“Sex at age 90 is like trying to shoot pool with a rope,” quipped comic George Burns before he or anyone had ever heard of Viagra. Today, the little blue pill and other erectile dysfunction (ED) drugs offer a solution to the estimated one in ten North American men who suffer from ED. But better sex doesn’t mean safer sex. Even though sexually transmitted diseases (STDs) are more pronounced among younger men, a study by Boston’s Dr. Anupam Jena found that men over the age of 40 who used ED drugs were more likely to have STDs than were non-users.
“Anyone who does not practice safer sex, no matter their age, can contract an STD,” says Dr. Jena of the Massachusetts General Hospital’s Department of Medicine, whose study investigated the associations between STDs and ED use among 1.4 million privately insured U.S. men over the age of 40.
His report echoes the findings of other studies when it comes to the increase in STDs among older adults, including one from the United Kingdom which showed the doubling of STDs among adults aged 45 years or older from 1996 to 2003. An earlier study from Harvard showed that STDs rose by 83% for older, recently bereaved men from 1998 onward.
Safe sex reminders do appear on ED drug company websites (along with warnings of possible four hour erections). But there are many reasons that older men may be ignoring or not processing the safe sex message. One is that many older men are simply unaware of STDs – think of Austin Powers’ quip of “Only sailors wear condoms, baby” after time-travelling from the 1960s to the late 1990s. Others, having come from an age when the language of sex and the courtship dance was different, would rather eat nails than ask someone their sexual history.
Older men are often the ones not using condoms, says Dr. Jena. “The reason is that their awareness of STDs is lower, and, even if they know they exist, they think STDs are not that common.” The main reason that young adults use protection is to prevent pregnancy, something that older couples don’t usually worry about, he adds. Older people over the age of 50 are also less likely to be tested for HIV infection.
In the study, Dr. Jena and his co-authors discovered that in both the year before and the year after users filled their first ED drug prescription, they had significantly higher rates of STDs than non-users. “The first implication of that finding is that men who are using ED drugs aren’t necessarily men who aren’t having any sex at all. That’s not the public you see these ads directed to,” says Dr. Jena. (Indeed, the medical community has expressed concern that ED drugs have become lifestyle drugs used to enhance sexual pleasure, even in men who have no ED.)
Dr. Jena stresses that the study does not conclude that ED drugs cause STDs but that the men who use them have a higher sexual risk profile (and STD rates two to three times higher) than men who are non-users. These rates include HIV infection.
An editorial in last week’s Annals of Internal Medicine, which published the July 6th report, notes that despite the study’s limitations, the findings are both “believable and alarming.” This study, writes Dr. Thomas Fekete, “reminds us that STD counselling should not stop at age 40.”
And that doctors shouldn’t assume that older people don’t have sex. Dr. Jena adds that doctors routinely address lifestyle and sexual issues – everything from tobacco use to safe sex — in younger patients: “We ask if he or she is monogamous, or if they have multiple partners, are they practising safe sex. We ask that whole set of questions to men and women who are young, but we haven’t been asking them of adults over the age of 40 or 50.”
What are STDs?
STDs are sexually transmitted diseases and include herpes, chlamydia, gonorrhea, HPV, HIV, trichomonas, syphilis and others. They are transmitted by kissing, touching, or by oral, vaginal or anal sex. For more on STDs, go to www.phac-aspc.gc.ca.
The language of sex
Your grandparents knew them as venereal diseases – words never uttered in polite company and associated with being dirty. In fact, a WWII poster from the military shows the face of a pretty young woman with the headline, “She may look clean, but…”
Today, they are known as STDs but are sometimes also referred to as STIs or sexually transmitted infections in order to include infections that may be asymptomatic.
According to www.sexualityandu.ca, in 2003, 854,817 Canadians aged 18 to 49 who have ever had sexual intercourse reported being diagnosed with a sexually transmitted infection. There are more than 25 classifications of STIs; they can lead to genital warts, blisters, infertility, spontaneous abortion, cancer and death. Some, including genital herpes, HPV and HIV are not curable.
What puts you at risk?
Despite STD rates being highest in younger populations, anyone who has sex with someone who already has an STD is at risk – no matter what your age. Having had multiple sex partners increases the risk that one of them may have passed on an STD to you. Condoms offer protection; if you think you might be infected, get tested so you can be treated.
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