A challenge concerning seniors of all genders is the stigma around testing and lack of discussion about safe sex practices. According to a 2007 study in the New England Journal of Medicine only 40 percent of men and 20 percent of women above the age of 50 talk to their doctor about sexual health.
John O’Keefe is trying to change that attitude. As the senior social worker at retirement care complex Northwood, O’Keefe says a contributing factor to this attitude is many seniors have had a low number of partners, and many have been in a monogamous relationship for decades. Combined with the loss of concern over pregnancy, safe-sex discussions are foreign and uncomfortable topics.
This type of life experience makes many seniors nervous and unsure about how to initiate new relationships once their spouse has passed away, O’Keefe says. His goal then “is to create an environment where you could come in here and have a lifestyle that’s not different than the kind of lifestyle that you’d want to try to maintain as a normally functioning person...and intimacy is a big part of that.”
While STI rates remain lower for seniors than their younger counterparts, age carries both biological and social challenges with respect to sexual health. Chlamydia is the most commonly occurring STI in Nova Scotia. According to Capital Health statistics, the disease has been on the rise for a decade—primarily in the typical 20 to 24 age group, but the increase can be seen across the spectrum.
“Frequency of sex and of multi-partner sex is naturally lower,” says John Britton, the director of the Halifax Sexual Health Centre. “Obviously the STI transmission rates are going to follow suit. But it’s very ignorant to think that it doesn’t happen.”
In fact, body changes due to age create ideal conditions for disease transmission, particularly in women. “As a woman ages and as her vagina changes, the risk of STI transmission can go up,” says Britton. These changes include shortening and narrowing of the vagina and loss of natural lubrication. That becomes a primary cause of pain during intercourse and increases friction. “Something that we’ve noticed on a national and global level is that there is an increase in older people contracting HIV,” says Britton. “When you look at the vagina as it’s aging, it’s getting drier and the friction is higher and the walls of the vagina get a lot thinner, HIV transmission is a lot more biologically easy.” Britton says the stigma is largely due to a generation gap: “People of a certain age don’t identify with the safe-sex messaging.”
For O’Keefe, the biggest issues around the sexual health of seniors are emotional. As physical mobility and well-being are effected, “sexual behaviour loses its physical focus and becomes centred around companionship.” Many seniors also develop mental health concerns which can affect their sexual behaviour. O’Keefe cites as an example someone with dementia who may forget that they are still involved in a decades-long marriage and try to strike up a new relationship. Or as cognitive inhibition becomes compromised, residents may unwarily behave inappropriately in public. Residence staff must also monitor the ability of mentally compromised residents to consent to sexual activity.
Despite these challenges O’Keefe encourages romantic and sexual activity among seniors. For him, the biggest challenge is not disease or dysfunction, but facilitating these relationships to happen in an open and healthy way.