Thursday, 29 September 2016

Metal Nurse: Sexual Health Care for the Older Generation

Everybody likes sex. Everybody likes to read up on sex. Everyone should have sex. On some level we should be more open about talking about sex. In recent years we also have been able to open up about one ageing taboo: Old people having sex. Now, it's is something that needs to be tackled but no one really wants to talk about it. Why? Well, who wants to imagine their parents having sex? I don't. I am pretty sure that my kids don't either. But it is quite frankly beautiful to know of, that people in their twilight years are still enjoying themselves. More and more people seem to be enjoying their retirement age having lots and lots of sex. And who can blame them? Now that it's all out in the open the next thing we have to discuss is the rise of STD's in the 50+ population.

During my university years I volunteered  in the Chlamydia Screening project which was part of Best2Know. So I got to know about how common STD's are in the university student population. There's a big focus in getting the 18-24 to get tested for chlamydia and give free condoms in order to stave infections. It was interesting and fun to assist with, but since most of the people I take care of are a lot older, I started wondering how common STD's are in that age group. Turns out it is quite a lot. I had read that currently the over 55's are second highest group in terms of increase in new STD's diagnoses.

Middle Aged Spread
So now that we've managed to open the discussion about older adults having sex. Maybe we should start talking about contraception with the elderly. Some survey's done show that a lot of those who are still sexually active do want to find out more about STD's, but often don't feel like that can. In recent years cases of STD's has rise in the population aged 50 and over. According to the CDC, HIV alone as increased by 15% from 2000 to 2010 in that particular age group. Syphilis has been on the rise again, even though you would have thought that that one was gone the way of the smallpox. Gonorrhea and chlamydia have both seen big increases in the older generation.  Now the issue we have with these numbers is because it is based on people who seek treatment, so there is a big danger that the number of infected individuals is much higher.

But why is this an issue? People of that generation tend to not want to talk about it. Unless it's about bragging rights, they like to talk about being in a new relationship. But don't want to talk about the potential consequences of being in a new relationship. With a partner they might not know the past sexual history off. Women in particular after menopause think that they won't need contraceptives like the condom because they won't get pregnant. But condoms are not just there to prevent pregnancy, they are the ONLY contraceptive on the market that prevents STD's. And you are never too old to use a condom. Maybe the conversation needs to be about how to use them correctly. Because it is a myth that sex is less pleasurable with a condom, but this myth persists. Besides this generation is the one that grew up with the contraceptive pill, so the talk for condoms most likely didn't happen, and research has shown that those over 40 are less likely to use condoms. Mostly I'd imagine it is because they are just so damn embarrassed about it, they shouldn't be. They've been given a new lease of life. You can get Viagra pretty easily (just don't buy them online) to help with erections, lubricants to help with vaginal dryness and meeting new people has never been easier thanks to the internet.

What would help, as we open up and talk more often course, is if doctors and nurses started incorporating sex education into our health promotion. Or maybe GP's could include sexual health checks with their annual physical assessments. Especially if we suspect that some individuals are practising unsafe sex. Maybe it's time to introduce sex education for over 50's, there is plenty of focus on sex education with teenagers. But in reality how much do adults know about safe sex? Should we really presume that as people get older the stop enjoying sex altogether? The urge to have sex might decrease but that is not the same as stopping altogether. It isn't just infectious diseases that they could discuss, this could be incorporated with talking about erectile dysfunction and vaginal dryness. What medication they could take to alleviate those symptoms and/or what medication they are taking could cause those symptoms. Because I don't don't know how often those side effects are discussed or even contemplated when new medication is being prescribed to patients. Us health professionals also have to do our bit and confront our fears and prejudice regarding sexual health, especially with people who are old enough to be our parents.

The focus on safe sex campaigns and use of contraception has been always on the younger age group, if only because they remain the group that contract most STD's on the most frequent basis. They tend to also be the most likely to seek out help if/when they are aware that there is a problem with their genitalia. They get free chlamydia screening kits and they get free condoms given on a regular basis. The other reason of course why the focus has been on this group is because they will hopefully be paying taxes for a long time, well up until they reach retirement age, and have children. But they won't be able to do any of that if they don't get their various STD's sorted and treated quickly. Because the economical factor of neglected cases is immense. The other reason why the focus is on the younger age group is because some STD's like the Human Papillomavirus, if left untreated, can lead to people developing assorted cancers. Up to 70% of cervical cancers have been attributed to an chronic and untreated HPV infection. Up to 25% of oropharyngeal cancers have been linked to HPV.  But of course the problem doesn't just lie with cancer. Then there is also the cases of infertility, because fertility treatments are extremely expensive and time consuming.

Then there is the issues of differential diagnosis. With all this in mind various STD's should be considered as such. Gonorrhoea, Chlamydia and Syphilis, all have various signs and symptoms that go with other diagnoses.

But why neglect those over 50's? Because as the populace get older they will need more treatment for long-term illnesses, and adding something that can be both treated and prevented so easily into the mix is just going to cost the society more. As The Kings Fund has pointed out, patients with long term conditions could cost the UK an additional £5 billion by 2018. So why add untreated STD's into the mix?

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