Since her marriage of more than 20 years ended in divorce, Amy, a 62-year-old Texan, has had a couple of committed relationships and a handful of sexual partners.
Amy is currently seeing a man she described as a “friend with benefits,” but it’s nothing she takes too seriously. What she does take seriously is talking to him — and every partner — about safe sex practices amid rising rates of sexually transmitted infections in seniors.
“I’m very aware of it,” said Amy, who asked to use only her middle name to protect her privacy. “I require proof of negative testing before I become intimate with anyone.” She also insists on using a condom.
Between 2012 and 2022, rates of syphilis, gonorrhea and chlamydia more than doubled among those 55 and older, according to data from the Centers for Disease Control and Prevention. Research suggests many older people are unaware of these risks, and that’s keeping them from adequate screening and practicing safer sex.
Joan Price, a sex educator who focuses on senior sexuality and who is the author of “Naked at Our Age: Talking Out Loud about Senior Sex,” said she was struck by the variety of reasons older daters may not practice safe sex, or even talk about it with partners.
She often hears some version of, “Oh, I can’t get pregnant,” she said, or “Our age group doesn’t get S.T.I.s.” Men have told her they were reluctant to talk about barrier methods of protection because their erections were unpredictable, and using a condom made them go away.
She has talked to older daters who were new to the scene after a divorce or the death of a longtime partner, and who felt uncomfortable navigating these conversations for the first time in years — or perhaps ever. Women, in particular, worried they would seem promiscuous if they raised the topic of using protection, she said.
“There are so many different reasons I hear,” Ms. Price said. “But a lot of it is just lack of awareness and lack of understanding.”
People are living longer, and still having sex.
The increase in S.T.I.s in older adults is part of a broader trend, and the reasons for it are complicated. But it is possible to see the rise among older Americans through a somewhat positive lens, said Dr. Shannon Dowler, a family physician in North Carolina and the author of “Never Too Late: Your Guide to Safer Sex After 60.”
“People are just living longer and having sex for longer than they used to,” she said. “Men have benefited from erectile dysfunction drugs, and women have benefited from hormone therapies that are able to help them maintain a more pleasant sex life.”
But doctors who see older patients for routine checkups often fail to counsel them about their sex lives or to offer routine S.T.I. screening, said Dr. Mariah Robertson, a geriatric medicine specialist with Johns Hopkins University.
Dr. Robertson said the rise in S.T.I.s stems, in part, from “pervasive ageism in health care” and a society that makes the harmful assumption that older adults simply don’t have much sex.
“In an ideal world, I’d wave a wand and every primary health care provider would ask their older adult patients about sexual activity during their annual wellness visit, or even more frequently than that,” she said.
How to talk about sexual health with doctors and partners.
Amy recently had her annual visit with her gynecologist of 35 years. At the end of the appointment, she asked the nurse if the doctor intended to order an S.T.I. panel. “She said, ‘I don’t think so, but we can ask for it,’” Amy recalled.
All the experts interviewed for this story expressed dismay that it often falls on older patients to ask for testing — and to understand what that testing entails. (Screening for genital herpes, for instance, is not always included in S.T.I. tests.) But they emphasized that it was important for patients of all ages to broach the topic with their health care providers.
S.T.I.s are treatable, but the immune system weakens with age, which makes it more difficult to fight infections. “Previous infections that hadn’t flared up in decades might suddenly reappear,” Dr. Dowler said. “You see that in herpes infections particularly.”
When Dr. Hilary Reno, a professor with the Washington University School of Medicine and the medical director of the St. Louis County Sexual Health clinic, sees a 70-something patient who has asked to be tested for S.T.I.s, she does her best to normalize the notion that sexual health care is for everyone. “I don’t, perhaps, congratulate them on having a healthy sex life,” she said with a laugh. “But I do emphasize that coming in and getting tested isn’t a failure. Coming in and getting tested is being proactive about your health.”
Condoms are also an important part of S.T.I. prevention, Dr. Reno said, and this is something she points out to her patients, particularly when they note they are not concerned about pregnancy anymore. Sexually active adults who prefer not to use condoms should talk about S.T.I.s and get tested before having sex with a new partner, she said.
As for navigating conversations with potential partners, Ms. Price said the simpler the language, the better. She recommends that people say something direct and nonjudgmental, like: “I always use condoms with a new partner to protect us both. Would you prefer a certain type?” Or even just: “Your condoms or mine?”
On a few occasions, Amy has been met with pushback from partners when talking about S.T.I.s. But she said she felt much more confident having these conversations now than she would have when she was younger. When she told her “friend with benefits” he needed to get tested if they were going to sleep together, he complained that he hated needles.
She told him that was OK, and that she didn’t want to make him do anything he wasn’t comfortable with. But they wouldn’t be having sex.
Shortly thereafter, Amy said, “I got a text with a picture of his test results.”