The Long Ride with Greg Pallone
Although I am borrowing from British humour and tropes to make a point, no discussion about healthy aging is possible without talking about sexuality in the seventh or eighth decade of life. Coincidentally, it is also conspicuously absent from most writing about healthy aging.
It is absent from most mainstream wellness magazines and much of social media, which prefer to feature younger adults exhibiting beautiful physiques, virility and sexuality, while highlighting people in their sixties and seventies happily practising yoga at sunrise.
It is also absent from most conversations between physicians and patients over 65, in which research suggests neither side rarely raises it. It is absent from the self-help shelves, which tend to stop at retirement planning and managing grief, leaving everything else to inference.
And it is almost absent from the longevity literature, which spends considerable time on sleep, creatine, and VO2 max and somehow never gets around to the thing most humans spend a significant portion of their inner lives thinking about.
It reminded me of something my doctor said when I turned 60, when he used a sports analogy to the state of my biology: “Greg, it’s the third period, the final period of play. How do you want to play it?”
He was implying, at the time, that I had done well at staying fit through my 50s, but not to be too comfortable with the prognosis. He also said something else in reference to my then biological age: “You might be a good example of ‘60 is the new 50’, but please know, 70 is just 70 - it isn’t the new 60.” He was 72 at the time.
After getting over the shock that, at 60, he thought it was entering my final period of play, and that the clock would now count down as I slowly declined into the sad reality of my 70s, I wanted to find out why and what I could do to alter what he thought was inevitable.
That’s what created this space on The Long Ride, and that’s why I am now writing about sexuality in our 70s. I’m going to talk about it because I believe this demographic needs to hear it and because it is, in large part, why we feel physically and emotionally well throughout our adult lives.
Not in a clinical way, and not as a confessional. But in the way that The Long Ride always tries to approach subjects relating to aging that deserve serious treatment: with research, with honesty, and without the kind of embarrassment that passes itself off as discretion.
The subject of intimacy and sexual connection in later life has surprisingly substantial research. But the misconceptions and silence surrounding it are doing real damage, disguised as good manners and deference towards seniors.
One of my subscribers to The Long Ride on Substack sent me a message after reading The Loneliness Epidemic (July 5, 2026), which prompted me to reflect on intimacy and sexuality in the broader context of health and well-being as we age.
At 73, she still writes erotic stories, some based on her own experiences and others extrapolated from her readers’ DMs - a lot of readers, it turns out. She reminded me that our chronological age and our biological age are quite often out of sync, and where you are on that scale makes all the difference in the world when it comes to sexuality.
Her message described something most people would recognize yet wouldn’t say out loud. It also made me realize it would be difficult to write about without including some personal elements and observations from people I know or who have confided in me. So, for our purposes here, my first-ever disclaimer:
Some information and details in this piece have been altered or composited to protect the privacy of the individuals who contributed to this piece.
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The first thing worth highlighting is that the silence itself is worth examining, because it is not neutral.
Research published in Social Science and Medicine found that social constraints around aging and sexuality may inhibit sexual expression in older adults more than any physical or functional limitation. In other words, the barrier is not primarily physiological. It is cultural and presumptive.
Many sexually active older adults experience ageism, stigma, and shame stemming from the perceived social unacceptability of their sexuality — internalized from a culture that both fetishizes youth and treats older bodies as post-sexual.
This cultural framing has two documented effects. The first discourages older adults from discussing sexual concerns with their physicians or partners, which leaves conditions that affect sexual health undiagnosed and untreated, with downstream consequences for overall health.
The second leads people to accept a reduction in intimate life that is neither inevitable nor, according to the research, biologically benign. Both men and women can experience uncomfortable biological changes when sexuality diminishes. Both physical and emotional.
Whether you are part of this demographic today or not, this will still be relevant.
A 2024 review in the Journal of the American Geriatrics Society found that most older adults continue to value and engage in intimate relationships, and that sexual activity and intimacy are among the strongest predictors of life satisfaction and well-being in later life.
The research consistently challenges what one academic paper called ‘the narrative of decline’ — the assumption that sexuality naturally ends in the sixth or seventh decade, leaving only a dignified, somewhat melancholy celibacy. Most older adults, the data shows, do not experience it that way. They have simply learned not to talk about it.
Physical changes are real, and we talk about them directly. But for most older adults, the primary barrier is not the body. It is the silence — and silence can be broken.
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Here is where the subject shifts from cultural observation to health science, which is where The Long Ride lives.
The biological case for sexual connection as a health variable in later life is now substantial enough to be considered alongside exercise, sleep, and social connection in the longevity literature. The mechanisms are numerous and well-documented, although not always obvious.
Cardiovascular health.
A frequently cited study found that men who engage in sexual activity twice a week or more have up to a 45 percent lower risk of cardiovascular events than those who are rarely or infrequently active. The mechanism is physiological: sexual activity raises heart rate, improves circulation, lowers blood pressure, and provides cardiovascular exercise with a particularly effective stress-reduction component. A 2020 study in the American Journal of Medicine found that sexual frequency was associated with long-term survival after acute myocardial infarction. The heart, it turns out, benefits from being used in this way.
Hormonal regulation.
Regular sexual activity helps maintain testosterone and estrogen levels that would otherwise decline more steeply with age. These hormones are not merely reproductive — they also support bone density, muscle mass, cognitive function, mood regulation, and social bonding. Suppressing these hormones through inactivity is not a trivial health outcome. It is a measurable contributor to the physical changes most often attributed to ageing.
Immune function.
Research has shown that regular intimate contact increases the production of natural killer cells, enhances the immune system’s surveillance capacity, and reduces inflammatory markers linked to accelerated aging. Oxytocin — the hormone released during physical intimacy — interacts with the autonomic nervous system and the HPA axis to lower blood pressure and modulate immune function. Its cardiovascular protective effects are well documented in the research literature. Research on oxytocin and longevity is still emerging, but the findings are consistent.
Telomere length.
This one surprised me when I first encountered it. Research published in Psychoneuroendocrinology found preliminary evidence that sexual intimacy is associated with longer telomere length in couples — telomeres are the chromosomal caps whose shortening is a primary molecular marker of biological aging. The researchers were careful to avoid implying causation: it may be that healthier people have both longer telomeres and more active intimate lives, rather than one causing the other. But the association exists and warrants the continued research the authors called for. In the context of my earlier essay on the Horvath clock and biological aging, the finding is worth noting.
Psychological and cognitive health.
A 2024 study linking depression, sexual frequency, and all-cause mortality found that regular sexual activity was associated with lower rates of depression and reduced all-cause mortality, independent of other health factors. The cognitive dimension is equally significant: sexual activity stimulates neural pathways associated with pleasure, reward, and social bonding, which support brain health and may offer some protection against cognitive decline. A 2025 review in Brain and Behaviour found that higher quality of life is associated with stronger sexual desire in older adults, and that the relationship operates in both directions — better health supports intimate life, and intimate life supports better health.
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The research also documents several specific misconceptions about sexuality and ageing that are worth discussing here because they are shaping behaviour in ways that harm health.
The first misconception is that physical changes associated with aging make sexual connection impossible or inevitably unsatisfying. This is empirically incorrect. Physical changes are real — they affect the mechanics, timing, and sometimes the priorities of intimate life. They do not end it.
Men, in particular, tend to avoid this conversation entirely — not from indifference, but because for many, acknowledging change in sexual function feels uncomfortably close to acknowledging something about themselves they are not ready to name.
The second misconception is that desire naturally ends in the sixth or seventh decade. The data do not support this claim.
An AARP survey found that most adults over 60 report that sexual activity is important to their quality of life.
The New England Journal of Medicine published a landmark study on sexuality and health among older adults, which found meaningful rates of sexual activity well into the seventies and eighties. Desire changes in character as we age — it becomes more contextual, more relational, more bound up with connection, and less driven by urgency. It does not simply stop.
The third misconception is that this is not a medical subject. It is. The World Health Organization defines sexual health as a state of physical, emotional, mental and social well-being in relation to sexuality, not merely the absence of disease or dysfunction.
A 2024 review in the American Journal of Lifestyle Medicine concluded that healthcare providers should include comprehensive sexual health assessments as part of routine care for older adults. Most do not. Most patients don’t raise the subject. The silence on both sides of that consultation is the gap in which health outcomes deteriorate without anyone defining the cause: “…you are 75, after all”.
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There is a distinction circling in this essay that deserves some discussion.
Sexuality and intimacy are not the same thing. They can be related, but the wellness conversation treats them as interchangeable, which is one reason so much of what gets written about aging and intimate life misses the point for older adults.
Sexuality, in the way most people use the word, refers to sexual activity, desire, and physical expression. It is real, it matters, and the research on its health benefits is described above. But it is also the variable that changes most visibly with age.
Intimacy is the broader and more durable category. It is emotional closeness. Physical tenderness. Being known by another person across decades. The comfort of a hand found in the dark, of a body lying beside yours, of the shorthand that develops between people who have shared a life.
Intimacy includes sexual expression but is not confined to it, and it is the variable that the research shows is most resistant to aging.
The Berlin Aging Study II, which examined 1,514 adults with a mean age of 68, found that older age was associated with considerably less sexual activity and fewer sexual thoughts — but with almost no decline in intimacy. The effect size was strikingly large for sexual activity and thoughts, barely measurable for intimacy. When researchers compared older adults with a reference group of 22- to 36-year-olds, the intimacy gap was nearly negligible.
A 2024 scoping review in Sexual Medicine Reviews found that sexuality in later life becomes more multidimensional — expressed through touch, physical closeness, shared presence, and attentiveness — and that intimacy and emotional connection, rather than physical performance, become the cornerstone of how older adults experience and appraise their intimate lives.
This is not a consolation prize. It is a reorientation to what matters most.
Research shows that couples who navigate the physical changes of later life with the greatest satisfaction share a consistent characteristic: they separate intimacy from sexual performance in their understanding of what their relationship requires. They communicate. They adapt.
They invest in closeness that is not contingent on any physical capacity. Research on older couples’ satisfaction finds that emotional connection and communication predict it more reliably than any physiological variable, which means that the dimension of intimate life most resistant to aging is also the one most within reach.
For people without a partner, or who have lost one, the intimacy question is different but no less important. The research on social isolation consistently identifies the loss of physical closeness — touch, warmth, the simple presence of another body — as one of the most underrecognized forms of deprivation in later life.
This is not only a clinical matter. It is a human one. The need to be known and to know another person does not diminish with age. It changes shape. It does not stop.
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Writing on this subject in The Long Ride is incomplete without acknowledging what does change with age, because the research is transparent about it, even when the wellness conversation is not.
For men, the most common physiological changes include longer time to arousal, reduced urgency, and changes in erectile function that become increasingly common from the mid-fifties onward. Erectile dysfunction affects an estimated 40 percent of men at age 40, rising to approximately 70 percent by age 70. These changes are not primarily psychological—they are vascular, hormonal, and neurological, and they are treatable in most cases.
Interventions are often avoided because the cultural shame surrounding them is disproportionate to the clinical reality. Importantly, some obvious interventions aren’t even discussed. Physicians would rarely suggest strength training as an important part of the protocol, yet it can provide an important boost to the other interventions for improved sexual health.
For women, the hormonal changes of menopause can cause physiological changes, including vaginal dryness, altered tissue sensitivity, and reduced lubrication, which can make sexual activity uncomfortable without appropriate management.
The research is clear that these are medical issues with medical solutions — topical treatments, hormone therapies, and lubricants that are effective and safe, yet dramatically underused because the conversation around them remains stigmatized.
A 2025 study published in the journal menopause found that for many older women, sexual pleasure and orgasm remain important through and beyond menopause, and that the changes associated with menopause do not inevitably lead to negative outcomes for sexuality.
Research most consistently finds that couples who maintain satisfying intimate lives into their sixties, seventies, and beyond share certain characteristics unrelated to youth or physical perfection. They communicate about what has changed. They adapt. They prioritize the relational dimension of intimacy alongside the physical dimension, recognizing its limitations. And they resist the cultural message that their intimate lives have a natural expiry date.
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The wellness industry has built a significant commercial enterprise around the idea of aging well. It will sell you supplements, fitness trackers, sleep monitors, and protein powders. It will not, in any meaningful way, address the dimension of human well-being that research identifies as one of the strongest predictors of life satisfaction in later life.
That is a significant gap. It is one The Long Ride is not going to step around, with apologies to my family and friends.
Intimacy in later life is a health variable. It affects cardiovascular health, hormonal regulation, immune function, psychological well-being, and, importantly, biological ageing. Age-related changes are real and manageable. The silence surrounding the subject is neither inevitable nor benign.
If I have prompted a conversation — with a partner, a physician, or even with yourself — about what you have accepted without question, that’s what I meant to do.
If you are experiencing changes in sexual function that are affecting your quality of life, or if you are managing a chronic illness that affects sexuality and intimacy, speak with your physician. Erectile dysfunction, vaginal atrophy, hormonal changes, and other conditions that affect intimate life are medical matters with evidence-based treatments.
In Canada, the Society of Obstetricians and Gynecologists of Canada (sogc.org) and the Canadian Urological Association (cua.org) offer resources and guidance on specialist referrals. In the US, the American Urological Association (auanet.org) and the North American Menopause Society (menopause.org) are appropriate starting points.
Research & sources referenced in this piece
Curley, C.M. & Johnson, B.T. (2022). Sexuality and aging: Is it time for a new sexual revolution? Social Science and Medicine, 301, 114865. Social constraints may inhibit sexuality more than physical limitations.
Muller, J.E. et al. Massachusetts Male Aging Study. Published in The American Journal of Cardiology. Men engaging in sexual activity twice weekly or more experienced 45 to 50 percent lower risk of cardiovascular events compared with men engaging once a month or less, after adjustment for other health factors. Referenced in the American Heart Association Journal Circulation (2012). DOI: 10.1161/cir.0b013e3182447787
Penhollow, T.M. (2024). Sexuality in Older Adults: Comprehensive Strategies for Clinicians and Patient-Centred Care. American Journal of Lifestyle Medicine, 19(3), 392-402. PMC11556589.
Penhollow, T.M. (2025). Psychosexual Health and Sexual Satisfaction in Older Adults: Strategies for Holistic Well-being. Sage Journals, 2025.
Banerjee, S., Anderson, P. & Davis, W.S. (2024). Connection Between Depression, Sexual Frequency, and All-cause Mortality: Findings from a Nationally Representative Study. Journal of Psychosexual Health, 6(1), 35-44.
Kepler, B.S. et al. (2020). Frequency of Sexual Activity and Long-term Survival after Acute Myocardial Infarction. American Journal of Medicine, 133.
de Baca, T.C. et al. (2017). Sexual intimacy in couples is associated with longer telomere length. Psychoneuroendocrinology. Preliminary evidence; causal direction not established. ScienceDirect.
Lindau, S.T. et al. (2007). A study of sexuality and health among older adults in the United States. New England Journal of Medicine, 357, 762-774. Landmark survey of sexual activity rates through the 70s and 80s.
World Health Organization. Defining sexual health. Technical consultation report, 2002. WHO's definition of sexual health is physical, emotional, mental and social well-being.
Rocamora-Perez, P. et al. (2025). Quality of Life, Pain, and Sexual Desire in the Elderly Over 65 Years of Age. Brain and Behaviour. Wiley Online Library. July 7, 2025.
Menopause journal (2025). Study on sexual pleasure and orgasm in older women through and beyond Menopause. Referenced in Forbes, July 28, 2025. Kinsey Institute Sex and Aging Symposium, 2025.
AARP (2024). Ageless Desire survey. The majority of adults over 60 report that sexual activity is important to the quality of life.
Psychology Today (2025). To Make Love or Not Make Love in the Elderly. February 3, 2025. Review of cardiovascular, immune, and longevity research on sexual activity in older adults.
Sorry, Steven. Not sure what you want us to know.
As I told my friends who are my age, but seem to be aging faster bc of society's attitude toward older people:
“I do not live to die.” I am here living UNTIL I die.