SMF 212, Navigating Sexuality and Relationships in Mid/Later Life, is offered through the Department of Sexuality, Marriage and Family Studies at St. Jerome’s University within the University of Waterloo. The course was taught in Spring 2021 as a fully remote offering by Stacey Jacobs, a community sexual health educator with over twenty years of experience who has taught in the SMF program for a decade. The course examines how people navigate sexuality, intimacy, and relationships as they age, drawing on a biopsychosocial framework and attending to the ways in which age intersects with gender, sexual orientation, health, disability, culture, race, and socioeconomic status.

Jacobs approaches all course content from a sex-positive standpoint — a framework that affirms each person’s right to define and experience their sexuality across the lifespan, that avoids moralistic value judgments, and that celebrates the diversity of bodies, identities, and consensual practices.

Introduction to Course, Language, and the Aging Landscape

The Classroom Environment and Self-Care

Jacobs opens the course by acknowledging that sexuality and sexual health material can provoke a wide range of responses — happiness, relief, excitement, embarrassment, sadness, anger, stress, or anxiety — and invites students to make an autonomous, informed decision about enrolling. She distinguishes between intellectual discomfort, which is a normal and productive part of university learning (arising when our ideas are challenged and we must resolve cognitive dissonance — the psychological stress that occurs when a person holds contradictory beliefs and then acts against one of them), and being triggered, which refers to emotional trauma and is qualitatively different.

Two interrelated concepts frame the course ethos. Self-care refers to what individuals do to establish and maintain their physical, emotional, and mental health and to prevent burnout; examples range from sleeping in and cooking a favourite meal to taking a walk in nature or turning off one’s phone for an evening. Jacobs notes, however, that self-care has been heavily monetized and that participation in it does not require spending money. Community care, by contrast, involves using one’s privilege or initiative to support others — showing up for people without being asked, demonstrating compassion, and engaging in activism. These two forms of care are not mutually exclusive; research suggests that helping others also increases our own happiness. Taken together, they reflect a recognition that we are fundamentally social and interdependent beings.

Sex Positivity and Critical Thinking

The course takes a sex-positive approach, grounded in comprehensive sexuality education. The SERC definition used in lecture describes sex positivity as “an important ideology that acknowledges and affirms each person’s right to experience and define their sexuality throughout their lifetime in whatever way they choose… inclusive and respectful of a wide range of sexual experiences, expressions, consensual activities (including non-activity) and identities (including asexuality).” Importantly, sex positivity is not sex promotion; it is a non-judgmental stance that promotes comfort with one’s own sexuality and body, and that of others, while respecting personal choices.

Critical thinking is also foregrounded as a fundamental skill. We are constantly flooded with information about sex from traditional media, social media, music, and peers, and this information is often contradictory, filled with half-truths, or misleading. The core of critical thinking is skepticism — not taking things for granted — combined with maintaining an open mind. This applies especially to claims made by authority figures, celebrities, government sources, or the internet.

Language, Inclusive Communication, and Ableism

Language carries power and the potential to cause harm. The course emphasizes the importance of using inclusive, non-assumptive language. Rather than defaulting to “Hello guys,” one might say “Hello everyone, friends, or folks.” Rather than assuming a partner’s gender (“Do you have a girlfriend?”), one asks “Do you have a partner?” Rather than universalizing behaviour (“Everyone masturbates!”), one acknowledges variation (“Some people masturbate, some don’t, either is okay”). Practical examples of inclusive language include using “person with a vagina” or “person who menstruates” rather than gendered anatomical shorthand, and using “they” when someone’s pronouns are unknown. Person-first language — “person with a disability” rather than “disabled person” — is another application.

Ableist language refers to words or phrases that intentionally or inadvertently target a person with a physical or mental disability. Terms such as “crazy,” “lame,” “dumb,” “insane,” “psycho,” or “spaz” function as filler language with no meaningful content but with real potential to harm. The course asks students to reflect on the casual use of diagnostic categories (e.g., “I am so OCD”) as a form of ableism that trivializes genuine clinical conditions.

Age Terminology and Ageism

One of the first substantive topics is the language used to refer to older people. Terms in common use include older adult, elders, aging adult, senior, senior citizen, mature, old, and elderly. The Journal of the American Geriatrics Society (JAGS) issued a policy in 2017 requiring authors to use “older adult” when describing individuals aged 65 and older, and to provide specific age ranges when discussing research findings or clinical recommendations. This policy shift reflects a broader awareness of how language shapes attitudes.

Ageism is defined by the Ontario Human Rights Commission as a socially constructed way of thinking about older persons based on negative attitudes and stereotypes about aging, combined with a tendency to structure society on the assumption that everyone is young. Manifestations of ageism include media and marketing industries that sell products to stop or slow the aging process, the use of “old” as an insult, and the cultural privilege attached to appearing or being young. The course invites students to examine their own internalized assumptions about aging.

Defining midlife and later life is itself contested. Chronological age (the number of years lived) is only one lens; other factors that shape the lived experience of age include societal and cultural norms, gender, health and activity level, appearance, family composition, living situation, and the subjective sense of how old one feels. In the course, midlife is loosely defined as approximately ages 45–65 and later life as 65 and older, though this division is recognized as imprecise and socially constructed.

Life Expectancy and Active Aging

Life expectancy in Canada was approximately 82.52 years on average as of 2020, with projected figures of 79 years for men and 83 years for women (2017 data). Significant disparities exist among Indigenous populations: Inuit life expectancy was approximately 64 years for men and 73 years for women, while Métis and First Nations populations showed figures of 73–74 years for men and 78–80 years for women. These disparities reflect the structural inequalities created by colonialism and systemic racism.

Active life expectancy refers to the average number of remaining years lived in an independent state, free from significant disability. This figure is increasing for Canadians. Related to it is the concept of sexually active life expectancy — the average number of remaining years spent as sexually active — a concept that underscores the continued relevance of sexual health across the lifespan.

Historical and Social Context

To understand the sexuality of today’s older adults, it is essential to understand the historical and technological landscape in which they came of age. People born before 1970 did not grow up with the internet, smartphones, social media, computers, online dating, or online pornography. Their sexual socialization occurred in a world shaped by different norms and information environments.

The legal landscape governing sexuality also shifted dramatically during their lifetimes. In Canada: birth control became legal in 1969; same-sex sexual activity was decriminalized in 1969; abortion became legal in 1988; same-sex marriage was legalized in 2005. Ontario’s Health and Physical Education curriculum began recommending (though not requiring) sexual health education in 1966–1978, introduced a first mandatory curriculum in 1978, and only added a mandatory AIDS component in 1987 in direct response to the HIV/AIDS crisis. This means that many current older adults received little to no formal sexual health education.

Gender Roles, Social Scripts, and Intersectionality

Gender roles are the expected behaviours for people of various genders; they vary across cultures and historical periods and are socially constructed rather than biologically fixed. Social scripts are the series of behaviours, actions, and consequences expected in a given situation or environment. Sexual scripts are a subset of social scripts — guidelines for what sexual behaviour and encounters are supposed to look like. Social norms are the informal understandings that govern people’s behaviour. Together, these constructs explain why people often experience sex and aging through a lens of expectation and rule-following rather than personal authenticity.

Intersectionality, a concept coined by legal scholar Kimberlé Crenshaw in 1989 and now widely used in social sciences, captures how racism, sexism, ableism, and other forms of discrimination overlap and create unique, compounded burdens for people. It is not simply about having multiple identities; rather, it is about how social structures make those identities the source and vehicle of vulnerability. When institutional and social protections fail to address the complexity of overlapping oppressions — what Crenshaw calls “intersection failure” — people fall through the gaps of advocacy and support systems. In the context of this course, intersectionality is critical for understanding how the sexual health needs of older adults are shaped not just by age, but by gender, race, class, sexual orientation, disability, and a host of other intersecting factors.

The Gender Unicorn and the Genderbread Person are visual models used in the course to illustrate the difference between biological sex, gender identity, gender expression, and sexual/romantic attraction — and to convey that each of these dimensions exists on a spectrum rather than as a binary.

Sexuality and Relationships in Mid and Later Life

Framing Assumptions

Week 2 begins by surfacing the assumptions that students and society at large hold about older adults and sex. The dominant cultural narrative treats older adults as asexual, frail, or past the age of sexual interest — assumptions that are not only inaccurate but actively harmful. When internalized, these stereotypes can prevent older adults from seeking sexual healthcare, disclosing their sexual activity to providers, or understanding their own sexuality as valid and worthy of attention.

The Biopsychosocial Perspective

The primary theoretical framework for understanding sexuality in later life is the biopsychosocial perspective, which integrates biological factors (health, illness, physiological changes), psychological influences (knowledge, attitudes, emotional well-being), and relational factors (quality and satisfaction of partnerships). This stands in contrast to a purely medical perspective, which focuses narrowly on physical and mental health, the effects of illness or treatment on sexual function, and dysfunction.

Research synthesized in the lecture reveals several key findings:

• Sexual activity remains important in later life; having a sexual partner and being in good health are major contributing factors.
• Normal physical changes of aging do not necessarily affect sexual functioning, but the meaning attached to those changes often does. Some people in later life come to see themselves as no longer sexually attractive even when their physical capacity is unchanged.
• For people with vaginas, the inability to reproduce following menopause can produce the mistaken belief that there is no longer a reason to engage in sexual activity.
• Medical illness is not a major factor in declining sexual desire or behaviour; stress (contributing to anxiety and depression) is identified as a more primary cause.
• A positive relationship between mental health and sexual functioning is well established.
• Many older adults take multiple medications — for blood pressure, cholesterol, pain, blood thinning, and sleep — that are known to affect sexual functioning. However, the research suggests that diagnosed illness and medication use are generally not correlated with frequency of sexual activity.
• Sexual desire may decrease with age in some studies, but access to a partner and overall health status are significant moderating variables.
• As people age, erectile difficulties and decreased vaginal lubrication become more common. Some people adapt by engaging in sexual activity that does not involve penile penetration; others may stop all sexual activity.
• Among people who sought treatment for sexually related concerns, the outcome was not an increase in sexual frequency but rather an increase in sexual satisfaction — an important distinction.

HIV and Older Adults

The lecture draws specific attention to HIV and aging. The National HIV/AIDS Strategy for the United States reports a continual rise in the number of individuals aged 50 and over contracting HIV each year. Several factors account for rising HIV rates among older adults:

1. People are living longer and remaining sexually active longer.
2. Medications such as Viagra have enabled continued penetrative sex for people who might otherwise have curtailed it.
3. Retirement communities provide greater opportunity for meeting and engaging with new sexual partners.
4. Older generations did not receive comprehensive sexual health education; the first reports of HIV did not emerge until 1981, when many of today’s older adults had already completed their formative sexual socialization.

Rates of condom use decline with age, and healthcare professionals are less likely to ask older adults about their sexual activity, which means HIV diagnosis in this population is frequently delayed. Delayed diagnosis delays treatment and education, worsening outcomes for individuals and increasing transmission risk in the community.

Diversity in Sexuality and Aging: The ADDRESSING Framework

To provide appropriate and adequate care, healthcare providers must understand how diversity shapes the attitudes, experiences, and sexual health needs of older adults. The ADDRESSING framework — a mnemonic covering Age and cohort effects, Degree of physical ability, Degree of cognitive ability, Religion, Ethnicity and race, Socioeconomic status, Sexual orientation, Individualistic life experiences, National origin, and Gender — provides a structured way to recognize the cultural factors and personal attributes that influence sexuality across the lifespan.

The lecture emphasizes that ageism reinforces the stereotype that older adults are not sexually active, and that healthcare providers internalize these stereotypes and consequently do not inquire about the sexual health of their older patients. This creates a cycle in which older adults’ sexual health concerns go unaddressed, which in turn reinforces the assumption that no such concerns exist.

Relationship Status, Widowhood, and the Gender Gap

A number of relational patterns are specific to later life. Many older women find themselves widowed because they tend to marry partners older than themselves and because women have a higher average life expectancy than men. The frequency of sexual activity among older adults is lowest for widows, highest for those who are married, and moderate for those who are divorced or never married. Marital satisfaction is positively correlated with frequency of sexual activity.

LGBTQ+ Older Adults

Older lesbian, gay, bisexual, transgender, and queer (LGBTQ+) adults have often navigated a lifetime of victimization — including violence, discrimination, and homophobia — that may prevent them from disclosing information about their sexuality to healthcare providers. There is less opportunity for many LGBTQ+ older adults to find partners, leading to greater isolation and less sexual activity than they might desire. Some individuals may suppress their sexual identity as they age, effectively re-entering the closet in institutional settings for reasons of safety. The lecture notes that existing research on aging and sexuality has largely focused on white, heterosexual, middle-class people — a significant limitation that must be acknowledged. Regardless of sexual identity, the research concludes: “older adults are in need of an accepting community that allows them to express their sexuality, and engage in healthy sexual activity.”

Discrimination and Its Health Consequences

A critical lens on structural oppression runs through the entire course. Racism, sexism, ageism, ableism, classism, heterosexism, ethnocentrism, sizeism, fatphobia, Islamophobia, homophobia, and transphobia all negatively affect physical, mental, and emotional health. They cause both acute and chronic stress; they prevent people from accessing the healthcare they deserve; and they shape every dimension of a person’s sexual health and relational well-being. Students are encouraged to hold these realities in mind throughout the course.

Sex in Mid and Later Life — Activity, Health, and Risk

Challenging Core Assumptions

Week 3 engages most directly with the content of sexual activity in later life, and it does so by first dismantling a series of harmful assumptions. Drawing on the Canadian Research Network for Care in the Community’s Keep on Rockin: Sexuality and Aging resource, the course identifies four common myths: that older adults are not interested in discussing their sexuality with care providers; that older adults are too fragile to engage in sexual activity; that sex education need only focus on young people; and that sexuality is reducible to penile–vaginal penetration.

In response, the course offers a broad, inclusive definition of sexual activity: “Kissing, cuddling, hugging, holding, squeezing, touching, stroking, licking, biting, oral sex, vaginal sex, anal sex, digital sex, massaging, caressing, using toys, kink, masturbation, mutual masturbation, sexting, phone sex, rubbing naked bodies, rubbing clothed bodies…” This expansive conception resists the cultural equation of sex with penetrative intercourse and makes space for the many forms of sexual expression available to people of all ages and abilities.

Health Benefits of Sexual Activity

Sexual activity — whether solo or partnered — is associated with a substantial range of health benefits. These include: stress reduction, mood enhancement, immune system strengthening, help fighting infection and disease, lowering of diastolic blood pressure, maintenance of genital health, improved blood flow, better sleep, headache and body ache relief, relief of depression, reduced risk of heart disease, reduced risk of prostate cancer, relief of chronic pain, improved blood flow to the brain, improved skin tone, relaxation, and increased happiness. The physiological explanation for many of these effects involves increased circulation and the release of hormones and neurotransmitters associated with pleasure and bonding.

Masturbation and Solo Sex

Despite these documented benefits, masturbation remains heavily stigmatized. As sex and relationship therapist Dr. David Pittle notes, “probably no other common activity carries such a burden of shame and guilt as masturbation.” The course asks students to sit with the inconsistency of a sexual health culture that encourages young people to delay sex with others while simultaneously not promoting masturbation as a healthy alternative.

For older adults specifically, the lecture notes that the less frequently a person experiences arousal and orgasm, the harder both become to achieve — a use-it-or-lose-it principle with physiological grounding. Blood flow to the genitals is beneficial even in the absence of orgasm. Solo sex may require advance planning for older adults, including attending to comfort, privacy, and physical accessibility.

The course also raises the question: Is pornography ageist? Most mainstream pornographic media features young, surgically augmented bodies, with cosmetic procedures being performed on vulvas specifically to make them appear younger. This reflects and reinforces cultural devaluation of older bodies as sexual.

Sex as Leisure

A significant conceptual reframing introduced in Week 3 comes from the academic field of leisure studies. Drawing on Berdychevsky and Nimrod’s (2017) netnographic study, the lecture argues that sexual activity in later life — whether partnered or solo, with or without penetration — can usefully be understood as leisure: freely chosen activity performed for its own sake, with anticipated satisfaction.

Understood as leisure, sex in later life may enhance self-perception, a sense of well-being, and feelings of vitality. Regular sexual activity is associated with high self-esteem, a sense of competence, pleasure, intimacy, and an overall sense of happiness. It offers particular practical advantages for older adults: it is familiar, relatively safe, performed indoors, free, and can require minimal physical effort.

Leisure in general has a significant positive impact on older adults’ physical, psychological, social, and spiritual well-being, and can help people successfully navigate major life transitions such as retirement or the loss of a partner. However, constraints to leisure — including isolation, age-related norms, health challenges, low motivation, limited income, mobility restrictions, ageism, racism, sexism, homophobia, and transphobia — increase in number and impact as people age.

The specific barriers to sexual leisure in later life include questions of social acceptability (which depends on age, gender, and relationship status); the degree of sexual permissiveness in the historical period when the individual was coming of age; and internalized ageism — the process by which older adults incorporate social norms that devalue or marginalize older people, thereby policing their own sexuality.

The netnographic study used for the course employed netnography (online ethnography), observing technologically mediated communication in online networks. The study found that many community members were interested in sex-related discussions but few participated — a phenomenon the researchers called “lurking.” Masturbation was rarely discussed, reflecting its continued status as taboo even in relatively open online communities.

Practical Strategies for Sexual Health

The course provides a range of practical strategies for maintaining and improving sexual health in later life. These span several domains:

Physical and lifestyle approaches: eating a healthy diet; regular exercise; yoga and meditation; ensuring adequate sleep (and adjusting the timing of sexual activity if energy is better at certain times of day); using lubrication and vaginal moisturizers to address dryness; engaging in physical activity that increases blood flow to the genitals.

Relational and communicative approaches: communicating openly with a partner about desires, preferences, and concerns; maintaining physical affection even outside explicitly sexual contexts; using sensate focus techniques — a method commonly recommended by sex therapists that involves structured, non-goal-oriented touch focused on sensation and emotion rather than performance or orgasm. Sensate focus begins with partners taking turns caressing each other’s bodies while avoiding the genitals and breasts, and gradually progresses while maintaining open communication about what feels good. It has demonstrated effectiveness for increasing sexual satisfaction across age groups and for people with medical conditions.

Exploratory and adaptive approaches: broadening definitions of sex to include the full range of sexual activities described above; experimenting with new sexual positions; using pillows or sex furniture to accommodate physical limitations; incorporating sex toys; consulting healthcare professionals including family physicians, pelvic health physiotherapists, counsellors, and sex therapists; participating in online communities; being open-minded, adventurous, creative, playful, and romantic.

Sexual Response and Dysfunction

The sexual response cycle describes the physiological sequence of sexual experience: desire (the wish, need, or want for sex, which may be sparked by any of the five senses or a particular situation), arousal (the vasocongestion or blood flow response to stimulation), orgasm (the peak of sexual pleasure), and resolution (the return to a pre-aroused state, including a refractory period during which re-arousal is typically not possible).

Sexual dysfunction refers to any aspect of this cycle — desire, arousal, orgasm, or resolution — that causes significant dissatisfaction or distress. The clinical criteria require that the condition be troubling to the person or people involved, that symptoms be present the majority of the time, and that they persist over a period of time. Common presentations include:

• Sexual desire disorder: absence of sexual fantasy, thoughts, or behaviour.
• Sexual arousal disorder (in people with vulvas and vaginas): lack of excitement or pleasure, absence of vaginal lubrication, and other absent physical indicators of arousal.
• Orgasmic disorder: difficulty, delay, or absence of orgasm.
• Sexual pain disorders (in people with vulvas and vaginas): genital pain during sex; vaginismus, the involuntary tightening of the vaginal walls during sex; pain due to vaginal dryness.
• Erectile disorder: problems obtaining or maintaining an erection sufficient for penetration. Harvard Medical School data cited in lecture suggests that 44% of people with a penis between the ages of 40–70 experience partial or complete erectile problems.
• Ejaculatory disorders: rapid, premature, or delayed ejaculation.

Viagra and Erectile Dysfunction Medications

Sildenafil (Viagra) came to market in 1998. Originally developed as a blood pressure treatment, it was found to have the side effect of facilitating and maintaining erections, and it became one of the fastest-selling medications in FDA history. Its approval and commercial uptake reflect the cultural significance placed on erectile function and penetrative sex, particularly for older men. The lecture invites students to consider the perspectives of the partners of people using Viagra — an often-overlooked perspective in discussions of erectile dysfunction.

As of 2020, Pfizer’s remaining patents for Viagra had expired, opening the market to cheaper generic versions. Viagra is effective in approximately 70% of users but carries side effects including headaches and stomach pain; for severe erectile dysfunction it may not be effective at all. Erectile dysfunction medications are prescribed by healthcare professionals and are used specifically for difficulties obtaining or maintaining an erection sufficient for penetration; they should only be taken as directed, and are contraindicated in combination with some other medications (e.g., blood pressure drugs).

Health Conditions That Affect Sexual Function

A range of chronic conditions that become more prevalent in later life can affect sexual function through various physiological mechanisms:

Heart disease involves narrowing of the arteries and reduced blood flow — which affects not only the heart but also the genitals, whose function depends on adequate circulation. High blood pressure damages arteries and alters circulatory patterns; many blood pressure medications also cause erectile difficulties as a side effect. Diabetes can damage both blood vessels and nerves, leading to erectile dysfunction in people with penises and interference with clitoral sensation and vaginal lubrication in people with vaginas; diabetes is also associated with frequent yeast and bladder infections that can make sex uncomfortable.

Arthritis causes pain and stiffness that often interferes with sex, particularly when it affects the hips, knees, or spine. Chronic and acute back pain presents similar challenges. Cancer and its treatments are among the most disruptive forces for sexual health in later life: cancer causes fatigue, pain, fear, depression, guilt, and stress, while surgeries often damage nerves and chemotherapy and radiation affect hormonal balance and tissue health.

Urinary or fecal incontinence — the involuntary leakage of urine or stool — can create significant anxiety and embarrassment in sexual contexts. Stroke disrupts blood flow to the brain; depending on where in the brain the damage occurs, a stroke may impair sex drive, cause fatigue, depression, or loss of sensation on one side of the body, affect communication ability, and interfere with erection, ejaculation, or vaginal sensation and lubrication.

Depression can be both a cause and a consequence of sexual problems. It disrupts libido and can cause erectile dysfunction and orgasmic difficulties; many antidepressant medications additionally cause arousal difficulties, delayed orgasm, and vaginal dryness. Antihistamines (common allergy medications) may also cause vaginal dryness and erectile dysfunction.

A useful empirical note: the American Heart Association reports that fewer than 1% of all heart attacks occur during sexual activity, and that having sex actually lowers the risk of a heart attack because it constitutes a form of exercise. Of deaths that do occur during sex, 82–93% involve men, and the majority occur during extramarital activity, with a younger partner, in an unfamiliar setting, and/or following excessive food and alcohol consumption.

Sexually Transmitted Infections and Older Adults

The final major topic of Week 3 is sexually transmitted infections (STIs) in older adult populations. STIs are categorized as:

• Bacterial infections: chlamydia, gonorrhea, syphilis
• Viral infections: HIV, herpes, HPV, hepatitis A, B, and C
• Parasitic infections: pubic lice, scabies

Yeast infections, while not classified as STIs, can be transmitted sexually.

Although young people aged 20–24 continue to account for the highest rates of STIs in Canada, rates among older adults are rising substantially. In Canada, adults over 50 represented 18% of all positive HIV tests in 2011, up from 10% in 1999. Between 2002 and 2011, chlamydia cases in people over 60 more than tripled; gonorrhea cases more than doubled; syphilis cases increased fivefold. Older adults represent two-thirds of all chronic hepatitis C infections.

The reasons older adults are especially vulnerable to STIs are numerous and intersecting:

1. Sexual health education and prevention campaigns in Canada have historically targeted youth and younger adults; older adults are not conceptualized as a vulnerable population for STIs or HIV.
2. Older generations received little formal sexual health education, and the first reports of HIV did not emerge until 1981.
3. Ageism among healthcare professionals leads to the assumption that older adults are not sexually active and therefore do not need STI information, testing, or safer sex counselling.
4. Healthcare providers often assume older patients are heterosexual and either in no relationship or a long-term monogamous one.
5. Many older adults internalize norms of silence around sex and do not bring sexual health concerns up themselves; they may conceal sexual orientation, extramarital activity, involvement with sex workers, or substance use from their providers.
6. Because birth control is no longer a concern after menopause, condom use typically declines sharply — and healthcare providers often discuss safer sex alongside contraception, meaning that when contraception becomes irrelevant, safer sex conversations stop happening.
7. In later life, women significantly outnumber men; this demographic imbalance gives older heterosexual men greater bargaining power in sexual negotiations, potentially disadvantaging women in their ability to insist on condom use.
8. The thinning of vaginal and anal membranes that occurs with aging increases the likelihood of tearing during sex, which elevates susceptibility to STI transmission. Postmenopausal vaginal dryness compounds this risk.
9. Signs and symptoms of STIs may be attributed to other conditions common in old age (e.g., pain, fatigue, cognitive change), causing delayed diagnosis, delayed treatment, prolonged transmission risk, and increased complications.
10. Immune systems decline with age, and the chronic conditions prevalent in later life (high blood pressure, heart disease, arthritis, diabetes, cancer) further suppress immune function.
11. Medications like Viagra have extended the sexual activity of many older adults without a corresponding increase in safer sex practices.
12. Older adults may not know where to access STI testing; sexual health clinics are typically designed for and marketed to younger people. Senior centres generally do not provide information about STIs or distribute condoms.
13. Older adults are frequently absent from STI research, limiting the evidence base for educational interventions targeting them.
14. Older adults often do not perceive themselves as being at risk and therefore do not adopt preventive behaviours.
15. Re-entering the dating scene — after widowhood, divorce, or separation — in an era of online dating dramatically increases the ease of finding new partners and raises sexual activity levels.
16. Retirement enables more travel; Canadian snowbirds in particular have been documented engaging in high-risk sexual behaviour (multiple partners, low condom use, low STI testing rates) in destinations such as Florida, which has among the highest sexual risk behaviour rates for adults over 50 in the United States.
17. Retirement communities, assisted living facilities, and adult living communities increase opportunity for meeting new partners and engaging in sexual activity in contexts where sexual health resources are typically absent.

Weeks 4–12: Overview of Remaining Course Topics

The following topics are covered in Weeks 4 through 12, primarily through assigned readings rather than the slide materials available for this summary. They are outlined here to convey the full arc of the course.

Relationships in Mid and Later Life

Week 4 examines the experience of intimate relationships among middle-aged and older adults, including marriage, cohabitation, and re-entry into the dating world. The reading by Schlesinger and Schlesinger (2008) explores marriage and cohabitation among Canadian-Jewish seniors after age 65, attending to how religion and culture shape relationship decisions in later life. A companion piece from The Atlantic (Hill, 2020) describes the experience of newly single older adults navigating a dating landscape radically different from the one they knew decades earlier — shaped now by online platforms, shifting social expectations, and the particular emotional textures of loss and renewed desire.

Aging with Pride — 2SLGBTQI+ Experiences

This week centres the experiences of 2SLGBTQI+ older adults. Fabbre’s (2015) study examines gender transitions in later life from a queer perspective on successful aging, challenging normative conceptions of what it means to age “successfully” when gender identity is in transition. Wilson, Kortes-Miller, and Stinchcombe (2018) examine the hopes and fears of LGBT older adults as they consider end-of-life care, exploring the pervasive anxiety about having to suppress or conceal their identities in institutional care settings — essentially re-entering the closet — in order to remain safe.

Dementia and Sexual Consent

Week 6 addresses one of the most ethically complex topics in the course: sexual consent and dementia. The two core readings — Bartlett (2010) on sex, dementia, capacity, and care homes, and Holdsworth and McCabe (2018) on the impact of dementia on relationships, intimacy, and sexuality — frame the discussion. The associated Case Study One draws on a Globe and Mail article about Karen Best, a woman with dementia who formed a new romantic and sexual relationship in a long-term care facility, raising profound questions about capacity, consent, autonomy, institutional authority, and the rights of people with cognitive impairment. The assignment asks students to consider this situation from multiple perspectives — those of the person with dementia, the family, care staff, the law, the government, and their own standpoint.

Family and Friends

Week 7 broadens the lens from intimate partnerships to the wider social network, exploring the roles of friendship and grandparenthood in later life. Edward’s (2016) study of friendship in old age and Mansson’s (2016) qualitative analysis of the joys of grandparenting both speak to the importance of non-romantic relationships for the well-being, identity, and social engagement of older adults. The assignment Case Study Two is due at the end of this week; it is based on a CBC News article about Joe Overtveld, a multimillionaire whose children disputed his marriage to a younger woman, raising questions about autonomy, exploitation, ageism, the role of loneliness, and the legal thresholds for consent to marriage versus consent to manage property or care.

Healthcare and Long-Term Care

Week 8 examines sexuality within institutional and healthcare settings. Everett’s (2008) nursing ethics paper on supporting sexual activity in long-term care confronts the tensions between residents’ autonomy and sexual rights on the one hand, and institutional rules, staff values, and family expectations on the other. Fileborn and colleagues’ (2017) qualitative study with older Australian men and women explores the barriers and facilitators to discussing sexual health with healthcare providers in later life — barriers that include provider discomfort, ageist assumptions, and a lack of routinized sexual health inquiry with older patients.

Menopause

Week 9 focuses specifically on menopause, using Dodd’s (2014) discussion of “post-menopausal zest” — a concept describing the new creativity, sexual energy, and self-confidence that many people with uteruses report experiencing after menopause. This framing challenges the dominant cultural narrative of menopause as purely a story of loss and decline, and positions it instead as a potential site of liberation from reproductive expectations, body image anxieties associated with fertility, and prior constraints on sexual expression.

End-of-Life Planning and Alternative Living

Week 10 addresses planning for the later years of life, including both living arrangements and end-of-life care. Treleaven’s (2017) article about a group of female seniors who created a co-living arrangement rather than entering a retirement home raises questions about the social organization of aging, feminist approaches to interdependence, and the importance of community in later life. Thomeer and colleagues’ (2017) qualitative analysis of end-of-life planning among gay, lesbian, and heterosexual couples highlights the unique challenges facing same-sex couples — particularly around legal protections, family recognition, and the fear of institutional discrimination — as they plan for illness, incapacity, and death.

Death and Dying

Week 11 engages directly with death, dying, and the concept of a death-positive movement — an orientation Jacobs notes as one of her own personal interests. The reading by van Wijngaarden and colleagues (2016) presents the deeply intimate case study of an elderly couple who chose to end their lives together through spousal self-euthanasia, exploring the phenomenology of that decision and the meanings both partners attached to dying together. This reading invites reflection on autonomy, love, suffering, and the social and legal contexts that shape end-of-life choices for older couples.

Ageism and Aging Anxiety

The course concludes by returning to the social and psychological dimensions of ageism — this time examining it from the perspective of younger adults. Barnett and Adams’ (2018) study of ageism and aging anxiety among young adults explores the relationships between contact with older people, knowledge about aging, fear of death, and optimism as predictors of ageist attitudes. The implication is that ageism is not simply an attitude problem of older or discriminatory individuals; it is rooted in existential anxieties about mortality that young people carry, and addressing it requires expanding intergenerational contact, improving knowledge about aging, and cultivating a more honest cultural relationship with death.