Sexually transmitted diseases aren't just a problem of the young. Older people can suffer from them, too. In fact, there are several reasons why older adults may actually be in more danger from STDs than their younger companions, including:
- Lack of regular screening for sexual problems can increase the risk of a disease going unnoticed for years, leading to serious complications.
- After menopause, women's vaginal tissues thin and natural lubrication decreases. This can increase the risk of micro-tears and of sexual transmission of certain diseases such as HIV/AIDS.
- Older people are less likely to use condoms, both because they don't consider themselves to be at risk of STDs and because they were never educated that condoms should be part of their sex lives.
- The immune system naturally becomes less effective as people age, which can also increase the risk of sexually transmitted infections.
The Size of the ProblemMore than 60% of individuals over 60 have sex at least once a month, and yet they are rarely considered to be "at risk" of an STD. Furthermore, even those elderly adults who are no longer sexually active may still have a sexually transmitted infection for which they were never treated or screened, and the long term neurological side effects of diseases such as HIV and syphilis may be easily mistaken for other diseases of aging.
It is therefore essential that not only older adults, but the individuals who care for them, be educated about STD risk in the elderly. Additionally, older individuals, and their caregivers, need to be taught about safer sex, so that they know how to reduce their risk if, and when, they choose to engage in sexual activity. Sex can be an important part of a person's life, no matter what their age. It's important that everyone learn how to engage in it safely so that it enhances their health rather than damaging it.
HIV: A New Problem for Older Adults
Recent statistics from the CDC have shown that the number of new HIV infections is actually growing faster in individuals over 50 than in people 40 years and under, and HIV may just be the tip of the iceberg. Numerous factors have contributed to the increase in sexually transmitted diseases in the elderly, and many of them stem from a single problem. Namely, clinicians and scientists don't spend enough time thinking, or talking, about older individuals having sex. Not only are the elderly usually overlooked in many STD studies, but they are frequently less likely to get screened for STDs than their younger counterparts.
Part of the problem, at least, is addressed by the new CDC screening guidelines which, among other things, recommend that health care providers screen all patients between the ages of 13 and 64 for HIV as part of their regular visits. In this age, when divorce rates are up and Viagra and other erectile dysfunction medications are available online, sex among the elderly may be at an all-time high.
Every year, thousands of women in the United States die from cervical cancer. Most of these deaths should never occur. Cervical cancer is largely a preventable disease. Caused by the sexually transmitted virus HPV, regular cervical screening via Pap smear is an effective way to catch early cancerous changes before they can start to cause problems.
One of the many reasons why the incidence of cervical cancer rises so quickly in older women is that many women, once they stop needing birth control pills, stop going to their gynecologist. Although Pap smears can be done by any clinician, many older women are reluctant to seek out the discomfort of a sexual health exam, particularly if they are unmarried, not sexually active, post-menopausal, under-insured, or have a limited income. Older women may also be reluctant to be screened for something that, in its early stages, has no symptoms and for which they perceive themselves to be at little risk.
Screening, however, is essential. It can take a decade or more for an HPV infection to develop into the early stages of cervical cancer. Although screening guidelines vary by organization, in general even older women who are not sexually active should still be considered to be at risk.
If you are a woman, aged 55 or older, it is important to talk to your doctor about how often you need to be screened for cervical cancer. Most women will need to be tested every couple of years, but certain women who are considered to be at very low risk may be able to stop screening after a certain number of negative tests. If you have a woman in your family of that age, such as a mother or a grandmother, make certain she knows she needs to be regularly tested. It could save her life.
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Leach, CR et al (2007) "The Vicious Cycle of Inadequate Early Detection: A Complementary Study on Barriers to Cervical Cancer Screening Among Middle-Aged and Older Women" Prev Chron Dis 4(4): http://www.cdc.gov/pcd/issues/2007/oct/06_0189.htm. Accessed 10-1-07.
Lindau ST et al (2007) "A study of sexuality and health among older adults in the United States." N Engl J Med 357(8):762-74.
M-M.G. Wilson (2003) "Sexually transmitted diseases" Clin Geriatr Med 19: 637–655