Article By Kate Silver
~ MAY 2022 ~
“OK, so we know you’re not going to get pregnant.”
Sexuality educator Jane Fleishman, PhD, typically opens with this line when she goes into senior communities to talk about safe sex. It’s her way of trying to break the tension and clear the air. Sex talk can be awkward at any age, whether you’re 15 or 50-plus.
Then she brings out the puppets. But these aren’t the kind you see at a children’s puppet show. They’re made in the form of male and female sex organs – a vulva and a penis. That usually breaks the ice and gets a laugh.
“But then I say, ‘This is real stuff. You don’t want to get an infection from somebody else,’ ” says Fleishman, who got her degree in human sexuality studies while in her 60s.
There’s a real need for this type of education among people who are older, she says. To start with, sexual intimacy does not end when a person receives their AARP card.
About three-quarters of adults 65 to 80 agree that sex is an important part of a romantic relationship, regardless of age, according to a 2018 survey from the University of Michigan. And more than half of those in romantic relationships reported being sexually active. Men in this group were about four times more likely than women to be “extremely interested” or “very interested” in sex.
Another recent study found that 43% of women ages 50 to 80 were sexually active in the past year. And 62% were satisfied with their sexual activity. Only about 28% said menopause-related symptoms interfered with their ability to be sexually active.
Fleishman wants to make sure that those adults – many of whom may be widowed or divorced and dating someone new – are approaching sex safely, so she starts with the basics. “I talk about mouth to anus, mouth to vulva, mouth to penis, penis to vulva, penis to anus,” she says. “I really try to be as blunt as I possibly can be.”
Just as importantly, she discusses the need for consent and communication in a sexual relationship. “The business of consent is taught to teenagers and to college students now,” she says. “But nobody’s teaching older adults about it.”
Finding the Gaps
Older adults are far less likely to get sexually transmitted infections (STIs), compared to other adult age groups. Still, infection rates are going up at an alarming rate, experts say. Between 2009 and 2019, in people 55 and older, STIs – including hepatitis C, syphilis, chlamydia, and gonorrhea – increased by four to five times, according to the CDC.
Part of the problem is a lack of knowledge. When researchers tested STI awareness in adults 65 and older with a questionnaire, they found plenty of gaps. “On average, older adults only correctly answered about 12 of the 27 items, which means they did not know facts about STI risk, presentation, transmission, or treatment,” says Matthew Lee Smith, PhD, who led the research at Texas A&M’s School of Public Health.
Health care professionals can provide helpful education and guidance, but only to people who are open and honest about their sex lives. That’s happening more now than it has in the past, says Nicole Williams, MD, of the Gynecology Institute of Chicago. But often, the conversation happens too late with her older patients. They’re just not as willing to talk about sex.
“They’re not worried about pregnancy. They’re just having unprotected sex and then coming to me and asking for testing,” she says. “I find that problematic because they’re getting exposed to HPV, trichomoniasis, bacterial vaginosis, and other sexually related infections.”
Cornelius Jamison, MD, makes it a point to bring up sex with his patients in his family medicine practice in Michigan. He does his best to make the conversation comfortable and easy, but even still, older patients often have trouble speaking openly about it, says Jamison, an assistant professor in the Department of Family Medicine at the University of Michigan.
“It will be like the last thing at the end of the visit, where they’ll say, ‘Oh, and by the way, Doc, I was wondering, is it possible to get Viagra, Cialis? I’ve seen that they work, and I’m having some issues.’”
Jamison says he wishes more doctors would ask about sex during standard physical exams, no matter what the age of the person. “The desire to have sex never really goes away,” he says. “Sometimes providers aren’t thinking about that.”
Gynecologist Barb DePree, MD, has noticed a big spike in dating among women 50 and up. Dating apps that zero in on certain age groups could be one reason for that, says DePree, director of women’s health at Holland Hospital in Holland, MI. And the numbers bear that out. Nearly 20% of adults ages 50 to 64 report using dating apps or sites, according to Pew Research. While that’s not as high as the next age group down (38% for ages 30-49) it’s still a lot of online activity.
Let’s Talk About (Safe) Sex
Whatever the reason, this spike in dating could do much to explain the rising number of STI cases in this older set. In addition, DePree says, many older adults don’t seem as accepting of condoms as younger people.
But protection is still important at every age when there’s a possibility of an STI. Where the penis is involved, that typically means a condom. For women, in particular, the vulva and vaginal tissues thin with age and could be more susceptible to infections such as human papillomavirus (HPV), herpes simplex virus (HSV), hepatitis B, and hepatitis C, says DePree. As women age, vaginal dryness is common, and DePree says most will benefit from a lubricant. But where condoms are involved, DePree has a tip: While silicone lubricant is a popular choice for postmenopausal women, it doesn’t pair well with condoms.
“Most condoms will be somewhat degraded with a silicone lube,” she says. Use a water-based lubricant instead.
But condoms won’t always help. Oral-to-genital transmission is also possible for STIs such as herpes and HPV, as well as in other types of sex. Ask your doctor about ways to protect against STIs when a condom isn’t possible.
Keeping It Fun
Fun starts with being comfortable with your partner. And getting comfortable often starts with a conversation.
“Talk about previous STIs, talk about sexual partners, talk about whether or not you want to use condoms, whether or not you feel comfortable doing certain positions,” says Jamison from the University of Michigan.
“If someone’s had a hip replacement, then maybe this is not the position to do.”
And, importantly, get tested for STIs, says Williams. “I offer that to every one of my patients, no matter how old they are.”Safe sex education, at all stages of life, tends to include only the cautions. Fleishman, the sex educator, says it’s important to talk about the joys and pleasures as well.