Older adults are having sex, and they’re getting STIs, too
“Any falls in the past 90 days? Are you sleeping okay, getting enough exercise, eating well? What medications are you taking?” My primary care doctor asked the questions you’d expect at the annual physical of someone who had just turned 60.
There was one topic she didn’t mention, though. Even though she knew I’d recently been divorced, the doctor didn’t ask if I’d become sexually active, nor did she talk to me about screenings for chlamydia, syphilis, gonorrhea or HIV. I’m a little embarrassed to admit that I didn’t ask her about sex, either.
In my younger years, checkups typically included at least a mention of safer sex. Granted, the topic wasn’t as pressing during my married years, but now that I was single, why wasn’t sexual health on the checklist? Because I’m… “old”? Because older people don’t have sex?
“Unfortunately, a lot of providers perceive that older adults don’t have sex, that they don’t want to have sex, or they cannot have sex, and that’s simply not true,” says Matthew Lee Smith, an associate professor in the health behavior department at Texas A&M’s School of Public Health.
Well, in fact, older people are having sex. Not only that, they like having sex. According to a new study from the National Poll on Healthy Aging, 4 in 10 adults ages 65 to 80 report being sexually active. More than half say sex is important to their quality of life. That’s the good news.
Here’s the bad: Sexually transmitted infections (STIs) are surging among older adults, according to the Centers for Disease Control and Prevention. Cases of gonorrhea among those 55-plus have grown about 600 percent since 2010. Chlamydia cases have quadrupled, while syphilis cases are now nearly 700 percent higher than in 2010.
What’s going on?
“Rising divorce rates, forgoing condoms as there is no risk of pregnancy, the availability of drugs for sexual dysfunction, the large number of older adults living together in retirement communities, and the increased use of dating apps are likely to have contributed to the growing incidence of STIs in the over 50s,” said Justyna Kowalska, a professor of medicine at the Medical University of Warsaw and author of a 2024 study on how to manage STIs among older adults, in a news release about the study.
Mary Susan Fulghum, a retired OB/GYN in North Carolina, is on a mission to educate older people, primarily women, about rising rates of STIs, and often speaks to church groups, book clubs, community groups - such as nursing homes and retirement villages.
“I have felt a need to explain and identify risk factors,” she told me, “and let people know it’s okay to talk about it to the doctors.” On occasion, the women she talks to seem shocked - at one event an older woman told her, “I can’t believe you are actually talking to a group about this.” But more often the older women exhibit a mix of curiosity, gratitude and some denial.
Experts offered five reasons that help explain why STI rates are rising among older people:
- Older adults tend to underestimate their risk. “These individuals have limited knowledge about STIs - transmission, symptomology and ways to prevent them,” Smith said. He notes that educational resources are not readily available in senior centers, residential communities or doctors’ offices. And who wants to be the one to ask for them? Fulghum agrees, which is why she goes to those in need of resources. “These people have been smart their entire lives. ... They want to know what to do and they will do it,” she said, noting that older adults may need encouragement and support about how to make smarter choices.
- Providers have their own issues about discussing sex. Texas A&M’s Smith acknowledges that most health-care providers don’t talk to their patients about sexual needs, behaviors and desires - a significant proportion of providers believe that their older patients aren’t generally having sex, so “they’re not testing older adults for sexually transmitted infections.”
Fulghum suggests that if doctors feel uncomfortable having these sorts of discussions, “it’s their responsibility to make sure they have the resources in their office to make things as comfortable as possible” for patients. One suggestion she has for male providers: turn to a female associate - another doctor or nurse practitioner - who may be better able to communicate with female patients.
Chris Skidmore, deputy director of Whitman County public health department in Washington state, said time-crunched providers often focus on “larger health concerns of folks at that age, like heart disease, diabetes, arthritis and cancer” rather than sex education.
- Older adults tend to shy away from condoms. Those over 55 may associate using condoms with avoiding pregnancy, not preventing STIs.
“This generation rarely considers using protection because they came of age when sex education in school did not exist, HIV was virtually unheard of, and their main concern … was to avoid pregnancy,” wrote Janie Steckenrider, associate professor of political science at Loyola Marymount University, in a study published in Lancet Healthy Longevity.
Fulghum recommends anyone starting a new sexual relationship be tested for STIs. “From there you can move the conversation towards condoms,” she said, adding rhetorically, “What 70-year-old woman is going to go into a drugstore and ask to buy condoms?” (Note: They’re generally in the family planning aisle; it’s also easy and more private to buy them online.) Fulghum said it’s important that both partners take responsibility for buying and using condoms, regardless of gender.
- Older adults aren’t comfortable talking with new partners about their sexual histories. Those dating again after being widowed or divorced can find themselves in uncomfortable terrain, Smith said, but conversations about sex are important - to assess risk - even if challenging. Some relevant questions to ask a new partner include: Have you had unprotected sex? When were you last tested for STIs? Timing is everything: Have that talk before you have sex. Anyone hooking up via an app - which older folks are doing - has even more reason to use protection.
- New medications are helping older people remain sexually active. There are drugs for erectile dysfunction as well as injectable medications that can help a man achieve an erection (typically after prostate removal). According to the Michigan study, nearly 1 in 5 men had taken medications or supplements to boost sexual function. For postmenopausal women there are FDA-approved treatments for vaginal dryness, painful sex or low libido.
So what can be done to stop or slow rising STI rates among older people? Experts have two main suggestions:
- Sexual health screening questions should be part of every older adult’s routine checkup. And STI testing should be offered when warranted.
- Patients who are sexually active, or planning to be, need to be proactive with their doctors. It can be a challenge to talk with a health-care provider about sex, especially with a physician who may be much younger (more common as we age) or of a different gender or sexual orientation. If you’re not comfortable, seek out a new provider who might be a better match - or ask for someone in the practice who might be a better match.
Finally, as Fulghum said, “Our problem is that [younger] people don’t like to think about older people having sex. … Old people aren’t supposed to do things like that any more.” Except they are, she said, adding that she reminds her older audiences that sex is supposed to be a “fun kind of thing” - and safe. Even when you’re older.
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