Safe sex: an age-old dilemma

couple on a park benchAlthough they're easily preventable, sexually transmitted infections are on the rise and young people aren't the only ones at risk. By Joanna Egan.

In the past decade, rates of sexually transmissible infections (STIs) have surged in Australia. The infections, which are spread via skin-to-skin contact during sexual activity or by the exchange of bodily fluids (see box), predominantly affect teenagers and young adults – three-quarters of all reported cases occur in people aged from 15 to 29. However, recent figures indicate older Australians are becoming increasingly at risk.

Between 2004 and 2010, reported cases of chlamydia more than doubled in women aged between 40 and 64, and diagnoses of genital warts and genital herpes increased. While these trends could partly be attributed to more people being tested, they nevertheless confirm that STIs are a major public health issue in Australia. Chlamydia has reached epidemic levels – national infection rates have more than tripled since 2001, with the highest rates of diagnosis consistently being recorded in Queensland. In 2010 alone, almost 20,000 Queenslanders were diagnosed with the infection and 14 of these were aged 85 and older.


Why are STI rates increasing in older people?

Social shifts

Increased longevity, coupled with higher rates of divorce, mean people are living longer, healthier lives and many are becoming single and seeking new sexual partners later in life. Internet dating, improved long-distance travel and pharmaceutical aids for sexual function (such as hormone-replacement and erectile-dysfunction medications) have made it easier for people to start new sexual relationships, regardless of their age. However, older people are often overlooked when it comes to STI prevention, care and treatment services. Many received limited sexual-health education in their youths and because today's campaigns exclusively target teenagers and young adults, their awareness of safe-sex practices is lacking.


Risky sexual behaviours

Research suggests older people are less likely than young people to use a condom, female condom (a latex sheath that fits loosely inside the vagina) or dam (a thin sheet of latex placed over the vulval or anal area during oral sex). Many women may view condoms primarily as a form of birth control, so when they are no longer concerned about becoming pregnant, they may not insist on their use. Other women may find it challenging to introduce the topic of condoms to a new sexual partner; they may feel that raising the topic of condoms could lead to rejection; or they may feel nervous about negotiating condom usage for the first time in many years. Some older couples may also experience fears about condom use exacerbating erectile dysfunction.


Biological factors

As women age, their susceptibility to contracting an STI can increase. Not only does the immune system naturally become less effective with age, but physiological changes that can make women more vulnerable to infections occur during menopause. For example, decreased lubrication and the thinning of vaginal tissue can increase the risk of micro-tears during sex, allowing easier transmission of bacteria and viruses. The symptoms of some STIs, such as vaginal soreness and irregular bleeding, may also be mistaken as normal signs of ageing, which can delay detection and treatment, and potentially increase the spread, of the infection.


How can women protect themselves?

Many older women are reluctant to seek information about safe-sex practices from their doctor because they either feel they should already possess the knowledge or they fear being judged. However, it is important for women to have regular sexual check-ups and learn about safe-sex practices. A check-up can be performed by a doctor, or at a sexual health or family planning clinic. Barrier protection (condoms and dams) should always be negotiated when having sex with a new or casual partner, or with a partner whose previous sexual habits are unknown. Keeping condoms/dams in a convenient location and discussing their use prior to sexual activity can make it easier to use them.


What are STIs?

STIs are infections caused by bacteria, viruses and parasites. They are spread via the exchange of body fluids such as blood, semen, vaginal secretions and saliva, or through skin-to-skin contact during sexual activity. STIs include chlamydia, genital herpes, HIV (human immunodeficiency virus) and HPV (human papillomavirus).

Since many people experience no obvious symptoms, it is possible to have an STI and not realise it, or to be infected from somebody who seems perfectly healthy. If symptoms occur they can include:

  • itchy genitals
  • pain or swelling
  • a burning sensation during urination
  • a rash
  • open sores or small lumps in the genital area
  • unusual vaginal bleeding
  • unusual genital or anal discharge
  • pain during sex
  • a sore throat
  • swollen glands
  • fever and body aches
  • unexplained fatigue
  • night sweats
  • weight loss.

Women should be tested for STIs regularly, particularly if they have engaged in unsafe sexual activity, sexual activity with a new partner or with a partner who may have other partners. While many STIs are curable, if left undetected and untreated, they can lead to serious health complications including genital, heart and brain damage; pelvic inflammatory disease; ectopic pregnancy; infertility; chronic abdominal pain; cirrhosis; cancer; and an increased susceptibility to other infections such as tuberculosis and meningitis.


Last updated: September 2012

© Women's Health Queensland Wide Inc. This article was written by Joanna Egan and reviewed by the Women's Health Queensland Wide editorial committee. It was published in Health Journey Issue 2 2012.





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