- Background: The aim of this study was to assess the relationships between gender, migration status, perceived health, body image, and sexual activity and satisfaction among older adults. It was hypothesized that men and those who are long-standing residents in Israel will report better perceived health, a positive body image, and these will be associated with greater sexuality, compared with women, new immigrants with poorer perceived health and a negative body image. Methods: The sample included 200 respondents who were 60 years and older, functionally independent and living with a spouse or a partner for at least one year, heterosexual, and living in the community in Israel. Respondents were recruited through community-based services for older persons and snowballing. Multivariate analyses were performed to examine differences by groups of respondents and to identify the best predictors of the outcome variables. Results: The majority had some kind of sexual activity. No significant differences were found between men and women with regard to perceived health, body image, sexual activity and satisfaction, but significant differences were found between new immigrants from former Soviet Union countries and long-standing residents in Israel. Mental health, age, and migration status were significant in explaining sexual activity, while age, education, and sexual activity were significant in explaining sexual satisfaction. Conclusions: A variety of factors play a role with regard to sexuality in old age, in particular immigration status. Appropriate interventions can help older adults cope with the determinants that negatively affect their mental health and sexual life.