By Nell Bernstein
Courtesy of Caring.com

The sexual life of our elders is something we younger folks shudder to imagine (and I confess to being guilty)—whether it’s an aversion to thinking about what goes on behind a parent’s closed bedroom door, or horror at the notion of Viagra in the medicine cabinet.

This willed ignorance about the sexuality of those who, somehow or other, managed to beget us, continues all the way to the nursing home, it turns out—sometimes with heart-rending consequences.

A recent study by a team from Kansas State University includes a subtle, yet poignant, example. A married couple had moved into a nursing home room with adjacent hospital beds. One spouse had a condition that required him to elevate a leg, and the beds had been placed so that the leg was on the same side as his spouse, which made it hard for them to hold hands. Staff members didn’t see this as a problem, and told the couple, essentially, to live with it.

Slate offers an even more extreme example. Bob and Dorothy, both of whom suffered from dementia, fell in love in an assisted living facility. When Bob’s son walked in on his 95-year-old father in flagrante dilicto, he demanded staff separate the two, and ultimately moved his father to another facility. Heartbreak ensued, as did the rapid physical and psychological decline of the graying Romeo and Juliet.

Why all the suffering? Because Bob’s son couldn’t bear to think about it.

While we’re not thinking about it, our elders apparently are. A study in the New England Journal of Medicine found that the majority of those 75 to 85 years old—about 53%—are in fact sexually active.

The Kansas State researchers observed impediments to physical intimacy in nursing homes as basic as shared rooms with only a flimsy curtain for privacy. But the biggest obstacle was simply that staff, like the rest of us, weren’t prepared to acknowledge sexuality among the elderly.

The most common reason offered for restrictions on sex in nursing homes is the conundrum of Alzheimer’s and dementia. Are those afflicted able to offer genuine consent? Who decides?

We squeamish kids—although we may have legal decision-making power in some cases—are arguably the last ones who ought to be making decisions when it comes to the sex lives of our parents (remember how we felt as teenagers when they tried to butt into ours?). The Kansas State researchers are advocating for federal guidelines, and some elder advocates are now recommending that part of getting one’s papers in order should include a sexual power of attorney.

This seems like a pretty good idea to me, although frankly, I think I’d make a lousy candidate for the job of sexual trustee. Were my own divorced parents to move to retirement communities and luck into late-in-life romance, I imagine I’d be thrilled for them. But that’s about as far as my imagination is willing to take me. If dementia entered the picture, and a sticky situation were to arise…well, I’d be more than happy to pull the curtain, and leave the decision-making to, say, a duly deputized second cousin.

But that’s not going to happen if I can’t even bring myself to broach the subject in the first place.

Certainly, when the time comes for our parents to move into a nursing home or assisted living community, the list of things to talk about—money, location, what to do about the house—is long enough as it is. But if we’re going to treat our parents the way we wanted to be treated as, say, sexually nascent adolescents—as full human beings with needs and desires, capable of making choices and forming deep connections—it may be time to think about having “The Talk.”

Again.

More from Caring.com:
•Sex For Life
•Sex and Chemo: Is It Safe?
•Alzheimer’s Romance: Why Sandra Day O’Connor Is Right

Men who are circumcised are less likely to get sexually transmitted infections such as genital herpes and human papillomavirus (HPV), but not syphilis.

This finding—published in a March, 2009 issue of the New England Journal of Medicine—adds to the evidence that there are health benefits to circumcision, the surgical removal of the penis foreskin, usually performed on newborns shortly after birth. It was already known that circumcision can reduce the risk of penile cancer, a relatively rare disease, as well as the risk of HIV infection.

But in the United States, newborn circumcision is an elective procedure, and rates are declining. (See a picture of a penis before and after circumcision.) In 1999, the American Academy of Pediatrics reviewed evidence of the potential risks, benefits, and costs of circumcision, and declined to recommend the procedure for all newborns.

Circumcision should never be performed strictly because it seems to reduce the risk of sexually transmitted infections, experts agree, and it’s important to note that circumcision should not be considered appropriate protection. Practicing safe sex, including using condoms, is still necessary to provide the best protection, whether a person is circumcised or not.

Still, many scientists are hoping that this new research may persuade recommending bodies, both in the United States and around the world, to give the circumcision’s benefits another look.

Circumcision remains a controversial topic
In the United States, infant circumcision is declining. About 64% of American male infants were circumcised in 1995, down from more than 90% in the 1970s. Rates tend to be higher in whites (81%) than in blacks (65%) or Hispanics (54%).

Some opponents say the removal of the foreskin is an unnecessary surgical procedure that may reduce sexual sensitivity in adulthood. In Jewish and Muslim cultures, young or infant boys are routinely circumcised for religious reasons. Circumcision rates have traditionally been higher in the U.S. than in Europe, but the American Academy of Pediatrics currently says that the medical benefits are insufficient to recommend circumcision for all baby boys.

Study coauthor Thomas C. Quinn, MD, professor of global health at Johns Hopkins University, says that choosing circumcision, whether it’s the parents of an infant or an adult male for himself, is and should remain an individual decision.

“But the critics need to really look at the benefits versus the risks,” he adds. “By now a large body of evidence has shown that the health benefits clearly outweigh the minor risk associated with the surgery. In our study, we didn’t see any adverse effects or mutilation. We’re recommending supervised, safe, sterile environments—not circumcision out in an open field with rusty instruments.”

Study shows protection from HPV, herpes
Efforts to increase the practice of male circumcision in areas with high rates of sexually transmitted infections, including Africa, could have a tremendous benefit, say the author of the 2009 study. Genital herpes has been associated with an increased risk of HIV, and HPV can cause genital warts as well as a higher risk of anal, cervical (in women), and penile cancers.

In the study, a research team at the Rakai Health Sciences Program in Uganda—in collaboration with researchers from the Johns Hopkins University Bloomberg School of Public Health in Baltimore and Makerere University in Uganda—conducted two clinical trials involving 3,393 uncircumcised men ages 15 to 49. All the men were negative for HIV and genital herpes (also known as herpes simplex virus type 2); a subgroup of men also tested negative for HPV.

Roughly half of the men underwent medically supervised circumcision at the start of the trial, while the other half were circumcised two years later.

Overall, circumcision reduced the men’s risk of genital herpes by 28% (10.3% of uncircumcised men; 7.8% of circumcised men) and HPV infection by 35% (27.8% of uncircumcised men; 18% of circumcised men).

Circumcision did not, however, protect against syphilis. (About 2% of men in both groups contracted syphilis.)

Increasing circumcision rates in Africa may not only help men, but would likely protect women too, possibly lowering the rates of female cervical cancer, the authors say. Ronald H. Gray, MD, professor of public health at Johns Hopkins University and study coauthor, says that the researchers plan to look at whether male circumcision reduces the transmission of HPV to female sexual partners.

What does this mean for America?
Even in the United States, this study has relevance, says Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (which funded one of the trials).

“In this country, circumcision for infant boys remains a personal decision for the parents,” he says. “This makes us rethink whether doctors should be more aggressive in recommending that it at least be considered. If parents say no just because generations before them have said no, they should learn more about the significant health benefits before making that choice.”

Roughly three-quarters of U.S. adults have had at least one HPV infection, according to an editorial by Matthew R. Golden, MD, and Judith N. Wasserheit, MD, both of the University of Washington. Although vaccines against some of the most dangerous HPV strains have been approved for girls ages 13 to 26, the vaccines are expensive and routine Pap tests are still necessary to pick up cervical cancers.

Dr. Golden and Dr. Wasserheit note that “rates of circumcision are declining and are lowest among black and Hispanic patients, groups in whom rates of HIV, herpes, and cervical cancer are disproportionately high.” Medicaid, which insures many low-income patients in these populations, does not pay for routine infant circumcision in 16 states.

The study authors hope that this growing evidence in favor of circumcision will persuade policy-making bodies, both in the United States and in other countries, to officially recommend the procedure—which could make patient education and insurance coverage more likely.

It’s not clear why circumcision may affect infection rates. But the study authors suggest that penile foreskin may provide a moist, favorable environment for herpes and HPV to survive and enter cells on the skin’s surface. Once the foreskin is surgically removed, the risk of infection may be reduced.

They also note, however, that male circumcision is not completely effective in preventing sexually transmitted infections. Safe sex practices such as consistent condom use are still necessary to provide the best protection.

For more information to help you make a decision about circumcision, see the topic Circumcision.