Abstract
Sexuality is a vital part of human life that continues into older adulthood, yet the experiences of Lesbian, Gay, Bisexual, Transgender, Pansexual, and Queer (LGBTPQ) elders remain largely overlooked in research and practice. This study examines how older LGBTPQ adults navigate sexual expression and intimacy while facing unique social and structural barriers. Using a qualitative approach, we conducted in-depth interviews with 40 participants living in Portugal, aged between 64 and 83 years (M = 70.33, SD = 3.87). Analysis revealed that intimacy in later life extends beyond sexual activity, encompassing emotional closeness, identity affirmation, and resilience in the face of stigma, ageism, and healthcare invisibility. Findings highlight both persistent barriers, such as discrimination in care settings, internalized shame, and social isolation, and sources of strength, including chosen families, alternative relationship structures, and positive redefinitions of intimacy with age. The study underscores the need for inclusive policies, culturally competent healthcare, and recognition of LGBTPQ elders as active agents of sexual and emotional well-being throughout the life course.
Introduction
Sexuality remains a vital aspect of human experience throughout the lifespan, including in older adulthood. However, sexual expression and intimacy among older Lesbian, Gay, Bisexual, Transgender, Pansexual, and Queer (LGBTPQ) adults have historically been neglected in both research and clinical practice (Fredriksen-Goldsen et al., 2011; Srinivasan et al., 2019). This oversight reflects societal ageism, defined as the stereotyping and discrimination against individuals based on age (Hughes et al., 2019). This bias is compounded by heteronormativity - the cultural assumption that heterosexuality is the default - and cisnormativity, which privileges gender identities that align with birth sex, which often marginalize sexual and gender minorities, a population defined by sexual orientations or gender identities that differ from the majority norm (Fredriksen-Goldsen et al., 2011; Ribeiro-Gonçalves et al., 2025a).
Older LGBTPQ individuals frequently confront unique challenges, most notably internalized stigma, a process where negative societal attitudes are absorbed into one’s self-concept (Pereira, 2021). Furthermore, they face ageism, social isolation, and inadequate healthcare resources, particularly characterized by a lack of culturally competent services (Jen et al., 2020), that impede their ability to maintain fulfilling intimate relationships and express their sexuality openly (Wight et al., 2015).
Understanding a healthy sexual expression and intimacy in older LGBTPQ adults requires an intersectional approach that considers age, sexual orientation, gender identity, and other social determinants of health (Crenshaw, 1989; Gewirtz-Meydan et al., 2019). We conceptualize these dimensions through the ‘dynamic triad’ framework (Fredriksen-Goldsen et al., 2011). This model distinguishes internal anchors from behavioral actions. Here, Gender Identity refers to the internal sense of self, whereas Sexual Orientation describes patterns of attraction. In contrast, Sexual Expression represents the behavioral manifestation of sexuality, including physical acts and appearance (Weeks, 2011). This distinction is critical in gerontology. Although identity and orientation typically remain stable, the ability to express sexuality is uniquely precarious. It is frequently the dimension most eroded by external forces, such as declining health, lack of privacy in care settings, or social isolation (Srinivasan et al., 2019; Westwood, 2016).
Minority stress theory (Frost & Meyer, 2023; Meyer, 2003) offers insight into how chronic stress from stigmatization negatively impacts mental and physical health, which in turn affects sexual functioning and intimacy. Additionally, life course theory (Elder, 1998) situates sexual identity development and expression within a temporal context, acknowledging how past experiences of discrimination shape present behaviors and expectations. This means that sexual expression in older LGBTPQ adults encompasses a broad spectrum of behaviors, desires, and identities. This spectrum extends from sexual acts to forms of non-genital intimacy like cuddling or holding hands. It reflects a reality where the quality of emotional connection and sensuality frequently takes precedence over physical performance. Furthermore, it accounts for the fluidity of the self by recognizing that gender and sexual identities are not fixed endpoints but can shift and evolve well into older age (Elder, 1998). Research indicates that sexual activity and desire persist well in older age, albeit with variations influenced by health status and social context (Gott & Hinchliff, 2003). For LGBTPQ older people, sexual expression is often intertwined with identity affirmation, community connection, and resistance to societal invisibility (Fredriksen-Goldsen et al., 2013). As pointed out by Fredriksen-Goldsen et al. (2024), comprehensive efforts to examine the lives and difficulties that sexual and gender minorities have throughout their lives should consider a myriad of historical, sociocultural, and personal elements that interact across time. The Iridescent Life Course Model demonstrates how intersectionality and fluidity, as well as context, could impact the trajectories of life events for sexual and gender minorities as they become older. In particular, studies focusing on this model consider timing, context, and social change, rather than assuming stable effects within the lifespan (Fredriksen-Goldsen et al.. 2024). Yet, older LGBTPQ adults report higher rates of sexual minority stressors. Defined as chronic social stressors derived from a stigmatized status (Meyer, 2003), these stressors include internalized homophobia and discrimination, which may inhibit open sexual expression (King et al., 2020).
Intimacy needs among older LGBTPQ adults extend beyond physical sexuality to include emotional closeness, companionship, and social support. Studies reveal that many older LGBTPQ adults prioritize deep, meaningful connections that affirm their identities and provide mutual care (Murphy et al., 2018). The legacy of historical criminalization and marginalization often means older LGBTPQ adults have non-traditional relationship histories, including long-term partnerships outside of legal recognition and chosen families as vital support networks (Westwood & Rhodes, 2017). Intimacy, therefore, may be expressed through various relationship configurations beyond heterosexual norms (Ribeiro-Gonçalves et al., 2025b).
Several barriers uniquely impact the sexual and intimate lives of older LGBTPQ adults (Conyers et al., 2023). Societal ageism and heteronormativity contribute to the desexualization and invisibility of older sexual minorities (Hughes et al., 2019).
We define desexualization as the erasure of sexual agency. Following Gott and Hinchliff (2003), this is the cultural filter that labels older bodies ‘non-sexual’ and excludes them from the realm of desire. Invisibility (Jen et al., 2020) describes a different, distinct failure: the presumption of straightness. In aging care, the lack of explicit cues triggers a default to cisnormativity. The result is a coercive environment where older adults are either forced to ‘come out’ repeatedly or remain invisible.
Health disparities, including higher rates of chronic illness, HIV/AIDS, and mental health conditions, further complicate sexual health and functioning (Fredriksen-Goldsen et al., 2015). Additionally, healthcare environments often lack LGBTPQ cultural competence, leading to inadequate sexual health screening and support (Ezhova et al., 2020; Kwak et al., 2019). Fear of discrimination may discourage disclosure of sexual identity to providers, limiting access to affirming care (Jen et al., 2020). Social isolation, compounded by loss of partners and family rejection, also restricts opportunities for intimacy and sexual expression (Emlet, 2006).
In addition to societal barriers, physiological changes related to aging intersect with the unique health challenges faced by LGBTPQ older people. Chronic illnesses such as cardiovascular disease, diabetes, and arthritis are prevalent in older adults and can impede sexual activity and desire (Fredriksen-Goldsen et al., 2015). For LGBTPQ individuals, there are additional concerns related to HIV/AIDS, particularly among older gay and bisexual men, who may face stigma and discrimination in healthcare settings (Emlet, 2006; Marshall & Cahill, 2022). Pereira (2021) highlights that many older LGBTPQ adults struggle with accessing affirming healthcare that adequately addresses these intersecting health needs while supporting sexual health and intimacy.
The mental health of older LGBTPQ adults is also critical to their sexual expression and intimacy. Minority stress, that is, chronic stress stemming from societal stigma and discrimination, has been linked to increased rates of depression, anxiety, and loneliness in this population (King et al., 2020; Meyer, 2003). Pereira’s (2021) findings reveal that these mental health challenges can decrease sexual desire and satisfaction, as well as inhibit individuals from seeking or maintaining intimate relationships. Social isolation, which disproportionately affects older LGBTPQ adults (Wight et al., 2016), further exacerbates these issues by reducing opportunities for emotional and physical intimacy.
Unlike many heterosexual and cisgender older adults, older LGBTPQ individuals often rely heavily on chosen families, that form networks of friends and community members who provide emotional support and caregiving (Brotman et al., 2007; Pereira, 2021). These nontraditional kinship structures are essential for meeting intimacy needs and mitigating social isolation, particularly in the absence of biological family support. Therefore, chosen families can offer spaces where sexual expression and identity are affirmed, which is especially important in later life when mainstream social environments often exclude or ignore LGBTPQ identities, particularly in Portugal, where this study was conducted.
Portugal’s socio-historical trajectory regarding aging and older LGBTPQ individuals reflects a complex interplay of cultural conservatism, religious influence, and gradual legal reforms (Pereira et al., 2017). For much of the 20th century, under the authoritarian Estado Novo regime (1933–1974), LGBTPQ identities were heavily stigmatized and often criminalized, leading many queer individuals to live in secrecy and isolation—especially as they aged. This climate contributed to a generational legacy of invisibility and exclusion within both broader society and traditional aging support systems, with important negative impacts on their mental health (Pereira, 2021; Pereira et al., 2019). Although Portugal has made significant strides in LGBTPQ rights since the early 2000s—legalizing same-sex marriage in 2010 and adopting anti-discrimination laws—older LGBTPQ people remain marginalized due to lingering societal prejudices and the absence of targeted support policies (ILGA Portugal, 2021; Santos, 2013). In fact, many face unique challenges, such as a lack of familial support, compounded by heteronormative assumptions in healthcare and elder care services (Ribeiro-Gonçalves et al., 2022). As Portuguese society continues to grapple with an aging population, the experiences of older LGBTPQ people highlight urgent gaps in inclusivity and social protection.
Hence, older LGBTPQ adults in Portugal are often marginalized and rendered invisible in discussions of sexuality and aging. Their unique experiences regarding sexual expression, emotional intimacy, and relational needs remain underexplored in both academic literature and LGBTPQ healthcare practice. As the population of older LGBTPQ individuals grows in the country, it is increasingly important to understand how they navigate these needs within a societal context often shaped by heteronormativity, ageism, and discrimination.
Thus, the purpose of this study is to explore how older adults experience and express sexual and emotional intimacy; to identify the social, structural, and interpersonal barriers that impact their sexual expression and access to intimacy; and to examine the coping mechanisms and support systems that facilitate or hinder their relational well-being.
Drawing on Queer Gerontology, Intersectionality, and Critical Sexuality Studies, this research examines how older LGBTPQ people construct and experience sexual expression and intimacy in later life within sociocultural and institutional contexts in later life. These theoretical frameworks shape the research questions which focus on (a) the diversity of queer aging trajectories and relational configurations, (b) the diversity of queer ageing trajectories and relational configurations, (c) the compounded effects of intersecting forms of marginalization, including beyond ageism, the heteronormativity, and cisnormativity and (d) the regulation of sexual expression through cultural norms and institutional power. Therefore, the interview guide and analysis are structured to investigate the personal meaning of intimacy and the structural and interpersonal barriers that influence opportunities for sexual well-being in later life.
Method
This qualitative study utilizes a phenomenological approach through semi-structured in-depth interviews to explore the lived experiences of older LGBTPQ adults in Portugal. It draws on three interrelated theoretical frameworks: queer gerontology (Cronin et al., 2011), which challenges normative assumptions around aging and embraces diverse aging trajectories, particularly in LGBTPQ communities; intersectionality (Westwood, 2016), which recognizes how intersecting identities (e.g., age, gender identity, sexual orientation, race) shape experiences of privilege and oppression; and critical sexuality studies (Weeks, 2011) which frames sexuality as a socially constructed and contested domain influenced by culture, policy, and power. These frameworks support an inclusive, critical approach to understanding the complexity of older LGBTPQ adults lived experiences.
A phenomenological design was selected because the study aimed to privilege participants’ own meanings and lived interpretations of sexual expression, intimacy, and barriers in later life. More structured quantitative designs would have constrained the experiential nuance central to this aim, whereas observational or ethnographic approaches were less appropriate given the private and sensitive nature of the topic. Semi-structured interviews were therefore considered the most suitable strategy for balancing depth, flexibility, and comparability across cases.
Participants and Recruitment
Participants were recruited through multiple channels to ensure broad outreach within the LGBTPQ community. Recruitment efforts included collaboration with LGBTPQ community organizations and senior centers, as well as postings in relevant social media groups and online forums. Flyers, digital announcements, and word-of-mouth referrals were also used to advertise the study.
Guided by the framework of Intersectionality, a purposive sampling strategy was employed to capture a diverse range of experiences across overlapping identities (e.g., varying sexual orientations, gender identities, and age cohorts), ensuring that the sample did not treat older LGBTPQ adults as a monolithic group. Furthermore, informed by Queer Gerontology, snowball sampling allowed for additional recruitment through participants’ social networks, which is particularly valuable when working with populations that may be marginalized and less connected to formal LGBTPQ networks (non-governmental organizations (NGOs), advocacy associations, and community centers).
Eligibility criteria required participants to be aged 65 years and older, self-identify as LGBTPQ, and be able to provide informed consent. Individuals who were not fluent in Portuguese or could not provide consent were excluded. Interested individuals contacted the research team directly and were provided with detailed information about the study before giving informed consent. Recruitment and interviews were conducted in iterative cycles, during which researchers continuously reviewed and coded transcripts. Data collection concluded when additional interviews failed to yield new codes or insights. Purposive sampling was employed to enhance diversity; however, no subgroups were quota-set, resulting in variable representation across LGBTPQ identities.
This combined purposive and snowball strategy was used because no comprehensive sampling frame exists for older LGBTPQ adults in Portugal and because reaching both community-connected and less publicly visible individuals required multiple entry points. The age threshold of 65 years was chosen to align the study with later-life research and service frameworks, self-identification as LGBTPQ ensured that inclusion reflected participants’ own sexual and/or gender positioning, and Portuguese fluency was required so that nuanced accounts of intimate experience could be discussed directly, without mediation. At the same time, recruitment through community organizations, online groups, and peer referral may have favored participants who were more socially connected, more comfortable disclosing identity, or more willing to discuss intimacy; this possibility was treated as a potential source of selection bias when interpreting the findings.
Given the sensitivity of the topic and the potential risks of visibility in small community networks, care was taken to protect confidentiality and anonymity throughout the recruitment process. No identifying information was shared with community organizations, and participation was voluntary without obligation. All materials emphasized that individuals could decline or withdraw at any time without consequence. These steps were designed to uphold ethical principles of respect, autonomy, and safety, while fostering trust with participants.
Measurements
A semi-structured interview guide was developed to facilitate in-depth exploration of participants’ experiences, while allowing flexibility to follow emergent topics. The guide was organized into six sections. Section A (Introduction and Rapport Building) included broad, identity-oriented questions to establish comfort and context (e.g., “Can you tell me a little about yourself and how you identify?”). Section B (Sexual Expression) examined participants’ definitions, perceptions, and evolving experiences of sexuality and sensuality. Section C (Intimacy and Relationships) focused on the meanings of intimacy and the role of close connections, whether romantic, platonic, or otherwise. Section D (Barriers and Challenges) explored constraints to sexual expression and intimacy, including the influence of sexual or gender identity, ageism, heteronormativity, and discrimination. Section E (Support and Coping) investigated the role of affirming spaces, people, and practices in navigating these experiences. Finally, Section F (Reflection and Closing) provided participants with an opportunity to reflect on broader societal understandings and to raise issues not yet addressed. This structure balanced consistency across interviews with flexibility, encouraging participants to share rich, personal narratives.
For analytic consistency, the interview guide operationalized the study’s key concepts in advance. Sexual expression was explored through participants’ accounts of desire, sexual practices, sensual touch, flirting, embodied self-presentation, and communication of sexuality. Intimacy was operationalized broadly to include emotional closeness, affection, companionship, mutual care, romantic connection, and sexual closeness. Barriers were defined as the personal, interpersonal, institutional, and sociocultural conditions identified by participants as constraining sexual expression, disclosure, relationship formation, or access to affirming care. Support and coping were operationalized as the people, spaces, practices, and relational arrangements described as facilitating safety, connection, affirmation, or resilience in later life.
Data Collection
Semi-structured interviews were conducted either in person, via telephone, or through secure video conferencing platforms, depending on participant preference and accessibility. Interviews lasted between 45 and 90 minutes and followed an interview guide with open-ended questions designed to elicit narratives about sexual expression, intimacy desires, personal and societal barriers, and coping strategies. The guide was pilot-tested and revised for clarity and inclusiveness. All interviews were audio-recorded with participants’ consent and transcribed verbatim. Field notes were also taken to document contextual factors and non-verbal cues where applicable.
All interview sessions were conducted by the first author, which reduced inter-interviewer variation. To maintain consistency across participants, the same semi-structured guide was used in every interview, the session began with the same rapport-building approach, and the six sections were covered in a common core sequence, while follow-up probes were adapted to participants’ narratives. Minor procedural deviations, such as re-ordering prompts, spending longer on emotionally salient topics, or clarifying identity-related terms, were treated as part of the flexibility of qualitative interviewing and were documented in field notes when they occurred. Participant engagement was monitored throughout each session through the depth of responses, willingness to elaborate, signs of fatigue or distress, and overall conversational flow; when needed, the interviewer slowed the pace, reformulated prompts, or offered pauses. During analysis, notes on interview mode, engagement, interruptions, and contextual conditions were reviewed alongside transcripts so that session-to-session variation could be considered when interpreting procedural reliability and thematic patterns.
Ethical Considerations
Ethical approval was obtained from the Ethics Committee of the University of Beira Interior (Portugal). Participants were informed of their right to withdraw at any time, and all data were anonymized using pseudonyms. Given the sensitivity of the topic, particular care was taken to ensure emotional well-being, including offering referrals to LGBTPQ-friendly mental health resources when needed.
Data Analysis
Data were analyzed using a theoretically informed thematic analysis, guided by Braun and Clarke’s (2006) six-phase framework. This involved a systematic and iterative process where analytical activities began simultaneously with data collection. After each interview, transcripts were reviewed, and preliminary codes were developed to identify emerging patterns, which informed the need for additional interviews and enabled the assessment of thematic saturation.
While initial codes were generated inductively to capture the raw, meaningful features of the participants’ lived experiences, the generation and refinement of themes (Phases 3 to 5) were explicitly driven by the operationalization of the study’s three theoretical frameworks. To address how theory actively informed the analysis, the frameworks were utilized as specific analytical filters:
First, Intersectionality was operationalized to examine how overlapping systems of oppression compounded individual experiences. Rather than coding a generic “healthcare barrier,” this theoretical lens prompted the research team to analyze how ageism intersected with heteronormativity and cisnormativity. For example, it guided the distinction between a cisgender gay man’s experience of social isolation and a transgender participant’s structural experience of misgendering in elder care, ensuring that the psychosocial effects of stigma were analyzed across varying identities.
Second, Queer Gerontology was utilized to deliberately challenge deficit-based narratives of aging. During the coding process, this framework directed the researchers to actively look beyond themes of loss and physical decline. It informed the identification of codes related to resilience, the positive redefinition of intimacy in older age, and the reliance on non-traditional kinship structures (such as chosen families) as valid, successful trajectories of queer aging.
Finally, Critical Sexuality Studies guided the interpretation of institutional power and cultural regulation. This lens was applied to interpret how societal norms, public policies, and elder care environments actively desexualize or render invisible older LGBTPQ bodies. It moved the analysis of constraints on sexual expression from being viewed merely as personal or interpersonal issues to being understood as structural and institutional regulation.
The analysis was ultimately translated into a narrative account supported by illustrative quotes. Data management and coding were facilitated using NVivo (Lumivero, 2023; version 14). To enhance trustworthiness and rigor, several strategies were employed. A second researcher independently coded a subset of transcripts to strengthen intercoder reliability. Regular team debriefing sessions promoted reflexivity, allowing the researchers to critically examine assumptions and potential biases. An audit trail was maintained throughout the process, documenting coding decisions and the theoretical development of themes. Together, these steps ensured a transparent, rigorous, and theoretically grounded approach to data analysis.
To reduce the influence of any single interview context, candidate themes were compared across interviews conducted in different formats and with varying levels of narrative depth. Themes were retained only when supported across multiple cases rather than being dependent on isolated or highly idiosyncratic sessions.
Results
Sociodemographic Characteristics of Participants and Main Key Themes Addressed
Emergent Themes and Illustrative Quotes on Sexuality, Intimacy, and Aging Among Older LGBTPQ Adults Interviewed
To directly address the study’s stated aims and establish clear analytical boundaries between the findings, the 11 emergent themes were grouped into three overarching meta-themes: (1) Experiencing and Expressing Intimacy in Later Life; (2) Social, Structural, and Interpersonal Barriers; and (3) Coping Mechanisms, Resilience, and Support Systems. It is important to note that these findings are data-driven conclusions derived from a specific cohort of older LGBTPQ adults with varying degrees of connection to community networks in Portugal. Therefore, while these themes offer profound insights into queer aging trajectories, broader theoretical implications should be interpreted cautiously, recognizing that intersecting identities and differing levels of social isolation may produce divergent experiences.
Meta-Theme 1: Experiencing and Expressing Intimacy in Later Life
Persistent Desire Versus Changing Expressions
Contrary to prevailing societal narratives that often portray older adults as asexual, many LGBTPQ participants in this study articulated a persistent and meaningful desire for emotional closeness and physical intimacy. Analytically, it is crucial to distinguish between the persistence of the desire for connection and the behavioral adaptations in how intimacy is practiced. This desire extended beyond sexual activity to include deep affection, companionship, touch, and emotional validation. For many, the need to feel loved, desired, and connected remained a central aspect of their well-being, regardless of age.
Participants expressed frustration at being desexualized by both mainstream society and, at times, by members of their own communities. They emphasized that intimacy does not diminish with age, but instead evolves into more emotionally nuanced and meaningful forms. “Just because I’m in my 70s doesn’t mean I’ve stopped wanting to be held, to feel wanted. That never goes away.” — Eduardo, 72, gay man “I still flirt. I still want to feel that thrill. But finding someone who sees me, not just my age, is hard.” — Carolina, 68, bisexual woman “People assume we don’t care about touch or connection anymore, like we’ve aged out of desire. That couldn’t be further from the truth.” — Leonardo, 74, gay man “I miss sleeping next to someone more than I miss sex. It’s about that feeling of being known and cared for.” — Mariana, 70, lesbian
These quotes reflect the ongoing emotional and relational needs of LGBTPQ older people, challenging reductive assumptions about aging and sexuality. Their stories emphasize the importance of recognizing and affirming intimacy as a lifelong human need.
Participants described a range of changes in their sexual activity as they aged, including shifts in libido, physical responsiveness, frequency of sexual encounters, and how intimacy was expressed. However, rather than framing these changes solely as losses, many viewed them as natural transitions or even as opportunities for deeper, more fulfilling sexual and emotional experiences.
Some participants noted a decline in desire or ability related to aging, hormonal changes, or chronic health conditions, but also described adapting their sexual routines in creative and affirming ways. For many, aging brought a renewed focus on sensuality, communication, and emotional connection. “We don’t have wild sex like we did in the ‘80s, but we still touch, we still laugh in bed. It’s just… different now.” — Horácio, 75, gay man “Menopause changed everything, but not in a bad way. I learned to focus more on sensuality, less on performance.” — Joana, 64, lesbian “It takes longer to get going, and sometimes we don’t finish. But we connect in ways we never did when we were younger.” — Marco, 70, bisexual man “I used to think sex was just about orgasms. Now it’s about presence, eye contact, and holding each other. That’s what intimacy looks like now.” — Clara, 69, pansexual woman
Participants often emphasized that their redefined sexual lives were not inferior, but instead more intentional, emotionally grounded, and in some cases, more pleasurable than in earlier years. These narratives challenge ageist notions that view older adults as sexually irrelevant, and instead portray a complex and evolving relationship to sexuality over the life course.
Identity and Self-Expression
For many participants, aging catalyzed deeper exploration and fuller embrace of their LGBTPQ identities. Freed from earlier pressures, whether societal, professional, or family-older adults often found space to express themselves more authentically. Retirement, shifts in personal circumstances, and a growing sense of self-acceptance enabled many to shed longstanding masks and live more openly.
This process of self-expression included embracing gender identities that may have been suppressed for decades, adopting clothing and styles aligned with personal truth, and openly loving without fear of judgment. For some, aging meant reclaiming parts of their identity that had been hidden or denied, while for others, it was a time of continued discovery and affirmation. “Retirement gave me the freedom to transition. Now I wake up and see myself in the mirror—for the first time.” — Daniela, 68, nonbinary “No more code-switching, no more hiding. I dress how I want, love who I want.” — Tomás, 72, queer man “I finally stopped apologizing for who I am. Age gave me the courage to live openly and proudly.” — Eduarda, 70, lesbian “Exploring my gender identity in my 60s wasn’t easy, but it’s been the most liberating time of my life.” — Joaquim, 65, transgender person “I’ve learned that self-expression isn’t about fitting in, but about feeling whole. I’m embracing every part of me now.” — Mário, 69, gay man
These reflections demonstrate how aging can provide a powerful opportunity for self-actualization and authentic living. Participants’ journeys highlight the importance of social and cultural acceptance, as well as access to supportive communities, in fostering positive identity development throughout later life.
Meta-Theme 2: Social, Structural, and Interpersonal Barriers
The Enduring Rationale of the HIV/AIDS Impact
The long shadow of the HIV/AIDS epidemic profoundly influenced participants’ experiences of intimacy, loss, and aging. The rationale for emphasizing this historical trauma in the analysis is its spontaneous and pervasive recurrence in the narratives; for this specific cohort, the epidemic is not merely a historical event but a continuing presence that inherently shapes their emotional landscapes and social realities. The epidemic resulted in the devastating loss of friends, partners, and chosen family, contributing to experiences of grief, survivor’s guilt, and altered perceptions of mortality and intimacy.
Several participants recounted living through the height of the epidemic, describing feelings of isolation as they outlived many peers and navigated aging with the weight of loss. For some, sex and intimacy are entwined with memories of those who passed, creating complex emotional responses that blend desire, remembrance, and pain. “I never thought I’d make it past 40. Now I’m 69 and alone, because all my friends died in the ‘80s.” — Miguel, 69, gay man living with HIV “Survivor’s guilt is real. Sex still brings back memories of who we lost. Sometimes I feel like I’m betraying them just by being alive.” — Rui, 71, gay man “The epidemic took so much from us—not just bodies, but hope, trust, and connection. It’s hard to open up when the ghosts are always there.” — Helena, 67, lesbian “Living with HIV means I carry a history with me, and sometimes that history makes intimacy complicated.” — David, 70, gay man living with HIV
Participants also spoke about resilience and how surviving the epidemic fostered a commitment to living fully despite loss. This duality of grief and survival informs their ongoing relationships, community involvement, and sense of self as they age.
These reflections illuminate the persistent impact of HIV/AIDS on older LGBTPQ adults, underscoring the importance of trauma-informed and compassionate healthcare and social support systems.
Internalized Shame vs. External Ageism in Sexual Markets
Participants highlighted both internal psychological barriers and external exclusionary systems. A clear analytical distinction emerged between internalized shame—a product of lifelong societal rejection that complicates self-worth and trust—and present-day external ageism within queer sexual and romantic markets.
For many participants, lifelong experiences of social rejection, discrimination, and stigma have deeply impacted their sense of self-worth, making self-acceptance and the pursuit of intimacy challenging well into older adulthood. Internalized shame—a product of pervasive societal messages condemning LGBTPQ identities—remained a persistent barrier to emotional openness and authentic connection.
Many described carrying the emotional scars of hurtful family rejection and cultural condemnation, which shaped their self-perceptions and complicated their ability to trust others or feel desirable. This internalized negativity often translates into fears of rejection, reluctance to pursue relationships, or difficulty embracing their identities fully, even after decades of self-reflection. “I still hear my father’s voice: ‘You’re disgusting.’ It’s hard to feel desirable when that’s buried in your bones.” — Paulo, 70, gay man “I didn’t come out until I was 60. I spent decades hating myself. It’s not easy to unlearn that.” — Madalena, 66, bisexual woman “Even now, I sometimes wonder if people love me or just tolerate me. That fear sticks with you.” — Daniel, 73, gay man “Growing up, I was taught to hide and be ashamed. It’s a lifelong process to undo that.” — Margarida, 69, lesbian “I hesitate to be vulnerable, worried I’ll be rejected again. It’s hard to shake that feeling after so many years.” — Luís, 69, transgender man
These narratives reveal how internalized stigma can persistently affect emotional health and relationships in later life, underscoring the need for therapeutic support and community spaces that foster healing and affirmation. Participants’ stories highlight the complexity of navigating intimacy while carrying a history of rejection, and the courage involved in pursuing connection despite fear.
At the same time, older LGBTPQ participants described experiencing significant marginalization within sexual and romantic spaces, where ageism intersects with rigid beauty standards to create barriers to connection and desire. Many expressed feelings of invisibility, rejection, and exclusion, particularly in digital dating environments, where youthfulness is often prized and age is stigmatized.
Participants highlighted a pervasive culture that values idealized body types and youthful appearances, which can marginalize older adults and limit their opportunities for romantic and sexual engagement. This stigmatization often compounds existing challenges related to LGBTPQ identity, leaving older individuals feeling sidelined within their communities. “On dating apps, you're invisible if you’re over 50. I get messages like, ‘You’re too old for me, gramps.’” — Luís, 69, trans gay man “There’s a double standard—some older men can still find younger partners, but older queer women? We disappear.” — Maria, 70, lesbian “I’m constantly reminded that my age makes me less desirable, even though I feel vibrant and open to love.” — Ana, 65, bisexual woman “Ageism in queer spaces is real. It’s like once you hit a certain number, you’re written off, no matter how fabulous you are.” — Daniel, 73, gay man “I’ve been ghosted many times after disclosing my age. It’s humiliating and makes me hesitant to put myself out there.” — Sílvia, 75, lesbian
Interestingly, the data revealed less consistent and somewhat unexpected nuances regarding how ageism intersects with gender. While older gay men reported marginalization, some narratives suggested an asymmetric experience of erasure for older queer women. As Maria observed above, this suggests that patriarchal beauty standards may compound age-based discrimination differently across gender identities within the LGBTPQ community. These reflections reveal how sexual and romantic markets perpetuate exclusion through age-based discrimination, which can erode self-esteem and limit access to meaningful relationships for older LGBTPQ adults. The persistence of ageism alongside heteronormative and homonormative beauty ideals underscores the importance of creating more inclusive and affirming spaces where older individuals are visible, valued, and desired.
Barriers in Care Facilities and Healthcare Settings
Many participants expressed significant fears and real experiences of discrimination, invisibility, and erasure within healthcare environments and elder care facilities. The prospect of aging in places where their LGBTPQ identities might be ignored or stigmatized led to profound anxiety. Several described having to “go back into the closet” or actively hide their relationships and authentic selves to avoid mistreatment or exclusion.
This concealment often led to feelings of isolation and invisibility, exacerbating health disparities and undermining trust in care providers. Participants reported that heteronormative assumptions by medical professionals created discomfort and sometimes compromised the quality of care. The reluctance or inability to disclose one’s identity due to fear of judgment also prevented many from receiving appropriate, affirming medical advice. “I can’t be myself at the nursing home. I hear what they say about ‘those people.’ So I pretend I never had a partner.” — Diana, 83, lesbian “Doctors assume I’m cis. When I correct them, the energy in the room changes—every time.” — João, 65, transgender man “When I was hospitalized, the nurses avoided talking about my partner like we weren’t a family. It was lonely and degrading.” — Maria, 70, bisexual woman “I avoid telling my providers I’m trans because I don’t want to be treated differently or refused care.” — Alexandre, 68, transgender man “The staff at the assisted living residence didn’t know how to support a gay couple. We felt invisible and unwanted.” — Horácio, 75, gay man
These accounts highlight how systemic barriers in healthcare and elder care facilities marginalize LGBTPQ elders, forcing many to navigate aging with significant emotional and social costs. Participants emphasized the urgent need for comprehensive training on LGBTPQ issues for healthcare staff and the implementation of inclusive policies that recognize and respect diverse identities and relationships.
Isolation and Loss of Community
Isolation emerged as a poignant theme among participants, many of whom described the profound impact of losing key social networks and chosen families over time. The cumulative effects of aging, illness, and the devastating losses wrought by the HIV/AIDS crisis have led to the erosion of long-standing community spaces such as LGBTPQ bars, social clubs, and support networks that once served as vital hubs for connection and belonging.
Participants also pointed to a troubling gap in intergenerational support. Many felt disconnected from younger LGBTPQ generations, experiencing feelings of invisibility and marginalization within evolving community landscapes. This perceived distancing exacerbated their sense of loneliness—not merely due to being single, but because of a deeper experience of being forgotten or sidelined. “Our bars are gone, our friends are gone, and the younger folks don’t want to hear from us.” — Sílvia, 75, lesbian woman “Loneliness isn’t just about being single. It’s about being forgotten.” — Ricardo, 78, gay man “When your chosen family dies or moves away, the silence is deafening. You realize how fragile a community can be.” — Luísa, 73, lesbian “I don’t feel like I belong anywhere anymore—my old friends are gone, and the new generation has different ways of connecting.” — Marco, 70, bisexual man “The pandemic made it worse. We lost even more spaces to gather, and that deepened the isolation.” — Fernanda, 69, queer/lesbian woman
These reflections highlight the importance of maintaining and rebuilding LGBTPQ community infrastructure that spans generations. They underscore the critical need for social programs and safe spaces that combat isolation by fostering connections, celebrating histories, and ensuring older adults remain integrated and valued within the broader LGBTPQ community.
Meta-Theme 3: Coping Mechanisms, Resilience, and Support Systems
Resilience, and Positive Sexual Aging
Amidst the challenges faced by older LGBTPQ adults, many participants conveyed powerful narratives of resilience, self-discovery, and joy in their sexual and intimate lives. Rather than viewing aging solely through a lens of loss, these individuals emphasized a redefinition of sexuality and connection that embraces authenticity, depth, and self-acceptance.
For some, later life represented a period of liberation—a chance to live openly after years of concealment or fear. Coming out later in life or reclaiming their identities allowed many to experience a renewed sense of vitality and purpose. Participants also described how sexual expression in older age often shifts towards slower, more meaningful experiences that prioritize emotional intimacy over physical performance. “I’m 74 and finally living my truth. I came out at 70 and never felt more alive.” — Rita, 74, transgender woman “We’ve earned our wrinkles, our scars. Sex now is slower, deeper, more honest.” — Bernardo, 66, gay man “Aging has taught me to appreciate the small moments—holding hands, long conversations, knowing someone truly sees you.” — Rosa, 68, lesbian “The fear and shame I carried for decades have lifted. I’m free to explore and enjoy intimacy on my own terms.” — Manuel, 71, queer man “Resilience isn’t just surviving; it’s thriving. I feel more confident and connected than ever.” — Elisa, 69, bisexual woman
These stories illustrate how older LGBTPQ adults actively resist ageist and heteronormative narratives by embracing sexual aging as a positive and transformative experience. Their resilience underscores the importance of affirming spaces and support that celebrate sexual expression and identity across the lifespan.
Alternative Relationship Structures
A primary coping mechanism identified was the embrace of nontraditional relationship arrangements. Participants frequently described relationship structures that challenge traditional, heteronormative models, reflecting the diverse and evolving ways older LGBTPQ adults form and sustain meaningful connections. Many embraced nontraditional arrangements such as polyamory, long-term partnerships without legal marriage, and chosen families that defy societal expectations of what constitutes a “valid” or recognized relationship.
For some, these relationship models provided freedom from legal and social constraints, allowing love and commitment to be defined on their terms. Others highlighted the significance of late-life partnerships—whether first-time or renewed—underscoring the ongoing human desire for companionship, intimacy, and support regardless of age. “We’ve been in a triad for 15 years. It’s not ‘normal,’ but it works for us. Love is love.” — André, 67, bisexual man “I never got legally married, but I had a partner for 40 years. She was my wife in every way that mattered.” — Ana, 65, bisexual “After my divorce in my 60s, I found a partner who accepts all parts of me. We create our own rules.” — Leo, 69, gay man “Chosen family means everything to me. We care for each other in ways traditional families often don’t.” — Maria José, 72, queer/bisexual woman “Marriage wasn’t an option for us back then, but our commitment was real and deep. Love doesn’t need a certificate.” — Horácio, 75, gay man
These narratives emphasize the fluidity and creativity with which older LGBTPQ adults navigate relationships, highlighting the importance of recognizing diverse forms of intimacy and commitment. The prevalence of alternative relationship structures challenges dominant cultural norms and calls for broader definitions of partnership in policy and social discourse.
Calls for Affirming Policies and Education
Across the board, participants voiced a strong demand for more inclusive, affirming policies and educational initiatives tailored to the needs of older LGBTPQ adults. Many emphasized that healthcare providers and staff often lack basic training on LGBTPQ identities, resulting in disrespect, misunderstandings, and inadequate care. They stressed that cultural competency is just as critical as medical knowledge in ensuring dignity and quality of life.
Beyond healthcare settings, participants called for broader recognition of LGBTPQ elders in aging policies and programs, noting that invisibility in official materials—pamphlets, care plans, or public services—perpetuates marginalization. They advocated education initiatives that span generations to foster understanding, reduce stigma, and build intergenerational solidarity within the LGBTPQ community. “They train staff on diabetes but not on how to respect someone who’s trans or gay. That’s just as important.” — Paula, 73, transgender woman “I want to be seen in the pamphlets, the policies, the care plans. We exist. We matter.” — Óscar, 77, gay man “Healthcare workers need real training, not just a checkbox. It’s about respect, trust, and understanding.” — Maria, 70, bisexual woman “Aging services often ignore queer older people. We need policies that recognize our unique histories and challenges.” — Horácio, 75, gay man “Education isn’t just for the young. Older LGBTQ folks can learn too, and we can teach about resilience and history.” — Fernanda, 69, queer/lesbian woman
These calls underscore the urgent need for systemic change to create affirming environments that validate and support the identities and experiences of older LGBTPQ adults. Participants’ advocacy highlights how inclusive education and policy reform can improve health outcomes, foster community, and affirm the dignity of all aging individuals.
Discussion
This study explored how older LGBTPQ adults in Portugal experience and express sexual and emotional intimacy, as well as the barriers that impede these processes. The findings reveal a complex interplay between persistence of sexual and intimacy needs, evolving expressions of sexuality across the life course, and the enduring impact of stigma, discrimination, and systemic invisibility. In challenging assumptions that older adults are asexual or uninterested in intimacy, participants highlighted that the desire for connection is a fundamental and lifelong human experience.
By integrating Queer Gerontology, Intersectionality, and Critical Sexuality Studies, these findings move beyond mere descriptions of aging. They provide a theoretically grounded understanding of how historical trauma (such as the HIV/AIDS epidemic and the Portuguese Estado Novo dictatorship), institutional regulation in elder care, and cumulative lifelong stigma actively shape the intimate trajectories of sexual and gender minorities, aligning closely with the dynamic perspectives proposed by the Iridescent Life Course Model.
Sexual Expression and Intimacy as Lifelong Needs
The persistence of intimacy and sexual needs into later life underscores the importance of recognizing sexuality as integral to healthy aging. Participants in this study emphasized that while the form and frequency of sexual activity may change the desire for physical touch, companionship, and emotional closeness does not diminish with age. This echoes previous research demonstrating that sexual activity and desire often remain significant in later life (Gewirtz-Meydan et al., 2019; Gott & Hinchliff, 2003). However, unlike heterosexual peers, older LGBTPQ individuals frequently frame sexual expression as a critical aspect of identity affirmation and resistance to societal invisibility (Fredriksen-Goldsen et al., 2013).
From a Queer Gerontology perspective, the persistence of desire reported here is analytically significant because it unsettles chrononormative assumptions that later life is defined by erotic decline, dependency, or a retreat from intimacy (Cronin et al., 2011; Westwood, 2016). What participants described was not the disappearance of sexuality but its rearticulation under changing bodily, relational, and social conditions: touch, recognition, slowness, mutual care, and emotional intelligibility increasingly displaced performance-centered ideals as the primary markers of erotic meaning. Critical Sexuality Studies helps clarify why this matters. Dominant sexual scripts continue to privilege youth, genital functionality, and heterosexual coupledom as the benchmark of “real” sexuality, thereby rendering older queer forms of intimacy culturally secondary or even unintelligible (Weeks, 2011). Read intersectionally, these redefinitions were also unevenly lived, since the capacity to experience later-life intimacy as affirmation rather than loss was mediated by participants’ positions within overlapping regimes of stigma related to age, gender identity, sexual orientation, and institutional visibility (Crenshaw, 1989).
Intersection of Stigma, Ageism, and LGBTPQ Identity
An intersectional perspective helps clarify why the barriers identified in this study may not be experienced equally by all older LGBTPQ adults. Needs for intimacy and sexual expression are shaped not only by age and sexual and gender diversity, but also by racialization and ethnicity, which can influence safety, sense of belonging, and perceived risks of visibility. For older adults belonging to racial and ethnic minorities, racism may intersect with heteronormativity and cisnormativity in ways that intensify mistrust of health care systems and increase concerns about being judged or misunderstood. In practice, this can contribute to avoiding conversations about sexual health, limiting disclosure about intimate relationships, or delaying care, especially when previous encounters have involved stereotypes, differential treatment, or communication barriers.
Intersecting identities can also influence the feasibility of intimacy in daily life by restricting privacy, mobility, and access to spaces of affirmation. Older adults with fewer economic resources may be more dependent on family members or institutional services, which can restrict their autonomy to establish relationships, maintain private encounters, or express affection at home. In long-term care settings, limited privacy, shared rooms, and informal control by staff can further intensify restrictions, especially when relationships are already socially stigmatized. These dynamics can be particularly consequential for trans and gender-diverse older adults, whose gender expression and care needs may be more closely monitored in environments structured by rigid gender norms.
Experiences such as gender misidentification, incorrect administrative classifications, or the absence of gender-affirming practices can undermine bodily autonomy and erode the sense of safety that often underpins sexual expression and emotional closeness. Sexual orientation can further intersect with gender identity and racialization in ways that shape recognition and access to support.
Bisexual and pansexual older adults may experience erasure in both heterosexual contexts and LGBTQIA + spaces, which can weaken their sense of belonging and reduce opportunities to affirm intimacy. When combined with racism and ageism, this invisibility can reinforce isolation and discourage engagement with community resources.
Together, these processes suggest that the barriers highlighted in our themes are best understood as cumulative, reflecting overlapping systems of inequality that shape trajectories of intimacy across the lifespan. Participants’ narratives also illustrated how ageism intersects with heteronormativity and cisnormativity, producing compounded constraints.
Many reported feeling invisible in both dominant discourses on aging and in LGBTPQ community spaces, particularly in dating markets and digital platforms. This double marginalization aligns with minority stress theory (Frost & Meyer, 2023; Meyer, 2003), which emphasizes the impacts of chronic stigma on health. For many participants, prolonged exposure to discrimination and rejection contributed to the internalization of shame and persistent fears of vulnerability, consistent with previous research (Hughes et al., 2019; King et al., 2020).
Healthcare and eldercare settings emerged as particularly stressful. Participants often reported hiding their identity to avoid mistreatment, echoing findings that LGBTPQ older adults may return to the “closet” in care facilities (Jen et al., 2020). These reports highlight broader gaps in healthcare training and policies, in which LGBTPQ older adults remain insufficiently recognized and supported, reflecting the challenges faced by the Invisible Generation (Fredriksen-Goldsen et al., 2013).
The accounts of concealment in healthcare and eldercare settings further demonstrate why intersectionality should be treated here as an interpretive framework rather than a descriptive label. Participants were not encountering ageism on one side and heteronormativity or cisnormativity on the other; these regimes converged in concrete institutional encounters that positioned older LGBTPQ bodies as simultaneously hypervisible as “different” and invisible as desiring subjects. Queer Gerontology helps explain the specificity of this violence, because later life is already socially organized through expectations of passivity, dependency, and desexualization, expectations that become even more restrictive when filtered through non-normative genders and sexual orientations (Cronin et al., 2011; Westwood, 2016). Critical Sexuality Studies extends this interpretation by showing that the repeated need to hide a partner, avoid disclosure, or tolerate misrecognition is not merely a failure of interpersonal sensitivity, but part of a broader regulatory order that determines which intimacies are speakable, which bodies are legitimate, and which relationships are institutionally recognizable (Weeks, 2011).
Historical Context: The Legacy of HIV/AIDS and Portugal’s Socio-Political History
The shadow of HIV/AIDS emerged as a defining feature in participants’ narratives. Many carried grief, survivors’ guilt, and trauma that continue to shape their experiences of intimacy. This aligns with Emlet’s (2006) findings that HIV/AIDS constitutes a “double burden” of health and social stigma for aging LGBTPQ adults. For Portuguese participants specifically, these struggles were compounded by the socio-historical legacy of the Estado Novo dictatorship, during which LGBTPQ identities were criminalized and heavily stigmatized (Pereira et al., 2019). The long-lasting effects of secrecy and marginalization continue to influence older LGBTPQ adults’ willingness to disclose their identities and access care, even in a context where legal protections have expanded (ILGA Portugal, 2021; Ribeiro-Gonçalves et al., 2022). This equally aligns with the Silenced Generation within the framework of the Iridescent Life Course Model (Fredriksen-Goldsen et al., 2013).
The historical texture of these findings is equally central to their theoretical interpretation. Through the combined lenses of Intersectionality and Queer Gerontology, the legacies of the HIV/AIDS epidemic and the Estado Novo emerge not as contextual background but as structuring conditions of later-life intimacy. They shaped who learned to associate disclosure with danger, who entered old age after repeated losses of partners and chosen family, and who continued to negotiate sexuality through grief, vigilance, and anticipatory shame. Critical Sexuality Studies is particularly useful here because it frames these histories as regimes of sexual regulation: both authoritarian moral governance and epidemic-era stigma disciplined queer visibility by linking sexuality to pathology, risk, or social abjection (Pereira et al., 2019; Weeks, 2011). In this sense, participants’ survivor’s guilt, relational ambivalence, and ongoing caution should be understood as historically sedimented effects of power that continue to organize intimate life in the present, even within a formally more inclusive legal landscape (Fredriksen-Goldsen et al., 2024).
Resilience, Resistance, and Alternative Relationship Models
Despite these barriers, participants expressed resilience through redefining intimacy, forming chosen families, and embracing alternative relationship models such as polyamory or long-term partnerships outside legal frameworks. These findings are consistent with queer gerontology perspectives (Cronin et al., 2011; Westwood, 2016), which emphasize diverse aging trajectories and the centrality of chosen families for LGBTPQ communities (Brotman et al., 2007). Later life was often described as a time of liberation, when individuals could live more authentically after decades of suppression, reinforcing theories that recognize how past experiences of discrimination shape present identity development (Elder, 1998; Fredriksen-Goldsen et al., 2013).
Resilience narratives also reflect positive sexual aging, where intimacy is redefined not as diminished but as more emotionally meaningful. Participants described deeper connections rooted in authenticity, emotional presence, and self-acceptance. These findings contribute to a growing body of literature challenging deficit-based models of aging and sexuality (Murphy et al., 2018; Weeks, 2011).
The themes of chosen family, non-marital commitment, and late-life self-disclosure further show that resilience in this study was not reducible to individual coping, but was relationally and politically organized. Queer Gerontology has long argued that queer aging trajectories frequently unfold outside the institutional milestones that anchor normative adulthood, such as marriage, biological descent, and state-sanctioned kinship, and our findings strongly support that proposition (Cronin et al., 2011; Westwood, 2016). From the standpoint of Critical Sexuality Studies, polyamory, chosen families, and enduring partnerships without formal legal recognition are not peripheral curiosities; they are counter-normative arrangements that challenge the cultural monopoly of reproductive, couple-centered, and youth-centered sexual legitimacy (Weeks, 2011). Intersectionality sharpens this argument by showing that access to these affirming relational forms was uneven: resilience was facilitated when participants could mobilize community, symbolic recognition, and safer spaces, but constrained when aging, gender variance, cumulative loss, or institutional erasure reduced the conditions under which intimacy could be sustained on one’s own terms (Crenshaw, 1989).
Limitations
Although this study provides relevant information about sexual expression, intimacy needs, and barriers faced by older LGBTPQ adults, it is important to recognize several limitations. First, the qualitative design and purposive sampling strategy allowed for an in-depth exploration of lived experiences but restrict the generalizability of the results to the broader population of older LGBTPQ adults in Portugal. Furthermore, snowball recruitment may have favored individuals with stronger ties to LGBTPQ networks, which may have resulted in the underrepresentation of socially isolated individuals who are less visible or reluctant to reveal their identity. Consequently, the narratives obtained tend to reflect the experiences of participants with greater access and community support.
In addition, the composition of the sample showed inequality among LGBTPQ subgroups. Gay men and lesbian women were more represented than bisexual, transgender, and non-binary participants, which may have influenced the thematic emphasis and reduced the diversity of each subgroup’s specific experiences. Issues such as bisexual erasure, identity invalidation, and barriers faced by transgender and non-binary individuals in accessing gender-affirming care may not have been fully captured. It is recommended that future research prioritize underrepresented groups through targeted recruitment strategies and oversampling, including partnerships with bisexual- and trans-led organizations, outreach in gender-affirming healthcare settings, and purposive stratified sampling.
Third, race, ethnicity, and socioeconomic status were not systematically assessed in the current sample, which limits our ability to examine how racism, racialization, and socioeconomic inequality may intersect with sexual orientation, gender identity, and aging to shape intimacy needs, disclosure strategies, and access to affirming care in old age. Given the relevance of intersectionality to stigma, health experiences, and relational well-being, future research should incorporate a more explicit intersectional design and include racially and ethnically diverse participants from different socioeconomic backgrounds.
Fourth, reliance on retrospective self-reports may have introduced memory bias, particularly when participants reflected on experiences spanning several decades. Social desirability may also have influenced reports, leading some participants to downplay stigmatizing encounters or emphasize narratives of resilience.
Finally, this study was conducted in the Portuguese sociocultural context, marked by decades of authoritarian repression and recent advances in LGBTPQ rights. Although the findings are in line with the international literature, their interpretation must consider the national context, and transferability to other cultural and political settings may be limited.
These methodological constraints may have shaped the substantive patterns reported here. Recruitment through community-linked channels may have increased the visibility of narratives of resilience, identity affirmation, and chosen-family support, whereas the experiences of more socially isolated, closeted, or institutionally marginalized older adults may be less fully represented. Likewise, the use of in-person, telephone, and video interviews probably created differences in rapport, access to non-verbal cues, and degree of elaboration, which may have influenced how comfortably participants discussed sensitive topics. Because the study relied on one-time, retrospective interviews, the findings may also privilege especially memorable experiences, such as HIV/AIDS-related loss or discriminatory encounters, over less salient but recurrent aspects of everyday intimacy. These limitations do not invalidate the findings, but they indicate that the themes should be read as contextually grounded interpretive patterns rather than exhaustive representations of all older LGBTPQ adults in Portugal.
Implications for Research, Practice, and Policy
The findings of this study carry significant implications for research, practice, and policy.
For research, the study highlights the need for intersectional approaches (Crenshaw, 1989) that account for the interplay of age, gender identity, sexual orientation, race, and historical context. Future studies could benefit from comparative analyses across different cultural and policy environments, as well as longitudinal designs that capture how intimacy needs and barriers evolve across the life course. Beyond the immediate findings, the long shadow of the HIV/AIDS crisis demands closer scrutiny. We need to understand the ‘ripple effects’ of survivorship on mental well-being and the often-invisible economy of informal caregiving. Simultaneously, the digital realm requires attention. Our data on app-based exclusion highlights the need to investigate ‘Digital Intimacy’, specifically, how older LGBTPQ adults might repurpose these exclusionary spaces to forge community and offset physical loneliness.
For practice, there is an urgent need for culturally competent healthcare and elder care training that goes beyond general awareness. Our data supports a three-pronged approach: (1) Contextual Education, specifically modules linking patient mistrust to the legacies of the Estado Novo and the HIV/AIDS crisis; (2) Linguistic Precision, training staff in non-heteronormative phrasing and rigid pronoun adherence for transgender elders; and (3) Institutional Recognition, establishing protocols that validate chosen families in medical decisions and visitation. These represent not just ‘best practices,’ but essential baselines for equitable care. Mental health professionals should be trained to support clients dealing with internalized stigma, grief, and survivor’s guilt. Creating therapeutic and community spaces where older LGBTPQ adults can explore and affirm their identities is critical to promoting well-being.
For policy, the findings point to the necessity of integrating LGBTPQ elders explicitly into aging policies and services. This includes legal recognition of chosen families in caregiving and inheritance frameworks, targeted anti-discrimination protections in elder care facilities, and inclusion of LGBTPQ representation in public health campaigns. Moreover, investment in intergenerational LGBTPQ programs could combat isolation and rebuild social infrastructures that were lost during the HIV/AIDS crisis or through broader social change. In Portugal specifically, policymakers should address the legacy of invisibility by embedding LGBTPQ issues into national aging strategies and by funding programs that foster affirming community spaces.
Conclusion
This study demonstrates that sexual expression and intimacy remain central to the lives of older LGBTPQ adults, even as they face persistent barriers rooted in stigma, discrimination, and systemic exclusion. While challenges such as ageism, healthcare invisibility, and the enduring trauma of HIV/AIDS complicate these experiences, participants also illustrated remarkable resilience, redefining intimacy and embracing authenticity in later life. By centering the voices of LGBTPQ elders, this research contributes to an emerging narrative that reframes aging as not only a site of vulnerability but also of liberation, resistance, and growth. Addressing the needs of older LGBTPQ adults requires sustained attention from researchers, practitioners, and policymakers to ensure that they can age with dignity, visibility, and connection.
Footnotes
Acknowledgements
The author wishes to thank all participants in this study.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data Availability Statement
Data is available upon request.