A Guide To Sexual Health & STDs in Seniors

Are Older Adults Still Sexually Active? 

While many people may believe that people suddenly stop having sex when they reach a particular age, the truth is that many older adults continue to enjoy an active sex life well into their later years. Although sexual interest and activity tend to decline with age, studies indicate that 73% of Americans aged 57 to 64 are still sexually active. More than half of all people between 65 and 74 are still sexually active, and 26% between 75 and 85 are still active. Furthermore, people with dementia may become hypersexual, meaning they have more interest in sex than previously.

Misconceptions About Older Adults and Sex 

Many younger people hold incorrect views about seniors and sexual activity. Common misconceptions include:

• Lack of desire: Many people believe that seniors have no sexual desires. However, most people retain interest in sex for their whole life. Although sexual acts may change, seniors still desire intimacy.
• Inability: A common misconception is that seniors are physically unable to have sex. Barring specific disabilities and health conditions, most seniors can still enjoy a healthy sex life. Medications and lubricants can help to enhance performance and pleasure.
• Danger: Some people believe that it’s dangerous for seniors to have sex. They may think it increases the risk of heart attack, stroke, high blood pressure and other complaints. On the contrary, for many seniors, a healthy sex life can actually enhance overall well-being.   
• Protection: Because there’s no risk of pregnancy for postmenopausal women, many people believe seniors don’t need to use protection when they have sex. However, sexually transmitted diseases are a serious threat regardless of a person’s age.   

Improving Sexual Health Education for Seniors 

Seniors may have received inadequate sex education when younger and believe common myths about sexual health and STDs. These are some topics that sex education classes for seniors should cover:.

Preventing STDs

Many seniors grew up during a time when it was even more taboo to talk about sex than it is today. Sex education was often limited, and many seniors have inadequate awareness and knowledge of the risks of unprotected sex. Older individuals generally have a lower understanding of how STDs spread and how they can be prevented, and studies have found that condom use is lower among the older generations.

Senior sex education should begin with the assumption that older adults know nothing about STDs and start by providing basic information. It’s important to inform seniors about diverse transmission methods, including vaginal, anal and oral routes, discuss how male and female condoms can reduce the risk of transmission, and detail common signs and symptoms of STDs.

Sex education should also emphasize that seniors shouldn’t feel ashamed to approach a health care professional if they have any concerns or wish to undergo tests. It’s also vital that seniors understand the need for general abstinence while undergoing treatment and the importance of informing their sexual partners so they can also get tested and treated if necessary.       

Addressing Changes in Libido

While many seniors are sexually active, libido tends to decrease with age for both men and women. Sex drive changes may be concerning for those who previously enjoyed active sex lives, so it’s beneficial for seniors to understand that changes are to be expected. It’s useful for seniors to learn how libido typically changes for people of different genders, along with medications and tips that can help restore sex drive.  

Seniors in relationships may find their libido is different than their partner’s, with one wanting more frequent sexual activity than the other. Senior sex education should discuss this possibility and give older adults the tools to communicate, compromise and navigate their new sex lives.

Dementia can affect a person’s libido and sexual preferences. For example, individuals may become more interested in sex, lose all sex drive or start acting differently, such as masturbating more or touching strangers inappropriately. Senior sex education should include the common effects of dementia, taking into account the perspectives of individuals, couples, family members, caregivers and bystanders.       

Dealing With Sexual Problems

Seniors may desire sex but face an array of physical or emotional barriers. For example, seniors who have lost a long-term partner may feel guilty or shy about having sex with someone new. Mobility issues or pain can cause difficulties in physically performing certain acts. Certain illnesses or health conditions can cause sex-related problems for older adults.

Sex education should cover common issues, possible ways to overcome these issues and the importance of open dialogue with a sexual partner. Education should also emphasize that seniors shouldn’t feel shame in seeking advice from a healthcare professional, such as a physician, therapist, nurse or counselor.      

Maintaining an Enjoyable Sex Life

Sex education for older adults should include a variety of practical tips and advice for maintaining sexual fun and intimacy. For example, it should cover ways that seniors can still safely enjoy sex with various health conditions, after surgery, with reduced physical functioning or with a new partner. Topics may include:

• Trying new positions or acts
• Considering using toys
• Discussing medications and hormones with their doctor
• Using adequate lubrication
• Exploring different ways to be intimate
• Setting the mood for intimacy
• Exercising and maintaining physical health
• Getting appropriate nutrition and sleep
• Increasing body confidence

Consent

Sexual consent is an important topic for people of any age, especially those who may be more vulnerable. It’s vital that seniors understand how to give and receive informed consent. Discussions surrounding consent should include people who are nonverbal, have dementia or have mental disabilities. It’s also paramount that older adults know how to report any unwanted sexual contact or abuse and feel comfortable approaching caregivers for assistance if necessary.  

How To Protect Older Adults From Contracting STDs in Senior Living 

While anybody is potentially at risk of contracting an STD in a retirement community, some people have a higher risk than others, including:

• Individuals with dementia
• Women
• Seniors with compromised immune systems
• Individuals who have sexual relations with multiple partners
• Seniors who practice anal intercourse

Common STDs Affecting Seniors in Retirement Communities 

Although seniors can be affected by any STD, some are more prevalent in long-term care facilities than others. The overall prevalence of STDs is increasing, including within the senior population. Looking at adults aged 55 or over, cases of gonorrhea increased 164% over a 4-year period between 2014 and 2018. Syphilis cases increased by 120%, and chlamydia cases rose by 86%, per statistics from the CDC.

Common STDs can lead to a wide range of health conditions if left untreated. Seniors could potentially contract any sexually transmitted disease, including:

• HIV
• HPV
• Genital warts
• Herpes
• Hepatitis
• Trichomonas vaginalis

Sexual contact may also trigger bacterial vaginosis or yeast infections. Seniors may pass on diseases typically transmitted through close contact, such as Shigella flexneri and Neisseria meningitidis.

How To Protect Seniors from STDs in Retirement Communities 

Basic measures in memory care units, assisted living communities, nursing homes and retirement homes can help to reduce the spread of sexually transmitted infections. These include:

• Continuing sexual health education for residents
• Visual reminders, such as posters, reminding people to practice safe sex
• A wide selection of literature that explains sexual health in easy-to-understand terms
• Availability of protection, such as condoms
• Confidential counseling and nursing services
• Readily available STD tests, including blood, urine and fluid swab tests
• Routine health screenings
• Availability of medication to treat STDs

Identifying Possible Signs of Sexual Abuse 

Sexual violence is sadly fairly common. Unfortunately, studies show that sexual abuse sometimes occurs in residential senior care facilities. Perpetrators of abuse may be members of staff, visitors to the facility or other residents. Victims sometimes know the perpetrator. Sometimes, they're strangers. Abuse may be systematic or a one-off occurrence. Statistics differ regarding the prevalence of sexual abuse in nursing homes, although it’s likely that abuse in institutions is under reported. Although sexual abuse can affect people of any gender, females are the most common victims. Individuals with dementia are especially at risk, largely because of their enhanced vulnerability, reduced memory function and inability to report issues.

STDs may be a strong indicator of sexual abuse. Additional things to look for include:

• Bruising: Bruising around the genital area or on a woman’s breasts may indicate abuse. Bruises on the arms may suggest a struggle and being held or restrained, especially if both arms have similar bruises.
• Bite marks: Caregivers and relatives should be highly suspicious of bite marks on a senior, particularly if they're in areas where the individual couldn’t possibly bite themselves.
• Reduced appetite: A loss of appetite may be a sign that something is troubling a senior, especially if they previously had a healthy appetite and there’s no other obvious reason for them to avoid food.
• Hostility: Seniors who display uncharacteristic hostility may be reacting to abuse. It can be especially telling if their hostility is directed at a particular person.
• Fear: As with hostility, uncharacteristic fearfulness may be a sign of abuse. Seniors who are afraid of certain people may become extra-clingy around others. Fearful seniors may also become scared of the dark and start leaving lights on at night or be reluctant to move around the community alone.  
• Mood changes: Sexual abuse can cause a range of mood changes, including depression, agitation and anxiety. Abuse victims may become withdrawn or unusually tearful, have panic attacks or avoid certain situations.
• Sleep problems: New cases of insomnia or nightmares alongside an STD may point to sexual abuse.     
• Clothing: Torn or blood-stained clothing, particularly underwear, may be a cause for concern.

What to Do if You See Signs of Sexual Abuse 

Anyone who suspects sexual abuse should report to their local Long-Term Care Ombudsman program. The ombudsman is responsible for investigating complaints, advocating for seniors and helping seniors and their loved ones resolve any issues they have with long-term care facilities.

The local Area Agency on Aging or Aging and Disability Resource Center can provide contact details for the relevant Long-Term Care Ombudsman. Alternatively, AARP maintains a list of state ombudsmen programs, current as of April 2022.

Bystanders should call 911 if someone is at risk of imminent harm.

Where to Report Elder Abuse in Each State 

Adult Protective Services investigates allegations of abuse, neglect and exploitation against seniors and other vulnerable groups. APS looks into all complaints made regarding seniors who live in private homes. In some states, APS doesn’t have jurisdiction over care homes. If this is the case, an APS advisor will direct people to the most appropriate organization. This table lists the contact details for Adult Protective Services in every state.