Sexual health at every age: what you need to know

Your sex life is uniquely yours, but there are some issues we all face at some point in our lives. CityMD physician Seema Sky Sharma, MD, MPH, and Summit Health nurse practitioner Susan Angelicola, MSN, APN, highlight ways to stay healthy and put your sexual health first.

Sexually transmitted infections

Exploring your sexuality with others can be exciting, but there are also risks. The Centers for Disease Control and Prevention (CDC) estimates that 1 in 5 people in the U.S. had a sexually transmitted infection (STI) in 2018. A year later, STIs reached an all-time high for the sixth consecutive year.

STIs affect people of all ages. Some of the most common STIs are the human papillomavirus (HPV), herpes, syphilis, chlamydia, gonorrhea, and hepatitis. Fifteen- to 24-year-olds accounted for more than half of new infections in 2020, and STIs more than doubled among U.S. adults ages 65 and older between 2007 and 2017, according to the CDC.

Dr. Sharma and Ms. Angelicola say these trends underscore the need for education on safer sex practices, recommended vaccinations such as the HPV (human papillomavirus virus), and routine screening for STIs.

Dr. Sharma encourages asserting your “personal power” with sexual partners. This includes insisting on condom use as well as transparency. “Ask your partner if they’ve been tested. If the answer is no, ask them to get tested and share the results,” she explains.

Preventing unintended pregnancy

If you’re sexually active, another risk to sexual health may be unintended pregnancy. The number of unplanned pregnancies in the U.S. has declined over the past 15 years, though it still disproportionately impacts teens ages 15 to 19, especially women of lower income and education levels.

Understanding your birth control options is a must for women of all ages, explains Ms. Angelicola. Whether you don’t want children, aren’t ready to have children, or your family is complete, you’ll need to find a reliable method to avoid unintended pregnancy.

There are more than a dozen birth control methods, including intrauterine devices (IUDs), pills, and permanent methods like vasectomy. Ms. Angelicola encourages you to discuss different options with your provider and find what works best for you, depending on your lifestyle and life stage. It’s also important to remember that not all contraceptives prevent STIs, and the effectiveness among methods varies.

For women of advanced maternal age, over age 35, it is important to continue using birth control until you officially reach menopause. “You need to use contraception until you have had 12 months without a period — which marks the start of menopause. This may happen in your late 40s or into your 50s,” says Ms. Angelicola. “Although the risk of pregnancy declines as women age, it can still happen.”

Dr. Sharma also urges routine OB-GYN care throughout and beyond your reproductive years. Women at average risk for cervical cancer are advised to get a Pap smear every three years between the ages of 21 and 65. Your doctor may also recommend an HPV test since almost all cervical cancers are caused by HPV.

Sex and aging

You may find welcome changes to your sexual health as you age. For example, you may have fewer pressures and more time for privacy as your children become adults or your career and life pursuits evolve. You may also feel freer in expressing your sexual needs and desires.

But normal aging brings physical changes that can impact sexual health. A woman’s vagina can shorten and narrow, and the vaginal dryness associated with menopause can make sex uncomfortable. Meanwhile, men are more likely to experience erectile dysfunction (ED). You may also worry about how your aging body or health conditions may affect your sex life.

Women might find relief from vaginal dryness by using over-the-counter lubricants or vaginal moisturizers. Your doctor may also suggest prescription hormones or non-hormone medication to treat menopause symptoms.

If you’re a man who experiences frequent ED, you should talk to your doctor to determine possible causes and treatment options. Fortunately, today there are various medications as well as other therapies that can be used to help men get and maintain an erection. 

Other health concerns, which are not a part of aging, can also affect your sex life. Chronic conditions such as diabetes, heart disease, and obesity may impact your sex drive and satisfaction. Since many of these chronic illnesses are preventable, your provider may recommend behavioral or lifestyle changes.

“If you’re taking care of the rest of your body so that you feel good, attractive, and energized, you will increase your vitality and connect to your sexual self at any age,” says Dr. Sharma.

Ms. Angelicola also disagrees with stereotypes older adults face regarding sex. “What intimacy and sexual activity look like may be different as you age, but that doesn’t mean it has to be any less satisfying,” she says.

Sexual health’s biggest issue

When it comes to sexual health the most common struggle for every age group is simply talking about it. Tiptoeing around your sexual health — whether it’s sex, STIs, sexual orientation, or gender identity — is a missed opportunity. “It’s so personal, so emotionally charged, and there’s fear of judgment — yet it’s a piece of our health and well-being that should be discussed and treated as importantly as anything else,” says Ms. Angelicola.

Both providers say getting over this hurdle requires people and information you can trust, and safe spaces where you can ask questions and share concerns without judgment.

Dr. Sharma often invites parents of young patients to leave the exam room so she can engage in an open, private conversation about what they are experiencing and learning. “There’s so much access to information today — good and bad,” she says, including social pressure to engage in risky behaviors.

Ms. Angelicola says asking and answering uncomfortable questions is critical to promoting healthy sexual experiences. Open dialogue also helps providers recognize signs of sexual violence — sexual activity that’s coerced or engaged in without consent. Over half of women and almost 1 in 3 men have experienced sexual violence in their lifetime, according to the CDC.

Whether it’s your provider, partner, or a trusted adult, communication is key to sexual health at any age. “Sexual health is how you identify and relate to your body and how you want to share it with others,” Dr. Sharma says. “Cherish yourself. And find someone who can help you be your healthiest self.”