So why am I beating that same, tired drum again?
Because it’s so darned important, that’s why.
The North American Menopause Society (NAMS) just published yet another study reviewing the sobering uptick in STIs—sexually transmitted infections—in women at midlife and advising physicians to discuss the issue with their older female patients.
That’s what I’m doing here.
This latest NAMS study confirms what we all know experientially—that many of us suddenly find ourselves single again at midlife due to death, separation, or divorce. That we are still sexual creatures and want to be sexually active. But also that we tend to be more vulnerable to sexually transmitted infections and surprise pregnancies for several reasons.
Reason #1: When we reenter the singles scene after a long hiatus, we tend to be less assertive and more naïve. We don’t know the lingo or the rules of the dating game. We may also be unaware of how widespread and ferocious STIs are these days and of how to protect ourselves. After all, we haven’t had to think about prevention in a while. In this case, what we don’t know really can harm or even kill us.
Reason #2: Men are able to have sex later in life now due to erectile dysfunction drugs, thus creating a greater pool of potential sexual partners, according to the NAMS study. This isn’t a bad thing, necessarily, as long as everyone is being careful.
Reason #3: Loss of estrogen and the resultant thinning and drying of genital tissue makes us particularly susceptible to infection. Tiny tears and thin tissue along with a generally less acidic environment puts an older woman at greater risk of infection than a younger woman with healthy, intact vaginal tissue. Sorry, ladies, that’s just how it is.
Reason #4: If we do contract an STI, we may end up sicker than a younger woman. The NAMS study referred to Danish research demonstrating that women between 40-50 years are more likely to develop cervical cancer after contracting HPV than women aged 22-32.
Reason #5: Then there’s that pregnancy thing. Because of irregular menstrual cycles along with changing birth control options, and perhaps a new relationship status, women over 40 have the highest rate of unplanned pregnancy, second only to women under 24. (C’mon, ladies, we’re accidentally getting pregnant at the rate of 24-year-olds!)
We are also more likely to terminate these accidental pregnancies. Again, according to the NAMS study, “as many as two-thirds of midlife pregnancies are terminated.”
While the NAMS study urges physicians to ask their patients about safe sex practices—and I take that responsibility very seriously—you are also responsible for informing, protecting, and empowering yourself if you’re single and sexually active. And sometimes even if you’re in a committed, long-term relationship.
At the very least, insist that both you and any new partner be tested for STIs before you have sex, and that you discuss the results. Even then, use condoms for six months afterward because some infections, such as HIV, take time to show up.
Discuss your contraception options with your physician. Birth control options change at this point in life, and the guidelines state that you should be on some effective form of contraception for a full year after your last period.
But remember, just because you’re on birth control or no longer fertile, you can still contract an STI. So talk about that with your physician, too.
Dr. Barb DePree, M.D., has been a gynecologist and women’s health provider for almost 30 years and a menopause care specialist for the past ten.