Globally, the voices and experiences of older people tend to be excluded from discussions of sexual health and well-being. Their sexual health needs are stereotyped as insignificant beyond the reproductive periods of life. Yet sexual activity occurs, of course, in older people and between older people and young adults, making them vulnerable to sexually transmitted infections.
When access to essential sexual health services is limited – as in many African countries – this vulnerability is a concern.
Research into sexually transmitted infections (STIs) in adults over 50 is expanding gradually, with evidence of new cases and delayed diagnosis. Evidence also predicts a future increase in cases among the elderly in developed and developing countries. Some evidence has already confirmed that older people in African countries are vulnerable to new cases of sexually transmitted infections. Gonorrhea, syphilis and HIV are at the top of the list.
Despite new evidence, sexually active older people face systemic, cultural and individual barriers to accessing the services they need. And it starts with a conversation about their sexual health. Barriers include the stigma associated with contracting STIs, poor attitudes of health professionals, and the unavailability of age-appropriate health services.
Existing research shows a lack of strategies to promote open communication on sexual health needs in African countries. In addition, there is little contextualized research on the unmet need for communication about sexual health in old age.
Our research aimed to identify some of the common sexual health needs and concerns among older people in Nigeria. We also explored the barriers to communicating these needs and how these barriers could be removed.
We have found that seniors and their health care providers are sometimes overwhelmed by other health needs. Conversations about their sexual health needs take a back seat. Tensions and contradictions around personal beliefs, subjective well-being, cultural expectations and the responsiveness of the health system also emerged as critical constraints.
Sexual health needs and concerns
We conducted 16 focus group discussions with adults over 50 in two cities (Ibadan and Lagos) in Nigeria. We used a story about the sexual behaviors of older people in the Yoruba cultural context to stimulate discussion. The aim was to explore how older people perceive sexual health issues and share them with their peers and those who they think could help or support them.
Participants’ sexual health problems differed by gender.
Most men were concerned about using their penises for sexual activities. They were interested in enhancing their sexual pleasure and that of their partners during sex. In their view, any decline in penile function in the elderly was a serious concern. Erection difficulties, low libido, premature ejaculation, and slower arousal were common concerns among older men.
Women were more aware of changes in their bodies and the need to adapt accordingly. The participants thought their bodies were fragile and unable to clean themselves, which could lead to illness. Some believed that intercourse should be minimal in old age due to the perceived consequences such as the development of fibroids and the likelihood of contracting a sexual infection. The women were also concerned about vaginal dryness, vaginal bleeding, STIs, and low sexual desire.
Stigma and name calling discouraged older women from sharing their sexual concerns. Often they preferred to talk about menopausal issues. In this sense, older women believed that low sexual desire and disengagement were signs of âsexually aging wellâ.
Participants explained how they discuss their sexual concerns with nurses. Here, too, there were differences between men and women.
The women recognized that they could get help from health care providers, but preferred to ignore their problems.
Men preferred to voice their sexual health concerns and seek help or solutions in tight spaces, such as private rooms in health facilities or one-on-one interaction with their doctors. Older men feared losing their social respect. They thought they would be labeled as perverted if they decided to talk about their sexual health issues during their hospital visits.
Older men compared their scores with peers and relatives on sexual performance. Such conversations sometimes provided clues to medical and non-medical measures that could stimulate sexual desire and improve their sexual performance. A few older adult women have expressed reluctance to share their sexual concerns with their peers.
In some ways, both women and men seemed willing to share their sexual health issues with others. However, they emphasized âtrustâ and âsafe chat roomsâ as major considerations.
Participants said they had sexual health issues, including how to sexually satisfy their partners. But they felt compelled to openly share these concerns with nurses, doctors or relatives. The spaces for seeking care and the opportunities to discuss these needs are limited.
Social campaigns around communication about sexual health are needed to make it easier for older people to talk about it.
Studies on communication about sexual health in the elderly are urgently needed. Providers and health systems must be able to act on emerging sexual health needs and diseases.
The need is in part shaped by the risk of reversing the gains made in the fight against STIs among young people. Dating and sexual activity take place between age groups.
Counseling, testing and treating everyone without bias or discrimination is a cardinal strategy to reduce the stigma attached to STIs and to build older-friendly sexual health services.