Sexual health among older adults in Nigeria: a systematic review of evidence, gaps, and opportunities for intervention

BACKGROUND: Sexual health remains an understudied dimension of wellbeing among older adults in Nigeria. This review synthesised existing evidence on sexual health among Nigerians aged 60 years and over, and identified gaps in knowledge, policy, and practice. Despite global recognition of sexual health as a lifelong concern, cultural taboos, gender norms, and health system neglect continue to marginalise older adults' sexual wellbeing. METHODS: A systematic review was conducted according to PRISMA 2020 guidelines (PROSPERO: CRD420251064655). Peer-reviewed empirical studies from PubMed, Web of Science, and Scopus were eligible if they reported on sexual activity, dysfunction, satisfaction, condom use, STI and HIV knowledge, or health service use among Nigerian adults aged ≥60 years. Using narrative synthesis and an aggregative from Synthesis Without Meta-analysis, data were abstracted using a structured form, and findings were narratively synthesised through thematic analysis to identify key themes and evidence gaps. RESULTS: Seventeen studies (2003-2024) met inclusion criteria. Evidence reveals that older Nigerians remain sexually active but face significant barriers to sexual wellbeing. Gendered expectations privilege male sexuality while discouraging female expression. Misconceptions around HIV transmission persist despite widespread awareness, and condom use remains low. Cultural norms and provider discomfort inhibit uptake of sexual and reproductive health services, while traditional healers are often preferred for their perceived respectfulness. Older women, rural populations, and those with disabilities remain underrepresented in the literature. CONCLUSION: Sexual health in older Nigerians is shaped by a complex interplay of cultural norms, structural neglect, and limited policy attention. Integrating age-sensitive and gender-sensitive approaches into geriatric care and sexual and reproductive health programming is essential to meet the needs of this growing population.