"Sexspan": How to Keep Sex Healthy Well Into Old Age

"Sexspan" is the working concept from urologist Mohit Khera at Baylor College of Medicine: the same logic behind healthspan (more years of good health, not just more years) applied to sexuality. The goal is satisfying sexual activity as far into old age as the biology allows. The research supporting the effort is real, if not airtight. A 2022 Dutch study tracked 1,042 middle-aged and older adults over 27 years and found that enjoyment of sexuality was linked to longer survival, but only among people who also said sexuality mattered to them. A separate 2025 analysis of nearly 16,000 U.S. adults found that sex once or twice a week had the strongest association with lower rates of depression.

Psychologist Noam Shpancer breaks the obstacles into four areas: cultural stigma that pushes older people to treat sexual health as embarrassing or beside the point; the predictable physical changes on each side (erectile dysfunction and lower testosterone in men; vaginal dryness and menopause-driven hormonal shifts in women); lifestyle factors that affect everything else (sleep, diet, exercise, stress, social connection); and partner health and communication. His through-line is that as physical flexibility declines, psychological flexibility matters more. That includes talking openly with a partner and pushing the conversation with a physician who would rather let it drop. Doctors routinely avoid the subject. The reader who wants to address it has to bring it up themselves.

A concept called "sexspan" — coined by urologist Mohit Khera at Baylor College of Medicine — applies the same logic as healthspan (extending years of good health) to sexuality: the goal is to prolong satisfying sexual activity as far as possible into old age. Research backs the effort. A 2022 Dutch study tracking 1,042 middle-aged and older adults for 27 years found that enjoyment of sexuality was linked to longer survival, but only among those who also said sexuality was important to them. A separate 2025 analysis of nearly 16,000 U.S. adults found that sex one to two times per week had the strongest association with reduced depression.

Psychologist Noam Shpancer identifies four domains that shape sexspan: cultural stigma that discourages older adults from prioritizing sexual health; sex-specific physical changes (erectile dysfunction and reduced testosterone in men; vaginal dryness and menopause-related hormonal shifts in women); lifestyle habits — sleep, diet, exercise, stress management, and social connection; and partner health and communication. He argues that as physical flexibility declines, psychological flexibility and open communication with both partners and healthcare providers become more important. Older adults, he writes, need to be proactive and assertive in raising sexual health concerns with physicians, who often avoid the topic.