Mama & Papa, sitting in a tree...

It's a curious affair, this whole sex thing.

It seems to be, like so many things, an activity reserved for youth. Oh, those carefree days of vim, vigor, & virility! Those days when we were young & beautiful, lazing around in the summer sun, eating grapes & getting fanned by palm--hey wait a minute!

It is misguided to think that everyone loses not only the physical capacity but also the general drive to have sex as they age. It is true that some people may have less interest or less capacity, but this is not universally true, and seems to be decreasingly 'true' as time goes on--whether that be a general cultural shift, the aging of the 'free love' baby boomers, or the invention of a bevy of medications to overcome erectile dysfunction.

When I talk to medical students about the importance of sexual history-taking, I emphasize the fact that, as much as they might not like to think about it, the truth of the matter is that none of them (or almost none, given the wonders of technological advancement in reproductive options) would be there without sex. So yes, that means that your parents did it, your grandparents did it, and all their ancestors before them did it. And thank heavens they did, or you wouldn't be here today, making that squick face that so many people do when they think about this.

So why does it freak people out so much to think about it?

This concerns me a great deal, not only because I'm a sex nerd who thinks that healthy sexuality is a woven into the deepest parts of humanity, but also because I'm a health nerd who also spends a lot of time thinking about disease burden, transmission, morbidity & mortality.

For a lot of folks, safer sex is all about keeping the babies from happening, so once that's not an issue anymore, they give the old heave ho to contraception/barriers & never look back, delighting in their newfound freedom. Unfortunately, they're not out of the woods yet.

The data on STDs in this population is scarce, but in 2005, the CDC found that people 50 & older accounted for 15% of new HIV/AIDS cases--that's incidence, not prevalence! That same year, they found that this population made up 25% living with HIV/AIDS. And with the disease becoming more of a chronic condition, it is quite likely these rates will only increase without the proper education & prevention efforts. Beyond HIV, the data is even less available--but one study in England found that rates of STDs in this population had nearly doubled between 1996-2003. On top of that, STD symptoms often mimic the natural progress of aging--so if no one's asking them about their sexual history or screening them for STDs, there may be significantly more time in between infection & diagnosis, & therefore, potentially accelerated aging and increased mortality.

Not to go all doom & gloom on you there, but it's kind of scary, especially since older adults are almost always excluded from risk reduction clinical trial research, and there's a dearth of educational materials & population-specific prevention efforts being made.

So yeah--your old folks might be having sex. And yeah, that might cause a little heave ho in your digestive tract. But what if they're at risk & don't know it? What if they get infected & no one catches it? Is it worth the risk?

Maybe it's time for you to sit them down & have 'The Talk.'