Guest Post by Dora Flores-Ryan, MSN, RNC, CNM, WHNP-BC Chair, Education Committee, National Association of Hispanic Nurses–Garden State Chapter
Four years ago, several of my coworkers and I found ourselves pondering a dilemma. I must tell you that as nightshift nurses go we tend to be a tight group. Being health care providers where we work a lot of hours, weekends, and holidays, we are very much like family. Just like family, we talk and share almost everything. One autumn, several of us were preparing to send our sons off to college. Like most parents, we shared in their excitement of going away to college and cringed at the thought of the unrestricted opportunities they could experience with the female co-eds on campus. Why worry so much, you say? Or you could also be asking, “Isn’t it a little late for that?” The reality is that we really did not want to revisit “the birds & the bees talk” with our kids again, but we did want to impress upon them something much more important that spans across all life spans: Sexual Health.
In honor of April being National Sexually Transmitted Disease (STD) Awareness Month, this blog post takes a closer look at sexual health among the senior population.
Sexual health is so important that in A Public Health Approach for Advancing Sexual Health in the United States, a CDC key point defines sexual health as a, “steeple of physical, emotional, mental, and social well-being in relation to sexuality and is not merely the absence of disease, dysfunction, or infirmity.” (December 2010). As more and more Baby Boomers approach retirement, they bring with them sexual behaviors that are more open and accepting than previous generations. Talking to these senior “free-spirits” about sexual health is often an uncomfortable subject to broach, but is actually very important.
What do we know? We know that seniors, especially those that are generally in good health are sexually active, and we also know that unless we initiate those conversations in the healthcare provider’s office, they are not very likely to share or ask any questions. While sexual frequency could be found to decrease with age, sexual satisfaction continues to be important in the lives of older Americans. Baby Boomer ideology aside, multiple factors appear to be contributing to the rise of sexually transmitted infections in this age group.
For one, we are living longer. The average life expectancy in the U.S. in 2013 was 78.8 years, with males averaging 76.4 years and females 81.2 years (CDC, 2014). With people living longer and being in better health later in life, there is an increased chance for people to have more sexual partners. Higher divorce rates also play a part in increasing this number. Also suspected is the rise of senior-only communities, assisted living, and even nursing homes, as well as the introduction and increased use of medications for sexual dysfunction, such as Viagra, that have given rise to increased rates of STIs in this population. While the latest CDC statistics show that STI rates are highest amongst those ages 15-24, statistics also show that between 2007 and 2011, chlamydia infections rose 31% and syphilis rates were as high as 52% among Americans ages 65 and over. (CDC, 2013) Persons aged 55 and older accounted for 26% of the estimated 1.2 million people living with HIV infection in the U.S. in 2011 (CDC, 2013).
Whether one finds themselves on either side of sexually transmitted infections, younger or older, the staggering estimated costs are shocking. CDC’s new estimates show that there are about 20 million new infections in the United States each year, costing the American healthcare system nearly $16 billion in direct medical care. (CDC, 2013)
Given that outlook, it becomes clearer why we need to revisit the “birds and the bees” talk.
- Avoid Infection: Believe it or not, those STDs (Sexually Transmitted Disease) now called STIs (Sexually Transmitted Infections) are alive and well in the 21st century. Why? Simply because we continue to engage in unsafe sexual practices; the majority of older Americans do not practice safe sex even if they have multiple partners. (CDC, December 2010). Although we can cure some sexually transmitted infections with antibiotics/antifungals (Chlamydia, Gonorrhea, Trichomonas, Syphilis), some infections, like syphilis, can have long lasting effects if not treated in time. Viral STIs, like herpes and HIV, are with us for life, and while they have become more manageable to some degree, they are not curable. So what can we do? The answer, first and foremost, is to practice the art of self-preservation. It is important to remember that in most cases it is not just good enough to be treated when an infection is acquired, but in all cases it is important that sexual partner(s) are also treated so as to avoid re-infection.
- Protection: Although many regard them as something for teenagers, young adults or those who are not in monogamous relationships, condoms continue to be a great defense to avoiding and transmitting sexually-acquired infections. Today, not only are there a wide variety of condoms types, but female condoms are also now available. with any method of protection, it is important to remember that nothing provides 100% safety, but with proper use and consistency, condoms can effectively provide protection against infections.
- Know the Signs: Knowing what to look for when suspecting a sexually transmitted infection can help, but be aware, not all STIs have obvious signs and symptoms. Several STIs, (Chlamydia, Gonorrhea, Trichomoniasis) can cause vaginal/penile discharge. Pain in the pelvis for women and burning on urination for men and women, as well as abnormal vaginal bleeding in women may be a possible symptom. Herpes is characterized by red bumps that turn into painful blisters/sores on genitals and elsewhere. Syphilis may appear as a single sore (chancer) in the first stage and can include a rash (often in the palms of the hands, soles of the feet, or genital area) in the second stage. Hepatitis B virus and HIV may not have obvious symptoms initially, but flu-like symptoms such as lack of appetite, nausea and vomiting, darkening of urine and tenderness in the stomach are initial signs of possible hepatitis exposure, and flu like symptoms along with weight loss, diarrhea, persistent fevers, night sweats, and headaches can indicate possible HIV infection. Remember, while all of these symptoms may or may not result with a positive sexually transmitted infection, none are normal, and you should seek medical care.
- Provide(r) Trust: Your sexual health depends on a variety of things, but the first and most important is a genuine commitment to not just enjoying being sexually active, but being willing to care for yourself and for the health of others you love or become intimate with. Avoiding sexually transmitted infections and getting treatment for you and your partner if infected is something all of us can do; being open, honest, and educating others about sexuality and sexual health is another. So please, ask that awkward or uncomfortable question you have, and I mean that to both you and to health care providers. Provide a culture of trust and environment where conversations flow easy and casual, no less important but displaying a genuine concern for sexual health. Remember that everyone comes from a different background and sexuality may be an uncomfortable or even painful subject.
- Pleasure: Yes, sexuality is mostly always associated with pleasure and yet for many that is not the case; it can be embarrassing, uncomfortable, painful and even not that important. There are such things as sexual dysfunction and sexual aversion. Both can be very challenging, and yet there is always the possibility of treatment or not depending on your choice. Sexual health is not just about sex; it’s also about intimacy. The most important thing to remember is that sexual health is a part of you and, just like you, is ever-evolving. While some of you might decide it’s not for you or you’ve had enough sex to last you a lifetime or two, and are not interested in that anymore, remember that you do not have to be sexually active to share intimacy or the pleasure of another’s company.
So what happened to the kids in college? Our sons graduated this past spring: STD- and parent-free, with a college degree!
You can find more detailed information by visiting the websites in the references. Article submitted on behalf of National Association of Hispanic Nurses-Garden State Chapter. Visit us at www.GardenState-NAHN.org.
Centers for Disease Control and Prevention (December 2010) A Public Health Approach for Advancing Sexual Health in the United States: Rationale and Options for Implementation, Meeting Report of an External Consultation, Atlanta, Georgia: www.cdc.gov/std
Centers for Disease Control and Prevention (July 2015) HIV Among People Aged 50 and Over. Atlanta, Georgia: www.cdc.gov/hiv
CDC Fact Sheet: (February 2013) Incidence, Prevalence and Cost of sexually Transmitted Infections in the United States. Atlanta, Georgia: www.cdc.gov/std
National Center for Health Statistics (2014). Health, United States: With Special Feature on Adults Aged 55-64. Hyattsville, MD. www.cdc.gov.nchs
Poynten, I. M., Grulich, A. E., & Templeton, D.J., (February 2013). Sexually Transmitted Infections in Older Populations. Current Opinion in Infectious Diseases. 26, no. 1, 80-85. Lippincot Williams & Wilkins. DOI: 10.1097/QCO.ob013e32835c2173