May is Sex Ed for All month, and Dr. Shannon Dowler, MD, CPE, FAAFP is here for an interview! She is an STDs (sexually transmitted diseases) specialist, Chief Medical Officer of North Carolina Medicaid, and the author of Never Too Late: Your Guide to Safer Sex after 60. STDs is a topic that gets attention, but how it relates to older adults is far less so. Her book is the first to educate the aging generation on STDs, and she does so by bringing humor to the topic.
Disclosure: This sponsored interview intends to include seniors in the sex ed conversation. Let’s stop pretending the age 55+ group isn’t having sex and educate all.
Interview with Dr. Shannon Dowler
Seniors are dating, with online matchmaking sites catering to them. Seniors in retirement communities and elsewhere are having sex. They need to be safe when being sexually active, and that doesn’t seem to be happening, judging from the AARP website stats that Dr. Dowler provided me:
What exactly are STDs?
STDs (also known as STIs) are Sexually Transmitted Diseases and Infections. Examples include herpes, caused by a virus, or gonorrhea, caused by a bacteria. We are experiencing the highest rates of STDs/STIs in the United States in our history, and there is no sign of significant decreases.
The list of STDs/STIs continues to grow as we learn about new infections, and existing infections have gotten harder to treat due to drug resistance. Bet you didn’t know Ebola was sexually transmitted!
You’re right; I didn’t know that. Can you share more about the rising STD rates in the US?
In all fairness, the demographic with the highest rates of STD/I’s are our teens and young adults. They make up 25% of the sexually active population but get over 50% of the infections!
Having said that, we are undeniably seeing a new pattern of infections in adults in both the 55-64 and the 65+ groups where infections are doubling or even tripling year after year over the past 5 years, even throughout the pandemic. Because only certain infections are reportable and tracked by the CDC, we have very little hard data on some infections that are incredibly common, like Herpes and Human Papilloma Virus.
Wow, why are STD rates in those ages 55+ doubling in the US, in your opinion?
There are a variety of things that contribute to the increasing rates. One, life expectancy is increasing, and adults are enjoying sexual vigor longer due to improvements in health and medicines that support sexual function.
Two, adults are retiring earlier and living together in communities at increasing rates, which creates an environment for more partners (I like to say, think college without work or classes!). Third, the advances in the technology world mean dating or hook-up apps are creating opportunities for making connections anytime and anywhere, and there is something for everyone—whether you are looking for a one-night hook-up, fellow swingers, or even a non-sexual long-term relationship.
Fourth, and not to be missed, older adults are the least likely of any age group to use condoms to protect themselves against STDs (STIs), and they haven’t had a good sex ed class in decades (if ever). So, they may not even be aware of all the opportunities for infection that exist!
What are the dangers associated with STDs? In other words, why should we worry about these stats?
Many of the infections have no symptoms, so you might be spreading them and not even know it. What might you have that you don’t know about?
Many of the infections can occur in “extra-genital” locations. When was the last time you got tested for oral or anal infections?
While many bacterial infections like chlamydia and gonorrhea can make you pretty uncomfortable, they probably won’t kill you. The same is true for some of the sexually transmitted protozoa and viruses like trichomonas and herpes.
However, Human Papilloma Virus is the cause of the vast majority of cervical cancers and increasingly implicated in head and neck cancers in older adults. Hepatitis B and C are sexually transmitted infections that can be life-limiting as well.
Almost half the people living with HIV are over age 55. When is the last time you had a hepatitis or HIV test?
Knowing this, I hope more people take precautions and consider getting tested. Why is the 55+ age group often being left out of STD awareness campaigns when they are at high risk?
There is a prevailing assumption in society and health care that older adults are asexual, and the data says that simply is not true. Particularly when we talk about the children of the Sexual Revolution, who are now moving into retirement communities, we should not be surprised that they are continuing to push the edge of our expectations around aging sexually!
This same demographic brought us Free Love, normalized masturbation, and gave us the Pill, turning society on its head 50 years ago. Sex in seniors is nothing to be ashamed about. Rather, it should be celebrated—but we have to arm people with knowledge to keep everyone healthy.
And that’s exactly what you’re doing – Let’s talk about your book, Dr. Shannon Dowler
What can readers expect from your book Never Too Late: Your Guide to Safer Sex after 60?
A no-holds-barred grown-up sex ed that tells stories, shares limericks, and has a little of something for everyone. Maybe you don’t need the update because you are not sexually active and have no plans to be—but I bet you have a friend, neighbor, cousin, or family member who sure could use your insight!
The book also issues a challenge to all of us—doctors and patients alike—to ask and speak openly about sexual risks and seek timely screening for infections.
Your book uses humor to educate readers. Why was it important to you to educate through humor?
Topics around human sexuality have historically been stigmatized, and many people are incredibly uncomfortable talking openly and honestly about sex. One way to take the pressure off and dial down the tension is to have a little fun while we are talking about it. Sex and the human body can be fun—and funny—so why not embrace that?
What would you say to someone embarrassed and unsure how to start talking about safe sex with a new partner?
In the book, I offer up some “practice scenarios” because this is a real challenge for many people, regardless of age! (I just had this conversation with my son, who has not asked his occasional partner if she has other partners!)
I encourage people to try role-playing in front of the mirror or with your dog, and then maybe with a good friend, because it will help make the real conversation that much easier. And no matter how awkward the conversation about potential risks is, I promise it is a million times easier than having to make a call to tell someone you gave them chlamydia, herpes, or syphilis!
Get Your Copy of Never Too Late by Dr. Shannon Dowler
Find the book Never Too Late: Your Guide to Safer Sex after 60 by Dr. Shannon Dowler, MD online through the publisher Johns Hopkins University Press, and on Amazon. It is also available through independent bookstore sites and local bookstores. You can hear the audiobook on Audible too.
For the audiobook, Dr. Dowler was cast to read her book. She explains,
“You get my voice telling the stories and sharing a career of learning to help you navigate this often-dreaded topic. Guarantee you will have fun and learn something!
Connect with Dr. Shannon Dowler online
She’s got great wit, so wouldn’t we want to get to know her better?! Find her at ShannonDowlerMD.com, where you can also find her rap video that went viral, book her for speaking engagements, and learn more about the book.
Top image: Meet Dr. Dowler. Photo credit: Margaret Brown.