Geneva Hayden, a community educator for Planned Parenthood in Chicago, was going over the intricacies of the female anatomy with a half dozen women in a workshop at the Homan Community Center in North Lawndale recently.
As usual, she had to clear up some misconceptions, such as the belief that a birth control patch protects against sexually transmitted diseases. She also talked about such topics as pelvic exams, Pap tests and menopause.
There was nothing unusual about this scene except that the women were well past 50. Counseling women over 50 is the latest trend in sex education. Some Planned Parenthood affiliates have expanded their missions to include women past their childbearing years.
In the age of AIDS and Viagra, sex among seniors finally is coming into the open, but not without some ambivalence and discomfort.
The number of AIDS cases among people older than 50 has quintupled since 1990, now representing an estimated 14 percent of all people diagnosed with HIV/AIDS, according to the Centers for Disease Control and Prevention. Senior women, who may have tuned out the safe sex message because they didn’t think it applied to them, account for 18 percent of female AIDS cases.
Menopausal changes can intensify vulnerability to sexually transmitted diseases, and many women older than 50 discover they are infected with HIV only after progressing to full-blown AIDS, doctors said. Symptoms such as general fatigue, aches and pains that in younger people might prompt a test for HIV can be mistaken for symptoms of aging in an older person, delaying diagnosis and treatment.
A recent Emory University study of women older than 50 revealed a significant knowledge deficit about HIV. About half of the 514 women surveyed erroneously believed vasectomies provided some protection against HIV and that diaphragms prevented spread of the virus as well.
Many women may be naive about risks. “Sometimes after a divorce or the death of a spouse, women start dating again, and it’s a different environment than it was when they were originally dating and starting relationships,” said Michael McGee, vice president of education and social marketing, Planned Parenthood Federation of America Inc.
An educator in Planned Parenthood’s Grand Rapids, Mich., affiliate has written a curriculum to help professionals counsel older clients, McGee said.
Some older people buy into a cultural assumption that interest in sex wanes later in life, but that is not necessarily true, McGee said.
“Many people enjoy very satisfying sex lives into very late years,” he said. “And folks who believe that because of a cultural message it’s not OK to be sexual feel guilt and shame over desires they think they’re not supposed to have.”
Not just for the young
Therefore, another aspect of Planned Parenthood’s effort is helping women embrace their sexuality and not buy into society’s message that sex is only for the young.
“You are a sexual being,” Hayden told the women at the community center. “Being old doesn’t mean you have to crawl into the corner.”
Then Hayden pulled the cover from a table revealing an assortment of items related to romance and sex: a rose and a card, a silky night gown, massage oil, condoms, dental dams (a kind of protective device used during oral sex) and vibrators. The women were, well, interested.
“Don’t let anyone tell you you’re too old,” Hayden told them.
Women experience more issues regarding sex than men do, said Dennis P. Sugrue, a clinical psychologist in Bloomfield Hills, Mich., and co-author of the guide “Sex Matters for Women” (The Guilford Press). “Men have always been scripted to be sexual, whereas many women, even when they were young, got a conflicted view about sexuality.”
In regard to older people, the topic is a “taboo, because we don’t conceive of sex after people get gray hair,” said Vincent Delgado, a founder of National Association HIV Over 50 and deputy director for special populations at Borinquen Health Care Center in Miami.
“It’s not an issue brought into conversation in a family, much less in the community. Doctors don’t talk to seniors about sex.”
Nor is sexual behavior among older people well-studied by social scientists, Sugrue said.
But a mail survey of 1,384 adults age 45 and older, conducted for AARP in 1999, provided some information.
For example, the survey showed that a third of the women age 60 and older reported having sexual intercourse once or more a week.
Of men and women without partners, more men (26.4 percent) than women (2.9 percent) reported self-stimulation once or more times a week.
More women (29.3 percent) than men (21.4 percent) reported that they were “extremely satisfied” with their sex lives.
Anecdotal reports indicate some older women have begun doing what men have done for years: seeking out younger partners.
One day Delgado fielded a frantic call from the manager of senior housing center in Florida who asked him to come counsel the women there about safe sex. The manager noticed that when Social Security checks arrived, women were bringing in much younger men for sexual trysts. “The women are looking for more pleasure than they would get with men their age,” Delgado said. “Through our network we know this is also happening in New York, New Jersey and California.”
Delgado also said that a nightclub in Miami is informally known as the “wrinkle club” because older women of means go there seeking young immigrant men. “The youngest of the women would be maybe, 55, 60, but it goes up to 70,” he said. “And of course, the younger new immigrant would want to have a `Sugar Mommy.'”
In other settings, sexual expression may be more covert. Women may hide their relationships from their adult children.
`Family issues’
For example, Dr. Stacy Tessler Lindau, a gynecologist and geriatrician at the University of Chicago, recalled a widow who came into the hospital for cancer surgery and was asked who doctors should contact in the event someone else had to make a decision for her.
In the presence of her family, the patient said her son should be called. But when Lindau checked in on her that evening, the woman handed her a slip of paper with a man’s name and phone number written on it, telling Lindau he was a “special friend” and knew what would be best for her. Lindau said such incidents have happened on many occasions with female patients. Because of “stigma” or “family issues,” she said, many widows are not able to experience all the advantages of an intimate relationship, including social support as well as sexual activity.
Practicing safe sex might be different for seniors, Lindau said.
“The typical intervention is the use of the male condom during intercourse,” she said. “We don’t know, though, whether the male condom is really very effective for older couples. In order to use a condom properly there needs to be a full erection, and we need to know whether the timing of condom application is appropriate for older men.”
And when a man seeks treatment for erectile dysfunction, that has an impact on the woman too. Not unexpectedly, the increased use of Viagara plays directly into sexual safety issues for women.
A small New Zealand study published in the journal Sociology of Health and Illness in 2003 showed that Viagra made some women feel pressured to perform on demand sexually so that their partner could take full advantage of the expensive pill.
Women said they experienced pain and discomfort from prolonged and repeated sexual intercourse.
They also feared that the drug would have adverse effects on their partner’s health and that using it would cause their partner to be unfaithful.
“There is concern that [restoring] men’s erectile function may lead them to seek other outlets for sexual activity and could increase their wives’ risk for sexually transmitted diseases,” Lindau said.
As Geneva Hayden told the women at her workshop:
“You need to be aware of [an infidelity] situation and take it into consideration. HIV is on the increase in our neighborhood and among seniors. We have to come out of denial. Denial can kill you. Be safe.”
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Midlife and beyond
How much do you know? Quiz yourself:
1. Depression has a bigger effect on female sexuality than age.
2. Women are prone to sexual problems at certain times of life such as after childbirth and during menopause.
3. Sexual function decreases for women who have a hysterectomy and oophorectomy.
4. Sexual problems in older women appear to be related more to social and psychological factors than physical factors.
5. Older adults are more likely than the young to use condoms.
6. In sexual intercourse, women are at a greater risk of getting an STD than men.
Answers: 1. T, 2. T, 3. F, 4. T, 5. F, 6. T
Source: “New Expectations: Sexuality Education for Mid and Later Life,” by Peggy Brick and Jan Lunquist, a publication of the Sexuality Information and Education Council of the United States
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E-mail ctc-woman@tribune.com
