A Systematic Review of Sexual Health in Older Chinese Adults: Significant Challenges, Marginalized Voices, and Directions for Future Interventions.

OBJECTIVES: China has a substantial population of older adults, defined as individuals aged 60 and above. In mainstream social and cultural scripts, older Chinese adults are frequently portrayed in a desexualized or asexual manner, reflecting traditional cultural norms that regard seniors as paragons of virtue. However, it is vital to acknowledge that older adults possess sexual desires, needs, and expressions, even though discussions about older sexuality are often viewed as taboo in Chinese society. METHODS: In accordance with PRISMA guidelines for systematic reviews, this study included 42 English-language and 13 Chinese-language articles published between 2005 and 2025. The R programming was utilized to assist in thematic analysis. Furthermore, a policy review was undertaken to examine China's aging policies and assess the extent to which they address older sexual health. RESULTS: Four primary themes were identified: older adults' attitudes toward sex, their sexual activeness, the adverse health outcomes associated with risky sexual behaviors, and current levels of sexual health literacy. The findings indicate that a substantial proportion of older Chinese individuals maintain sexual desires and needs, which are often suppressed by prevailing societal and cultural scripts. It not only negatively impacts their well-being but also contributes to further health risks, including a rise in extramarital or other risky sexual behaviors. The policy review further revealed that sexual health issues among the older population are largely overlooked in China's active aging policies. CONCLUSION: Recommendations are offered for sexual education toward older Chinese adults based on the framework of sexual health literacy, which highlights the importance of accessing, understanding, evaluating, and practicing sexual health knowledge that are related to pursuing sexual pleasure and engaging in sexual behaviors. Particular attention should be given to disadvantaged subgroups, including older adults with lower socioeconomic status, those who self-identify as sexual minorities, and individuals living with HIV.