Maybe it's time teens gave their parents—and grandparents—a sex talk. Condom use declines with age, new research suggests, and adolescents are more likely than any other age group to engage in safe sex. It is adults over 40 who seem to have the strongest aversion to condoms, according to a large study whose first round of findings were published today in the Journal of Sexual Medicine.
"When we talk about sex and sexual health, we often focus on young people," says New York-based sexologist Logan Levkoff, who was not involved in the study. "Teens are so often portrayed as being irresponsible and promiscuous, even though that's not the case. One of the trickle-down effects is this perception by older adults that they don't need to use condoms, that sexually transmitted infections are for young people. But sexual health has to be ongoing."
Pregnancy may be less of an issue in middle age and beyond, but condom use is not just about pregnancy, say the researchers who spearheaded the study. It's also about sexually transmitted infections, or STIs, another term for sexually transmitted diseases. STIs are no respecter of age. Yet more than 90 percent of men over 50 didn't use a condom when they last had sex with a date or casual acquaintance, and 70 percent didn't do so when they had sex with a stranger. Among women over 50, a majority also report having sex without a condom. By contrast, 70 to 80 percent of teens say they used a condom during their last sexual encounter. All age groups were more likely to use condoms with casual partners than in monogamous relationships.
The research, part of the trove of data emerging from the National Survey of Sexual Health and Behavior, provides the largest snapshot of Americans' sex lives since the last similar survey in 1992. Nearly 6,000 people from age 14 to age 94 were asked about their sexual behavior, including sex positions, same-sex experiences, pain during intercourse, and condom use. The study, by sex researchers at Indiana University-Bloomington, was financed by Trojan condom maker Church & Dwight. The company did not participate in data analysis or write any of the reports that appear in the journal, says study author Michael Reece, director of Indiana University's Center for Sexual Health Promotion.
The "elevator drop" in condom use among older adults traces back to a lack of education and a false assumption that protection is unnecessary—especially since pregnancy is no longer a concern for many due to menopause, says Pepper Schwartz, a sexologist at the University of Washington. "Many of these people haven't been single for a long time, and they missed the public health messages," she says. "They missed the need to use condoms, because they were dependent on methods like the pill. But this older population is often dating—and often dating more than one person at a time."
Indeed, the low rate of condom use among older adults isn't for lack of sex. This survey shows, as others have, that Americans remain sexually active into their 80s. But as older people lose a partner because of divorce, death, or a move to a nursing home, new sexual partners often enter the picture, and they may bring new risks. STIs are a growing problem in nursing homes. Unlike younger people, however, who have been on the receiving end of countless safe sex campaigns, the graying population tends to be relatively unaware of or unconcerned about HIV and other STIs, researchers say.
Those 70 and older may also consider condoms unnecessary or inappropriate. "It's easy to say that everyone should be aware of sexually transmitted infections. But for that generation, these issues were presented in a different, stigmatized way," says Reece . "When I think about great-grandparents and public health campaigns during World War II and shortly thereafter, STIs were only talked about as the types of things soldiers would pick up from prostitutes."
The key to making older adults more condom friendly? Education can help. So can healthcare providers, by asking older patients more often about their sexual health, instead of assuming they're in stable, low-risk relationships, the NSSHB researchers say. Often, patients are embarrassed to broach such topics.
"We need to start targeting campaigns to older people, saying, 'It's great you're having sex,'" Levkoff says. "But that doesn't mean you shouldn't be doing it safely and smartly."