Sexuality, Aging and the Rise of Sexually Transmitted Infections

By Rhonda Alexander

During teenage and young-adult years, sexually transmitted infections (STI)—and how to prevent them—is a regular topic of discussion, but what happens to the discussion after the age of 40?

“There are no kid gloves in my office,” says Dr. Monique Jones, obstetrics and gynecology specialist in Hazel Crest.

“We talk about it all.”

Jones, who has practiced at the Advocate South Suburban Hospital campus in the Doctor’s Pavilion since 2002, says the topic of sexually transmitted infections is a regular part of the conversations she has with her patients.

“Sexual health is a part of all women’s health. It’s always a topic I bring up… current behavior, risk factors and concerns.”

This may not be out of the norm for a specialist like Jones, but for internists and family practice physicians who are more focused on controlling high blood pressure, diabetes and other chronic illnesses that the older population often encounters, the issue of STIs may be more daunting.

“During the course of a busy day in the office, doctors may shy away from the topic—beyond the basics of menstruation, reproduction and how sexually transmitted infections are contracted and treated—for a variety of reasons,” says Anita P. Hoffer, PhD, EdD.

Hoffer, a former associate professor who worked at Harvard Medical School for 25 years and current sex educator, says we would be shocked to know that doctors receive very little sexual education in most United States medical schools beyond the basics of anatomy and physiology, reproduction and the diagnosis and treatment of sexually-transmitted infections.

“[Doctors] may feel time-constrained or even unprepared to deal with detailed, every day sexual concerns of older adult patients and may even believe their older female patients are not interested in this kind of information at this stage of their lives.”

The statistics disprove that theory.

The Illinois Department of Public Health revealed more than 50 percent of all reported cases of sexually transmitted infections (chlamydia, gonorrhea and early syphilis) in Illinois for persons over age 40 were in Cook County. The numbers rose steadily between 2010 and 2011.

Why Are the Rates of Sexual Infections Rising in the Older Population?

Of course, it’s not just local older people at risk for STIs. This problem is national.

“Once they get out of the concern for pregnancy, the conversation stops,” says Deb Choma, RN, administrator and sexual health educator at Shard Villa, a residential home for seniors in Salisbury, Vermont.

Hoffer conducted research that revealed only 30 percent of older women even expressed concern over STIs. Choma reports that she’s experienced this lack of concern among residents as well as co-workers who find themselves dating again after divorce or the death of a spouse.

“There is also a lack of correct information as it relates to how many of these infections are transmitted,” says Choma.

As part of her research, Hoffer conducted a sexuality profile and behavior survey in 2009 on 153 educated, heterosexual women between the ages of 60 and 75. The results revealed that two-thirds of the women had never had any formal sex education at all. She also found through teaching and counseling many older women that many are squeamish and unfamiliar with their own genital anatomy.

More Opportunities for the Older Population

As the baby boomer generation transitions to living in a community setting, whether it is assisted living or a long-term care facility, there is more opportunity.

“Our older population is becoming more sexually active with more partners, or their partner is having more partners, says Jones.

The men are now able to have sexual enhancement medication, and [some] are feeling like they are 18 again, and they are perpetuating the promiscuous behavior of an 18-year-old.”

The issue is further complicated because, as Hoffer says, many older women either don’t understand the necessity of using protection since they no longer fear pregnancy or they don’t feel empowered to ask their partners to use condoms. Older men may also assume that condoms are unnecessary, or be reluctant to use them lest they interfere with sensitivity and hence their ability to become and stay erect. There is also competition for male partners as women outnumber the men in later years and and are eager for sexual companionship.

“This is a basic human need – from a hug, a kiss, a caress, up to the act of intercourse; it’s all normal,” says Choma.

“At some point in their lives, they had the [caring]; they had the affection and now, things have changed,” says Jones.

As much as we would like to believe things change when we reach a certain age, the older population is just as much at risk as anyone else who is sexually active.

“I would encourage people to still consider that STIs are present in all age groups, and the barrier method such as a condom is always recommended in all circumstances,” says Jones.