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

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For women who are living independently, issues related to sexuality are difficult enough. What about women in long-term care facilities? There is insufficient training regarding seniors’ sexual health for caregivers in these settings. Requests for training are often initiated because of fears of body fluids even though they follow “routine practices” (formerly known as “universal precautions”) for infection control. As the population ages, more and more of these facilities will care for people with HIV/AIDS. Once staff is reassured that health and safety have been covered, any sexual health training should start with caregiver comfort in discussing sexuality.

There are many issues involved in training caregiver staff. For example, people with partners in nursing homes will not appreciate intrusions on their privacy. A second is consent. How does one know if a woman who is cognitively impaired wants to be sexual with a partner? Some facilities medicate seniors to eradicate their sexual drive. That is also a consent issue. Is there a role for staff in assisting seniors in practising safer sex; for example, putting on a condom? There are also equity issues. Does a woman who was an out lesbian her whole adult life feel the need to go back in the closet? What about someone assigned as a male at birth who transitioned to a female as an adult? What was private is no longer so in a long-term care facility. And we as a society and as individuals need to be prepared to address these issues and questions as they arise.

People make assumptions about their own health status. “I feel fine” is not a medical diagnosis. Given that most people are unaware that they have an infection (about 75 per cent of women infected with chlamydia are unaware of it) even asking a person if they are “clean” just doesn’t cut it. And if you ask, does that imply that you may have a sexual history that is not entirely pristine?

So, although a little lube may go a long way, baby, it is clear that the needs of older women require a good deal more attention—and a great big reality check.

Lyba Spring recently retired from Toronto Public Health and now runs Lyba Spring Sexual Health Education and Consulting Services in Toronto.

While we are waiting for the research to catch up, here are a few things you can do:

Don’t assume your doctor is testing you for STIs when you have your regular Pap test. Ask to be tested for chlamydia and gonorrhea. If you think you may have been exposed to HIV, ask for a blood test or go to a clinic where they do point of care rapid testing.

Don’t assume a new partner has no STIs. Even when someone has been tested for the above STIs, they may have Human Papillomavirus (HPV) or herpes.

Learn more about STIs including HIV/AIDS. Your local health unit is a good source of information.

Decide on the level of risk you’re willing to take. Talk with a new partner about protection. If you have male partners, learn to use condoms.

If you trust that your doctor will not automatically reach for the prescription pad, talk with him or her about any sexual issues you have including lack of libido or vaginal dryness.

If you have a partner, talk about everything. No one can guess how you feel or what you want.

Practise talking to your mirror:

- “I use protection with my partners for three months and then we both get tested. Can you live with that?”

- “It feels better in this position because of the arthritis in my hip.” 

- “There’s something you need to know about me. I’ve had a mastectomy.”

- “You know what really makes me hot...?"

Learn about the issues of sexuality and long-term care; and if you come across what looks like abuse in a long-term care facility, report it.

Talk to other women about their experiences and share notes.