Is sex in old age becoming an oxymoron in our youth-obsessed societies? Teenage children find it difficult to imagine their parents having a sex life, let alone their grandparents. Older people are ignored in epidemiologic surveys of sexual behavior or, worse, are excluded because of the conservatism of ethics committees. The elderly resent this oversight. An Australian study (1) challenged the assumption that older people are "asexual," reporting that sex is indeed important to them and contesting the view that older men and women are unwilling or unable to report on their sexual function.

The sexual liberation that began in the 1960s in Western Europe and North America involved a generation of people who are now entering retirement and old age. Demographic and social changes have led to a much more open attitude by all people to their sexual lives. So, what do older men think about sex and how do their sex lives evolve? This single-author book on the biological, social, and psychological aspects of sexual behavior in older men is to be welcomed. It takes a multidisciplinary approach to a wide range of issues that have an impact on the sexual life of men aged 60 and older.

This comprehensive work includes painstaking reviews on what is known about aging in men and how it affects sexual function. Although not rigorously systematic in its review of the evidence, it has the consistency of a single-author approach, a rarity these days in academic publishing. The book covers a wide territory, including sexual function and physical status, the diseases of aging, the use of substances and prescribed drugs, and the psychological changes that accompany aging. A chapter specifically devoted to gay men is to be welcomed. The price paid for such a comprehensive coverage is lack of depth in several chapters. For example, the social context of aging and sexual function is covered in a mere seven pages.

Each chapter is supported by data from the world literature and in several instances from the author’s own work. The latter includes research on and audit of his clinic program in the Department of Psychiatry at Mount Sinai Medical Center. Inevitably in a fast-changing field, the biological and physiological aspects of the nature of sexuality are somewhat dated by a lag in publication time. This is not a book in which to catch up on new research on the biology of sexual function; rather, it is book to consolidate one’s knowledge about principal biological mechanisms. At the time of writing the book, sildenafil had just completed phase-three trials and was not available as a prescription medication.

Although this is a book for the sexual specialist, professionals entering the field would gain a considerable amount from many of its sections. Most men who attend sexual problem clinics are in the second half of their life. Although restricted to one-half of the elderly population, information on this age group is highly relevant to the work of all professionals who treat people for sexual problems. It is clearly written in an interesting style, and I can highly recommend it. Sex is important to elderly men, and the more health professionals know about it the better.