Sexual Health

Sexual Response Problems and Their Correlates Among Older Adults From the Sexual Well-Being (SWELL) Study in China: Multicenter Cross-Sectional Study.

TL;DR

Sexual response problems are common among older adults in China, affecting 43.1% of men and 52.0% of women, and are associated with adverse physical health, mental health, and poor sex-partner relationships rather than being an inevitable consequence of aging.

Key Findings

Older women reported a higher prevalence of sexual response problems than older men in this Chinese multicenter sample.

  • 52.0% (247/475) of older women reported at least one sexual response problem compared to 43.1% (363/842) of older men.
  • The study included 1317 sexually active older adults (842 men, 475 women) aged over 50 years.
  • Data were collected via face-to-face interviews at multiple centers in China between June 2020 and December 2022.
  • Sexual response problems included lack of interest or enjoyment in sex, anxiety during sex, pain, no excitement, no desire, no orgasms, and lack of lubrication.

Living in rural areas was associated with lower odds of sexual response problems in both older men and older women.

  • For men, living in rural areas was associated with reduced odds of sexual response problems (aOR=0.31, 95% CI 0.22-0.43).
  • For women, the association was similar (aOR=0.29, 95% CI 0.19-0.43).
  • Rural residence was identified as a common factor across both sexes using stepwise logistic regression models.
  • This finding suggests urban older adults may experience greater sexual response problems than their rural counterparts.

Abnormal BMI was associated with higher odds of sexual response problems in both older men and older women.

  • For men, abnormal BMI was associated with increased odds of sexual response problems (aOR=1.52, 95% CI 1.11-2.07).
  • For women, the association was stronger (aOR=2.19, 95% CI 1.47-3.28).
  • Abnormal BMI was identified as a common correlate across both sexes.
  • This finding highlights the role of physical health status in sexual functioning among older adults.

Anxiety was strongly associated with sexual response problems in older men.

  • Anxiety was associated with markedly increased odds of sexual response problems in older men (aOR=4.26, 95% CI 1.12-21.27).
  • Frequently experienced fatigue was also significantly associated in men (aOR=2.47, 95% CI 1.59-3.90).
  • Poor sleep quality was associated with sexual response problems in men (aOR=1.87, 95% CI 1.30-2.68).
  • Seeking professional help for sex life was associated with higher odds of sexual response problems in men (aOR=1.58, 95% CI 1.14-2.21).
  • Emotional connection with sex partners during intercourse was associated with lower odds of problems in men (aOR=0.69, 95% CI 0.50-0.96).

Depressive symptoms, poor sex-partner relationships, and lack of physical exercise were associated with sexual response problems in older women.

  • Depressive symptoms were strongly associated with sexual response problems in women (aOR=3.18, 95% CI 1.18-10.24).
  • Poor sex-partner relationships were associated with increased odds of sexual response problems in women (aOR=1.70, 95% CI 1.12-2.60).
  • Lack of physical exercise was associated with higher odds of sexual response problems in women (aOR=1.69, 95% CI 1.13-2.54).
  • These factors were identified as women-specific correlates in contrast to the male-specific correlates of anxiety, fatigue, and sleep quality.

The study found that sexual response problems among older adults are not an inevitable consequence of aging but are associated with modifiable physical, psychological, and relational factors.

  • The study design was a multicenter cross-sectional study across China conducted between June 2020 and December 2022.
  • Participants were sexually active older adults (aged >50 years) who reported vaginal, oral, or anal sex in the past 12 months.
  • The findings highlight the importance for healthcare providers to consider physical and psychological health as well as relationship quality when addressing sexual response problems.
  • Common modifiable correlates identified included BMI, mental health conditions (anxiety and depression), fatigue, sleep quality, exercise habits, and partner relationship quality.

What This Means

This research surveyed over 1,300 sexually active Chinese adults aged 50 and older across multiple cities to understand how common sexual response problems are and what factors are linked to them. The study found that sexual difficulties — such as lack of interest in sex, inability to orgasm, pain during sex, anxiety, or lack of lubrication — affected more than 4 in 10 older men (43%) and more than half of older women (52%). Importantly, the researchers found these problems are not simply an unavoidable part of getting older, but are connected to factors that can potentially be addressed. The study found some factors that mattered for both men and women: people with abnormal body weight (BMI) were more likely to have sexual response problems, while people living in rural areas were less likely to report these problems than urban dwellers. However, many correlates differed by sex. For older men, poor sleep quality, frequent fatigue, and anxiety were strongly linked to sexual difficulties, while feeling emotionally connected to a sexual partner appeared protective. For older women, depression, poor relationship quality with their sexual partner, and lack of physical exercise were the key associated factors. This research suggests that healthcare providers working with older adults should not dismiss sexual health concerns as simply a normal part of aging. Instead, addressing underlying physical health issues (like weight management and exercise), mental health conditions (like anxiety and depression), sleep problems, and relationship quality may all be relevant to improving sexual well-being in this age group. The findings underscore that sexual health in older adults is shaped by a complex mix of physical, psychological, and social factors.

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Citation

Liang B, Xu C, Wang B, Li X, Peng X, Wang Y, et al.. (2025). Sexual Response Problems and Their Correlates Among Older Adults From the Sexual Well-Being (SWELL) Study in China: Multicenter Cross-Sectional Study.. JMIR aging. https://doi.org/10.2196/66772