A Guide to Sexual Health and STDs in Retirement Homes

Reviewed by: Dr. Brindusa Vanta, MD

Family-friendly sitcoms often portray older adults as doting grandparents who would rather clip coupons than engage in acts of intimacy. What these sitcoms don't show you is that many older adults remain sexually active well into their 70s and 80s. Sexual activity has many benefits for men and women, including better sleep, lower blood pressure, improved immune function and increased self-esteem. Intimate touch also brings partners closer together, which may help ward off depression, anxiety and other mental health problems.

Unfortunately, many seniors are unaware of the need to use protection during intercourse and other types of sexual activity, putting them at risk for chlamydia, gonorrhea and other sexually transmitted diseases. For example, the number of cases of chlamydia among adults aged 65 and older nearly tripled between 2000 and 2020. Even more concerning, these STDs often go undetected, putting older adults at risk for serious complications.

This guide dispels some common myths related to seniors and sexual activity, highlights the importance of comprehensive sex education and explains how to protect seniors from contracting STDs in senior living communities. It also provides information on elder sexual abuse and outlines the steps you should take to report any concerns to the Adult Protective Services agency in your state.

If you think that older adults have no interest in sex, think again. According to a study published in the New England Journal of Medicine, 73% of respondents between the ages of 57 and 64 were sexually active during the study period. Sexual activity did decline a bit for adults in older age groups, but it didn't disappear completely. More than half of all respondents between the ages of 65 and 74 reported that they were sexually active, as did 26% of respondents between the ages of 75 and 85.

Thanks to inaccurate portrayals of older adults in movies, television shows, books and magazines, many people have misconceptions about seniors and sex. Here's an overview of the most common myths, along with an explanation of why they're wrong.

• Sex is only for young people: Adults go through physical and emotional changes as they age, but that doesn't mean the desire for sex magically goes away after 50. In some cases, older adults find sexual activity more fulfilling than they did when they were younger.
• Older people don't have sex once they move into senior living communities: Many senior living communities offer private accommodations, allowing seniors to engage in intimate relationships. Researchers have even used nursing homes as the setting for studies on sexual health in older adults.
• It's impossible to have sex as an older adult: Although it's true that some seniors have erectile dysfunction, vaginal dryness and other problems that make it more difficult to have intercourse, there are many other ways to be intimate.
• Seniors don't need to use protection: Many people assume that older adults don't need to use condoms because there's no risk of pregnancy. Unfortunately, pregnancy isn't the only potential consequence of unprotected sex. Without protection, it's possible to contract chlamydia, gonorrhea and other STDs.
• Sex is unsafe for people with heart problems: Some seniors shy away from sex because they have a history of heart disease, heart attack and other heart problems. The truth is that sex isn't any riskier than other physical activities for people with stable heart disease. Researchers from Johns Hopkins University explain that the risk of having a heart attack during sex is "exceedingly low."

One reason these misconceptions are so prevalent is because many older adults received little to no sex education when they were younger. Therefore, seniors may benefit from sexual health education provided by doctors, senior living staff and other professionals. If you feel comfortable doing so, you can also share information about sexual health with your older loved ones. Comprehensive sexual health education should touch on the following topics.

Many physical changes occur as part of the aging process, making it more difficult to engage in vigorous sexual activity. For example, older adults with arthritis may have reduced range of motion in their joints, preventing them from finding a comfortable sexual position. Many older adults also develop problems with their balance and coordination, increasing the risk of falls.

Some changes affect the reproductive organs, making sex uncomfortable for older adults. For example, the vaginal walls get thinner due to lower levels of estrogen. It's also common for older women to have less vaginal lubrication than they did when they were younger. Both of these changes can make sex painful. In men, erectile dysfunction makes it difficult to get and maintain an erection. An erection requires adequate blood flow, so ED often occurs in men with high blood pressure, heart disease and other cardiovascular problems.

Age-related changes aren't the only reason some seniors have sexual problems. These are some of the most common contributing factors.

• Dementia: Dementia doesn't necessarily reduce the desire for sex, but it does make it difficult for some seniors to recognize their partners. As a result, they may fear intimacy rather than embracing it.
• Chronic pain: Chronic pain makes it more difficult to move around. Some people with chronic pain also feel weak and fatigued, reducing their interest in sex.
• Alcohol consumption: Excessive alcohol consumption may make it more difficult for a woman to have an orgasm. Alcohol has also been linked to erection problems in men.
• Medication side effects: Many seniors take medications that cause drowsiness, fatigue, vaginal dryness and other side effects, reducing the desire for sex or making it more difficult to have intercourse.
• Diabetes: If diabetes is poorly managed, it can cause yeast infections, making sex uncomfortable. Uncontrolled diabetes also damages the blood vessels, which may lead to erectile dysfunction.
• Incontinence: Bladder incontinence causes urine to leak out of the body, while bowel incontinence causes the leakage of feces. Seniors with these problems may be too embarrassed to engage in sex.
• Obesity: Obesity has been linked to insulin resistance, high levels of inflammation and excessive amounts of cholesterol in the bloodstream, all of which increase the risk of erectile dysfunction.
• Surgery: Some older women need hysterectomies to treat uterine fibroids, endometrial cancer and other health conditions. Men with prostate cancer may need to undergo prostatectomy, which involves removing some or all of the prostate tissue. These procedures may affect sexual function or make an older adult more hesitant to engage in sexual activity. 
• Stroke: In some cases, stroke results in long-term paralysis or weakness, making it more difficult to engage in intercourse.
• Depression: One of the main symptoms of depression is a loss of interest in normal activities. As a result, some people with depression lose interest in sex and intimacy.

Just because older adults have an increased risk of developing certain health issues doesn't mean that sex is impossible. That's why it's important for sexual health education to include information on how to overcome these issues before they become a barrier to sexual activity. For example, someone with a history of stroke may be able to use an assistive device to help them move around during intercourse.

Seniors also need information on how to maintain an active enjoyable sex life. Education on this topic should focus on the emotional as well as the physical. Using lubricant and addressing physical health issues are important, but they don't address the emotional aspects of sexual activity. Seniors should also be prepared to give themselves more time to get aroused.

Even when they have access to comprehensive sexual health education, some seniors still have a heightened risk of contracting STDs in senior living communities. Your loved one may be at risk if any of the following apply:

• They use online dating sites to find potential partners.
• They're using erectile dysfunction medication.
• They're too embarrassed to discuss sex with a physician or other medical professional.
• They're being sexually abused by a staff member or other resident.
• They have dementia or another condition that makes it difficult to remember how to use condoms or take other steps to protect themselves from STDs.

Senior living communities have an obligation to protect residents from STDs. In addition to providing comprehensive sexual health education, these communities should provide condoms, make it easy to get tested and ensure that residents have access to medications and other treatments. Communities without on-site medical staff should provide transportation to local clinics to ensure that residents get tested and treated as quickly as possible.

Although sexual abuse accounts for just 0.6% of all elder abuse, it's still a serious concern for older adults and their loved ones. In some cases, seniors contract STDs as a result of abusive behavior, not because they've been engaging in consensual sexual activity. Protect your loved one by watching for these signs of sexual abuse:

• Bruising of the thighs and other parts of the body
• Bloody or ripped underwear
• Anal or vaginal bleeding
• Agitation
• Hostility
• Depression
• Lack of appetite
• Irritability
• Difficulty sitting down
• Nightmares
• Fear of specific people

If you're concerned about the possibility of sexual abuse in a senior living community, contact your long-term care ombudsman, which is the person responsible for investigating complaints about long-term care facilities. Your local Area Agency on Aging can provide contact information for the ombudsman in your region.