I spent the last few weeks reading everything credible I could find on sex after 50, and the clearest finding has nothing to do with hormones or technique. It's silence. Most older adults who run into a sexual problem never mention it to anyone, and most doctors never ask. A subject that touches health, mood, memory and the quality of a marriage gets handled the way we handle a strange noise in the car: Ignore it and hope it goes away.

It usually doesn't go away on its own. But most of these problems are navigable and a surprising number are treatable without a prescription pad.

Half of people in their 60s are still having sex

Start with the assumption the silence is built on; that is, that sex winds down and then stops with age. The data clearly say otherwise. Roughly half of adults in their 60s remain sexually active. People in their 70s and beyond remain so in numbers that would surprise anyone who absorbed their ideas about aging from social media or, for that matter, traditional media.

What changes after 50, it seems, is the shape that sexual connection takes.

And it does change a lot. Erectile dysfunction, menopause, the genitourinary effects of lower estrogen, chronic stress, medications, the plain absence of a willing partner: any of these can rearrange a person's sex life.

The biggest barriers the research raised are partner availability and personal health, which means a good portion of the problem is circumstantial rather than physiological. That distinction matters because circumstance is often more fixable than biology.

Sex becomes many things that are not intercourse

The most useful idea I came across in my research is that sex, for many people past a certain age, becomes a great many things that are not intercourse. This is an expansion of the definition that the culture stubbornly refuses to update. When intercourse becomes difficult or impossible, couples who treat it as the only valid form of sex tend to quit. Couples who don't adapt and report satisfaction that has little to do with the mechanics that younger people fixate on.

Then there's the health argument, which deserves more attention than it gets. The research links regular sex to lower mortality, better cardiovascular markers, less depression and sharper memory. I'd treat any single one of those findings with the usual caution about correlation and causation and I'd want to see the strength of each link before overselling it. Healthier people may simply have more sex, rather than the other way around. But the direction of the evidence is consistent enough that it belongs in the same conversation as exercise, sleep and diet, instead of being filed under recreation.

So why the silence?

Part of it is embarrassment, on both sides of the exam table. Part of it is a medical system that schedules seven-minute visits and rewards efficiency over inquiry. And part of it is a cultural script that finds older adults' desires either invisible or not important.

Those assumptions can do real damage. It tells a 65-year-old that a treatable problem is just the cost of getting old and it discourages the one question that might fix things.

The fix starts with refusing the premise

If you're dealing with a change in your sex life, it is not automatically permanent and it isn't automatically untreatable. Some of it responds to medical intervention. Some respond to addressing the cardiovascular fitness and strength that are the foundations of sexual function. Some respond to a willingness to redefine what counts.

Most of it responds to being named outright — first to yourself and then to a clinician who should have asked (but probably didn't).

We've spent decades getting more comfortable talking about exercise, mental health and even death. Sex after 50 remains the holdout, governed by a quiet agreement to pretend it isn't happening. The least we can do is talk about it as if it's real.

To find out more about Paul Von Zielbauer and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate website at www.creators.com.

Photo credit: Matt Bennett at Unsplash