My 13-year-old son has a habit of barging into my bedroom late at night when his mother and I have settled in under the glow of the television. He'll come in with a question of little consequence and try to plant his ass on the bed, flop onto his side, and watch TV. I have told him to knock before entering without success. Finally, the other day when I raised the subject with him, I said, "what if we're having sex?"

His eyes widened and he blushed and chuckled at the absurdity of the notion. "You don't still do that, do you?"

My effort to shock him with that most dreadful of images of his own parents forming the beast with two backs not only failed, but it elicited laughter and a barrage of obnoxious questions. That was followed by him issuing a stern warning for the two of us to use birth control because at our age, we didn't need any unplanned surprises. I thanked him for his concern.

As it turns out, a new survey finds that people considerably older than my middle-aged self are still sexually active. Though that doesn't come as a surprise to gerontologists, it at least provides me with the best news about retirement since the last time I had an uptick in my 401K.

The study, published in the Aug. 23 issue of the New England Journal of Medicine, comes from the National Social Life, Health and Aging Project. Researchers queried more than 3,000 people in the United States aged 57 to 85 on their intimate lives. They found a majority of them remained sexually active as defined as having sex with at least one partner within the past 12 months. While sexual activity declined with age, the study found sexuality is more closely linked to health than age.

Among the most significant findings from the study was that while sexual problems are common among older adults, they are infrequently discussed with doctors. Half of all respondents reported having at least one "bothersome" sexual problem and almost one third of participants reported having at least two. The most common among men were difficulty achieving or maintaining an erection (37 percent), lack of interest in sex (28 percent), climaxing too quickly (28 percent), anxiety about performance (27 percent), and inability to climax (20 percent). For women, the most common sexual problems were lack of interest in sex (43 percent), difficulty with lubrication (39 percent), inability to climax (34 percent) finding sex not pleasurable (23 percent), and pain—most commonly at the vagina at entry (17 percent).

Poor Communication
But despite such problems and the fact that the majority of older adults regard sexuality as an important part of life, the researchers found that overall, only 38 percent of men and 22 percent of women said they discussed sex with a physician since the age of 50. The researchers attributed poor communications between older patients and doctors over sex include the unwillingness of either to initiate such discussions, sex and age differences between patients and their doctors, and negative societal attitudes about women's sexuality and sexuality of older people.

"We found, despite the high prevalence of problems, that most older adults have never discussed sex with a physician," said Stacy Tessler Lindau, assistant professor of obstetrics and gynecology and of medicine-geriatrics at the University of Chicago and lead author of the study. "From a medical and a public health perspective, we have an opportunity and an obligation to do better patient education and counseling about health-related and potentially preventable and treatable sexual problems."

The authors also noted that lack of dialogue between older patients and doctors can have serious consequences since sexual problems may be a warning sign or consequence of a serious underlying illness such as diabetes, an infection, urogenital tract conditions, or cancer. Undiagnosed or untreated sexual problems can also lead to or occur with depression or social withdrawal. In addition, patients may discontinue needed medications because of side effects that affect their sex lives, and medications to treat sexual problems can also have negative health effects, yet physician-patient communication about sexuality is poor.

High Frequency
Todd Semla, president of the American Geriatrics Society, said the findings about the lack of communication between patients and doctors is significant and hopes that it helps foster discussion on matters of sexuality between the two.

"A lot of the reasons older adults are not sexually active has to do with medical conditions that they have that can be medically treated," said Semla. "That's one of the take-home points. There needs to be a dialogue about this so issues can be addressed."

For me, among the most interesting findings was that the frequency of sexual activity of respondents to the study who were sexually active was similar to that reported among adults 18 to 59 years of age in the 1992 National Health and Social Life Survey, the only other comprehensive, population-based study of sexuality in the United States, the researchers said. The frequency of sex did not decrease substantially with increasing age through 74 years of age.

In fact, among respondents who were sexually active, even though the frequency of sex was lowest among the oldest participants in the survey, 54 percent of sexually active adults 75 to 85 years of age reported having sex at lest two to three times per month and 23 percent reported having sex once a week or more.

Because of that, I'm going to take some of my own advice. When I visit my parents, I'm going to knock before I go into their bedroom.