STI Quarterly

Seniors may be older and wiser, but don't assume they know STI risks

Risks have increased — only a minority use condoms

If your clinical practice includes the care of age 50-plus women, are you including information on risks for sexually transmitted infections (STIs)? You should. Results of a new study indicate that there is a critical need for improving communication between older women and their clinicians about sexual health and for providing senior women with tools on how to negotiate with partners about safe sex practices.1

Many older adults continue be sexually active well into their 80s, state results of a 2010 study.2 Due to divorce or loss of a partner, many women over 50 years old are returning to the dating scene, where they become sexually active and thereby face STI risks. However, most STI prevention campaigns are designed to target younger generations, says Cynthia Morton, PhD, associate professor in the Department of Advertising in the College of Journalism and Mass Communications at the University of Florida in Gainesville. Morton served as lead author of the current research.

The "baby boomer" generation, defined as those who were born between 1946 and 1964, is redefining senior citizenship, much as it has reshaped every other age of life, says Morton. Case in point: statistics show this "new aged" group of people ages 50-plus as the fastest-growing segment for Internet dating services.3,4

"As the television series 'The Golden Girls' taught us, life goes on, dating goes on, and so too does sexual activity," notes Morton.

In conducting the current study, Morton and other researchers conducted focus groups among women age 50 years and older. In group discussions, women talked about the challenges in finding male partners, negotiating condom use, and seeking credible information sources to help them make good choices about sexual health.

Older women uncomfortable

While older women are aware of STI risks, they are uncomfortable about seeking sexual health information from their clinicians, the study notes. And while older women might know the importance of condoms in preventing STIs, they might avoid negotiating condom use with their partners to avoid conflict or rejection.1

In recent years, there has been a noted increase in STI risk for older adults, yet only a minority of older adults report using a condom, says Vanessa Schick, PhD, research scientist at Indiana University in Bloomington and co-author of Read My Lips: A Complete Guide to the Vulva and Vagina (Rowman & Littlefield Publishers, 2011). Statistics reinforce Schick's message: From 2005 to 2009, the number of reported cases of syphilis and chlamydia among those 55 and older increased 43%, according to an Orlando Sentinel analysis of data provided by the Centers for Disease Control and Prevention.5

Schick and other Indiana University researchers published a 2010 paper on sexual behaviors in those age 50 and above. Their data indicate about one-third of women and about 50% of the men reported their last sexual partner was not a relationship partner.2 When researchers questioned single or newly partnered men and women whether they had used a condom the last time they had sex, the answer was an overwhelming 'no.' Just 20% of men and 24% of women reported they used a condom the last time they engaged in intercourse.2

Older adults should receive similar messages to those that younger adults receive, says Schick: that STIs are prevalent, that condoms remain the only effective device for reducing STI and HIV transmission among sexually active individuals, and that communicating with one's partner and seeking regular healthcare — including talking with one's healthcare provider about STI risk — are important.

How can you help?

What can clinicians do to help older patients protect themselves against STI risks? Schick suggests discussing the value of water-based lubricants and vaginal moisturizers. For older women who might be more likely to be dealing with issues of vaginal dryness, not only can lubricant use make sex more pleasurable and comfortable, but it can reduce the risk of vaginal tearing and condom breakage, both of which are relevant to STI risk. Advise against use of oil-based lubricants, such as petroleum jelly, which reduce condom integrity and might facilitate breakage.6

Also include a discussion and demonstration of different condom sizes and types, says Schick. Men and women who find themselves in new sexual partnerships after being in a long-term monogamous relationship need to know about the many technological advances in condoms, she notes.

Condoms now come in many shapes, sizes, and textures that were not available several decades ago, states Schick. Emphasize that patients' past experiences with condoms might be quite different from the experiences they would have with condoms today, notes Schick. Case in point: a 2010 study by Indiana University researchers found that some men and women have equally or more pleasurable experiences with condoms.7

Changes on the way

In 2009, the Centers for Medicare & Medicaid Services announced coverage for HIV screening for Medicare beneficiaries at increased risk for the infection. It is now assessing whether to include STI screening in Medicare-covered services.8

The University of Florida researchers plan a partnership with providers and public health officials in the health community to develop larger intervention programs, pilots, and opportunities to reach seniors, says Morton. "As health communication researchers, what we are looking at this point is message strategies, because there have been no campaigns that have been specifically targeted at the mature market," she notes.

Until more resources are developed specifically for seniors, start now by talking with your older patients about their sexual habits, says Morton. Your patients might be waiting for you to initiate the discussion.

"A consensus expressed across the participant pool was that, although they wanted answers to sexual health questions, they did not feel comfortable asking their doctors about sex or sexual health practices, even though some women admitted to having the same family physician for many years," the University of Florida researchers report. "They also lamented the fact that the doctor never explored questions they might have about sex, presuming that women over 50 are already informed or not interested in knowing."

References

  1. Morton CR, Hyojin K, Treise D. Safe sex after 50 and mature women's beliefs of sexual health. J Consumer Affairs 2011; 45:372-390.
  2. Schick V, Herbenick D, Reece M, et al. Sexual behaviors, condom use, and sexual health of Americans over 50: implications for sexual health promotion for older adults. J Sex Med 2010; 7 Suppl 5:315-329.
  3. Ballal S. Who says e-romance is dead? Business Week, July 17, 2006: 12.
  4. Juarez V. 2006. In the Internet dating world, boomers are a hot commodity. Newsweek, Feb. 20, 2006: 60.
  5. Jameson M. Seniors' sex lives are up — and so are STD cases around the country. Orlando Sentinel, May 16, 2011. Accessed at http://articles.orlandosentinel.com.
  6. Warner L, Steiner MJ. Male condoms. In: Hatcher RA, Trussell J, Nelson AL, et al. Contraceptive Technology: 19th revised edition. New York: Ardent Media; 2007.
  7. Sanders SA, Reece M, Herbenick D, et al. Condom use during most recent vaginal intercourse event among a probability sample of adults in the United States. J Sex Med 2010; 7 Suppl 5:362-373.
  8. Veciana-Suarez A. Medicare may pay for STD screenings for seniors. Miami Herald, Aug. 23, 2011. Accessed at http://www.miamiherald.com.