Postmenopausal Women At-Risk for Sexually Transmitted Diseases

Patient Expert

I had lunch with several girlfriends yesterday. We've all reached or are about to reach menopause and the talk turned to hot flashes, hormones and other symptoms. One of the friends mentioned that she had seen a story fairly recently about the number of sexually transmitted diseases (STDs) in older adults. I realized that I probably hadn't alerted readers in this community about this subject so I wanted to give you notice that just because you can't get pregnant doesn't mean that you won't potentially face consequences by having unprotected sex.

Surprised by this news? You shouldn't be. "It is a common myth in our youth-oriented society that older persons are asexual," Tresa Imparato and Dr. Debra Sanders wrote in the January/February issue of Aging Well. "Yet human beings are sexual beings, and feelings of sexuality do not just disappear as people age.

In fact, in good health, elders can and do remain sexually active well into the seventh, eighth, and ninth decades of life. Since sexual contact is the No. 1 risk factor for STDs and HIV/AIDS transmission, why is it that older adults are less likely to be routinely evaluated for STDs, and prevention and educational efforts, medical care, and support services aimed at this healthcare need are often nonexistent in this population?"

Back in February, CNN reported on recently published research found that 80 percent of adults between the ages of 50 and 90 are sexually active; furthermore, the number of STDs had more than doubled for people in this age group during the past decade. CNN also reported that the Centers for Disease Control and Prevention had determined that cases of syphilis and chlamydia in adults between the ages of 45 and 65 have tripled during that same time period, while cases of gonorrhea also have increased.

And often we don't even know that we're putting ourselves at risk. Many educational and prevention programs about STDs are aimed at younger individuals, not women who have gone through menopause and their partners.  "I've seen many midlife women and even great-grandmother geriatric women, freed from the burden of pregnancy concerns, throw caution to the wind and end up with serious infections," Dr. Holly Thacker, the director of the clinic's Center for Specialized Women's Health, wrote in The Cleveland Clinic Guide to Menopause.

The changes that render us unable to have babies also leave us more vulnerable to STDs. "The vaginal mucosa is more susceptible to abrasions and tears during sexual intercourse as the vaginal walls become drier and thinner, thus promoting viral entry," Imparato and Sanders explained.   Furthermore, declining levels of estrogen and progesterone could leave women more vulnerable to vaginal infections, thus creating a fertile environment for STDS.

Older women also often have difficulty getting a correct diagnosis of STD. Imparato and Sanders believe that healthcare providers may underestimate and misdiagnose STDs and HIV/AIDS in these women. Additionally, early disease symptoms - weight loss, decreased appetite and fatigue - often are chalked up to the normal aging process, not an STD.

And treatment can be more difficult. Imparato and Sanders believe that the aging immune system may limit the body's response to therapy in order to get rid of these infections. They also find that older individuals may have negative responses to the drug regiments due to interactions with other drugs they may be taking as well as drug toxicity.

So what should you do? I'd suggest following Thacker's advice throughout your life: "Any exchange of any bodily fluid can put you at risk. Mutual monogamy with a trusted partner and 'safer sex' techniques like the consistent use of a latex condom must be given high priority."

Primary Resources for This Sharepost:

CNN. (2012). Sexual activity and STD rate up among seniors.

Imparato, T. & Sanders, D. (2012). STD prevalence demands clinical awareness. Aging Well.

Thacker, H. L. (2009). The Cleveland Clinic guide to menopause. Cleveland Clinic.