I remember, a long time ago, seeing a commercial with an older man discussing medication to enhance sexual performance. The first time I saw it, I thought about my parents and I had to say to myself, "There's no way that my parents are having sex! Not at their age—they're way too old for that!" It came as a shock when one day I accidently went over to their house without notice—and found them in bed. OOPS!
Many of us question whether older people have sex on their minds and if there are age limits for when we're supposed to stop having sex. The answer is a great big YES to sex and NO, there are no limits as to when one will stop wanting to have sex. As a matter of fact, I began to ask all of my patients about their sexual relationships in order to have a better understanding and found two schools of thought. Both are very normal!
- Enough already! I'd rather read a book or knit than have sex.
- I am very active and I just love having sex!
Older people do have sex. More importantly though, older people also have the same exposure to the risks of sexual encounters that younger people have, including Sexually Transmitted Diseases (STDs). There are no exceptions. For example:
An older woman goes to her doctor and she is diagnosed with an abnormal pap smear, including the high risk Human Papilloma Virus (HPV), which can increase her risk of cervical cancer. In this case, she had been married for 40 years and her husband died of cancer ten months ago. After grieving her husband, she has now finally found a new man and has begun having a sexual relationship with this new boyfriend. In all the years before she met her new boyfriend and started having sex with him, she had never had an abnormal pap smear.
Now, you may be thinking that the woman was infected by her new boyfriend—a quick conclusion—but that's not actually necessarily the case. Virus transmission can be more complicated than that, so let's look at all the options:
- Her Husband
- Her Boyfriend
- Exposure prior to being with her husband (yes, all those years ago) due to past relationships. Yes, the virus can lay dormant for that long!
The truth is that it could be any of the above, for the virus can present itself when our immune response is down, lay dormant and not actually "blossom" for days, weeks or, in this case, years. Just think about how your body responds when you are run down and you get a cold or flu virus!
The woman's doctor must now do further testing to find out if her abnormal pap is more advanced or not. This means that the doctor will do a colposcopy, a procedure in which a high-powered microscope is used to find the area of the cervix that is infected. The doctor will then actually take some of the tissue (a "biopsy") to test, instead of just performing a swab as done with a pap. The colposcopy provides valuable information in order to determine how the abnormal pap should be treated.
If you've been keeping up with celebrity stories, you may have heard about Michael Douglas' oral cancer, which he partially attributes to his HPV. As a result, you may have learned that the HPV virus can also be found orally as well as in the genital areas of both men and women who are having sexual relations and oral sex. As most of you know, a lot of information about sexually transmitted diseases and other health conditions can be gathered via the Internet these days. We doctors realize this too. If, at any age, you become worried about STD prevention or possible contraction, the INternet can be an excellent tool. Just make sure that you are looking it up on valid websites such as WebMD or the Center for Disease Control (CDC)! Once you have gathered information, discuss it with your OB/GYN and ask for guidance about treatment and other cautionary measures to take.
This article, however, is not about the treatment of HPV. It is about situations like the one described above where a beautiful older woman—who could really be any of us— faces a threat to her life. How does she deal with where it came from? After all, her husband of 40 years is now dead, so she cannot even ask or confront him about it. Does she suddenly doubt that he was faithful? Does the possibility of his being unfaithful ruin their entire past relationship or ruin her current relationship with her boyfriend, someone who now—after all this time—she has finally found and with whom she wishes to share the rest of her life?
Let's take this one step at a time:
- The love of her life—her husband. Should her entire 40-year relationship be discredited?
- She can't ask him if he was unfaithful or not. Her opportunity to ask this question passed on when he did.
- Can she forgive him, even if it was his fault?
- How can she live with the fact that it may or may not have been him and just go on with her life, potentially never knowing if it was him or not? After all, 40 years is a long time to honor and love each other.
- Is there a chance that she will not allow herself to get the best treatment due to her embarrassment, anger and confusion? Will she be willing to decrease her stress, anxiety and anger so that she can get the help she needs?
- Her Boyfriend:
- Does he know anything about his ex-wife's pap smears? Is his wife deceased or are they divorced? Did she have cervical cancer? (That would increase his chances of being a carrier of the HPV virus.)
- Did he have multiple partners? He could indeed be an HPV carrier himself and not even know he was passing it on.
- Has he gone to his own doctor to get himself checked out? Does he have a wart? He may not have anything showing, but he could still be a carrier.
- What are his true feelings towards her? Will he be with her and provide comfort and support while she is being tested and treated?
- Does she have open communication with him to discuss wearing condoms and how to prevent re-infection?
- Is there trust, commitment, openness and love between them? These are all important ingredients that are needed for the stability of their relationship.
- Does she feel partnership, safety and nurturing from her partner?
Answering these questions will help her figure out how to move on from her diagnosis.
The two biggest questions that I hear asked most often by older people are:
Question 1: Do I need to get a pap smear after a hysterectomy?
Answer: Absolutely. You can get vaginal cancer, vulvar cancer, rectal cancer or oral cancer during any time that you are sexually active, throughout your lifetime.
Question 2: Do I need to get a pap smear after age 50? My doctor says that I do not need them anymore.
Answer: Absolutely. You need an OB/GYN doctor to examine you. What are they looking for? Moles, discoloration, and any changes in anatomy that can cause painful sex or bleeding after sexual relations.
Many times the OB/GYN providers are the only ones who perform not only pelvic exams but also rectal exams (because yes, you can get HPV there as well) that check and hopefully screen for rectal and colon cancers.
Many patients who bleed vaginally or rectally are sometimes told it's normal or it's "only hemorrhoids" by their doctors. Please have your doctor actually look at your pelvic or rectal area and examine you. You need to be an advocate for your own health and care.
This is all about you, so you can be your own advocate and get the proper information from your healthcare provider in order to make the best choices for your body.
No matter what age you are, if you are faced with the news that you have an abnormal pap and you are in a relationship, it is important for you to find the treatment you need. This is also about you and your happiness! It is about your enjoyment of your sexual relationship at any age with your partner. Just do it safely!
Be cautious out there, you fine ladies, and remember: you are precious cargo. Do not let anything or anyone harm you. Identify and fortify your relationship with strength, trust and love, and protect your health and your partner's.
I wish you all safe sex and enjoyment!
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