OBJECTIVES: To investigate the sexual health and behaviour of older Australians attending a sexual health clinic. METHODS: A retrospective patient record of people aged 50 years and over attending the clinic. RESULTS: 2438 people aged 50 years and over attending. The main reasons for attending were assessment of genital symptoms (40%), testing for sexually transmitted infections (STIs) (23%), and HIV testing/care (13%); more than 50% of the clients had a previous sexual health problem and more than 50% had not been tested for HIV. Men reported more lifetime sexual partners than women and were significantly more likely to report using condoms (P < 0.05), although condom use was variable. Genital herpes (10% women, 6% men) and non-gonococcal urethritis (9% men) were the most commonly diagnosed STIs. CONCLUSIONS: High levels of unsafe sex and many important sexual health problems were identified which provide direction for public health interventions for older sexually active Australians.