If you’ve been waiting in line at the supermarket or browsed a newsstand recently, you cannot help but notice the controversial and attention getting covers of today’s women’s magazines. If they are not sharing “the secret to losing weight overnight,” these magazines are offering up tips on how to have a better sex life or how to be and feel sexier.

They do this, of course, because sex sells – most of us wouldn’t mind feeling more sexy and having more enjoyable sex. If only it were as simple as a magazine checklist! So many women entering perimenopause or menopause have entered a new phase of their relationship lives – some may have been widowed while others may have ended a long-term relationship.

However they arrived there, more and more of my patients are finding themselves navigating the dating scene once again and they are discovering that it’s a different world today than when they were last single. In addition to the media images about what is sexy and the magazine stories offering us “quick-fix sex solutions,” the presence of social media and internet dating sites has changed the way people meet and date. These tools have made it easier for newly single people to connect with more people, even if it’s not for a long-term relationship.

Despite the ease with which we can meet people today, I’m often surprised when women come in for their annual exams and share that they have had unprotected sex. Whether pregnancy is a concern or not, they may have forgotten, or just not been aware, that there are other health concerns that come from being intimate with someone, regardless of your age.

In other ways, though, I am not so surprised. After all, sex is a wonderful, pleasurable experience. And being touched, held, caressed, and cuddled feels incredible, especially if you have not had that experience in a long time. Some of my patients tell me that after years without physical contact or connection, they couldn’t resist and the moment just got away from them.

Talking about sex with a new partner can be difficult. Inquiring about your partner’s dating history may make you feel like a prude. You may have no idea how to bring it up. But the same media that brings us information about the weight loss secrets of the stars is telling us that the incidence of sexually transmitted diseases among the 45-64 year old group has tripled in recent years.

We know it can be hard or awkward to discuss sex and sexual health. At marcellepick.com, we believe it’s important to talk about sex — it’s benefits and it’s risks — so that you are informed and you can make the best choices for your long-term health and well-being.

Whether you are single, divorced, or still committed to a long-term relationship, let’s start the conversation so you can enjoy the healthy, safe sex you deserve in the second phase of your life.

Sex, STDs, and Menopause/Perimenopause

How many stories have you heard about an unexpected pregnancy later in a woman’s life?  Many women don’t realize that just because their periods are slowing down and becoming less regular, they can still become pregnant during perimenopause. Until you have gone 12 months without menstrual bleeding, you still need to protect yourself from the possibility of pregnancy.

But while there are many forms of birth control that can help you avoid pregnancy, only a condom can protect you from sexually transmitted diseases, or STDs. If you have had sex without a condom and you have not been tested recently, even in a committed relationship, you really should consider getting tested for your own health and peace of mind.

That may seem extreme, and it surprises some of my patients, but there are several important reasons why I tell my patients this.

First, whether or not you have been using condoms faithfully, the reality is that many of us have already been exposed. It’s estimated that about 1/3 of us have had or will have a diagnosed STD in our lives. If you’ve already been diagnosed, there is nothing to ashamed of – 15 million Americans get diagnosed each year and 65 million people are living with an STD that is considered “incurable.” STDs are becoming increasingly common.

Second, many STDs can remain dormant for years – they may be there from your single days before you committed to a partnership, and the same could be true for your partner. While many are treatable, left undiagnosed they can cause more serious health concerns so it’s best to find out so you can take action to protect your body.

If you’re entering into a new relationship, it’s best to wait 6 months (because that’s how long some exposures such as HIV require to confirm a positive or negative result) and then both get tested before engaging in sex without a condom. That way you can both be sure. Meanwhile, you don’t have to wait to be intimate – just be sure to use condoms until you get your results back.

While it can be hard or feel embarrassing to talk to your partner about sexual health concerns, especially if it is a new relationship it is important to have that conversation (we’ll talk more about how to do that next). Whether you grew up as part of the love generation or had a different experience, most of us have had more sexual exposure than our parents did.

By the time you have had 12 partners in your lifetime, you have had 4,000 potential exposures to STDs – when you sleep with your partner, you sleep with everyone they have slept with too. That doesn’t mean we need to panic, but we do need to be aware of that reality and begin to take control of our own sexual health – it can be very empowering!

Lastly, your partner may not be totally honest with you and even if they are, their partners may not have revealed all to them. Chances are, the man you are with has not had the conversation you’ll want to have with him with his other partners. In my experience, I find that women are the ones who tend to take control and lead the conversation. Most men have never been questioned about their sexual practices or sexual health by their practitioner or their partner.

In addition, research shows that 91% of men did not use a condom when they had sex with a date or a casual acquaintance. So your seemingly healthy partner may well have found intimacy with a friend, date or acquaintance when he became newly single, seeking the same connectedness you are longing for, and he is now bringing that exposure into your bedroom. Using a condom until you are both sure you have not been exposed, or are comfortable enough with each other, is an easy way to take control of your long-term sexual health.

When you lead the conversation, most men will respect that and be happy to honor your request – if not, you might want to question whether this is a good relationship for you! While your partner will most likely oblige and agree to wait until you are both tested, most men will not initiate the conversation themselves. So if you want to take control of your own health and body, the burden of having the conversation may fall onto you. Let’s talk about how you can begin the conversation with someone you care about.

Talking About Safe Sex, Sexual History, and STDs

So what do you do now that you’re in a new relationship with someone wonderful and things are going well? You are ready, maybe even eager, to become intimate and take your relationship to the next level but how do you approach your partner about his sexual health and history? How do you ask tough questions without scaring him off or seeming to be a prude?

Asking a man how many people he’s been with would likely be awkward and uncomfortable and the reality is, he may not tell you everything anyway. After all, he may have been wild in his younger days and may not want to scare you off because he’s very different now. Or he may feel that the one night stand he had with a neighbor when he first got divorced is not meaningful or relevant to him now. And he may never have even thought of the possible risks of having multiple partners until now.

You can begin by asking about his relationship experiences since becoming — or while — single. If you’re ready to be intimate, you’ve probably already discussed how and why his last committed partnership ended, what his sexual experience was within that relationship, and what he is looking for in an intimate relationship now.

If you haven’t already asked what his intimate life has been like since that relationship ended, that’s a great starting point. You may also have discussions about what your sexual experiences were in your younger years and how much sexual freedom you both had prior to your long-term relationship.

Sharing important past life experiences sheds light on who he is and how he became that way; learning about sexual experiences and views on commitment, relationships, fidelity, sexual expression and freedom can build intimacy and strengthen your relationship.

Without it being a sexual inquisition, these loving conversations can yield healthy and helpful information for you both to explore the journey you have taken and how you came to be who you are now.

In the end, however, while these important conversations will provide helpful insights into your new partner, you cannot be sure that your partner is being 100% honest with someone they have recently met. And you can’t be sure that they are healthy (even if they have been a monk since their last relationship) unless they have been tested. So after you have had these conversations, you may want to share your desire and why you feel it’s important. You might share that you read about the increasing incidence of STDs in the 45-64 year old age group, which we’ll discuss more later.

Or perhaps you feel that you want to set a good example around safe sex to the younger generation. You might discuss your desire to take more control of your health and suggest that sex will be much more enjoyable if you both know and feel that you are safe. Or you may choose to be more direct and simply say that you are getting tested and suggest that he do so as well before you become intimate.

Whatever approach feels right for you, present your concerns in a loving non-judgmental way and simply share that you love and respect your body and want to ensure it is there for you in a healthy way for a long time. Ask that he respect your wishes by respecting your body, your health, and your desire to feel safe by engaging in safe sex with a condom for six months until you can both be tested.

STD testing for men is a simple, easy process so you don’t need to feel bad about asking. You have an amazing, incredible body and it is the only one you are ever going to have – isn’t it worth taking simple precautions to ensure it serves you well for a long, long time?

I’m in a Monogamous Relationship – What You Should Know About Monogamy and STDs

Once you have passed the waiting period of six months, either by waiting or by using condoms, and you’ve both been tested, monogamy means the freedom to explore your sexual passions and desires and to experience healthy and exciting sex with a committed partner! But the truth is that even if you are already in a long-term, committed relationship, you are still not without the risk of contracting STDs.

One reason is that, as we discussed previously, many viruses can remain dormant and symptom-free for years. Either you or your partner may have been exposed before you even began the relationship. You may be totally unaware that you have an infection and that you could be spreading it to your partner.

Statistically, men are less likely to go in for check ups or to be screened for sexually transmitted diseases than women. Because men are also more likely than women to be asymptomatic than women, you can’t be sure that sex is safe, even if you’ve been together for awhile. The only way to know for sure is to be tested.

And not to be the bearer of bad news, but monogamy is not always monogamy. One survey revealed that 22%, or one in five adults, in a committed partnership had cheated on their partner. Another poll indicated that nearly half admitted to being unfaithful at some point in their lives. That may not be the case in your relationship, but it’s just another reason why it makes sense to ensure that you have full peace of mind by getting screened.

I believe that if we want to be authentic and practice what we preach to our youth, we should practice safe sex. Even if the chances that you are infected with an STD are slim, as women we can lead by example, take charge of our own sexual health, and get tested. So now let’s look at what you need to know about STDs in today’s world.

Common STDs

There are several types of common STDs – some are treatable and curable, while others remain with you for life, though they can be controlled. Chlamydia, gonorrhea, syphilis (in its early stages) and trichomonas are examples of STDs that can treated with medication and “cured.”

STDs are on the rise, especially among 45-64 year olds. In fact, syphilis and chlamydia cases tripled in this age group between 2000-2010. Syphilis is particularly concerning because it can lay dormant for awhile but if it goes untreated, it can lead to more serious consequences including blindness, paralysis, and even death.

Recent reports confirm that cases of syphilis, chlamydia and gonorrhea have all doubled or tripled in the past decade. They attribute the rise to the fact that the “love generation,” began being sexually active and has continued to be so throughout their lives.  Other factors include a rise in divorce, and in certain STDs to the arrival of Viagra, which allows more men to remain active sexually longer.

In addition to the “treatable” forms of sexually transmitted disease, there are many STDs that cannot be “cured,” but they can be managed very well with medications or lifestyle and dietary interventions, so that you can live with them. Examples of these include herpes, HPV, and genital warts. In addition, HIV remains a concern, as cases of HIV among patients over 50 have doubled recently. HIV’s minor symptoms may appear within weeks but it can take up to ten years for more serious symptoms to develop. The symptoms that appear earlier may seem like those associated with aging such as lack of energy, short term memory loss, headaches, loss of appetite or cramps, meaning so many cases of HIV go undiagnosed in older patients.

10% of new HIV cases are being diagnosed among the over 50 crowd and the CDC blames this rise on older Americans not understanding the need for condoms and health care practitioners not educating older patients about the risks of unprotected sex. The good news is that getting screened and using a condom until you are sure you and your partner are healthy can prevent this.

Condoms – How Effective Are They?

While STDs cannot be completely prevented, studies show that latex condoms, when used correctly, are your best protection against HIV, gonorrhea, chlamydia and trichomonas. But the key is that you have to put them on prior to contact or penetration. Even then, they are not foolproof.

According to Dr. Cheryl Gibson, the Medical Director of Planned Parenthood of Northern New England, “Contraceptive Technology states the effectiveness of condoms for contraception at 88% in typical use and 97% in perfect use. For STD prevention…we generally quote a greater than 90% chance of reduction.”

At marcellepick.com, we believe using a condom is the best strategy unless and until you have both been screened and committed to a monogamous relationship. And because HIV may not be detectable for six months, that means using condoms until you are certain you are healthy.

Condoms are not perfect or foolproof – they can break and they need to be used correctly and before contact. They also only cover part of the genital area and warts and HPV can still be present. But they remain our best line of defense.

We recommend that women take control, buy their own stash of condoms, and keep them handy. That means in your purse, your car, your briefcase, your gym bag – make sure they are accessible anytime, anywhere so there are no excuses!

In this day and age, safe sex empowers women – choose your own flavors, colors, textures and have some fun taking control of your own sexual health and safety. It bears repeating that if he won’t wear one, you should seriously question whether this is a good relationship for you. After all, is risking your own health worth it for a man who doesn’t seem concerned about yours?

One more important tip: Remember that condoms have expiration dates – so check and make sure they have not expired before use!

Immune Health and STDs – What You Can Do To Reduce STD Risk

In addition to using condoms, there are a few other things we can do to minimize our risk of exposure to sexually transmitted diseases at midlife. You may not realize that improving your immune system can boost your sexual health as well! If your immune system is compromised, it will make exposure more likely to lead to infection, so an overall healthy, strong immune system can minimize your risk.

During perimenopause and menopause, when we are experiencing hormonal changes, the tissues of our genitals can become more fragile, which can leave them more vulnerable to infection if exposed. In addition, when estrogen levels drop, as they may with the hormonal shifting that occurs naturally during this transition, the vaginal tissues can thin and become drier. This can lead to tears in the lining during intercourse that can make it easier for viruses, such as HIV, to enter.

Because so many changes are going on in our bodies during this time, we may not notice symptoms of exposure. An atypical herpes presentation may be disguised as a fissure from low estrogen or yeast. Chlamydia and bacterial UTIs may take hold in your urethra because lower estrogen levels make it more vulnerable. Chlamydia can also impact the bladder and is rarely tested for in traditional urine tests.

Taking control of your vaginal health can help to minimize your risk. Keeping the vagina moist can help eliminate tears – use a sexual lubricant or a topical vaginal estrogen during intercourse. Consider taking a good probiotic with healthy yeast and high levels of lactobacilli to help prevent urogenital infections.

And finally, avoid douching as it alters the pH balance of the vagina. The vagina is full of lactobacilli, tiny little producers of lactic acid that help to keep the vagina clean, ward off pathogens and maintain the proper pH of the vagina. Douching removes those healthy secretions, which are part of the vagina’s natural means of cleansing itself and will actually increase the bacterial imbalance – and the risk of HIV and other STDs.

Douching was invented as a marketing concept to convince women that our vaginas are not “clean.” Nothing could be further from the truth! In my training I have learned that the vagina is actually like an amazing self-cleaning oven! If we leave it to work as nature intended, it will work to stay in perfect balance and keep us healthy.

Making a Plan for Safe Sex in Our Middle Age

There is much that we can do to take control of our sexual health and protect ourselves from STDs! Instead of ignoring the risk, being embarrassed to talk about it, or pretending that it won’t happen to us, we can make a few smart decisions to ensure that we stay healthy.

Having an advance plan so you don’t leave things to chance and “hope for the best” is your very best defense. And after all, sex will be much more enjoyable if we feel safe and can relax knowing that we are protecting our bodies from exposures to STDs.

While one third of us will be diagnosed with an STD in our lifetime, many more women will be exposed but not infected. Exposure is common – so again, it’s  nothing to be ashamed of.  But we can take action to prevent infection and ensure our bodies remain healthy and strong for the rest of our lives.

Because you may have already been exposed or may become exposed in midlife, I always remind my patients that it’s important to get screened to have peace of mind and know that you — and your partner — are healthy. STD infections can remain dormant and symptom-free, but if not diagnosed, can cause more serious health concerns so it’s important to have them treated.

Until you know you are healthy, latex condoms remain your best option. Buy the varieties you like or experiment with different kinds, but keep them handy. And be sure to check the expiration date!

Finally, take care of your body, your immune system and your vagina. A few simple self- care practices will help ensure that your body will be there to support and serve you for another 40-50 years!

Your Sexual Health Plan

  • Talk to your partner about your health histories and any concerns
  • Screen for STDs and ask your partner to get tested too
  • Make a plan for having safe sex until you know you are healthy
  • Take care of your vagina, especially during sex
  • Make sure your immune system remains strong