Safe (and Enjoyable) Sex in Your Middle Years
If your immune system is compromised, it will make exposure more likely to lead to infection, so a healthy strong immune system overall can minimize your risk. Keeping your vagina healthy can reduce your risk as well.
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 during intercourse or a topical vaginal estrogen. 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! I have been taught in my training 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.
Making a plan in advance 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 we can relax and know 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