Ask the HIV Specialist: Safe Sex Is for Seniors, Too

Helen C. Koenig, M.D., M.P.H.

Q: I am a 65-year-old woman. I lost my husband six years ago and have finally decided to enter the dating world again. My friends have convinced me to go on a cruise especially for single seniors, but my daughter is giving me all kinds of warnings about sexually transmitted diseases and HIV. HIV didn't even exist back when I first became sexually active. Seriously, how great is my risk of contracting such diseases? After all, we are all going to be senior citizens and I'm not going on this cruise intending to "hook up" (as they say). Is all this safe sex stuff really necessary?

A: As you head for the sun, the all-you-can-eat buffets, and the cruise festivities, don't forget to pack some condoms with your sun block. While the risk of bringing home HIV or another sexually transmitted infection (STI) is not high, it's not zero either. You are joining a growing population of women who are sexually active in their 60s and 70s and, unfortunately seeing a higher rate of STIs than ever before.

What really is your risk of acquiring an STI? This depends entirely on the partner or partners with whom you choose to be sexually active, what type of sex you choose to have (oral, vaginal, or anal) and whether you choose to use protection or not. You have no way of knowing the sexual history of the men you'll meet or their risk of having an STI. Studies have shown that even doctors, after taking a complete sexual history in a medical setting, are still terrible at predicting whether someone has HIV. Your prospective partners may not know they have STIs, as many can be present for months or years without symptoms, including HIV.

Women who have been in a monogamous relationship for the last 20 or 30 years, or for whom sex hasn't been an issue, may find it difficult to think about buying and asking their partner to use condoms. But here are some good reasons to brave that aisle at the drug store before you hit the high seas, as well as empowering yourself enough to make sure they're used:

• 3,500 women over age 45 were diagnosed with AIDS in 2009. People over the age of 50 now account for 15% of new HIV/AIDS diagnoses, and over 35% of all deaths from AIDS.
• The highest percentage of trichomoniasis (a parasitic infection, considered the most common curable STI) is now actually in women over 50. Also on the menu are syphilis, gonorrhea, chlamydia, hepatitis B and C, herpes, and human papilloma virus.
• Postmenopausal women are at a particularly high risk of acquiring HIV and other STIs because the vaginal wall is thinner as a result of lower estrogen levels and the immune system is not as strong as it used to be.

You can't control the risk of STIs in your partners, but you can control the risk of bringing one home yourself with correct condom use. Perhaps you think it's "the man's job" to come prepared with protection, but I encourage you to bring your own as backup! Chances are, the condom colors, flavors, and textures out there have changed a bit since you last looked. Lubricants now also come in wider varieties and are important if you experience vaginal dryness, both for your own comfort and to prevent condoms from tearing. So pack some protection and enjoy the festivities ahead!