The aim of the study was to explore attitudes towards sexuality and sexual behaviour in older adults in Norway, Denmark, Belgium, and Portugal. A cross-sectional survey with representative samples of the population aged 60–75 years recruited through phone registers in Norway (676 men and 594 women), Denmark (530 men and 515 women), Belgium (318 men and 672 women), and Portugal (236 men and 273 women) was conducted. The data collection was carried out using an anonymous postal questionnaire. Four dimensions of attitudes towards sexuality were identified: ‘sex for love’, ‘sexual pressure in society’, ‘sex for well-being’, and ‘sexual changes and ageing’. Discriminant analyses identified three discriminant attitude functions: sex for well-being, sexual changes due to ageing, and sex for love. Portuguese men had positive attitudes towards sex as good for well-being in older adults but believed ageing was an obstacle to being sexual at this stage of life. Portuguese women believed sex was good for well-being and did not consider ageing an obstacle to sexual enjoyment. Norwegian men and Danish women believed changes in sexuality due to ageing were no obstacle to being sexual but did not believe that sex was good for well-being. The attitudes of Belgian and Danish men were largely inclined in the direction that sex is not particularly important for elderly people and that changes in sexuality occur due to the ageing process. Men and women were committed to the attitude of sex for love, although this was observed most in Belgian participants and least in Danish men. Positive attitudes towards sex for well-being and towards ageing and sexual changes correlated with less change in sexual interest and sexual enjoyment, and with increased frequency of intercourse and masturbation. To tailor successful sexual health interventions, attitudes of sexuality in older people should be addressed.