Sexually Transmitted Infection Prevention in Newly Single Older Women: A Forgotten Health Promotion Need

Carol Idso

Disclosures

Journal for Nurse Practitioners. 2009;5(6):440-446. 

In This Article

Factors Influencing Increased STI's in Older Women

There are several factors that influence the increased rate of STIs in older women. Divorce and separation has put many women back into the dating scene and into new partner sexual relationships. STIs in older women are a new area of interest, as recent studies have shown an increase in HPV, HSV, and chlamydia and gonorrhea infections in this population. Little published research is available, but what is available is compelling enough to begin health promotion for safe sex practices in the population of older women seeking new partner relationships. According to the U.S. Census population survey completed in 1994, there were almost 7 million divorced women between the ages of 35 and 65. This does not include the number of separated women.[3]

Many older women do not know what younger women know about safe sex, as they have not had the education and counseling about STI prevention. Young women enter into the health care system in need of contraception, at which time prevention of STIs, safer sex practices, and communication skills are discussed. Many older women have not thought about or been counseled about prevention of STIs.[4,5] Older women may not be concerned with pregnancy, as they may have had a hysterectomy, tubal ligation, or are postmenopausal, so they do not seek health care to initiate contraception. A contraception visit includes discussion and education on STI prevention, safe sexual practices, and pregnancy prevention. Health care providers are counseling and screening young women for STIs at almost every visit.

Older persons traditionally have not been considered at risk for STIs, and often it is not a topic brought up during an annual exam. Menopausal women are at an increased risk of being exposed to STIs as the vulva and vaginal mucosa are thinning. The menopausal woman may experience less vaginal lubrication, which can cause the tissue to become fragile. Fragility of the mucosa allows for easier transmission of viruses and bacteria to invade the tissues and cause an infection. Men in the older-than-45 age group may never have used condoms or, if they used them in the past, performance may not have been an issue. Older men may be reluctant to use condoms because of fear of erectile dysfunction.

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