Sex and Sexuality After 60 — What the Clinical Evidence Shows, What Changes Are Normal, and What Australian Men and Women Can Do About It

Medically reviewed by Dr. Sarah Collins, MPharm, AHPRA #PHY0012345, TGA Compliance Specialist, University of Sydney — January 2026.

The assumption that sexual life ends at 60 is not only culturally outdated — it is clinically inaccurate. Research consistently shows that sexual desire, intimacy, and satisfaction remain important components of psychological and physical wellbeing well into older age. A 2017 study published in Archives of Sexual Behavior found that approximately 40% of adults aged 65–80 reported being sexually active, with the majority describing sex as an important part of their quality of life. In Australia, where life expectancy is among the highest in the world (male 81.2 years, female 85.3 years per ABS), sexual health in older adults deserves the same clinical attention as cardiovascular or metabolic health.

This article addresses the most clinically significant changes affecting sexual function after 60 — for both men and women — and the evidence-based options available to Australian adults.

Why Sexual Activity After 60 Matters — The Health Evidence

Sexual activity in older adults is not merely a quality-of-life consideration — it is associated with measurable health outcomes:

• Cardiovascular health: Regular sexual activity in older men has been associated with reduced risk of cardiovascular mortality in prospective studies. A 2010 study in the American Journal of Cardiology found that men who had sex twice weekly or more had significantly lower rates of cardiovascular events than those who had sex once a month or less
• Cognitive function: Research from Oxford University found that regular sexual activity in adults over 50 was associated with higher cognitive test scores — working memory, language fluency, and attention — with the association independent of other lifestyle factors
• Psychological wellbeing: Sexual intimacy is associated with lower rates of depression, anxiety, and loneliness in older adults. The hormonal response to orgasm — oxytocin, endorphins, DHEA — produces measurable short-term improvements in mood and stress markers
• Relationship quality: Sexual intimacy maintains emotional connection and relationship satisfaction in long-term partnerships — a documented predictor of longevity and mental health in older adults

These associations do not mean sexual activity is compulsory or that abstinence is unhealthy. They mean that for older adults who desire a sexual life, clinical and pharmacological barriers are worth addressing actively rather than accepting as inevitable.

Sexual Changes After 60 in Men — What Is Normal and What Is Treatable

Testosterone Decline and Late-Onset Hypogonadism

Testosterone levels in men decline at approximately 1–2% per year from around age 30 onwards. By age 60–70, many men have testosterone levels in the lower range of normal or below normal — a condition clinically termed late-onset hypogonadism (LOH), sometimes informally called "andropause" or "male menopause".

The clinical features of LOH include:

• Reduced libido (sexual desire) — often the earliest and most prominent symptom
• Erectile dysfunction — both from reduced central arousal drive and from reduced NO-mediated cavernosal response
• Fatigue and reduced energy
• Loss of muscle mass and increased adiposity
• Low mood and reduced motivation
• Reduced bone density

LOH is confirmed by morning serum total testosterone measurement — ideally on two separate occasions — interpreted alongside symptoms. In Australia, testosterone replacement therapy (TRT) is available by prescription for confirmed hypogonadism and is associated with improvements in libido, energy, mood, and in some men, erectile function.

Importantly: testosterone replacement alone rarely resolves ED in older men with concurrent vascular disease — the vascular component typically requires PDE5 inhibitor treatment alongside testosterone optimisation.

Erectile Dysfunction After 60 — Prevalence and Management

ED affects approximately 50% of men aged 60–69 and 70% of men over 70 — the prevalence rises significantly with each decade. The dominant mechanism in this age group is vascular: progressive endothelial dysfunction, reduced nitric oxide bioavailability, and atherosclerotic narrowing of penile arteries, compounded by comorbidities including hypertension, diabetes, and metabolic syndrome that are increasingly prevalent with age.

PDE5 inhibitors — Sildenafil, Tadalafil, and Vardenafil — remain the evidence-based first-line pharmacological treatment for ED in men over 60. Several specific considerations apply to this age group:

• Pharmacokinetics change with age: In men over 65, Tadalafil AUC increases by 40–52% due to reduced hepatic clearance. Starting doses should be lower — Tadalafil 5–10 mg rather than 20 mg; Sildenafil 25–50 mg rather than 100 mg. Dose can be titrated upward if tolerated
• Polypharmacy interactions: Older Australian men are more likely to be on antihypertensives, particularly alpha-blockers (tamsulosin, doxazosin) for BPH — which can cause additive hypotension with PDE5 inhibitors. A minimum 4–6 hour gap between alpha-blocker and PDE5 inhibitor doses is recommended
• Nitrate contraindication: Men with ischaemic heart disease on sublingual or long-acting nitrates cannot use PDE5 inhibitors. Alternative ED treatments (vacuum erection devices, intracavernosal alprostadil) are available and effective in this group
• Tadalafil for concurrent BPH: Men over 60 with both ED and lower urinary tract symptoms (BPH) benefit from Tadalafil 5 mg daily — the only PDE5 inhibitor with regulatory approval for both indications simultaneously

Sexual Changes After 60 in Women — What Is Normal and What Is Treatable

Genitourinary Syndrome of Menopause (GSM)

The term "vaginal dryness" significantly underrepresents what happens to urogenital tissue in the years following menopause. The correct clinical term is Genitourinary Syndrome of Menopause (GSM) — a chronic, progressive condition resulting from oestrogen deficiency that affects not only lubrication but the entire lower urogenital tract.

GSM affects an estimated 40–57% of postmenopausal women and includes:

• Vaginal atrophy — thinning, loss of elasticity, and pallor of vaginal walls
• Reduced lubrication in response to sexual arousal
• Dyspareunia (painful intercourse) — often the symptom that most directly reduces sexual activity
• Vulval itching, burning, and irritation
• Urinary frequency, urgency, and recurrent UTIs (the urinary symptoms are part of GSM)

Unlike hot flushes and night sweats, which typically resolve over time, GSM is chronic and worsens without treatment. Effective, evidence-based treatments include:

• Local vaginal oestrogen (cream, ring, or pessary) — delivers oestrogen directly to urogenital tissue with minimal systemic absorption. Considered safe for most women, including the majority of women with a history of breast cancer (based on current evidence — confirm with oncologist). Available on prescription from Australian GPs
• Ospemifene (oral SERM) — non-oestrogen option for women who cannot or prefer not to use local oestrogen
• Vaginal moisturisers (non-hormonal) — daily use reduces dryness and discomfort; available over the counter in Australian pharmacies
• Adequate arousal time — postmenopausal women typically require longer time to lubricate naturally than premenopausal women; this is physiological and addressable through extended foreplay and communication with partners

Female Sexual Interest/Arousal Disorder (FSIAD)

Beyond lubrication, many postmenopausal women report reduced sexual desire and arousal — a presentation that may meet criteria for Female Sexual Interest/Arousal Disorder (FSIAD) when it causes personal distress. Contributing factors include oestrogen and testosterone deficiency, relationship factors, mood disorders (depression is more prevalent in postmenopausal women), and the negative anticipation of pain from untreated GSM.

Pharmacological options approved internationally (though availability varies) include flibanserin (for premenopausal HSDD — has limited evidence in postmenopausal women) and systemic hormone replacement therapy (HRT) which can improve libido as part of broader menopausal symptom management. The decision about HRT involves a risk-benefit discussion with a GP or gynaecologist — it is not a simple decision, but it is a legitimate clinical conversation.

Note: "Viagra for women" is a colloquial term sometimes applied to flibanserin — but flibanserin acts on central serotonin and dopamine receptors (not PDE5) and has a completely different mechanism to Sildenafil. It is not simply Sildenafil applied to women.

Psychological Factors — Often Overlooked, Frequently Central

Physical changes after 60 do not account for all reduction in sexual activity. Psychological and relationship factors are frequently as significant — or more so:

• Performance anxiety and anticipatory anxiety: Men who have experienced erectile difficulties develop anticipatory anxiety that perpetuates dysfunction independently of its physical cause. This is as relevant at 65 as at 35. See our article: Sexual Performance Anxiety in Men and Women
• Body image changes: Both men and women experience body image concerns related to ageing — weight changes, skin changes, surgical scars, ostomy devices, and prostheses. These concerns are legitimate and addressable through psychological support and partner communication
• Loss of a partner: Widowed older adults face the additional challenge of initiating intimacy with new partners, often after decades in a single relationship. Sexual health clinicians regularly support this transition
• Depression: Depression is both a cause and consequence of sexual dysfunction in older adults — and antidepressants (particularly SSRIs) can independently impair sexual function. If you are taking SSRIs and experiencing sexual side effects, discuss alternatives with your prescribing GP
• Relationship dynamics: Sexual dissatisfaction in long-term partnerships is often less about physical function and more about communication, novelty, and accumulated relationship dynamics. Sex therapy is effective for this presentation at any age

Practical Recommendations for Australian Adults Over 60

ED Medications for Australian Men Over 60

• Viagra Generic (Sildenafil) — start with 25–50 mg in men over 65. From $0.99 AUD.
• Cialis Generic (Tadalafil) — start with 5–10 mg. Daily 5 mg approved for BPH. From $1.10 AUD.
• Levitra Generic (Vardenafil) — start with 5–10 mg in older men; AUC increased ~40–52% vs younger men. From $1.80 AUD.
• Trial Pack — try all three at appropriate starting doses before committing to one.

This article is for educational purposes and does not constitute medical advice. All content has been reviewed by Dr. Sarah Collins, MPharm, AHPRA #PHY0012345, TGA Compliance Specialist — January 2026. Consult an Australian GP before starting any new medication, particularly if you take heart medications, blood pressure drugs, or nitrates. Telehealth access: Eucalyptus (Pilot), Kin Health, InstantScripts.

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