Sex-positivity among middle-aged and older adults: a series of participatory activities

BACKGROUND: Sexual health is a fundamental aspect of wellbeing, encompassing physical, emotional, mental, and social dimensions. However, sex-positive approaches often focus on younger populations, neglecting middle-aged and older adults (aged 45 years and above). Sex positivity treats sexuality as natural and healthy, emphasizing consensual, respectful, non-judgmental expression, and promoting autonomy, inclusivity, and access to accurate sexual health information and services. This study explored how sex-positive frameworks can promote pleasurable, healthy sexual lives among middle-aged and older adults. METHODS: A co-creation workshop was organized at the STI & HIV World Congress 2025 in Montreal, Canada, inviting selected participants to small-group discussions on what a sex-positive approach might look like. This was followed by participatory discussions between co-authors and adults aged over 45 years, exploring perceptions, experiences, and barriers related to a sex-positive approach among middle-aged and older adults. Data were analyzed thematically to identify key influences on sexual health and pleasure. RESULTS: Participants highlighted that stigma, silence, and cultural norms shape understanding of sexuality in middle and later life. These were reinforced by the discomfort of healthcare providers in discussing sexual issues and widespread misconceptions that sexual desire inevitably declines with age. Such barriers limited access to accurate information and supportive care. Despite this, participants expressed enthusiasm for inclusive, age-appropriate campaigns and health services that affirm pleasure, intimacy, and connection as vital components of well-being. CONCLUSIONS: Findings underscore the need to integrate sexual health into aging policies, clinical training, and public health advocacy. Embedding sex-positive principles across the life span ensures that desire and intimacy remain recognized, supported, and celebrated throughout life.