June 22, 2016


HPV ›   STIs ›   women's sexual health ›  

HPV after 50? It’s No Joke

You’ve come a long way, baby. You survived the sexual revolution of the 1960s and 1970s. You raised your family. You have a rewarding career. And you’re conquering menopause.

Now it’s time to face facts about human papillomavirus (HPV), the most common sexually transmitted infection.

It’s also the most common cause of abnormal pap smears, although a new abnormal pap result doesn’t mean you’ve been re-infected.

HPV 101

There are roughly 100 different types of HPV, and the most dangerous ones don’t have any symptoms.

And, just like other viruses, it can’t be treated with antibiotics.

Think you’re not at risk? Think again, because 8 of 10 sexually active people are infected at some point in their lives. And, according to a 2013 study, you can develop HPV after age 50 when a virus that was dormant for years "reactivates" decades later.

Kinda like getting chicken pox as a kid and then fighting shingles years later. Except worse, because some high-risk types of HPV (e.g., type 16, 18, 13) could lead to cervical cancer as well as head and neck, cervical, vulvar, vaginal, penile, and anal cancer.

Think you're not at risk? Think again.HPV infections occur when the virus enters your body, primarily by skin-to-skin contact. In some cases you may develop genital warts, which look like flat lesions, small cauliflower-like bumps or tiny stem-like protrusion. They can show up on your vulva, cervix, vagina or near your anus. (Warts can be treated with creams or, in some cases, removed.) 

You can also get HPV infections in your throat, tongue, tonsils, larynx and nose.

Safety first

Women are twice as likely to develop STIs, especially after menopause when our genitals have aged and we’re more likely to develop small tears and cuts. (By the way, moisturizers and lubricants can help with that.)

Keep these tips in mind:

  • Don’t put off pap smears – especially if you’ve had multiple partners. At ages 30-65, you should have a Pap test every three years (or every five years if your health care provider does dual testing). Talk to your health care provider about the right plan for you, given their specific options. And, if you get an abnormal result, be sure to follow doctors’ orders.
  • If you’re in a newer or non-monogamous relationship, use protection to avoid getting and spreading HPV.
  • If you’ve been with the same partner for 20 years, you can’t be re-infected by the same HPV type. So no worries. You can relax and enjoy sex without a condom.

The bottom line: Although most HPV types are harmless, you’re always smart to be on guard.




December 09, 2014


Condition News ›   HIV ›   safe sex ›   STDs ›   STIs ›  

Single? Sexual? Be safe

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.

June 05, 2013

1 comment

Condition News ›   HIV ›   HPV ›   safe sex ›   STIs ›  

Remember: Safe Sex Isn't Just for Teenagers

I’ve blathered on about safe sex before. Several times, in fact. I’ve also pontificated about the risk of unexpected pregnancy at midlife.

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.

So over Contraception? Think Again.

Yeah, I know. You’ve been doing the contraception shuffle for, oh, decades now. Isn’t it “safe” yet? After all, you’re past 40. Maybe you’ve even missed a couple periods.

Not so fast.

You’re in the midst of a very hazardous crossing—those uncertain years between fertility and menopause during which you are less likely to get pregnant, but, make no mistake, you still can!

While women are indeed less fertile after 40, they absolutely can get pregnant. In fact, women can conceive even during perimenopause, when the menstrual cycle is beginning to become irregular.

For some reason, however, women seem to become more casual as they near the goalposts. How else to account for the fact that women over 40 are the least likely to use birth control of any age group, and that their abortion rates are as high those of adolescents, according to a 2008 USA Today article.

In Great Britain, women in their 40s are now called “the Sex and the City generation,” and they, too, have grown careless. In the UK, abortions within the over-40 age group have risen by one-third in the past decade. In the US, 38 percent of pregnancies in women age 40 and older are unplanned. Of those, 56 percent end in abortion, according to this article in HealthyWomen.org.

By the time they reach 40, women are generally old hands at birth control. But at this point in life some reevaluation may be in order. Levels of fertility are decreasing, and hormonal levels are (or soon will be) in flux. Some women may not want to have children; others may want to keep the option open. In any case, an unplanned surprise complicates life really fast.

This is a good time for a conversation about birth control with your healthcare provider, and you may have to initiate it. While you have more options than ever, the best one for you might be different than what worked for you in your 20s.

And just so you know, current guidelines advise that you remain on birth control until one year after your last period, the official definition of menopause. Complicating the picture is the fact that with hormonal forms of birth control, such as the pill, your cycles may be irregular or may stop completely, which masks the onset of menopause. And the withdrawal bleed during the week off the pill isn’t considered a true period.

Birth control after 40 falls into several categories: permanent, long-term or short, hormonal or barrier method. They vary in levels of effectiveness and in the side effects you may experience. And remember that condoms are the only type of birth control that protects against sexually transmitted infections.

Probably your most immediate decision is whether to end childbearing permanently. Tubal ligation is a laparoscopic procedure that happens under general anesthetic in a hospital. There’s also a new, non-surgical option that a doctor can do with a local anesthetic right in the office.  Or, of course, your partner could have permanent sterilization as an outpatient office procedure.

Hormonal types of birth control are very effective, but can have both side effects (bloating, risk of stroke for some women) as well as protective benefits (against bone loss and some forms of cancer, for example).  It is very important to carefully review your health history with your health care provider to select the best option for you.

Short-term hormonal options include

  • Combined estrogen-progestogen pill (COCP). This is “the pill” you are probably familiar with. Since it now has very low estrogen levels, it’s considered safe for women who have no risk factors until age 55.
  • Progestogen-only pill (POP), which is a good option for older women. It must be taken regularly at the same time of day, however.
Long-term hormonal options include
  • Progestogen shot, which is a once-every-8-12-week option.
  • Progestogen implant, in which a tiny rod is inserted in the upper arm. It lasts for three years.
  • Vaginal rings release low dosages of estrogen. The ring is kept in the vagina for three weeks, then removed for a week.
  • A patch, which also releases low dosages of estrogen and progestogen.
  • An IUD impregnated with progestogen, which is highly effective and lasts for years.
The old non-hormonal standbys still include
  • Condom. Again, the only birth control that also protects against STIs.
  • Non-hormonal IUD. Also highly effective and long-lasting.
  • Diaphragm with spermicide, cervical cap, or spermicidal sponge.

Your choice of birth control at this point should be informed and careful. You need a plan to carry you through menopause, and you need to begin the dialog with your healthcare provider.

Since the consequences of ignoring the issue are so life-changing, this conversation ought to begin now!

STIs: Up Close and Personal with Viruses

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.

Viral Infections

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?

STIs: Up Close and Personal

In a post last week we established that folks over 50 are reentering the singles scene with seriously outdated information about the sexually transmitted infections (STIs) that have become commonplace since their own prom nights.

When it comes to older people and STIs, “don’t ask; don’t tell” is the MO. Doctors don’t think to ask Grandma about her sex life, and Grandma sure ain’t talking.

“What we are really witnessing with trichomonas, especially in older women, is that no one ever looked, no one ever tested and diagnosed, and no one is really getting treated, so the infection persists year after year,” said Charlotte Gaydos, a professor at Johns Hopkins School of Medicine in a news release.

And what is true for trichomonas, is true for all the other nasty little STIs— These infections respect neither age nor social status. Anyone can get an STI. Even Grandma.

So, in this post and one more, we’ll give you a primer on the most common STIs circulating now. (Yes, this is the short list.) The topic is complex and evolves quickly, so if you’re sexually active and especially if you have a new partner or several partners, talk to your doctor about prevention and getting tested.

Finally, if this information doesn’t scare the bejeesus out of you, then you have a higher tolerance for risk than is probably good for you.

First, a few general observations.

  • Get an annual pelvic exam. New guidelines from the CDC now recommend annual pelvic exams and Pap tests every three years. But if you have a new partner, tell your doctor.
  • If you have a new sexual partner, insist on using a condom (properly) until you are both absolutely certain nothing is getting passed between you. It can take several months for infections like HIV to show up on a test.
  • Both you and each new partner should be tested for STIs. (See the last post.)
  • Drug and alcohol use impairs judgment and leads to more risky sexual behavior. (Yes, that means you.)
  • Condoms help, but they’re never 100 percent effective. Some viruses can be on places not covered by the condom.
  • One infection reduces your ability to fight off others. This is especially true with HIV, that’s why it’s important for both partners to know their health status.
  • Many infections have no symptoms. Someone can have, and spread, an infection without knowing it.

 Bacterial infections

These are the most common bacterial STIs. These are much easier to detect and treat in early stages. Without treatment, they can do a lot of damage and are harder to get rid of.


This is really a parasite, but it’s treated with antibiotics. And, ladies, this is Grandma’s infection of choice, since women over 50 have the highest rates of infection.

How common is it?

Trichomoniasis has become the most common curable STI in the U.S. with about 3.7 million people infected. In one recent study, of those testing positive for trichomoniasis, 13 percent were women over 50; 11 percent were over 40. By contrast, 8.3 of women in their 20s tested positive. Based on these findings, researchers are recommending routine screening for sexually active women over 40.  

How do you catch it?

Trich is passed from penis to vagina or vice versa. It doesn’t seem to infect other parts of the genitalia. Latex condoms help prevent infection.

What are the symptoms?

Seventy percent of women have no symptoms. Others may experience a greenish vaginal discharge, itching, inflammation, redness, or burning with urination in the month following the infection. Symptoms may come and go. The concern for older people with trich is that they are more susceptible to catching other STIs. It’s easily cured with antibiotics.


How common is it?

Very. Rates of Chlamydia have more than doubled in the past decade, and it’s probably greatly under-reported. The U.S. Centers for Disease Control and Prevention (CDC) estimates that 2.8 million new cases occur annually.

How do you catch it?

Through oral, anal, or genital sex. Latex condoms are effective at prevention. Those with multiple sex partners should be tested regularly.

What are the symptoms?

Most women (70 to 80 percent) have none. The infection is particularly concerning for younger women, who are more susceptible to becoming infected and because, left untreated, it causes PID and infertility.

Chlamydia is easy to treat with antibiotics, but all partners must be treated to prevent reinfection.


How common is it?

The CDC estimates that about 700,000 cases of gonorrhea occur every year, although only about half are reported.

How do you catch it?

Gonorrhea is becoming known as a “super-bug,” one that’s very resistant to antibiotics. Because of this, doctors are advised to prescribe two kinds of antibiotics. It’s spread through contact with the penis, vagina, mouth, or anus of an infected person. The CDC says, “Latex condoms, when used consistently and correctly, can reduce the risk of transmission of gonorrhea.”

What are the symptoms?

Women tend to have very mild symptoms or none at all. Urination may be painful, or there may be vaginal discharge. Left untreated, the bacteria, which tends to flourish in the urethra, cervix, fallopian tubes, and uterus, can cause a massive internal infection called pelvic inflammatory disease (PID).


How common is it?

According to the CDC, there were 36,000 new cases of syphilis in 2006, and rates have held steady since, so this isn’t the most worrisome STI. How do you catch it? Through contact with the syphilis “chancre” or sore. These can be on the genitals, anus, vagina, or in the rectum. But they can also be on the mouth and lips. Condom use may not offer complete protection if the chancre isn’t covered by the condom.

What are the symptoms?

First stage: 10 to 90 days after contact, a hard, round, painless sore (chancre) appears where the bacteria entered the body, usually on the genitals. This heals by itself within a few weeks.

Second stage: A more extensive rash appears that may be brown or pinkish, often on the palms of the hands and bottom of the feet. It may be accompanied by flulike symptoms: fever, headache, weight loss. These, too, go away.

Last or latent stage: Without treatment, the disease may remain asymptomatic for 10 to 20 years, all the while the infection is slowly damaging internal organs and the neural system.

Syphilis is easy to treat with antibiotics in early stages. Later stages are very hard to treat.

Had enough?

We’re only halfway through. In the next post, we’ll discuss the viral diseases—you know, the kind that can’t be cured.

STDs for Grownups: What You Don’t Know Can Hurt You. A Lot

Sit down, Girlfriend. We need to talk.

Remember those uncomfortable discussions you had with your kids back in the day? You know, the birds-and-bees and how-not-to-get-pregnant talks?

Well, now it’s your turn to listen. This is your middle-age sex talk.

At some point in life, you’ll probably be alone, demographics and life expectancies being what they are. Maybe you already are. Maybe you’re newly divorced. Or widowed.

And maybe, after being married for many years you’re not ready to write off a relationship—or sex—for the rest of your life.

That’s great! We’ve already discussed the health benefits of sex. And we’ve talked about the research that shows that older women really like sex and are good at it.

But the singles scene is now a completely different ball game from those long-ago days when you were a player. “When I was younger we only worried about getting pregnant or getting crabs. Now that I’m divorced, I realize it’s a whole new world!” said a woman on one health website.

“In my practice I see a lot of older single women who don’t know the rules of dating,” says Mary Jo Rapini, psychotherapist and MiddlesexMD advisor. “They’re looking for someone to desire them again, and they’re much too easy with letting sex happen. They aren’t comfortable with demanding that the guy wear a condom.”

You may not need protection against pregnancy any more, but you sure need protection against a cornucopia of STDs that has flourished since your first date.

STDs affect every age group, but rates of infection are growing fastest among older people. According to the Centers for Disease Control, 15 percent of new HIV infections are in those over 50—and death rates are rising, too. In 2008, the journal Sexually Transmitted Infections noted that infection rates among those over 45 had doubled in less than 10 years. Research at Indiana University in 2010 indicated that condom use was lowest in that age group. Maybe there’s some connection there?

Besides general lack of awareness, a few physiological factors make it easier for older women to become infected. The thin, dry vaginal walls that accompany loss of estrogen create small tears and microscopic vaginal bleeding during sex, thus offering a warm welcome to invading nasties. Further, our pH balance tends to be less acidic after menopause, creating a friendly environment for bacterial infection.

So what’s a newly single older gal to do?

Empower yourself, says Rapini. Take a page from your kids’ playbook and insist on safe sex. This isn’t about being difficult or demanding, it’s about your health, and you have every right to safeguard it. Here are the safe sex rules:

  • Wait to have sex. Isn’t this the advice you give your kids? What’s the rush? Date for a while and get to know the person. A lusty first date could fizzle on the second or third. And then you might be stuck with an unpleasant reminder of a fleeting passion.
  • Get tested. And insist that your partner does as well. How can I ask that? you’re thinking. Girlfriend, this is how you empower yourself. You don’t take chances. “If the guy has nothing to hide, he shouldn’t resist.” says Rapini.
Once you’ve decided that sex is on the horizon, you could say something like, “I’m getting tested for STDs, and I think it’s a good idea for you as well.” That creates a level playing field and opens the door to discussion later.
  • Share the results of your screening. This gently opens the door to honest talk about sex. If you’ve never talked openly about sex before, it’s time to change. “If you stay passive you’re less likely to have good sex.” says Rapini.
  • Continue to use condoms for at least six months after a screening. Some infections, such as HIV, don’t show up immediately. Always keep latex condoms with you, just in case. If a condom is used correctly, it provides 90 percent protection. It’s less effective against the genital herpes virus or the HPV virus because those viruses are more widespread on the genital area.
  • Take care of your vagina. We’ve talked (and talked) about good vaginal hygiene. In addition to the infection-fighting properties of a healthy vagina, the sex will be better and more comfortable, too.
  • Keep communicating. This may be uncomfortable at first because our generation didn’t talk about sex, but this is the time of life for discovery. Learn what you like, and learn to ask for it.

Empowerment, remember? Respect yourself enough to insist on safe sex.

Let us know how it goes.

Q: Should I be comfortable with anal sex?

Estimates say that up to a fifth of heterosexual couples have anal intercourse at least intermittently, more rarely exclusively.

The risk of sexually transmitted infections is the same or perhaps higher with anal than with vaginal penetration. There's more likelihood of trauma, since anal intercourse requires complete relaxation of the rectal sphincter muscles before penetration. Trauma or injury to those muscles can lead to loss of muscle tone or control. That makes this form of intimacy not entirely "safe," but, more importantly, consent freely given by both partners is an essential feature of sexual activity in a loving relationship.

You asked whether this was a new phenomenon and whether you were "too old" to adapt! I don’t think it's new (or, at less than 20 percent, a phenomenon), but our notions about sexuality and what's "typical" or even erotic are very complicated and influenced by many factors. You may never become comfortable with this form of intimacy, but you are never too old to explore options and be open to new sexual techniques.

The Virus that Doesn’t Go Away

There are literally millions of women in the U.S. who have the genital herpes virus—including many of us at midlife. Not everyone is aware that outbreaks can increase during menopause, which concerns not only women who’ve managed the virus within a relationship, but also those who may be considering a new relationship.

The most obvious reason for the increase in occurrences is that menopause may cause some stresses; as you probably know if you carry the virus, stress can trigger outbreaks. Also, aging makes genital tissue more delicate and prone to small cuts or tears that provide pathways for infection. Many more of us are single at this stage of life these days; if we’re sexually active with multiple partners, that can increase the rate of infection overall in our age group.

(By the way, herpes and other sexually transmitted infections are most commonly transmitted from men to women, but they can pass from woman to woman as well.)

Nothing yet makes genital herpes go away permanently. Symptoms can be controlled with medication, either taken daily to minimize the number of outbreaks or at the onset of an outbreak to limit its duration or intensity. If you’re currently taking meds, there’s no reason not to continue during menopause, even if you’re on hormones. If your medicine isn’t as effective as it was, talk to your doctor about upping the dosage or switching to another. If you’re experiencing more frequent outbreaks, you may want to consider the continuous daily approach.

Whether you’re single and contemplating intimacy or in a long-term relationship, there are some things you can do to avoid sharing this virus with your partner:

  • Avoid sexual contact from the moment the symptoms first appear until the sores have completely healed.
  • Don’t let embarrassment stop you from discussing your sexual history; it’s imperative that your partner be aware of your situation. (And vice-versa!)
  • Prevent transfer of any bodily fluids to cuts or other openings.
  • Use a condom for any kind of sex – oral, genital or anal.
  • Keep fit and have regular physicals.
  • Keep the infected area clean and dry.
  • Don’t touch the sores. If you do have contact, wash your hands right away.

I’m happy to report, too, that researchers are vigorously exploring ways to protect women from the herpes virus and prevent it from spreading. One solution might be a herpes vaccine; other possibilities include gels and creams that could kill the virus before it has the chance to infect someone else.

But until scientists do come up with a more effective way to fight herpes, stay on your meds, manage your stress, be mindful, and stay healthy!

Q: If my partner previously had a partner with HPV, am I at risk?

HPV (Human Papilloma Virus) is so common that the lifetime cumulative risk of being an HPV carrier is 80 percent. In other words, we're nearly all carriers of HPV.

Fortunately, most people do not suffer adverse effects. Reactions to HPV exposure depends on our immune systems and whether we are exposed to high-risk or low-risk HPV types. The most common consequences for women are vulvar warts or abnormal pap smears, but, again, most women have no symptoms at all.

So you can assume two things: That your partner (like 80 percent of adults) is an HPV carrier, but that the likelihood of a health consequence is small. If this proves to be a long-term relationship, enjoying sex without a condom will be acceptable and safe for you.

For anyone entering into a new relationship: Getting screened for sexually transmitted infections is smart--and it's a way of signaling you care about each other and the new beginning you're making together.