Recently, a friend and her sister visited a retirement community in our neighborhood. They chatted up several residents, including the sweet, 90-year-old widower who’d lost his beloved wife some months before. When they turned to leave, he asked the sister for her phone number. Since she is 50 and married, they laughed it off. Not long after, they heard that their elderly Don Juan had found himself a girlfriend in a nearby senior living community and was visiting her regularly.
The anecdote is cute, but it also points to a larger reality. We are never too old to enjoy sex—that’s the entire premise of this website—but somewhere on the road to the golden years, single seniors have thrown youthful caution to the winds when it comes to safe sex. The result is that sexually transmitted infections (STIs), such as Chlamydia and syphilis, are spreading more quickly among people over 55 than among any other age group except 20-24 year olds, according to a 2010 report from the Center for Disease Control and Prevention (CDC).
Even more alarming—one in four people with HIV/AIDS is over 50. In the Sunbelt, where large communities of seniors live, the rates of increase are off the charts: In two counties in Arizona cases of syphilis and Chlamydia among those over 55 rose 87 percent between 2005 and 2009; in central Florida, the increase was 71 percent, according to this article in Psychology Today. News reports use words like “epidemic” and “skyrocketing” to describe these increases. Medicare has begun offering free testing for STIs, but most (95 percent) of seniors remain unscreened.
What the heck is going on here? What happened to all those lectures in responsibility and self-control we subjected our kids to? What seems to be happening is that we are, luckily, more long-lived and healthier than our forebears. We are also newly empowered with drugs to maintain erections for men and to make sex more comfortable and enjoyable for women. All the years of hard work, career-building, and childrearing are in the rearview mirror. Many of us find ourselves alone and treading tentatively back into this brave, new world of sex and dating. Add to this the sometimes freewheeling life in retirement communities (some of which are the size of small cities), which create hotbeds (no pun intended) of people of similar age and background—kind of like a college dorm.
Trouble is, unlike kids in a dorm, seniors don’t have to worry about pregnancy and aren’t nearly as well-informed about the risks of unprotected sex. Condom use for those over 60 is the lowest for any age group (6 percent vs. 40 percent for college-age males). And condoms, in case you’ve forgotten, provide the only dependable protection against STIs, and even they aren’t effective against every sexually transmitted bug.
Also unlike their much younger counterparts, older folks have a less robust immune system, so the chances of catching and spreading infections are higher. Plus, many STIs are asymptomatic, so the person doesn’t know he or she is infected—and that the STI is degrading the immune system even further. Finally, doctors rarely think to ask Grandpa about his sex life in the normal course of an exam, even if he has classic symptoms of an STI.
All this adds up to a lively Petri dish of bugs circulating around the singles scene. Yet, prevention is so easy, and the cost of ignorance or of ignoring common-sense precautions is high. So, ladies, even if the prospective partner is someone you’ve known all your life, don’t assume you’re familiar with the intimate details of his sexual forays. Others have walked this path before—and are paying the price. Jane Fowler, 71, and founder of HIV Wisdom for Older Women, was infected with HIV by just such a friend when she was 55 and now advocates for more information and support for older women with AIDS. I’d suggest that if you’re dating, stick a couple condoms in your purse right with the lipstick. And get yourself tested if you’ve ever had unprotected sex. And read this series of posts about STIs on MiddlesexMD. The rule of thumb these days—better safe than sorry.
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.
In our little roundup of sexually transmitted infections, maybe you’ve noticed that many of them have no symptoms, and others mimic common illnesses like the flu or a urinary tract infection.
The take-away? There’s no way to know if you’re carrying an STI without getting tested. And there’s no way to prevent reinfection unless your partner gets tested, too.
That said, here’s an overview of the most common viral sexually transmitted diseases. That’s right, they’re caused by viruses, and you know what that means. You may well be stuck with this bug and at risk of infecting others for the rest of your life.
Here’s the list of bad boys:
Herpes Simplex Virus (HSV)
How common is it?
Very. One in five women has genital herpes. There are two types: Type 1 is the oral virus that causes cold sores. Type 2 infects the genital area. But the oral virus can infect the genitals and vice versa.
How do you catch it?
Through genital contact or oral-genital contact. The affected area can be contagious even when the lesions have healed. Condoms can help reduce infection, but it may not cover all the affected areas.
What are the symptoms?
The first outbreak is the worst and usually occurs within two weeks of infection. It may be accompanied by flu-like symptoms as well as pain and burning in the area of the lesions. But many people hardly notice the infection. Several less severe episodes may occur in the first year, then with lessening frequency and severity after that.
As with other STIs, herpes compromises the immune system, making the person more susceptible to new infections.
Human Papillomavirus (HPV)
How common is it?
HPV is the most common viral STI in the U.S. today. There are many strains of HPV and about half of sexually active people have one or more of them. How do you catch it? Through genital contact during sex, even though the carrier may not have symptoms. It can also be passed through genital-oral contact. A person can carry—and pass on—the virus for years without knowing he or she has it. A person may also be infected with more than one strain of HPV. Latex condoms offer some protection, but the infected skin may not be covered by a condom. “To be most effective, they [condoms] should be worn with every sex act, from start to finish,” according to the CDC.
What are the symptoms?
HPV is usually asymptomatic, and about 90 percent of infections spontaneously clear up after a year or two, but for those that don’t some strains of HPV cause genital warts and others cause cervical cancer.
Genital warts (considered a low-risk virus) may be small bumps of various shapes and sizes on the genital area that appear weeks or months after infection, even if the partner doesn’t know he or she is a carrier. They may go away, become smaller, or grow, but they don’t become cancerous.
Cervical cancer (considered high-risk) has no symptoms until it is advanced. Abnormal cells are usually found in a Pap test; that’s why regular screening is important to determine whether the virus is high-risk. Vaccines are available against several strains of HPV HIV/AIDS
How common is it?
One million people have HIV/AIDS in the U.S., according to the National Institute of Allergy and Infectious Diseases. About 20 percent don’t know they’re infected. About 50,000 new cases are diagnosed every year.
How do you catch it?
Through contact with vaginal fluid, sperm, blood, and breast milk of an infected person. The virus is most contagious shortly after a person is infected, but it takes from 3 to 6 months for an accurate diagnosis of infection. Before that, tests results can yield false negatives.
People who have another STI are up to five times more likely to contract HIV/AIDS. People who have HIV/AIDS plus another STI spread the disease more effectively. For example, levels of the HIV virus are 10 times higher in men with gonorrhea. This is why it’s critically important to be tested and treated for other STIs. It’s also critically important to use latex condoms with a sex partner until you’ve both been tested and are sure enough time has passed for the test to be accurate.
What are the symptoms?
There may be no symptoms at first or the infected person may experience and intense flulike episode within a month of infection. The “flu” goes away; the system begins to produce antibodies to fight the infection, and the disease appears dormant.
Eventually, however, after several years, the compromised immune system collapses, and full-blown AIDS develops. Other infections take hold—pneumonia, diarrhea, and the telltale lesions of Kaposi’s sarcoma.
Medical science has progressed to the point that, with daily medication and close monitoring, a person can live with HIV for many years without the disease progressing to AIDS.
So, there you have it. But before you join a convent, remember how nice sex is, and especially with a special someone. Chances are, you both are infection-free. But why take chances when the stakes are so high and prevention is relatively easy?