Guide To Sexual Health & STIs in Retirement Homes

Sexual health and sexually transmitted infections (STIs) are often associated with the younger generations. However, contrary to popular belief, they’re an issue that also affects older people, especially those living in retirement homes. Senior living communities encourage seniors to socialize and build relationships with other residents, so it’s inevitable that sexual partnerships develop.

STI cases are on the increase across all age groups, with the Centers for Disease Control and Prevention estimating that 1 in 5 Americans are affected at any one time. Although cases are most prevalent among teens and young adults, more and more adults aged 60 and older require treatment for STIs, including herpes simplex, syphilis, gonorrhea, chlamydia and trichomoniasis.

Sexual health is a difficult subject to discuss with an elderly relative or friend. But, as older adults are still sexually active, it’s a conversation that needs to happen. Raising awareness can help encourage seniors to practice safe sex and reduce their risk of contracting STIs.

This guide discusses this sensitive issue and will help seniors, their families and caregivers understand sexual health in older adults, the risk of STIs in retirement homes, how to identify and protect against STIs, and how to recognize the signs of and report sexual abuse.

Everyone has a psychosociological need for affection and tenderness. From hand-holding to sexual intercourse, this desire for intimacy doesn’t fade as people age, with sex remaining an important part of relationships. Adults remain sexually active as they get older according to an article in The New England Journal of Medicine.

Results of seniors studied as sexually active:

• 73% of the 57 to 64 age group
• 53% of the 65 to 74 age group
• 26% of the 75 to 85 age group

Many people think older adults don’t have sex and that sexuality belongs to the young. Often it’s because they feel seniors can’t have sex or don’t want to. These are some of the misconceptions society has about older adults and sex.

• Seniors don’t want to have sex: The natural need for intimacy doesn’t go away just because someone is elderly. Seniors may not talk about sex in the same way as younger people do, but many of them still have a desire for a sexual relationship.
• Older men can’t perform in the bedroom: Erectile dysfunction affects men of all ages but is more common in older men, with almost 70% of 70-year-old males having ED. Luckily, ED is treatable through prescription drugs, lifestyle changes and other methods, allowing seniors to overcome the condition and still enjoy a healthy sex life.
• Older women dislike sex: Older women may want sex, but find it uncomfortable due to vaginal dryness caused by reduced estrogen levels. Over-the-counter lubricants and creams can ease the discomfort, making intercourse more enjoyable.
• Seniors don’t need to use protection when having sex: Many seniors are under the impression that they don’t need to use protection when having sex. While pregnancy isn’t an issue, seniors can still contract STIs, so they should use condoms, especially if they’re in nonmonogamous relationships.
• Older people aren’t attractive: Aging causes changes to the body and appearance, but older adults still look after themselves. Chemistry brings two people together, whatever their age, attracted by looks, personalities, mutual interests and life experiences.

Sexual health education and safe sex campaigns came to the forefront in the 1980s. At that time, many of today’s seniors were already married, so they never learned about STIs and why practicing safe sex is important.

These lessons are generally aimed at young adults, but seniors also require the same education to help prevent the spread of STIs. In addition, having sexual relations in later life can bring up other issues due to physical limitations. Educating seniors on sexual health raises awareness of potential problems they may encounter and can help them maintain a healthy sex life.

Today’s seniors were around in the 1960s and ’70s when sexual expression was a part of everyday life. This generation still considers sexuality important, but with age comes certain changes.

Sexuality involves physical and emotional desires, feelings and actions. Some seniors crave intimacy in a relationship, while others choose to avoid sexual connections. Studies show that sexual activity declines in older age, and women are less likely to be sexually active than men. However, with more time, fewer distractions, more privacy and an ability to better express themselves, many couples find greater satisfaction in sex and a better connection than when they were young.

Disabilities, illness, surgery and medications can all cause sexual problems for older adults. Studies suggest that approximately half of sexually active seniors experience some sort of sexual problem as a result of health issues, such as:

• Arthritis
• Chronic pain
• Dementia
• Heart Disease
• Incontinence
• Surgery
• Depression
• Stroke

Luckily, there are plenty of ways older adults can overcome problems and continue to have an enjoyable sex life. Arthritic pain can be eased through exercise, rest and warm baths, while doctors, pharmacists and other health care professionals can help seniors address many of the common causes of sexual problems, such as medical conditions, incontinence, vaginal dryness and erectile dysfunction.

Bodies change with age, and physical health could be seen as an obstacle for two older people wanting to be intimate. However, aching joints, muscle pain and other physical limitations shouldn’t be a barrier to a sexual relationship.

Physical issues may change the way seniors approach sex. They should be encouraged to find ways to make intercourse more comfortable to ease pain and aches. Couples can try exploring new positions or use pillows or cushions to support different parts of the body. For further advice, speak with a therapist or a doctor.

Both elderly partners are going through age-related changes, so communication is key. You may feel your partner is avoiding sex or is no longer interested in you. But, often, this isn’t the case. Talk to your partner about how they’re feeling and express how you’re feeling in return. Taking the time to understand how changes are physically and mentally affecting both of you is the first step toward reigniting your sexual relationship.

Many therapists and health care professionals have experience in helping couples work through sexual matters. Physical problems, such as ED or vaginal dryness, can be solved with medications, while individual or couples therapy can help rectify any emotional issues that stand in the way of an enjoyable sex life.

The number of older adults contracting STIs, including  HIV, is on the increase, with studies showing cases more than doubling between 2010 and 2020 in the over 65s. Unfortunately, retirement communities have become a breeding ground for STIs, leaving certain seniors more vulnerable to infection. These seniors could be at the highest risk of contracting STIs in retirement communities:

• Men taking medication for erectile dysfunction
• Postmenopausal women
• Older adults who use online dating and are unaware of a partner’s sexual history
• Anyone with a weakened immune system
• Seniors embarrassed to discuss sexual matters with a doctor
• Older adults who are sexually active but not practicing safe sex

With STI cases in retirement communities growing, it’s essential that seniors and their loved ones are aware of the most common diseases, how to identify if someone is infected and what treatment options are available.

Retirement communities, families and health care professionals can take a number of steps to protect seniors from STIs and prevent them from passing diseases on to other residents.

Basic sexual health education in retirement communities can help prevent the spread of STIs. Residents should be learning about a range of safe sex issues, including:

• What STIs are
• How to recognize the symptoms of STIs
• How STIs can affect existing medical conditions
• Safe sex practices

It’s estimated that only 8% of sexually active adults residing in senior living communities use condoms every time they have intercourse and that another 4% use them sometimes. Retirement communities can increase this percentage by distributing free condoms and encouraging residents to use them to protect themselves and their partners from STIs.

Sexually active seniors should be regularly tested for STIs. Regular screening can quickly identify new cases so residents can receive the proper treatment. Fast diagnosis can also help prevent infections from rapidly spreading through a community.

Seniors are often reluctant or embarrassed to discuss sexual matters with their personal doctor. Community residents should have easy access to other medical professionals and be encouraged to speak about their sexuality and any problems or worries they may have. In addition to providing advice on how to maintain a healthy sex life, professionals can also ensure residents receive the medication they require should they contract an STI.

Elder abuse is more common than many people think, especially in retirement communities and nursing homes. The World Health Organization published a report in June 2022 claiming that 1 in 6 adults aged 60 or older and living in a community setting experienced some kind of abuse during the previous year.

Although sexual abuse only makes up 2% of the overall figure, it’s believed the number could be much higher as elderly victims are often reluctant to report abuse to the authorities. Many residents who experience this unwanted or forced sexual contact, assault or harassment are vulnerable seniors, such as those with disabilities or mental impairment, including dementia and Alzheimer’s.

There are a number of signs to look out for that could indicate that someone is being sexually abused.

• Lack of appetite
• Depression or withdrawal
• Fear or anxiety
• Bruising around the inner thighs, breasts, genitals or anus
• Torn or blood-stained clothing or bed linen
• Unexplained genital or anal bleeding
• Unexplained STIs or infections
• Difficulty in sleeping, walking or sitting

If you recognize any of the signs of sexual abuse, it’s important that you report it to the authorities. Long-term care ombudsmen exist to advocate for the rights of seniors to live healthily and safely in retirement and care communities.

If you suspect your loved one or another resident is experiencing sexual or another form of elder abuse, contact your local long-term care ombudsman for advice.

Adult protective services help seniors and disabled adults who are the victim of neglect, exploitation or abuse, including sexual abuse. Each state has its own APS that will investigate and intervene in any violation that endangers the welfare of older adults.