Middle-aged sex without the mid-life crisis

2017-01-10

More people are dating in middle age, but are they looking after their sexual health?

With more middle-aged people dating, or starting new relationships than ever before, are we taking enough care and consideration of our sexual health?

When we think of the faces behind recent statistics that are showing a rise in sexually transmitted diseases (STDs), we probably picture someone young. Those irresponsible students and twentysomethings playing around and not thinking through the consequences of their actions. But not so much. It is becoming clear that a large proportion of people contributing to those statistics are in fact, middle-aged. The Irish Family Planning Association (IFPA) annual report highlighted an increase in women aged over 50 coming to the clinics for sexual health services, including sexually transmitted infection screening and menopause check-ups.

The association said there was a perception that once women reached menopause, that they no long needed sexual health services. But that’s not the case. Minding our sexual health all through our life is as important as looking after our physical and mental health.

Unplanned pregnancies

For many women, perhaps coming out of a long marriage or relationship, they perhaps don’t seem to think they have to go back to the good old days of contraception and protection. Yet there are more unplanned pregnancies in the 40-plus age group than the younger ages.

“We definitely see an innocence and a lack of knowledge in middle-aged women seeking our services,” says Caitriona Henchion, medical director of the IFPA. “We see women not knowing if they need emergency contraception or whether they are experiencing menopausal symptoms. They’re not sure even in their late 40s and early 50s whether they still need contraception.”

The recommendation for contraception is very simple, yet perhaps not widely known. Until you have not experienced periods for two full years and you are under the age of 50, or one full year without periods after the age of 50, you need to still consider contraception. Amid constant talk of falling fertility as we age, many women are confused about their contraception needs.

This lack of knowledge about sexual health needs is apparent not just in the number of unplanned pregnancies in older women, but the rise of STDs in that age group as well. According to Henchion, advice from GPs can sometimes vary in quality and quantity, and so any sexually active woman over the age of 40 needs to seriously consider both her health risks and contraception needs.

Regular screening

The recommendation is that anyone who is sexually active needs regular screening. This seems to be something that many women feel unable to do. But emerging from a marriage or long-term relationship where the partner may have had other sexual partners means that STD screening is imperative.

“Discovering an unfaithful partner is a really common reason that we see older women coming to our clinics for screening,” says Henchion. “Our advice would be that the first thing to consider when starting with new partners is to ensure you have safer sex with condoms.”

But condoms don’t protect against everything, so the recommendation from the IFPA would be that if in sexual relationships you need to have testing twice a year.

“Obviously the people I see are a self-selecting group who are sexually active and attending our services, but certainly I would see a lot more people in the 50-plus [group] who are openly talking about their wants and needs and their problems with it, which is great,” explains Henchion. Who they do not see are the men and women not seeking sexual health services, or asking openly about their needs.

One of the reasons there is a rise in general of STDs is because far more tests are being carried out, and therefore, more positive results. The tests are better now for chlamydia and gonorrhoea, so whereas a few years ago tests had less than 75 per cent detection rate, today it is 99 per cent. The tests themselves are simple. For men with no symptoms it is a straightforward urine sample and blood test, and for a woman, a vaginal swab and blood test in a nurse-led clinic.

Simple rule

According to Henchion, “the simple rule would be if you have a new partner for a few weeks, get tested.” But for many people, we perhaps don’t even know what to look for.

The top three STDs in terms of prevalence would be chlamydia, warts and herpes, and although many of the symptoms are obvious such as bleeding or physical warts, in more than 50 per cent of cases there are no symptoms. How many cases are picked up is through automatic testing when going for certain contraception options such as the coil.

Henchion believes we need better sex education and awareness for all generations. “I see 21-year-olds coming in with no understanding of how STDs such as herpes and warts can still be spread even though they are using condoms. And for sexually active people in middle age, there is often a significant lack of knowledge.”

For now, until sexual health education is more widely available, there are plenty of support services including GPs, well woman/well man sexual health clinics and the Guide Clinic at St James’s Hospital. The IFPA offers free advice, and there are plenty of online services such as HealthyIreland.ie.

“The key message is that early detection makes a huge difference in reducing risk of pelvic infection and obviously reducing the risk of passing it on,” warns Henchion. “Anyone, whatever age, who is sexually active needs to mind their sexual health.”

Middle-aged, single and on fire – or talking ourselves celibate?

For many women who have reached the supposed sexual prime of their 40s and 50s, their body image is shattered along with their energy. A recent survey suggested some women in this age bracket have the lowest confidence of any other age group regarding body image, and it’s affecting their sex lives. Yet another survey highlighted the fact that some women in middle age are having the best sex of their lives. If both surveys are right, is it all just down to attitude, and can changing your attitude change your sexual mojo?

In the two decades since the iconic shenanigans of the “man-eater” Samantha shocked a nation in Sex and the City (while women everywhere sniggered at the delight of it), middle-age sex is becoming mainstream. The BBC were at it with Happy Valley, and even Cold Feet caught up. First time round, Adam and co were in their youth, but now that they are heading towards 50, who is the one having all the sex? Karen. Middle-aged, single and on fire. Now that ordinary middle-aged women are being shown to be – gasp! – sexual, it begs the question: what does this mean for us? Is this liberating or intimidating?

It seems your answer to that question is the difference between having an active sex life in and beyond middle age and putting away the sexy knickers and taking out the comfy slippers.

Like tight skin and fashionable clothes, sex used to be the domain of the young. But now middle-aged women can have tight skin, fashionable clothes and sex as well. It all depends on your attitude. If you think your sex life is over at 50, it will be.

“Attitude is so important,” says sex therapist Kate McCabe. “I see women challenging traditional values and beliefs that you are past it sexually after a certain age. Women are having babies later, new relationships later, are mentally and physically healthier and anxious to be active and participate fully in every aspect of their lives.”

In fact, a regular, happy sex life can benefit our physical, mental, emotional and social wellbeing, improving health and prolonging life. This generation of middle-aged women have opportunities to redefine what stereotype they fit into, experiencing greater sexual, financial, social and intellectual freedom than at any previous time. Contraception has meant we are not overburdened with childbearing, and openness about sex means that issues which might have caused discomfort and difficulty can be addressed. The increase in divorce and separation now means that middle-aged dating is an acceptable social norm.

So why are all middle-aged women not taking advantage of the chance to flirt their 50s away and sex up their 60s?

“Sex must be worth it,” explains McCabe. “I see women who come into therapy to see how they can best improve their sex life, even to the extent that they’ll bring in their partners and manage to engage in that conversation.”

And it’s women of all ages. McCabe has clients in their 60s and 70s. “They are definitely getting out there, and they want really good, honest information on how to make the most of their sexual potential.”

But what about those women who are talking themselves celibate because of lack of confidence? Media plays a huge part in how women can often rate themselves. According to McCabe, feeling sensual has nothing to do with how you look.

“Finding intimacy is a brave step. Overcoming hang-ups to really explore our own sensuality is vital. And much of it relies on getting the right attitude.”

Privacy concerns keep young people from sexual health services

2016-12-19

By Karen Pallarito, HealthDay News

Young people may abstain from seeking sexual and reproductive health care because they fear their parents will find out, a U.S. government report suggests.

About 7 percent of teens and young adults said they would not seek that care due to confidentiality concerns, the U.S. National Center for Health Statistics (NCHS) reported Friday.

he youngest teens expressed the greatest reluctance. Almost one in five 15- to 17-year-olds said they would not seek that care because their parents could find out, according to the report.

“It is concerning,” said Casey Copen, an NCHS health scientist and lead author of the report. The NCHS is part of the U.S. Centers for Disease Control and Prevention.

The CDC estimates that 15- to 24-year-olds account for half of all cases of sexually transmitted diseases in the United States.

“It’s important that we monitor any barriers that youth may experience to obtaining health care,” Copen said.

The report provides data from two new measures of confidentiality included in a nationally representative household survey involving face-to-face interviews.

Copen said these questions were added to get a sense of young people’s confidentiality concerns and any barriers to sexual and reproductive health care.

The survey revealed that young women with confidentiality concerns were less likely to receive sexual and reproductive health services in the past year compared to those without such concerns. Among females aged 18 to 25, for example, 53 percent with concerns received these services, compared with nearly 73 percent of those without such worries.

Among males, there were no large differences in the percentages receiving sexual and reproductive services based on confidentiality concerns.

Abigail English is director of the Center for Adolescent Health & the Law in Chapel Hill, N.C. She said the new report is “extremely important and useful” because it confirms findings from older and smaller studies and provides new data.

Concerns about young people’s health privacy and confidentiality have been around for decades, English explained.

Every state has a law allowing minors to consent to some range of health services, most commonly diagnosis and treatment of sexually transmitted diseases, she said. Most states also allow minors to consent to contraception services, she added.

The federal HIPAA law — short for Health Insurance Portability and Accountability Act — safeguards a patient’s medical information and also provides some confidentiality protection for minors, English said.

For example, when a teenager goes for her annual physician visit, the doctor may explain that it’s appropriate to have some time to talk privately and ask mom if she’d mind stepping out to the waiting room.

“That is recognized under the HIPAA privacy rule as having some significance, and affording, then, the young person some protection for those discussions,” English said.

Most health professional organizations already have guidelines on appropriate communications with young patients, Copen said.

Michael Resnick, immediate past president of the Society for Adolescent Health and Medicine, said confidentiality is the “keystone of effective communication between provider and patient.”

Doctors and other health providers also have a role to play in improving communication between parents and their adolescent children, said Resnick, chair of adolescent health and development at the University of Minnesota.

Still, only 38 percent of teens spent some time alone — without a parent or guardian — during a visit with a doctor or other health care provider in the past year, according to the new report.

With limited time during an office visit, it could be that the topic “gets short shrift,” English said. Or, it could be that parents are reluctant to leave the room, physicians are uncomfortable asking them to leave, or teens want a parent to stay, she added.

But having that one-on-one time seems to make a difference, the survey suggested.

Teens aged 15 to 17 who spent some time alone with a doctor were more likely to receive sexual or reproductive health services in the past year, compared to those who lacked the opportunity for a private discussion.

“It’s important for young people to know that they can consent for certain services on their own and not be afraid to seek services in a confidential way,” English said.

More information

The Society for Adolescent Health and Medicine has information on sexual and reproductive health for teens and young adults.

Copyright © 2016 HealthDay. All rights reserved.

Masturbation, penis size, rough sex: What Indians ask doctors online since no one will tell them at home

2016-12-15

Even before Saurabh Arora got his online healthcare platform off the ground, the former Facebook data scientist had an inkling of what Indians might want to ask doctors—especially if they could send questions via a smartphone app and in complete privacy.

 

The low-hanging fruits, as Arora described them, were mental health, women’s health, and well-being of children. But the subject that would probably provoke most curiosity, Arora felt, was sexual health.

Arora’s instincts were not off the mark. Two years after the launch of Lybrate, an online doctor database that connects physicians to patients through a mobile app, user data from the platform shows that an overwhelming number of Indians have many, many questions about sex.

Lybrate allows users to post general health queries, consult doctors in real time, search for doctors in the neighbourhood, and book appointments online. Users can choose to remain anonymous for online interactions.

Lybrate, of course, is not entirely representative of India’s patient population. But with an enrolled base of 100,000 doctors who interact with a daily patient load of 200,000 individuals, according to the company’s estimates, the user data still provides a significant insight into what health issues Indians are concerned about.

“I’m sure these discussions are not new,” Arora said, referring to the overwhelming interest in sexual health among Lybrate’s users. “Particularly in metros, the need has been there, and it has been circulating in private groups, one-to-one phone conversations, and things like that.”

Conversations around sex are still largely taboo in India. Sex education is not part of the curriculum in most schools. Few parents will openly talk about it and even doctors can be hesitant to ask patients about their sexual habits.

On the other hand, the environment that many young, smartphone-wielding Indians grow up in involves a liberal dose of pornography. Indians—and not just the men—are among the world’s most prolific consumers of online porn, with a special liking for smut involving “Indian bhabhi,” “Indian wife,” and “Indian aunty.” Obviously, all of this happens behind closed doors with little room elsewhere for serious discussion about sex.

So, in a country where over 40% of the population is under 20 years of age, people seem to be taking the discussion online. And platforms like Lybrate, which allows individuals to consult doctors without necessarily surrendering their privacy, provide a window into that exchange.

Lybrate’s data shows that across tier I, tier II, and tier III cities, the most common questions are on erectile dysfunction, premature ejaculation, menopause, and low libido.

The absence of an open conversation about sex and sexuality in India is an overwhelming concern for sex educators like Anju Kishinchandani who focuses on educating school-going children in Mumbai. For the lack of better options, children are turning to the internet for answers and there, pornography is often the first thing they find.

The recent smartphone boom in India, the world’s second largest smartphone market where 77% of users aged between 15 and 24 years surf the internet every day, has made matters worse.

“It’s very, very scary,” said Kishinchandani, “If they (children) are learning about sex and sexuality mostly through porn films, then they’re getting a very, very warped view because what they’re seeing there is not reality.”

The extent of misinformation can be frightening. Kishinchandani, for instance, recalls teenagers aged between the ages of 16 and 18 explaining how porn has shaped their assumptions about contraception.

“I’ve had children of that age group tell me ‘Why are you saying that we need to use contraception? Because when we watch porn films on our phones, those people don’t use contraception,’” she said.

Silence over sex

Meanwhile, parents are still unwilling or unable to broach the topic with their children. “Parents are still unfortunately clueless,” said Kishinchandani. “A lot of them want to talk to their kids but they don’t know how, so they don’t end up talking to them.”

The taboo is so overwhelming that even doctors sometimes hesitate to ask their patients about their sex lives. “They (doctors) say, ‘how can I ask? They (patients) might find the question irrelevant. They may think that I’m raising too personal a query’,” said Rajan Bhonsle, a sexologist. “This open dialogue between a parent and child, the teacher and student or a doctor and patient has to happen.”

The consequences of a lack of dialogue on sex can be serious.

“I meet people in their 40s and 50s and 60s, when they have avoided getting into relationships or getting married only out of some myths and misconceptions they carry about themselves, or about the sexual act,” explained Bhonsle, also a professor at the department of sexual medicine at Mumbai’s Seth GS Medical College and KEM Hospital.

Then, there is the possibility of individuals developing fetishes, paraphilias (abnormal sexual behaviour), and fixations related to sex, according to Bhonsle, only because they were not informed at the right time in the right manner.

The obvious risk of sexually-transmitted diseases, including HIV/AIDS, is also aggravated by the silence around sex.

Stigma and crime

Suppression of an accessible discussion on sex in India may have an even more wide-ranging manifestation: the endless wave of sexual crimes against women.

“This kind of taboo around talking about sex means people don’t understand what sexual relationships are about,” said Paromita Vohra, founder and creative director at Agents of Ishq, an online sex education project. “Because when there is a silence on a subject, then all kinds of hierarchies continuously get played out. And all of the stigma also (gets) attached to things.”

Men in India, Vohra explained, often have no idea what women’s pleasure is, what women’s consent entails, and how to negotiate that consent. So when they are rejected, it sometimes translates into violent reactions, like acid attacks or other acts of aggression.

Also, among women, who usually do not have space to speak about their own sexual desires and comfort, there is little awareness. “When you don’t ever talk about what is a healthy sexual relationship or a healthy sexual interaction, how do you learn to recognise it?” Vohra asked. “How do you learn to say, ‘No, this is not OK for me?’”

In a country where 95% rape accused are family, friends, co-workers or persons known to the victim one way or the other, this lack of information about sex—and stifled discussion on the subject—can evidently be dangerous.

And that is why the conversation that platforms like Lybrate are provoking is important. It is a fact that Arora recognises, although he is also acutely aware of its limitations.

“Tools like ours are obviously a great help but we understand that we cannot fulfil everything,” he said. “We still believe that to truly solve the problem, more and more people should know (about the subject). But more and more people should become aware at an earlier stage.”

WRITTEN BY

Devjyot Ghoshal

Major study: Sex-ed programs don’t reduce STI’s, teen pregnancy, HIV

A new peer-reviewed study of multiple “sexual and reproductive health” educational programs in several countries finds no evidence of improved health outcomes in any program studied.

According to the authors of the study, “School-based interventions for preventing HIV, sexually transmitted infections, and pregnancy in adolescents,” published in the Cochrane Database of Systematic Reviews, “There is little evidence that educational curriculum-based programs alone are effective in improving sexual and reproductive health outcomes for adolescents.”

The study’s authors reviewed eight studies that examined sex-education programs in schools in Africa, Latin America and Europe with a total of 55,157 participants, and performed randomized controlled trials on their data. They found the programs had no measurable impact on the rate of sexually-transmitted diseases among participants or rates of pregnancy.

“In these trials, the educational programs evaluated had no demonstrable effect on the prevalence of HIV or other STIs (Sexually Transmitted Infections),” the authors write, noting that in addition to HIV infection they also looked at results regarding herpes and syphilis. “There was also no apparent effect on the number of young women who were pregnant at the end of the trial,” they add.

The authors note that many studies of adolescent sex-education programs measure the programs’ effectiveness by examining their “effects on knowledge or self-reported behavior” rather than “biological outcomes” such as the rates of pregnancy and sexually transmitted diseases among program participants. In examining biological outcomes, the authors could find no benefit from such programs.

The findings of the study are consonant with other studies of “comprehensive” sex-education programs that show them to be ineffective or even counterproductive, particularly in comparison with abstinence-only programs.

A 2004 study conducted in the UK by the Family Education Trust, “Sex Education or Indoctrination,” examined teen pregnancy rates in different areas of the country to determine how they correlated with sex-education programs. It found that teenage pregnancy rates were highest in the areas that were most aggressive in promoting sex-ed.

A 2007 study conducted in the U.S. by the Institute for Research and Evaluation found that “comprehensive” sex-education programs had little impact on the behavior of teens during their education and no long-term effects whatsoever, noting “Of 50 rigorous studies spanning the past 15 years, only one of them reports an improvement in consistent condom use after a period of at least one year.”

The same study found that abstinence-based sex-education programs “can reduce teen sexual activity by as much as one half for periods of one to two years” at the conclusion of the programs.