of the 166 participants had physical sexual experiences, such as touching, kissing, holding hands, and hugging, ranging from daily to once a month. The majority did not want to engage in sexual experiences, such as masturbating, stroking, and intercourse, attributing their avoidance to lack of a partner, age, and lack of interest.

Gott and Hinchliff elicited data on attitudes toward and the value of sex in later life from men and women  ages 50-92 using the World Health Organization Quality of Life Importance Scale and semistructured interviews. These investigators reported that elders with a current partner rated sex as having at least some importance in their lives, whereas those without a partner rated sex as having no importance. Barriers to being sexually active meant placing less importance on sex.

For most people, age-related changes begin in midlife (around age 45) and increase over time. The physiological changes are multifactorial and can be related to diminished blood flow and hormonal and neurologic changes. In men, testosterone and estrogen levels start to decrease just about the same time that women experience menopause and a concomitant decrease in circulating androgens and estrogen.This decrease in hormones affects muscle strength, integument, bone mass, and inflammatory processes, as well as sexual functioning for both men and women. Thus, men may begin to experience erectile dysfunction, and women may experience urogenital atrophy. However, other factors also impact sexual health as individuals age. In both men and women, obesity, lack of exercise, hypertension, diabetes, atherosclerosis, incontinence, alcohol, drugs, smoking, and psychological issues are risk factors for sexual dysfunction.

Health care practitioners are mandated to obtain a complete health history from patients — both yearly and when a new patient presents to the practice. The health history includes a thorough review of systems, including a comprehensive sexual and reproductive history. Younger women are most likely to be asked about safer sex practices, menstrual cycles, last normal menstrual period, dysfunctional vaginal bleeding, abnormal discharge, number of sexual partners/preferences, obstetrical history, family history, social history, and habits. Young men are also asked about risky behaviors, penile discharge, lesions, sexual history, and partners.