Comment

Sexual healthcare is not just for the young

Nurses should have the courage to talk about sexual health issues with older patients – they will thank you for it 
Older people's sexual health

Nurses should have the courage to talk about sexual health issues with older patients they will thank you for it

Recently I carried out routine sexual health screening for a man in his late seventies. There was nothing unusual in asking him for a urine sample to test for chlamydia and gonorrhoea and a blood sample to test for HIV and syphilis. What was unusual was that it was his first visit to a sexual health clinic and I was the first healthcare professional that he had ever talked to about sex.

His wife had died ten years ago and he had just split from his only other sexual partner, a long-term girlfriend who had admitted to having a recent affair. He was worried about infection before embarking

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Nurses should have the courage to talk about sexual health issues with older patients – they will thank you for it 

Older people's sexual health
Nurses are well placed to support older people with their sexual health. Picture: iStock

Recently I carried out routine sexual health screening for a man in his late seventies. There was nothing unusual in asking him for a urine sample to test for chlamydia and gonorrhoea and a blood sample to test for HIV and syphilis. What was unusual was that it was his first visit to a sexual health clinic and I was the first healthcare professional that he had ever talked to about sex.

His wife had died ten years ago and he had just split from his only other sexual partner, a long-term girlfriend who had admitted to having a recent affair. He was worried about infection before embarking on further relationships. He said that he nearly hadn’t attended the clinic and worried that it would be ‘full of kids’. We had a frank discussion about sexually transmitted infections and I was able to address his concerns. I assured him that good sexual health is for everyone and that I was glad he had plucked up the courage to attend.

Sexual health needs should be included in routine assessments

It worries me that the sexual health needs of older people are not being met. Sexuality is a fundamental part of our make-up and it doesn’t vanish as we age. Healthy, consensual sexual relationships deepen intimacy and can greatly enhance our experience of life. Older people have the right to enjoy that for as long as they choose, and they may need help to do so. We shouldn’t overlook the sexual health needs of older people; they should be part of our routine assessment.

Few older people have had the opportunity to talk about sex and benefit from education in the way that younger people have. I recently taught a woman in her late sixties how to put on a condom as she had never been shown before. She'd been married for years and had only ever used a diaphragm for contraception. Recently divorced, she had begun dating and wanted to protect herself. We talked about negotiating sex and she said she felt a greater sense of control with some condoms in her handbag.

It is unusual for older people to ask questions or volunteer concerns about sexual health as they were brought up at a time when open discussion about sex was discouraged. They may have been unable to disclose same-sex relationships and may never have had their partners acknowledged or given the status they deserve.

Courageous conversations can help address the pain of past abuse

Many have struggled unnecessarily with problems that could have been resolved. Some women have endured the misery of years of heavy menstrual bleeding or unacceptable menopause symptoms that could have been treated.

Sensitive enquiry may open the way for people to release the burden of carrying long-hidden trauma. I routinely ask patients if they have ever been asked to do anything sexually against their will or if they have experienced intimidation or assault. It can be an enormous relief for survivors of abuse to be heard and offered support in coming to terms with events from the past.

Asking an older person a question about the most intimate part of their life may feel intrusive but nurses need to have courageous conversations and they have the necessary skills to do so, in a way that is sensitive and kind.

We cannot claim to offer truly holistic care to older people if we ignore this part of their humanity and neglect to support them with their sexual well-being and health.

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Ruth Bailey is nurse team leader, Sexual Health and Contraception, Brighton and Sussex University Hospitals NHS Trust

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