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

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Publication Date: 
Tue, 2012-07-17

By Lyba Spring

Lee figured she was getting so many yeast infections because she hadn’t had sex in so long. No amount of over-the-counter medication seemed to touch it. The funny thing was that she wasn’t even using lubricant, which used to provoke yeast infections when she was younger. No, with this guy, getting wet wasn’t an issue. So when the doctor asked her if she had ever had an HIV test, she laughed right in her face. As it turned out, the guy she was dating sometimes used cocaine on weekends. And, yes, even though he was in his 50s, he had shared needles.

Lee made assumptions about her partner. These are the same (or similar) assumptions younger people make about their partners, or for that matter, the assumptions society makes about older women’s sexual lives. The difference is that younger people have more access to information about their sexuality.

During my 30-year stint as a sexual health educator working for a public health unit, older women were not considered a “target population.” However, recent statistics indicating an increase in sexually transmitted infections (STIs) amongst seniors should encourage public health units to pay attention. Educators spend a lot of time talking with adolescents and young adults about the need for communication to promote healthy sexuality and prevent risks. Older people may never have learned or practised these skills. That makes older women vulnerable. But aside from the clear and present danger of STIs, looking at the broad picture of older women’s sexuality, it is clear to me that there are other issues to address.

Like younger women who are aware that women’s sexual pleasure is front and centre (in magazines at least), older women and their male counterparts may listen to the messages from the pharmaceutical industry offering solutions to their aging sexual systems. And as women become debilitated, they may lose control of their sexual selves toward the end of their lives (see sidebar). 

Typing “older women and sex” into a Google search yields 139,000,000 results in 0.22 seconds, most of which are porn sites. Well, I guess older women are still in the game. But even the few articles with tips for older women do not offer much more than “communicate with your partner” and “use lube.”  

However, we cannot assume that older women have regular sex partners.  A Google search for “dating sites for seniors Canada” yields 1,890,000 results in 0.32 seconds.

Research from 1999 to the present confirms what we already know: sexual activity persists well into the senior years. Libido in women is maintained until quite late in the aging process. The Journal of American Geriatrics reported in a 2011 article that self-rated successful aging, quality of life and sexual satisfaction appear to be stable in the face of declines in physical health, some cognitive abilities, and sexual activity and function from age 60 to 89.

But, the message to communicate with each other and use lube doesn’t help with the disabilities of aging like arthritis or body image issues like mastectomy. The stereotypical menopausal woman with her thinning and possibly atrophied vaginal walls, diminished lubrication and less frequent orgasm cries out, at least according to the pharmaceutical companies, for medical intervention. In a 2008 article in Geriatrics and Aging, after explaining female sexual arousal and response, the authors move straight to the hormone solution to rectify low libido. After devoting a few pages to testosterone therapy, they allow two short paragraphs to an alternative vision: that there might be psychosocial issues that play a larger role in defining the female sexual response; and that serum and androgen levels do not necessarily correlate with the degree of sexual interest or arousal.

The medicalization of female sexual dysfunction has pharmaceutical companies seeking the elusive magic bullet equivalent to those little blue pills for men.  However, an alternate perspective on so-called “female sexual dysfunction” by the grassroots New View Campaign indicates that the pharmaceutical companies seem to have missed something crucial: the psychosexual issues.

Newly single older women may be coming out of long-term relationships because of death or divorce. Those who are fortunate enough to find a new love may very well prove the old maxim that female sexuality is situational. A woman who was in a loveless relationship, with the lack of desire and lubrication that went along with it, may find herself—with a new partner—as frisky as a girl and awash in vaginal juices. She may throw away the lube and the Replens, but forget to reach for the condom, if her new partner is male.

Here’s the rub.

According to the Public Health Agency of Canada (PHAC), STIs are on the rise for people in their 40s and 50s. In an article that appeared in the January 2010 issue of the journal Sexually Transmitted Diseases, four researchers reported that the rates at which these STIs were increasing between 1997 to 2007 in Canada were higher among the middle-aged—those between 40 and 59—than among those 15 to 29.

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.


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.