Due to the fact that the elderly live longer nowadays than before the age for having sex has lengthened accordingly. Normally, sexual activity in old age is an important sign of good health, but at the same time it is also criticized as inappropriate in the view of people in society. Sex is generally considered as something only for the young in Thai culture, so aging and sexuality research in Thailand is limited. Objectives for this research are to study patterns of sexuality, factors affecting sexual activity and any opinions related to sexual needs among the elderly in rural areas. Data collection was through a questionnaire given to 473 elderly aged 60 and over in 11 villages in 3 tambons or sub-districts in Kanchanaburi province. Ten in depth interviews were conducted to give additional information. Logistic Regression Analysis was used as a tool for studying relationships between all factors and sexuality in the elderly. The research showed that of 318 married interviewees one third were still having sex. More of the male elderly than females were still sexuality active and those men were having sex more frequently than the elderly females who were still having sex. But as age increased, frequency of sexual activity and stopping of sexual activity altogether increased. On average, the rural elderly had sex twice a month. The rural elderly tended to stop having sex at the age of 59.1 on average and women tended to stop earlier than men. Factors affecting sexual activity in the elderly are age, race, opinion on having sex and sexual needs. In terms of problems related to sex activities, most elderly believed that they had no problem. But among those who were faced with sexual problems, the male elderly had many more problems than in females. Research recommendations are 1) concerned government agencies should provide counseling centers for the elderly who still have sex and 2) campaigns for widespread acceptance that sexuality in the elderly is normal should be provided for family members, caretakers and the elderly in general.