Sexual attitudes and conversations among heterosexual older adults in China: findings from the sexual well-being (SWELL) study

BACKGROUND: Sexuality is a key component of psycho-physical well-being among older adults. We aimed to understand sexual attitudes and conversations, and their correlates among older adults. METHODS: This study was based on a cross-sectional survey conducted from June 2020 to December 2022 in China. Community-dwelling heterosexual older adults aged ≥50 were recruited. Sexual attitudes included believing that sex is harmful to health and supporting sex education. The conversation was defined as talking about sex with a partner. Logistic regressions were used to assess the correlates of sexual attitude and conversation. RESULTS: A total of 3001 older adults (60.6% men, 39.4% women) were included. Of these, 13.3% believed sex is harmful to health, 53.2% supported sex education and 34.6% reported conversation. For men, age (60-69 years: aOR 0.57, 95% CI: 0.39-0.82), living in urban areas (aOR 2.78, 95% CI: 1.90-4.05), being employed (aOR 0.44, 95% CI: 0.29-0.66), higher annual incomes (aOR 0.42, 95% CI: 0.22-0.78) and being sexually active (aOR 0.54, 95% CI: 0.36-0.79) were associated with believing that sex is harmful. For women, higher educational levels (aOR 0.48, 95% CI: 0.29-0.79) and sexual knowledge acquisition (aOR 1.95, 95% CI: 1.24-3.05) were significantly associated with this negative belief. Notably, older adults who reported life satisfaction (men: aOR 1.70, 95% CI: 1.32-2.18; women: aOR 2.66, 95% CI: 1.90-3.72) and sexual knowledge acquisition (men: aOR 2.00, 95% CI: 1.53-2.43; women: aOR 1.56, 95% CI: 1.13-2.17) were more likely to talk about sex. CONCLUSION: A minority of older adults believed that sex was harmful to health, whereas over half supported sex education, and approximately one-third reported conversations with their partner about sex. Targeted interventions are needed to adjust sexual attitudes and facilitate sex-related conversations.