SexEd for Seniors

Sex reigns king over all taboo topics. Parents dread the infamous birds and bees conversation almost as much as their children do. Although sex education remains an awkward but important step for adolescents, recent studies indicate that an important demographic is due for a refresher course: grandparents. The risk of sexually transmitted diseases (STDs) in seniors is growing faster than in teens. Younger groups are still at a much greater overall risk of infection, but the U.S. Centers for Disease Control and Prevention (CDC) has reported skyrocketing rates of STDs in people more than 50 years of age during the past decade. Cases of syphilis and chlamydia alone have nearly tripled.

People often assume that sexual activity ceases after a certain age, when sex hormones and vitality begin to diminish. The truth is quite the opposite. The elderly may not talk much about sex, but that does not mean they are not engaging in it. More than 80 percent of people 50 years and older reported regular sexual activity in one British study, which included participants up to 90 years of age. A comparable study in the United States found 73 percent of those ages 57–64 years, 53 percent of those ages 65–74 years, and 26 percent of those ages 75–85 years to be sexually active. Sex can be good for general health if practiced safely. Unfortunately, seniors are less likely to use protection.

A 2009 AARP survey found that only 12 percent of single and dating men and 32 percent of single and dating women 45 years of age and older consistently used protection during sex. As a result, research from the British journal Sexually Transmitted Infections indicates that STD rates among those in this age group have doubled in one decade. Without fear of pregnancy, some seniors forgo condoms during sex. One theory is that older populations are hesitant to discuss sex and assume that STDs rarely occur in their age group. The hard truth is that 17 percent of all new HIV diagnoses and 23 percent of all new AIDS diagnoses in the United States in 2009 were in patients 50 years and older, according to the CDC.

The Benefits of Oxytocin

Studies show that human contact is good for all of us, seniors included. The hormone oxytocin, which is released during orgasm in men and women, plays a role in social bonding and our overall sense of wellbeing. Elders who live relatively isolated lives often lack opportunities for intimacy, which can promote mental and physical health. It is not unusual for people living in senior communities or nursing homes to turn to their peers for physical contact, even if suffering from a degenerative mental condition like dementia. A recent Australian study published in the Journal of Medical Ethics showed that patients still pursue sexual relationships during the earlier stages of such illnesses.

The study also discusses claims that some health care workers in institutions prohibited sex among patients based on the staff’s personal beliefs or safety concerns for patients. The question of when sex should be allowed or denied in nursing homes falls into a gray area that has not received much attention. Some nursing homes work to combat the touch deficit by bringing in pets for patients. The therapeutic effects of petting and cuddling with animals have been shown to increase oxytocin levels among older people who may be deficient in the hormone.

Although the benefits of touch and sexual activity are clearly documented, providing comprehensive information to sexually active seniors has its challenges. Society’s youthoriented culture often results in a negative portrayal of physical intimacy among old people, which can make some of them less forthcoming about sexual problems. Diagnosing sexually transmitted diseases and infections in seniors can be difficult due to the confusing of aging and disease symptoms. Patients may chalk up frequent urination and other mild aches and pains as a natural progression into the golden years. By the time an STD is caught and treated, it might have already spread to other sexual partners.

Physical effects of aging also catalyze the spread of diseases during sex. Vaginal atrophy, a thinning of vaginal membranes after menopause and a decline in estrogen, puts women at risk for tearing during sex and for transmission of sexual diseases. “There is an argument that changes to the vaginal mucosa postmenopause may make the tissues more friable and create microabrasions, which enhance transmission of sexually transmitted infections,” said Rachel Von Simson, a final year medical student at the King’s College in London and co-author of a recent editorial called “Sexual Health and the Older Adult” in the Student BMJ. “Vaginal pH is higher postmenopause, and in younger adults a higher vaginal pH has been associated with an increased risk of STDs.”

Research has not definitely explained why STD rates are increasing among older women, however, even though a higher pH has always been the norm among them, nor can it explain why the rates are increasing in older men. Erectile dysfunction (ED) drugs like Viagra provide one of the connections. A study published in the Annals of Medicine tested the hypothesis that older men using ED drugs were more likely to contract STDs than those who did not request these drugs from their physician. By reviewing thousands of insurance claims, Anupam B. Jena, M.D., Ph.D., an assistant professor of health care policy at Harvard Medical School and a physician at Massachusetts General Hospital, found that men more than 40 years of age using ED drugs were 2–3 times more likely to contract an STD than other men in the same age group. Although taking ED medications cannot be said to directly increase a patients’ risk of infection, Jena said, “the introduction of these medications allowed them to either have sex or to have sex more frequently, and by definition having sex more often one would expect that STD rates would go up.”

Safe Sex Campaigns

Longer lives and higher divorce rates have also been pinpointed as factors in the spread of STDs among older adults. With good health lasting longer into life, people are more likely to remain sexually active after retirement. This factor, combined with an uptick in divorces, many later in life, increases the likelihood of having a greater number of sexual partners over a lifetime. Von Simson explained that the STD trend has led to the inclusion of elders in the National Survey of Sexual Health and Behavior, started by Dr. Alfred Kinsey in the 1940s. A similar report, “NATSAL [National Survey of Sexual Attitudes and Lifestyles], is expanding to include older adults, but this will only give us a snapshot of now, not of how behaviors may have changed,” Von Simson said. The lack of historical evidence on the sexual behavior of seniors presents a challenge for researchers seeking the source of increasing STD infections. She believes that many opportunities remain for research in this field.

Because contracting STDs is still far more common among young adults, the primary focus of the medical community has been on the adolescent cohort. But the changing tides of sex-related issues in elders has inspired a new wave of safe sex campaigns and seminars in several cities, from New York to San Jose. In May 2012, SaferSex4Seniors.org released a risqué public service announcement in the form of a YouTube video. The 30-second video shows fully-clothed seniors demonstrating various sexual positions in rapid succession. The clip ends with the statistic that STD rates among seniors in Florida have risen 71 percent. The tagline encourages seniors to “Do it. Safely.”

Advising Older Patients

Experts agree that rising STD rates do not mean seniors should be pressed into abstinence. A study presented at The Endocrine Society’s 94th Annual Meeting, ENDO 2012, in Houston, Texas, found that testosterone levels remain high in healthy sexually active men between the ages of 35 and 80 years, especially in those who are married. Healthy levels of this hormone promote important bodily functions and help keep muscle-to-fat ratios in check. Physical intimacy and touch set off a complex chain of hormonal responses that have been shown to enhance quality of life at any age. When it comes to sex, a number of studies show that overall health is much more critical that one’s calendar age. From a scientific point of view it is perfectly fine for seniors to “do it.”

The conclusive cause of increasing STD rates in older populations many continue to elude researchers for a while. The answer may be too complex and multifaceted to pinpoint cause, but Jena suspects the trend is simply linked to a change in social norms. “It’s not like there were massive advertising campaigns or things like Facebook that only applied to older folks,” Jena said. Experts say doctors should be prepared to advise their older patients about how to carry on a healthy sex life even as they age, and to remind them of the basic safety tip they learned years ago in high school: Always use a condom.

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