Enjoying Safe Sex In MidLife

by Marcelle Pick, OB-GYN NP

Women sometimes wonder what is in store for our sex lives as we age. Women are commonly considered to be “over the hill” by midlife. Which is I want you to know is a completely false assumption. You still are still quite desirable. Women often come to the clinic telling me that they’re enjoying a renewed sex life. Whether we are married, single, or just re-emerging on the dating scene, more women from the “free love” generation are now starting a whole new sexual revolution. This is great news as there are so many health benefits of sex!

“At this age, I no longer care what people think about me,” one of my patients told me recently. “It’s taken me an entire lifetime to get here—but I am certainly enjoying it now!” That sense of “It’s my life, and I’ll live it as I please” also created for her a new sexual freedom, as well as a sense of being in her body rather than wondering what her body looked like to someone else. Feeling free and empowered and in touch with her body, this woman got into a new relationship in which she was able for the first time in her life to tell her partner what she wanted and to ask him what he wanted. “I can’t believe how much better the sex is!” she told me. “And I’m sixty-four! I wish I’d known this earlier, but I sure am enjoying it now. ”Did you know that the incidence of sexually transmitted diseases in nursing homes is equal to that among teenagers? In fact, having sex in their 60′s, 70′s, and 80′s is more enjoyable for many people, including women who no longer have to worry about becoming pregnant, who are no longer taking care of children at home, and who have perhaps finally come into their personal and professional power.

Midlife sexuality can be healthy, satisfying and enriching for both partners or it can become a source of physical and mental distress. The bad news is that the risk for women in midlife contracting a sexually transmitted disease or infection is on the rise as well.

Recently, one of my patients told me, “When I was younger, we only worried about getting pregnant or crabs. Now that I’m divorced, I realize it’s a whole new world!” And it’s true: the plethora of STD’s around broach all age groups and social classes in ways we just cannot ignore.

At Women to Women, we believe that talking openly about safe sex is extremely important for women of all ages. For the most part, sexual infections don’t care how old you are, but as our hormones change as we grow older, so can our vulnerability to STD’s. So whether you’re enjoying a wonderful relationship with your partner of many years or finding a new relationship after being widowed, separated or divorced. Let’s talk about how sexually transmitted infections (STI’s) and STD’s affect women, particularly in perimenopause and beyond, and then talk about what you can do to protect and educate yourself to have a healthy sex life at any age.

Too many menopausal and perimenopausal women are so overwhelmed with conflicting information about STD’s and safe sex. In addition to that, many women aren’t being screened for STD’s by healthcare providers, and infection is often undetected and under reported. Just looking at HIV, the Centers for Disease Control and Prevention recently reported that approximately 15% of all new HIV diagnoses are among the over 50 set for both men and women, and increasingly, the rate of people in midlife losing their lives to HIV is rising. This is a huge wake-up call for all of us.

Why are STD’s a concern for women in menopause and perimenopause?

Whether it is due to age, experience or monogamy, many women (and men) in midlife think contracting an STD is a concern for the younger generations, and doesn’t apply to them. Unfortunately, this isn’t true, and here is a great example why: Just recently I saw a 49 year old newly divorced woman, that had just ended a 24 year marriage very traumatically with a trial judgment and she had just begun having a hot, sexual relationship with a 34 year old coworker. This new relationship made her feel alive, beautiful, and sexy. She still had her copper IUD in place for birth control, and with her monogamous past and this nice young man who adored and cherished her, she felt she was at very low risk for contracting an STD. Unfortunately, he was young and they were in New York City. Because of the region in which he lived, this made him at high-risk for contracting chlamydia.

She was so taken aback when I suggested we test her for chlamydia along with doing her routine pap and pelvic exam, but she agreed. She was even more surprised when it came back positive, because she was asymptomatic (without symptoms). Because the IUD can be a conduit for more problems if one gets gonorrhea or chlamydia we had to talk about whether the IUD was the best option for her for a birth control method. She did decide to keep it in, but had to get used to using condoms as well for safe sex protection, and also had to learn how to say, “Let’s have the talk” before intimacy with anyone new. I can’t tell you the number of women I see that are in a new sexual relationship that are caught up in the moment and do not even consider safe sex.

What I find is that women today still carry much of the burden for STD screening, but many women in their late 40’s and over 50 are in denial and have this notion that, “it can’t happen to me”. Yet, the dangers of relying on your partner to make sure he or she isn’t carrying an STD isn’t a good idea for either one of you, but especially if you’re with someone new.

Men are not often asked about STD screening, and if his doctor or healthcare practitioner hasn’t laid it on the line for him, it’s likely your partner hasn’t been screened simply because he didn’t know his risks or his options. A man is also more likely to get tested only when his female partner has a problem he has a problem or when his new partner insists on screening before having sex.

All of this means that women usually need to ask first (no matter how “clean-cut” your partner may seem!) because there are a wide range of STD’s that women in midlife can be vulnerable to. As women we need to empower ourselves and take responsibility for our health.

Common STD’s to know about in midlife

If you do find yourself with an infection, don’t panic — speak with your healthcare practitioner and gather all the facts and information you need, communicate with your partner and begin to seek treatment. Some infections can be cured, like chlamydia, gonorrhea and trichomonas, and these are treated easily, while others remain with you for life but may be controlled, like the herpes, HPV and genital wart viruses.

Remember that STD’s are in fact very common, and it’s not something to be ashamed of. Roughly 65 million people in the United States are living with a so-called “incurable” STD, and approximately 15 million men and women in the United States develop a new STD each year — in other words, one third of all Americans have or have had an STD at some point in their lives. Remember, however that viruses are very affected by our immune system and this can be helped with many of the things we talk about in our other articles.

But the commonality of STD’s is even more reason to make sure you and your partner are screened and cleared. This is where it’s important that we communicate our sexual histories and/or begin a conversation about getting tested with our partners, even if we’ve been in a monogamous relationship for a long time.

I’ve been with the same partner for so long — should I be concerned about STD’s?

Don’t get me wrong: monogamy is a terrific strategy for enjoying safe sex, and finding the right partner and having both of you screened and cleared for STD’s is just the best recipe for healthy and exciting lovemaking! But women in monogamous relationships are not completely safe from the risk of contracting an infection. Why?

The primary reason is because of the asymptomatic nature of so many sexually transmitted infections. In other words, if you or your partner were exposed a long time ago, there’s still a possibility of transmitting a virus — and it’s not unusual for people with STD’s to remain symptom-free for years, unaware that they have an infection, or that they could be spreading one to their sexual partners. When I was just beginning at Women to Women it was not at all unusual to see a woman that had been in a monogamous relationship to have HPV, which is a virus.

Also, men are more likely than women to be asymptomatic for many types of infections, so unless your partner has been screened and goes in for check-ups regularly, there’s no way of knowing that sex is entirely safe. It might not come as a surprise that the chances of your male partner having already been (or recently) screened aren’t great — statistically, men are less likely to go in for check-ups than women on a regular basis. This is why it’s so important for women to put their health first and make it a priority when it comes to sex, no matter what type of relationship you are in, or how long you’ve been together.

A fact we must face is, unfortunately monogamy isn’t always what it seems, either. In one recent poll, about one in five adults in “committed” relationships, or 22%, had been involved in a relationship outside of the present one, and nearly half of people polled admit to being unfaithful at some point in their lives. These figures may or may not apply to you, but a reality check now and again is wise for a woman at any age, particularly since partners can carry viruses without symptoms for years.

So even if you think the chances of you having or getting an STD are very slim, I encourage all women who come to the clinic, moms and aunts, and anyone mentoring and guiding younger people, to practice what they preach to teens and start taking charge of their sexuality again by getting themselves screened.

Just like any other health issue, the more you know the better, and perimenopausal women especially have some unique preventative health issues to be aware of when it comes to STD’s.

Shifting hormones, the immune system and your sexual body

Many women don’t realize that how well we take care of our immune systems matters a great deal to the health of our sex lives. After all, our immune system greatly affects our susceptibility to many infestations. Mature women experience hormonal changes that can affect the integrity of our genital tissues, leaving them more fragile, and theoretically more susceptible to infection if exposed. And if our immunity isn’t as strong when a trace of an infection enters our body, then the risk for infection is greater. Natural hormone shifting that gives us lower estrogen levels can lead to vaginal dryness and thinning of the tissues, making them more prone to tearing during sex. Such tears, even small ones, provide an easy portal of entry for viruses like HIV. Some women need even more vaginal support in the form of localized estrogen. Without it, they can literally lose much of the integrity of the vagina. So if you’re someone who has a great deal of pain with intercourse caused by lack of estrogen, know that there are very easy and effective interventions available.

Some vaginal symptoms can be a little harder to differentiate in perimenopause, too. For example, what may seem like a fissure from low estrogen or yeast may actually be an atypical herpes presentation. Your urethra can be affected by lower estrogen as well, making it more vulnerable as a portal to infections like chlamydia and bacterial UTI’s. This is one of the things many women experience when the hormonal changes are occurring in perimenopause. And chlamydia of the bladder is often overlooked because it is not part of a normal urine test.

But a great approach for guarding yourself from many sexually transmitted infections is to begin by taking good care of your vaginal ecology. Using a sexual lubricant or a vaginal estrogen can help with tears, and a good probiotic containing healthy levels of lactobacilli and friendly yeast can also help inhibit urogenital infections. Also eating a diet that is lower in sugar and processed foods can be extremely helpful.

Most importantly, make sure that your vagina is working the way “nature” intended by avoiding douching. Douching was developed as a response to the notion that your vagina isn’t “clean,” which couldn’t be further from the truth. The vagina has its own ability to keep things well in balance without adding douching into the mix.

Many of the tiny lactobacilli naturally present in a woman’s vagina produce lactic acid, which keeps the pH of the vagina just right, along with protein inhibitors that ward off many troublesome pathogens. The vagina has everything it needs to clean itself out regularly — this is what the normal healthy secretions are for. Research shows that douching robs the vagina of these cleansing secretions, and actually increases bacterial imbalance and risk of contracting many types of STD’s, including HIV. Learning about safeguards we can take to prevent these kinds of infections as our bodies change is so significant for women in midlife, especially for women who think they’re at a very low risk for infection, and/or who haven’t spoken with their partners about safe sex.

Talking to your partner about safe sex

For many women, it can be just plain embarrassing to say the least, especially in a new relationship, to talk with their partners about an approach to safe sex. But the reality is that we need to care enough about ourselves to get over the awkwardness, and put our health and well-being first. If you think things are moving in a direction that may involve sex, talk about condoms or testing before its too late. Whether this is the first date for some or the fifth for others, it is never too late.

Communication with your partner can also make a huge difference for the both of you. Men and women tend to communicate very differently, and what may be crucial is to understand the difference so you can communicate on his terms and help him understand yours. Alison Armstrong makes the excellent point that we can’t expect our men to be like male girlfriends; that is an excellent point It may take some work on your part to learn how to communicate with that understanding in mind. Talking about safe sex is also a great way to open the lines of communication in a relationship by becoming closer and learning more about your partner I try to guide women not to feel bad when requesting their partners to get screened — STD testing for men is easy compared to the speculum exams we undergo annually!. Try simply stating that you’re planning to get tested, and that you think it’s a good idea for him or her to as well. This takes any suspicion away from one person, and puts you both on the same level. And let’s face it: most people have had other partners before and those people have probably been intimate with others as well. It’s not unrealistic to think that maybe somewhere down the line one or both of you was exposed to something. Sometimes, however, there isn’t time for testing or even a conversation, and in this case, it’s good to keep condoms with you at all times.

How protective is a condom?

At Women to Women, we recommend using condoms as the best strategy if you both haven’t been screened, and until you and your partner have had conversations and you are both comfortable that the risks are minimal. That means using them until you know that you’re both infection-free — particularly HIV-free. Since HIV can remain undetectable for up to six months, using condoms is a good idea for at least half a year, up to a full year.

Studies show that when used correctly, latex condoms are the best thing we have accessible to us to reduce infections transmitted through bodily fluids, like semen and blood — but only if they are put on before contact or penetration (leaving them on the bedside table does not count). That makes using a condom critical in reducing your risk of contracting HIV, gonorrhea, chlamydia, and trichomonas.

Statistics on the effectiveness of condoms vary a bit with how we use them. As Dr. Cheryl Gibson, the medical director of Planned Parenthood of Northern New England, points out: “Contraceptive Technology states the effectiveness of condoms for contraception at 88% in typical use, and 97% in perfect use. For STD prevention… we generally quote a greater than 90% chance of reduction.”

Those are certainly encouraging numbers, but keep in mind that nothing is totally safe. Condoms can break or be defective, plus they also only cover a limited portion of the genitals, and viruses like herpes and HPV-causing warts can be present anywhere in the genital region. But even though condoms don’t equal a free-for-all, if used properly, they are the best thing we have for protection and generally work well most of the time. So I encourage women of all ages to keep condoms in their purses, their bathroom cupboards, their cars, their computer bags, bedside dresser drawer and wherever the need may arise.

Even if we like the idea of being pursued by a new partner, I think we can be realistic at this stage of the sexual revolution. There is equality in safe sex. Women can feel empowered by keeping their own stash of condoms handy, and if he refuses to use one at all, stop and think before going any further — remember, this is your health we’re talking about.

Redefining safe sex in midlife

The risk for contracting an STD increases directly with the number of sex partners we have over a lifetime, so we want to choose our partners wisely. They should be worth it — and worthy of us. I don’t want this to scare you, but it is important to be aware. Knowledge is power.

Most of us recognize that nothing is totally risk-free other than abstinence, and even abstinence will not protect us from every kind of sexual infection. Barrier methods like condoms to prevent exposure to bodily fluids can be a great step to reduce risks. This is ideal when new partners are on the horizon and you’re not sure yet if he is “Mr. Right” or just “Mr. Right-Now.” Of course, this doesn’t mean that women over 50 should steer clear of sex, instead, we must take responsibility for our own safety. As we have mentioned, sex after 50 can be better than ever.

And remember that there’s a risk of contracting an STD at any point in your life for any sexually active woman, regardless of her age, sexual orientation, or if it’s been awhile since she was a part of “the dating scene.” Even married women and women in monogamous relationships should come in for screening. Being sexual is a wonderful thing, but taking responsibility is also important.

But if you haven’t been screened, the two pieces of wisdom to remember for practicing safe sex now are “communication” and “condoms.” Beginning or continuing a conversation about safe sex can only deepen and strengthen a relationship, and how you define those terms is up to you. We can learn so much about ourselves, and our partners, by trying. Sexually transmitted diseases (STDs) are a fact of life, and new partners (or even old non-monogamous partners) are a potential risk to your health. It’s crucial for both of you to get tested. You want to test for herpes 1 and 2, HIV, syphilis, gonorrhea, human papillomavirus (HPV), chlamydia, and hepatitis C. Please remember that HIV tests might not turn positive for as long as six months after exposure. And until the tests come in negative, use condoms for your safety.

Sex Is good for your health

I want you to enjoy sex because we now know that sex is good for your health! Daniel Amen, M.D. author of Unleash The Power of the Female brain: Supercharging Yours for better Health, Energy, Mood, Focus and Sex describes that there is an association between regular sex and regular menstrual cycles, lighter periods, better bladder control, fewer colds and fevers, reduced stress, less physical pain, and better weight control.

Women who are having regular sex tend to stay in better shape and they usually are in a better mood! Last but not least, regular sex helps balance our hormones and neurotransmitters. This is a significant piece of the puzzle that many people are not aware of.

The best sex is healthy sex

There are so many health and fitness benefits to sex, and regardless of your age, great sex is healthy sex, both physically and mentally. Taking into consideration, safe sex doesn’t make you selfish, nor does it lessen the excitement of your sex life in general. Far from it! When we take care of ourselves we’re taking care of those closest to us — focusing on your own body’s health gives you so much more to offer your partner. Practicing sex safely only means more pleasure, spontaneity and enjoyment for the both of you.

You can start protecting yourself from STD’s by making a few smart choices:

  • Choose a partner you can communicate with.
  • Get tested — and retested if necessary.
  • Choose a strategy for safe sex.
  • Strengthen your immune system.
  • Keep your vagina healthy.

The STD’s we most commonly treat in our clinic include:

  • Genital herpes
  • Genital warts/HPV
  • Crabs
  • Chlamydia
  • Gonorrhea
  • Trichomonas vaginalis
  • HIV
  • Hepatitis B