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Glenn D. Braunstein, M.D. Headshot

Sexygenerians: Why the Taboo Against Candor, Safety With Senior Sex?

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If your children have reached the age that you feel it's time to discuss with them the importance of safe sex, you might consider conducting that same chat with a few other family members -- your parents and maybe even your grandparents.

Even if your parents never got around to having "the talk" with you, you may need to consider having it with them, especially if they are divorced or widowed. Whether you want to know about it or not, seniors are having sex, and a stunning majority of them are not using condoms and are contracting sexually transmitted diseases.

This is occurring even as we seem more shy than ever -- as children, peers and even doctors -- about speaking candidly to this crowd about sex. Why? After all, they've raised families, fought wars, bought and sold homes, started and lost businesses, and seen plenty of things more likely to raise eyebrows than a frank discussion about sexual intercourse, oral sex, sexually transmitted infections, lubricant and condoms. According to a study published in the New England Journal of Medicine, although sexual activity does decline with age, a substantial number of men and women engage in sexual activity. In that survey, 73 percent of of those 57 to 64 years old, 53 percent of those 65 to 74 years old, and 26 percent of those 75 to 85 years old responded that they had sexual encounters. Like their younger counterparts, more men reported sexual activity than women -- even though women outlive men (males statistically have been more inclined to take on younger partners, giving them more opportunities for sex). For those seniors who were not having sex, some (especially women) indicated that it was due to a lack of interest, but for many it was due to the health of the partner, or lack of a partner.

Still, more seniors clearly are having more sex. Life and health extend longer than ever, and drugs, such as Viagra, make sex possible later in life. Statistics from the National Vital Statistics Reports show that life expectancy in the United States is steadily climbing. And while some races and sexes outlive others -- statistically, white women live longest and black men shortest -- men and women of all colors are living longer than before. Not only are we living longer, we're healthier. While I wouldn't go so far as to say that 70 is the new 60, a study published last year in Nature found that we've successfully slowed our aging by about 10 years.

Safe Sex for Seniors

A number of social phenomena contribute to the rise in senior sex. Divorce rates are higher, so more seniors are single. More live in retirement communities, where they have more chances to date, flirt and socialize. Even those in nursing homes may enjoy sexual activity with other residents. While sex may be part of life for adults well into their 60s, 70s, 80s and even 90s -- these adults also are part of a generation that's less aware of sexually transmitted disease. The safe sex campaigns that swept the nation as part of the AIDS epidemic weren't aimed at them. But according to the Centers for Disease Control, based on 2005 data, people 50 and older accounted for 15 percent of new HIV and AIDS diagnoses.

The CDC points out that older people are less likely to talk to their doctors about their sex lives -- and their doctors don't tend to ask them about their sexual activity or recreational drug use. Older folks also are more likely to mistake early symptoms of HIV for natural aches and pains of aging. And they're significantly less likely to use condoms.

According to data published last year from the National Survey of Sexual Health and Behavior -- the largest study of its kind in more than a decade surveying 5,865 people ages 14 to 94 -- those older than 40 are least likely to use a condom. Among men older than 50, more than 90 percent said they didn't use a condom the last time they had sex with someone they knew -- and 70 percent admitted they didn't bother with a condom when they last had sex with a stranger. A majority of women older than 50 also said their partners don't use condoms.

So this perhaps is one area in life where teenagers may show more wisdom than their elders: Around 80 percent of teens reported using a condom in their most recent sexual encounter. Unlike teens, of course, the older crowd generally needn't worry about pregnancy, but they should worry about sexually transmitted infections.

Concerns about STD rates among seniors are serious enough that Medicare -- which already covers HIV testing -- soon may start covering other STD exams, such as screening for syphilis, chlamydia, gonorrhea and hepatitis B. Isn't it clear that seniors' physicians and loved ones should talk about some facts of life with seniors?

Despite the frequent, in-your-face marketing that floods our email spam, TV ads and so many other media promoting little blue pills and the like, a misperception persists that older men are celibate. The seeming ubiquity of drugs to combat erectile dysfunction suggests otherwise. Some studies have found that men who use drugs for erectile dysfunction are more prone to STDs. For the record, those men who fill those prescriptions also were more sexually active than peers and were more likely to have STDs before starting the drug. It stands to reason, though, that if more people in a population are sexually active, there will be a higher incidence of sexually transmitted infection, too.

(And men, by the way, if it occurs to you while taking one of these drugs, you may want to read my earlier post on the woes of the erection that lasts four hours or more... )

Sexuality Silence

For women, there are different issues to discuss. Women seem especially reluctant or abashed about speaking even with their doctors about sex, particularly when their physician is younger and male. There are sexual health measures available for women, but these are less often publicized. Even among women who reported they were sexually active, 43 percent reported a lack of desire, and 39 percent reported vaginal dryness. Unfortunately, women are unlikely to speak with doctors about testosterone therapies that can help boost libido (in women as well as in men), as well as other therapies like estrogens to combat uncomfortable dryness.

Our stereotypes do more than contribute to late-night humor about seniors -- it can harm their health and well-being. Studies show an active sex life is a sign of good health, higher self-esteem and increased happiness in older people.

At the same time, our silence about the sexuality of seniors can keep them from getting prophylactic or needed care. As the immune system tends to weaken with age, seniors may be more susceptible to all kinds of infections -- including STDs. Because many of these types of diseases have few or no symptoms, they often go untreated. In someone with diabetes, heart disease or other chronic conditions common with age -- they can make those illnesses even worse.

As the Flower Children who cavorted through the Summer of Love saunter through the autumn of their years, we all should encourage them to keep making love not war -- and to do so safely. Just as you would check in with an older family member about any other serious health risk -- however embarrassing or private it might be -- talk to them about sexually transmitted diseases. If you're a senior with a healthy, active sex life, don't be shy: Insist your partners use condoms. Speak up with your doctor about being tested and about what might be available to make your sex life more comfortable and enjoyable.