Older women and sexuality ... are we still just talking lube?

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Publication Date: 
Tue, 2012-07-17

Not seniors you say?  A Student BMJ editorial in February 2012 cites studies showing an increase in cases of syphilis, chlamydia and gonorrhea in the United Kingdom, United States and Canada in 45 to 64 year olds. The journal reported “there has also been an increase in cases of HIV with those aged 50 and over accounting for 20 per cent of adults accessing HIV care, an 82 per cent increase on figures from 2001 … new diagnoses of HIV in the over 50s have doubled between 2000 and 2009.” Similarly, a 2008 study in the medical journal Sexually Transmitted Infections found that in less than 10 years, the rate of STIs in those over 45 had doubled.

What’s going on?

There are a number of factors at play here. A 2010 study by Indiana University found that those over 45 had the lowest rate of condom use. A study published in July 2010 in the Annals of Internal Medicine discovered that men who use erectile dysfunction drugs such as Viagra have higher rates of STIs in the year before and after use of these drugs.

It’s not surprising that older, single people are not using protection. Women who were in long-term relationships with men left the condom at the door decades ago. While pregnancy was still an issue, many were on the pill or used IUDs. Some women who date in later life meet partners who, like themselves, were in long-term relationships. The often erroneous assumption is that they were faithful during that relationship. But how many partners have they had since then?  Have they been getting tested and using protection with each new partner?

Going back to Lee’s experience, her doctor was on the ball. But what is the likelihood of older patients getting tested for the common STIs, let alone HIV?  Doctors make assumptions about their patients the same way patients make assumptions about their partners. They may hesitate to even raise sexual health issues with older people and certainly do not routinely test for STIs. Women who continue to have their Pap tests until the age of 70 are not likely to be tested for chlamydia, considered a young person’s STI. Even younger women, aged 15 to 24, who are at the highest risk for chlamydia and gonorrhea, assume that their doctor is checking them for “everything” when they have their annual internal exam. Often, they just get a Pap test without having any STI swabs. They have to ask their doctor to check for STIs.

STI testing for women takes several forms: a swab during an internal examination will reveal gonorrhea or chlamydia in an infected woman; a vaginal smear can detect trichomonas, yeast or bacterial vaginosis. She will need a blood test for syphilis, hepatitis B, C or HIV. Rapid testing for HIV is becoming more common, with results from a finger prick in less than a minute. 

Older women, like their younger counterparts, have little experience bringing up issues of protection and testing with a new partner. It is as difficult for them as for younger people to negotiate safer sex.

Take Canadian snowbirds as an example. At an HIV conference in 2009, gerontology researcher Katie Mairs reported she had surveyed 299 snowbirds over age 50 who winter in Florida. The study found that most were sexually active, and almost half had dated at least one Floridian.

In Florida, seniors account for 17 per cent of all HIV cases—the same as the proportion of those 65 and older among the general population. New cases among this age group are growing faster than in people under 40. But only 47 of those surveyed (17.7 per cent) had ever been tested for HIV. Less than 25 per cent of men and almost none of the women used condoms. The Senior HIV Intervention Project in Fort Lauderdale states that women over 60 are one of the fastest growing risk groups.

Postmenopausal women with vaginal dryness are at higher risk for acquiring STIs. HIV, for example, attacks white blood cells. There are increased white blood cells at the site of infection; so a woman’s irritated, inflamed vagina is very welcoming to the virus, which can then gain direct access to her bloodstream.