Written by Corey Whelan
Anyone who is sexually active can acquire a sexually transmitted infection or disease. But did you know that transmission rates for STIs and STDs have increased over the last several years among every age demographic, including adults over 50? Women who no longer require birth control are a particularly vulnerable group, for both physical and cultural reasons. If you’re postmenopausal and are actively having or hope to be having sex in the near future, here’s what you should know.
STDs and STIs in Older Adults – What the Numbers Say
The CDC publishes a Sexually Transmitted Disease Surveillance Report annually. Rates of STDs, such as syphilis, gonorrhea, and chlamydia, have up-ticked each year to all-time highs for the last six consecutive years.1
The most recent report shows an increase in STD rates for adults aged 55-64, as well as those over 65 years old. While this increase may look slight, it’s actually representing a significant growth in cases from one year to the next:2,3
According to the CDC, rates of HIV transmission have fallen in the over 50 group, which is good news. However, over half (51%) of all HIV positive people in the U.S. are over 50 years old, so the potential risk for transmission remains, and requires caution. In fact, one in six cases of HIV transmission occurs in people over 50.4
Drivers of STDs and STIs in Older Adults
So why are numbers on the rise? Societal and medical changes have both played a role in the increase of STDs and STIs in older adults. These changes typically pertain to lifestyle and relationship status shifts, such as divorce or the loss of a spouse/partner, which may inspire older adults to explore dating and sex again.
Medical options for addressing conditions such as erectile dysfunction are also readily available, enabling men to stay sexually active for longer. For women, changes in vaginal health commonly experienced during menopause, including dryness or pain with sex, may have previously impacted the frequency they were engaging in sexual activity, but with more options for treating these symptoms, such as hormones, other prescription treatments, vaginal lubricants and moisturizers, dilator use, and occasionally surgical procedures, women can also stay sexually active for longer once symptoms resolve.
Newly Single and Not Using Condoms
It’s not unusual for women to find themselves newly single and over 50. The divorce rate for women 55-64 years old is high compared to other age groups, at 43 percent.5 Losing one’s spouse or long-term partner can also be a more common and unfortunate occurrence during midlife. These changes in marital status may result in women seeking new partners for connection, companionship, intimacy, and sex.
After spending years or decades in committed relationships, some women simply don’t think about the need for protection from sexually transmitted disease with a new partner. They also may not realize that some STIs can be transmitted through oral sex or anal sex, as well as vaginally, in addition to kissing or through sharing toys.
Condoms, which are no longer needed to prevent pregnancy postmenopause, may become an afterthought. Woman may also feel uncomfortable discussing sexual history and STD prevention with a new partner, which can reduce the use of condoms.
Having More Sex in Older Age, Thanks to Viagra
Erectile dysfunction (ED) is a common condition, with studies showing that its occurrence increases as men age.6 Viagra (sildenafil) and other ED treatments have enabled many men to continue to enjoy sex for decades longer than in years past. More sex however, especially with new or multiple partners, can lead to a higher risk of spreading sexually transmitted diseases.
Changes in Vaginal Health Can Increase Transmission Risk
As women age, a reduction in estrogen production occurs. This often causes the onset of symptoms that can impact vaginal health, such as vaginal atrophy, a condition earmarked by the drying and thinning of the vaginal walls and tissues. Often, the first signs of vaginal atrophy are decreased lubrication and persistent dryness.
Masturbation, foreplay, and sex without adequate lubrication can lead to the development of vaginal fissures or tearing. These microscopic tears can in-turn make women more susceptible to STI transmission. Be sure to speak with your healthcare provider if you’re sexually active and experiencing symptoms of atrophy to determine the best treatment option for you.
Asymptomatic STIs and Symptomatic STDs – Talking to Your Provider About Each
STDs and STIs are often referred to interchangeably, but the two differ. STIs that become symptomatic are classified as STDs. STIs that don’t cause symptoms are referred to as infections, not diseases.7 This distinction can be impactful for postmenopausal women in particular, especially if they don’t have a long-term relationship with a gynecologist or healthcare provider they trust and feel comfortable with.
Data indicates that healthcare professionals don’t always address sexual health with their older patients, since they may assume that women over 50 aren’t interested in or are still actively having sex.8 While this is slowly changing, this lack of communication may be compounded by the embarrassment or discomfort women feel in proactively discussing sex with their healthcare providers. Without communication and testing, early symptoms of certain STDs or STIs can often go unnoticed, specifically for conditions such as HIV, chlamydia, and syphilis. This twofold problem makes untreated sexually transmitted infections and diseases a very real concern for older women.
A healthcare provider who knows your body and sexual history is more likely to uncover and treat asymptomatic STIs than one who doesn’t talk to you about your sex life. This can help avoid additional spread to subsequent partners. It can also help to prevent long-term complications and health deficits for you; treating sexual disease is vital for supporting long-term health.
Symptomatic STDs can be easier to catch, of course, and require immediate treatment. Some common symptoms to be aware of include:9
- Vaginal burning or itching
- Changes to or the onset of unusual vaginal discharge
- Pain or burning during sex
- Small skin growths on the vulva or vagina
- White patches in the mouth
- Flu-like symptoms, including fatigue and fever
- Swollen glands
- Sharp pain in the lower abdomen
- Bleeding after sex
Whether you have symptoms or not, if you’re sexually active, it’s important to let your healthcare provider know. They can discuss tests and treatments that can eliminate the possibility of long-term health-related implications from STDs.
Communication is the Key to Safe Sex
If you’re considering exploring a new sexual partner, that’s great! Don’t let fear of STDs stop you from enjoying this wonderful adventure. As with so many things, knowledge is power. And the key is usually communication.
Talk to your healthcare provider about your current life stage and vaginal health and ask questions that may be helpful for safeguarding yourself and potential partners. Are there things you might be doing that will make you less vulnerable to STDs? Are there ways you may be able to improve sexual satisfaction at the same time?
Let your physician know of any new or concerning symptoms you may have, either vaginally or anywhere else throughout your body. This is important to do, even if your symptoms subside. Many STDs have early symptoms that dissipate but can lead to ongoing damage later.
Talk honestly and openly to any potential new partner before you have sex. Let them know you are uncomfortable proceeding without using a condom and let them know why. Have a frank discussion about each other’s sexual habits and history, think about getting tested prior to engaging in any sexual activity, and you can even consider “at home” STI testing, confirming any results and receiving counseling from your healthcare provider. Over time, you may be able to forgo the need for condoms.