Written By: Skyler Noble
Turns out nursing home entertainment isn’t just bingo and solitaire… Let’s talk about the surprisingly vibrant sex lives of senior citizens.
Even as our generation becomes more open and comfortable discussing issues of sexual health there remain many topics that are still consideered taboo. One such topic that deserves its place in the modern public health spotlight is the sexual health of older generations. While its understandable that no one want to think of their parents or grandparents having sex lives, its important that families and medical professionals alike reognize this as an important part of human health.
In fact a recent study found that 73% people ages 57-64 identified as sexually active as well as 53% of 65-74 year olds and 26% of 75-85 year olds. Unfortunately, with active sex lives comes an active risk of STDs and STIs. Between the years 2010 and 2014 chlamydia infections increased by 52%, Syphilis by 65%, and Gonorrhea by more than 90% in adults over the age of 65. (1)
What causes these later life surges of STDs and STIs?
Cases of STDs and STIs in older generations are skyrocketing due to lack of awareness, lack of education, and medical conditions that come with advanced age. Like many of us, medical professionals often fail to discuss or ask about older patients sex lives. (2,3) Older people also tend to feel more shame or privacy about their sex lives and are reluctant to ask their doctors questions or discuss it with others. Additionally, the majority (89%) of STI risk-reduction clinical trials exclude people over the age of 65 so there is a lack of knowledge in this area. (4) Within nursing homes and communities, caregivers make assumptions about the mobility of the people under their care. One advocate of elder sexual helath, Dr. Lisa Granville, recalled an interaction with the staff of a hospital caring for a bedridden older gentleman;
"I asked the staff, 'Did you ask him about sexual activity?' And they said, 'no. He's bedridden. How would he do that?' I looked at them and said, 'Where do you have sex? Most people have it in a bed, so why would you think being bedridden eliminates it? It's just like Domino's (pizza). It can come to you, you don't have to go to it.' They had clearly decided frailty plus bedbound equaled no sex. Nope. Bedbound means already in position and easy to have sex. Change your thoughts." (4)
Secondly, as much of our modern sex-ed standards are lacking, many baby-booomers missed the “safe-sex talk” all together. They are less likely to get regularly tested or use various forms of protection. Once women reach menopause and don't have to worry about pregnancy, condoms often become an afterthought. (1) In fact, one study of sexually active adults over 50 found that less than one quarter of all participants reported using condoms.4 Individuals who lost long term partners may start engaging in sexual relationships with new partners or multiple partners for the first time in a long time. (3,5) It has also been found that people often engage in their first same sex relationship or sexual encounter late in life. (2) Without regular testing and safe sex practices, it makes sense that we are seeing higher rates of sexually transmitted diseases and infections in this demographic.
With old age comes a whole hoard of medical problems that can cause a higher risk of STDs and STIs. With the increased availability of erectile dysfunction medications more older citizens are able to have sex in the first place. (3) Older immune systems are more susceptible to infections and HIV. This paired with the lack of regular testing among older people leads to an increased risk of having a late-stage HIV infection. (2) In 2017 about 17% of the 39,000 people who were newly diagnosed with HIV were 50 years or older.2 Medical issues and treatments may also contribute to elevated risk. Medications associated with breast cancer treatment can thin tissue and allow pathogens easier access. Other issues including hormonal imbalance, vaginal dryness, and thinner tissue also add risk. (3)
So, how do we deal with this from a public health perspective?
Clearly, ignroing the fact that older people have sex lives isnt doing the job. We need sex-ed for seniors and more awareness in the healthcare and senior care sphere of senior sexual health. Older care can help by providing a basis fo sexual health knowledge such as: The need open communication with partners and doctors, that STDs can be transmitted from oral sex, the proper use of protection and the different forms (female condoms for example may be easier for older heterosexual couples), and the fact that condoms don’t protect from herpes or HPV. (6) Discussion of sex and sexual health can be awkward at any age but with more open communication doctors and their older patients can work together to improve the sex lives and health of the older demographic.
We also need to provide testing and protection. Having people get regularly tested is a proven method of limiting the spread of STDs and STIs. Colleges have condom dispensaries, nursing homes should too! (6)
Finally, we need to improve lgbtq+ health care for senior citizens. The sexual health care gap is wider for older lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+) people. (5) There are many reasons for this discrepancy including biases with both age and sexual and gender minorities, discomfort with discussions of sexuality, and lack of confidence in addressing patients’ sexual concerns. (5)
As mentioned, with older age and the lost of significant others, some older people experience their firsts same sex sexual relationship. Many biases push care providers to assume older people are heterosexual. There is a lot of progress needed in this area including, but certainly not limited to, information about pre- and post exposure prophylaxis for HIV, STD screening, sexual and mental health awareness, and having doctors take the time to develop full understandings of patients orientation, sexual activity, and health history. (5)
While it might not be the most comfortable or easy thing, its crucial that the public health sector recognized the imporance of the sexual health for our seniors. Everyone deserves to live and love in the healthiest way they can!
Note: here’s a quick reminder of the symptoms for the most common STDs! Stay safe and healthy! (6)
Chlamydia Symptoms
Burning sensation when urinating
Discharge from the penis or vagina
In men: pain or burning around the urethral opening or pain or swelling in one or both testicles
In women: pain during intercourse
Gonorrhea Symptoms
May produce mild symptoms or none at all early on
In men: pain with urination and/or discharge from the penis
In women: pain with urination and/or discharge from the vagina; spotting or bleeding also is possible
Syphilis Symptoms
A sore in the genital area, mouth or lips that heals within 3 to 12 weeks
Occasionally a swollen lymph node near the site of the sore
Fever, loss of appetite, nausea and fatigue beginning within 12 weeks of the store's appearance
Non-itchy skin rash on hands or feet
References:
Fowler K. Sexual health in retirement communities. A Place for Mom. https://www.aplaceformom.com/caregiver-resources/articles/sexual-health-in-retirement-communities. Published December 10, 2019. Accessed February 22, 2022.
Estes C. Historic high rates of STI's among older Americans. Forbes. https://www.forbes.com/sites/claryestes/2020/02/26/historic-high-rates-of-stis-among-older-americans/?sh=122d94284c39. Published February 25, 2020. Accessed February 22, 2022.
Howley EK. What to know about rising std rates among seniors ... What to Know About Rising STD Rates Among Seniors . https://health.usnews.com/health-care/patient-advice/articles/2018-12-10/what-to-know-about-rising-std-rates-among-seniors. Published December 10, 2018. Accessed February 22, 2022.
Smith ML, Bergeron CD, Goltz HH, Coffey T, Boolani A. Sexually Transmitted Infection Knowledge among Older Adults: Psychometrics and Test-Retest Reliability. Int J Environ Res Public Health. 2020;17(7):2462. Published 2020 Apr 3. doi:10.3390/ijerph17072462
Elizabeth Hanes RN. What seniors need to know about sexually transmitted diseases. Healthgrades. https://www.healthgrades.com/right-care/aging-well/what-seniors-need-to-know-about-sexually-transmitted-diseases. Published February 6, 2021. Accessed February 25, 2022.
HHS National LGBTQIA+ Health Education Center, The Fenway Institute, Sexual Health Care for Older LGBTQIA+ Adults | 2021, https://www.lgbtqiahealtheducation.org/wp-content/uploads/2021/03/LGBTQIA-Older-Adults-Sexual-Health-Brief-2021.pdf. Published 2021 Mar 31. Accessed 2022 Feb 23.
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