Sex in 2019: Your Guide to Safety
Dr Lisa Lanning, DO, MS, HopeHealth Family Physician and Timothy Wilkening, BS, MS3, University of South Carolina School of Medicine Florence Campus
Older adults live longer now than in previous generations. In 2019, retired adults may have 20 or 30 years of life ahead, and may find they have a lot more free time and freedom than they did when younger. In your case, perhaps you have lost a spouse, or a previous relationship has ended. Perhaps you haven’t dated in a long time but now you’ve met someone new and are considering becoming physically intimate with that person.
What should you know to keep your own health in great shape and reduce the risk of serious sexually transmitted infections (STIs)?
Use It or Lose It: Health Benefits of an Active Sex Life
Many older adults crave the physical and emotional closeness of having a regular sexual partner. As we age, it’s common to lose partners to disease, death, and divorce, and many older adults grieve the loss of their previously active sex lives. It is understandable that when one loses a partner, he or she would still desire to express their sexual feelings, and it’s entirely natural to seek a new partner.
Most adults in our culture recognize that sex is an effective way to reduce stress and improve overall well-being. Baby Boomers – those born between 1946 and 1965 – reached maturity during the 1960s-1980s, a much more sexually-liberated period than the formative years experienced by their parents and grandparents. Many vibrant older adults equate better health with better (and more) sex and expect to have sex well into their golden years. A 2007 New England Journal of Medicine survey of 3005 seniors’ sexual activity found that:
- 3/4 of seniors ages 57-64 were sexually active
- more than 1/2 ages 65-74 were active
- more than 1/4 of those 75-85 years old remained sexually active
So how do we navigate finding a new, healthy and safe partner later in life?
Older is Not (Necessarily) Wiser
Although older adults are having more sex and with more partners, they are not necessarily protecting themselves from infections. The advent of drugs designed to treat erectile dysfunction and other performance-based sexual disorders has increased the opportunity to participate in sexual activity while also increased exposure for men and women to STIs. Studies show that many older adults do not use condoms, and physiologic changes in the aging body (such as vaginal dryness and thinner vaginal tissue) increase the likelihood of injury and tear from sexual intercourse and other sex play. This can increase the risk of receiving and transmitting an STI. Men who have sex with men and women who have sex with women are also at risk of STIs, and need to be aware of how to protect themselves and their partners while enjoying their sex life fully throughout their life span.
What’s the Risk?
Something we don’t often discuss is that part of the natural aging process is a less robust immune system. Older adults are often prescribed medications that also suppress the immune system including many arthritis medications and other medicines for chronic conditions. Seniors are also more likely to have diabetes, heart disease, and chronic kidney disease which increases the chance of picking up an infection.
Between 2007 and 2014, diagnosed cases of syphilis increased 52 percent among older adults, cases of chlamydia increased 32 percent, and new diagnoses of HIV also increased according to a global STI study on emerging challenges to senior health. That same report found that between 2007-2014, 24 percent of HIV positive persons were more than 50 years old, and more than 15 percent of new HIV/AIDS diagnoses were among adults over 50. It’s also notable that, according to an American Journal of Public Health article, the risk of STIs is higher among recently widowed men than for women ages 67-99.
It’s time to be smart: we can no longer follow “don’t Ask, don’t tell” when being sexually active as older adults. Ignorance is truly dangerous and can be lethal. If you are concerned that you may have been exposed to an STI, please bring it up with your primary care provider. We aren’t very good mind readers, and while we SHOULD ask about your sexual health, studies show we don’t ask nearly as often as we should, and patients don’t bring it up either.
How Can You Decrease Your Risk of Contracting an STI?
Condoms help—both the everyday male condom and the less well-known female condom. These barriers reduce exposure to potentially infectious body fluids and protect the delicate older tissues. Lubricants help reduce trauma to sexual organs by decreasing friction and thus, tears and other injuries which can increase the likelihood of developing an infection after sex.
It’s also important to simply TALK ABOUT IT! Although these can be uncomfortable conversations, it’s critical that older adults embarking on sexual relationships have “the talk” with their partners. Here are a few key points:
- Be non-judgmental and approachable. Just ask: how is your sexual health? Let’s face it—you’re preparing to share something extremely intimate and satisfying together—it will be better if you can discuss your past experiences openly. Feel free to ask about past infections or other sexual health concerns and how you plan to manage the risk of future infections.
- Go get tested together. See your family doctor, internist, OB/GYN, PA or NP. Ask for advice. A little-known fact is that Medicare covers screenings for STIs, although less than 5 percent of seniors take advantage of this benefit.
- Laugh about it—share freely with your partner what you do and don’t like. Don’t compromise your values. If you are both open to new experiences and trying something you haven’t tried before, go for it!
- Learn about sex! We are never too old to learn something we didn’t know yesterday. The Internet is a fantastic resource, although it can be overwhelming. A particularly excellent website is the American Sexual Health Association, ashasexualhealth.org
- Lastly, check out this entertaining and educational rap video by family doctor Dr. Shannon Dowler, “STDs Never Get Old” at youtu.be/wMFRM1bkEDg. You can share it with your partner to help you start a conversation.
Dr. Lisa Lanning is a board-certified (ABFM) family physician at Hope Health. She practices family medicine with a concentration in chronic disease management and geriatrics. She is an active educator and enjoys teaching medical students, residents and physician assistant students. Student doctor Wilkening is a third-year medical student at University of South Carolina School of Medicine-Florence Regional Campus and collaborated on this article with Dr. Lanning during his family medicine clerkship.