The Graying of "Sexual Health": A Critical Research Agenda
Marshall, Barbara L., Canadian Review of Sociology
EARLY IN 2010, a study published in the British Medical Journal introduced a new health expectancy indicator: "sexually active life expectancy" (Lindau and Gavrilova 2010). Defined as the "average remaining years of sexually active life," the authors argue that such an indicator will be useful in "projecting public health and patient needs in the arena of sexual health" (Lindau and Gavrilova 2010, p. 818).
This study is only one of a spate of recent publications demonstrating the upsurge in interest in older adults and their "sexual health." (1) Reversing the long-held stereotypes of asexual or postsexual seniors, expectations of continued sexual functionality as an indicator of health in later life now underpin a growing medical and therapeutic industry. Clearly, new agendas have emerged which have put the relationship between aging and sexuality at center stage for both scientific research and public health promotion.
The intent of this paper is to unpack the concept of "sexual health" as it has been used in the recent literature on late-life sexuality, and to suggest that a more expansive and critical research agenda is required. As a number of scholars have noted, sociological research on both aging and sexuality has been slow to catch up with the cultural shifts in imagery and expectations about sexuality related to the aging of the baby boom and the introduction of, and widespread use of, pharmaceutical remedies for age-related sexual dysfunction (Calasanti 2004, 2009; Carpenter, Nathanson, and Kim 2006; Cronin 2006; Fraser, Maticka-Tyndale, and Smylie 2004; Gott 2006; Kirkman 2005; Marshall 2010; Vares et al. 2007). While in sociology both "aging" and "sexuality" are now understood as socially constructed and regulated across a range of institutions and contexts, there remains a fairly limited body of literature that brings these insights together, and little of this work has been incorporated into public health campaigns or reported in the mainstream media. Much of the visible ground has been ceded to clinical and therapeutic perspectives, driven by rehabilitative agendas. When sexuality and aging have been the focus of widely cited studies, they have been underpinned by a biomedical model of heterosexuality, deflecting attention from gender, sexual diversity, and the social construction of age and sexuality more generally. We thus need to ask what "sexual health" means in relation to new cultural understandings of aging. As Ken Plummer (2008) remarks: "it is time for a new critical sexual gerontology!" (2) (p. 18). My main task here is the elaboration of a research agenda that might map out such a field. I aim not to come to conclusions, but to review the literature, identify key gaps, bring together some diverse lines of analysis, and suggest a range of questions that might prompt further inquiry.
In what follows, I draw on social and cultural studies of aging, feminist studies, and science and technology studies to outline four domains that might frame a critical sociological research agenda that treats sexual health as a point of articulation for a range of technologies and processes, and which can encourage more sustained sociological attention to the cultural reconstruction of sexual life courses. These domains include: (1) elaborating a geneology of the concept of sexual health and its relationship to changing conceptions of life courses and discourses about "positive aging"; (2) mapping the medicalization of late-life sexuality in relation to pharmaceutical technologies; (3) analysis of the texts of sexual health and fitness; and (4) development of qualitative insights regarding how differently located individuals negotiate the sexualization of later life. Taken together, these four domains comprise a wide-ranging research agenda that may contribute to understanding the history, shape, experience, and limits of "sexual health" as a dominant idiom for thinking about sexuality in later life. …