Sex & fertility

Safe sex in midlife

by Marcy Holmes, NP, Certified Menopause Clinician

So many women coming to the clinic are telling me that they’re enjoying a renewed sex life. Whether 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! But with more Baby Boomers enjoying revitalized sex lives, the risk for women in midlife contracting a sexually transmitted disease or infection is on the rise as well.

Not long ago 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.

Too many menopausal and perimenopausal women aren’t being screened for STD’s by healthcare providers, and infection is often undetected and underreported. 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.

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 susceptibility to STD’s. So whether you’re enjoying a great relationship with your partner of many years or finding a new relationship after being widowed, separated or divorced, I’d like to talk about how sexually transmitted infections (STI’s) and STD’s affect women, particularly in perimenopause and beyond, and cover what you can do to protect yourself to have a healthy sex life at any age.

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

Whether due to age, experience or monogamy, many women (and men) in midlife think contracting an STD is a concern for the younger set, and doesn’t apply to them. Unfortunately, this isn’t true, and here’s a good example why: during my training, I saw a 45-year-old patient for her annual exam. She’d been divorced for several years and had just enjoyed a very hot affair with a much younger man in New York City. After a 20-year-marriage that ended badly, this boyfriend made her feel young again in many ways. She still had her copper IUD in place for birth control, and with her monogamous past and this nice young man who adored her, she felt she was at very low risk for contracting an STD. Unfortunately, he was under 30 and they were in New York City which made for a high-risk dynamic due to his age and the high incidence of Chlamydia in that region.

She was surprised when I suggested we test her along with doing her routine Pap and pelvic exam, but she consented. She was even more surprised when it came back positive because she was asymptomatic (without symptoms). So we discussed whether or not the IUD alone was the best choice for her as a method of birth control, since it didn’t provide any protection from STD’s. She decided 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’m finding that women today still carry much of the burden for STD screening. 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 seldom asked about STD screening, and if his doctor or healthcare practitioner hasn’t laid it on the line for him, it’s quite possible 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 or when his new partner insists on screening before having sex.

All of this means that women typically 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 susceptible to.

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 information you need, communicate with your partner and begin to seek treatment. Some infections can be readily cured, like Chlamydia, gonorrhea and Trichomonas, while others remain with you for life but may be controlled, like the herpes, HPV and genital wart viruses.

Bear in mind that STD’s are actually 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.

But the commonality of STD’s is even more reason to make sure you and your partner are screened and cleared, and this is where it’s essential 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 partners.

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 completely safe. To add more fuel to the fire, 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 when it comes to sex, no matter what form your relationship with your partner takes, or how long you’ve been together.

On top of this, monogamy unfortunately isn’t always what it seems, either. In one recent poll, about one in five adults in “committed” relationships, or 22%, had cheated on their current partner, 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 advise all women who come to the clinic, moms and aunts, and anyone mentoring 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. Mature women experience hormonal changes that can affect the integrity of our genital tissues, leaving them more fragile, and potentially more susceptible to infection if exposed. And if our immunity isn’t as strong when a trace of an infection enters our body, we’re at a higher risk for infection.

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 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. And Chlamydia of the bladder is often overlooked because it is not part of a standard urine test.

But a great strategy for protecting yourself from many sexually transmitted infections is to begin by taking good care of your vaginal ecology. Using a sexual lubricant or topical vaginal estrogen can help with tears, and a good probiotic containing healthy levels of lactobacilli and friendly yeast can also help inhibit urogenital infections.

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. In my training, I was taught that the vagina is like an amazing self-cleaning oven!

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 precautions we can take to prevent these kinds of infections as our bodies change is so important 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 talk with their partners about an approach to safe sex, especially on a first or second date. But the reality is that we need to care enough about ourselves to get over the embarrassment, 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 it’s too late. (This may be the first date for some or the fifth for others.)

I try to advise 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! And 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.

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: at this point you’ve both probably been intimate with other people, who have been intimate with other people and so on. 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 discussion, 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 are comfortable with monogamy as your next strategy for safe sex. 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 indicate that when used correctly, latex condoms are the best thing we have available to us to reduce infections transmitted through bodily fluids, like semen and blood — but only if they are put on before contact or penetration. 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 favorable numbers, but keep in mind that nothing is totally safe. Condoms can break. 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. So I encourage women of all ages to keep condoms in their purses, their bathrooms, their cars, their computer bags — wherever!

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.

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.”

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.

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.

The best sex is healthy sex

There are so many health benefits to sex, and regardless of your age, great sex is healthy sex, both emotionally and physically. Thinking about safe sex doesn’t make you selfish, nor does it lessen the excitement of your sex life in general. Far from it!

Taking care of ourselves means that 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.

Related to this article:

References & further reading on safe sex in midlife

 

Last Modified Date: 04/19/2011
Principal Author: Marcy Holmes, NP, Certified Menopause Clinician