Seniors & STDs
Is it time to have “the talk” with mom or dad?
By Jayne Jacova Feld

opener (4)Two years to the day Flora Reisman lost her husband after 52 fulfilling years of marriage, a man entered her life who made her think she could take a chance on love again.

Victor was a friend of a friend, and from their first phone conversation, he piqued her interest. A refreshing contrast to the men she had encountered through online dating, he was a good conversationalist, healthy and genuinely seemed interested in getting to know her.

Relaying this exciting information to her grown daughter in Florida, Reisman, 82, expected some words of encouragement.

“But the first words out of her mouth were, ‘Just be careful, Mom. Down here in Florida, venereal disease is rampant,’” the Marlton resident recalls. “I said to her, ‘Honey, I haven’t even met him yet and you already have me in bed with him?’”

To be sure, this is not the kind of conversation one expects of an adult daughter and her aging mother. But the reverse sex talk, in which grown children counsel their parents about the dangers of dating in the modern world, should be happening ? STAT.

In an age when older people are living longer and healthier lives, their interest in sex remains robust well into the golden years. Several major surveys report that among people ages 60 or older, more than half of men and 40 percent of women are sexually active. For many like Reisman, new partners usually enter the picture after years of monogamy, either following the death of a spouse or after divorce. But free from the worry of unwanted pregnancy, unaware of or in denial of the dangers of sexually transmitted diseases, the sex they are having is often unsafe – and puts many of them at risk of contracting sexually transmitted diseases (STDS).

Mirroring trends of rising STD rates across the demographic spectrum, since 2007, the incidence of syphilis among seniors, those 65 and older, has increased by 52 percent. The number of chlamydia cases has risen 32 percent, according to the Centers for Disease Control and Prevention. Areas with the highest number of reported incidences are in Arizona and Florida, where retirement communities are robust. But it’s not just a phenomenon here in the United States; the United Kingdom is seeing similar increases.

In South Jersey, the STD rate for seniors has been consistent over the past few years and not overly concerning, which is not to say that seniors are not at risk, says Susan Stewart, a nurse practitioner who oversees Camden County Department of Health’s STD clinics.

“Even though we tend to see more young people and their incidence rate is higher, older people are at risk also,” notes Stewart. “They often don’t use condoms, because they don’t think they’re at risk. Their inability to recognize their risk is a problem.”

A combination of causes is behind the rise in STDS among the elderly, including age-related changes to the body, medical advancements like testosterone-boosting Viagra, a lack of education or experience with condoms, as well as ageism. Then there’s also the housing patterns of seniors, many of whom have downsized following the emptying of their nests.

“People don’t want to be alone, they don’t want to be isolated, and sexuality is a normal expression of that,” says Rabbi Richard Address, a Cherry Hill resident who hosts the weekly Boomer Generation Radio show on WWDB AM 1060. “But people still carry with them a lot of myths, legends and unknowns about sexuality. The idea that, ‘I’m 79 years old and can’t get a disease because that doesn’t happen’ is part of the mythology.”

On the contrary, experts say older people are actually more susceptible to catching diseases, because the immune system weakens with age. There are also issues particular to gender: For women, perimenopause causes a decrease in lubrication in the vagina. With the friction of intercourse, women are vulnerable to micro abrasions. For men, erections (absent Viagra and other testosterone-enhancing medications) are not as firm with age, which makes condom use frustrating. In addition, many aren’t aware that condoms have improved dramatically since they were young.

“Their memories are of using condoms when they were younger, and they couldn’t get much sensation,” notes Melanie Davis, a certified sexual educator and partner at the New Jersey Center for Sexual Wellness. “They really need to be educated that there are a lot of better products out now that are very thin and transfer heat.”

In surveys of people older than 50, a condom was not used in sexual intercourse with 92 percent of casual partners, 76 percent of friends, 70 percent of new acquaintances and 33 percent of transactional sexual partners, according to a 2008 National Survey of Sexual Health and Behavior.

Another common misperception is that only intercourse leads to STDs. But oral sex is also a danger, says Allen Seftel, MD, chief of urology at Cooper University Health Care.

“It’s not ingrained in their culture,” says Seftel. “They’re not used to using condoms and just don’t understand them. In contrast, younger folks are used to it. It’s like growing up with an iPad or computers for them.”

While primary care doctors should be giving precautionary advice, it is often outside their comfort zone, he says.

“Doctors try to keep it positive to help them get rid of all their guilt and concerns,” he notes. “They don’t want to hit them with, ‘By the way, you could get an STD.’ Talk about a way to ruin the conversation.”

Even when doctors do inquire about an elderly person’s sex life, adds Davis, they often are not asking the right questions.

“They are not necessarily asking what kind of sex their patients are having,” says Davis. “Maybe they’re not having it with a lifetime partner or they’re paying for sex. There’s a lot more questions that need to be asked other than, ‘Are you sexually active.’”

Sex is also a typically taboo topic at nursing homes and assisted living centers, says Davis. But even when progressive staff want to provide condoms and education, there are impediments.

“Usually it’s the adult children who don’t want to even think about their parents having sex,” she says. “People in these homes don’t have their own money. What are the odds the children are going to bring their parents condoms?”

In the case of STDs, seniors are often the ones too embarrassed to bring up the topic, notes Stewart of the Camden County health department. Often people will travel great distances for testing and treatment at the clinics, she says, noting that every county offers free clinics.

“We’ve heard from seniors that they come to the clinics because they’ve known their doctor for years and feel uncomfortable talking to their doctor about it, “ she says, noting that the clinic provides treatment, education and condoms. “They don’t want any billing to come to the house, even though it’s confidential.”

Reva Farenback-Brateman, a social worker with Samost Jewish Family & Children’s Services, previously ran a social support group for widows and widowers called New Beginnings. More recently she hosted Encore, a discussion group for single seniors. Naturally sex and dating were topics of conversation – but not as often as you might think.

Some members were dating – she thought there was even going to be a marriage at one point – and others were on the lookout. She did arrange special programming with both groups on dating and sex. For New Beginnings, the session was called “Dating, sex and all that jazz.” Men and women were separated to encourage more candor. The Encore group took in a play about dating later in life that generated a lot of discussion.

When dating did come up, it seemed other issues were just as concerning – if not more – than STDs. For example, many were getting their feet wet with online dating and worried about being misled by scams.

“The women would sometimes complain the men were too fast,” Farenback-Brateman adds. “Most women would say they didn’t want to get married again. They wanted companionship.”

Charles Stein, 75, whose wife passed away several years ago after a long marriage, says his ideas about dating have evolved over time. When he first felt ready to date again, he admits to being preoccupied with the idea of finding someone just for sex.

“Regarding the STD risk, I wasn’t even thinking about it,” admits Stein, a South Jersey resident who was a regular with the JFCS groups. “I was too anxious.”

Lately, however, after a few dates with a woman he is starting to really care for, he is intentionally not rushing intimacy. This one, he says, has potential to be a “rest of my life” thing.

Also, he says he is now more willing to admit that unprotected sex is dangerous.

“I’m very active and in good health, but things can change fast when you reach three quarters of a century,” he says. “After giving it some thought, you realize you’re taking some risk.”

Still, for now, he has not had to confront the issue.

“There’s certainly no harm in getting tested, but it’s something that has to be handled delicately,” he says. “Speak to me in about two or three months and hopefully things will have advanced to that level.”

July 2016
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