Episode 85: Sex Education for Oldies

This week's episode has been sponsored by Oh My Bod, shifting the evolution of pleasure. Hi, I'm Suzanne Noble Noble, and this is Sex Advice for Seniors, and today I'm with a sex educator from the US, Kelly Connell. Kelly, welcome to Sex Advice for Seniors. Nice to have you.

Oh, thank you so much for having me. It's wonderful to be here.

It's great. I am so interested to speak to you because I have— we quite a while back actually, we spoke to somebody who was working more with doctors around patients' sexual health and She found it really difficult to get work, if I'm honest, and she found it very difficult to get referrals because it was almost like she was invisible. And then it was because sexual health and older people, it's— there's just so much negativity and stuff that I've heard from so many different people, whether it's people commenting on my TikTok channel or whether it's through through the interviews that we do here about how screwed up the healthcare system is when it comes to discussing and helping older people have a healthy and active sex life. Um, so I'm really curious to hear, who hires you? Who hires you?

Well, I have done a lot of stuff in healthcare. Where I have gone and given presentations to medical students, residents, attendings, nurses, and then I've also gone and given presentations to patients, whether it be in support groups or, you know, through their program. I've done a lot at Council on Aging, the AARP here, the retirement communities, assisted livings. It's— it can be hard to get your foot in the door because it's not something that's taken seriously.

Yeah, I bet. And, and when you go into these sort of places, what are the common questions that you get asked?

Well, it depends. On where I'm speaking, you know, some come from a very negative aspect and they want to know what they can do to stop seniors in their facility from having sex, which drives me crazy.

Wow.

What they can do about when they walk in on residents having sex, which is very simple, you know, knock on the door. They have a lot of questions about sexual function as We age, sexual function, chronic illness and disability as well, what happens to your bodies. But, you know, the, the people themselves, the seniors themselves, they have a lot of questions about all of that, but they also have a lot of questions about how do you meet a partner if they are without— suddenly without a partner. Yeah, they have a lot of questions about emotional issues and intimacy and connection and touch and affection and things like that. It's, you know, very well-rounded, the things that I get asked. Yeah. And, and what—

so we have a situation here, right, where generally if people, if women specifically, are struggling to have a healthy, active sex life. Often they go to their GP to talk about it, and sometimes they get rebuffed, right? They get told, why? Like, what's that about for you? You're, you know, you're past procreation age, blah, blah, blah, blah, blah. And then they feel, oh, okay, so what am I supposed to do? You know, so So they just kind of end up in this no man's land where they don't really know who to turn to. How— what, what's the situation in the States regarding women, particularly women that go with some sexual health issues?

Well, I think that, you know, healthcare providers, etc., are just as guilty as a lot of other people when they stereotype people of a certain age or past a certain age in thinking that they're not sexual anymore, that they don't have a sex drive, that they don't have needs or desires or fantasies or want connection or just want sex for that matter. They don't look at the health benefits of sex. They don't examine the whole picture. And one of the things that I try to do is create a shift where they recognize that, you know, sexuality is a quality of life issue. Right. And, you know, you want to treat the whole person, you want to treat their, their physical problems, their emotional problems, you know, to be a whole person, we got— we need to be physically healthy, emotionally healthy. Some would say spiritually healthy depending on their belief system, and sexually healthy. And all of those things are interconnected.

Yeah.

And when one is out of whack, it's like a domino effect. And they also don't look at the fact that, you know, sexual dysfunction or lack of desire, any kind of sexual dysfunction in anybody who identifies as male or female regardless, can be a symptom of an underlying illness. Yeah, and you can't just disregard it.

Yeah, yeah, yeah. No, we had a discussion with a guy who does a, a cock ring that measures nocturnal erections, talking about, you know, some of the benefits of just being able to measure your erections in terms of understanding whether you're— you've got good vascular health or poor vascular health, right? So, which was, for me, seemed like something that should just go in every, um, you know, every GP practice. Is go off with this device, do this for 4 days, come back, we'll look at the reading and then see where we are with this, right? But it's so disconnected in terms of how we think about our genitals with relationship to the rest of our bodies. It's almost like they're a separate planet, right?

It's really interesting, you know, the literature is very clear that patients feel— of any age— feel that the appropriate person to address their sexual health issues or their sexual dysfunctions or problems is their healthcare provider. But the literature also says that healthcare providers have among the lowest level of education around sexuality and the highest level of discomfort around sexuality. So the patients are waiting for the health provider to bring it up, and the health provider is waiting for the patient to bring it up. So it doesn't get brought up, you know, unless you sort of have what we call the doorknob phenomenon, where, you know, like you go through the whole, uh, appointment and you don't mention it, and then, you know, the doctor has his hand on the doorknob ready to leave, and the person, oh, by the way, can I have a prescription for Viagra? You know, can I have this? You know, and that opens a whole other discussion, a whole other can of worms. And it can be hard to find a provider who is comfortable and open. When I teach, you know, I've had residents tell me, and med students, you know, "Yes, yes, yes, we want this education. We need this education. This is so valuable. We don't get enough of this. I don't know how to talk about this with my patients. I don't know what I'm doing. I don't know what resources are available." But then you kind of go to the administration and they say, well, yeah, you know, that's important, but we don't want to add anything to an already overloaded curriculum and we can't pay you.

Yeah.

And it can— it's very tough to get people to recognize it as a quality of life issue instead of just thinking that as you get older, you know, it's your lot in life. And it's just, it's not true. Sex may change, it may be different, But that doesn't mean that it's not pleasurable. It doesn't mean that it's not satisfying. It doesn't mean that it's not possible. You know, it is. It just, it absolutely is.

Yeah. And we've also heard from somebody that worked in social care settings in the UK that one of the things that happens in residential homes, you know, where people might have some cognitive impairment dementia, things like that, that the staff don't really know what to do about it. And they're not really trained. And so typically what happens is people are separated, which can cause incredible distress to the people involved. And, you know, and, and just the whole thing is just swept under the carpet because it's such a big topic. They just don't want to deal with it. And it seems like from what I'm hearing you say, that hasn't— that's not any different where you are either, perhaps?

Not really. You know, it's only been probably in the last 15 years or so that nursing homes have started to allow married couples to share a room. Yeah, they used to make them have separate rooms, and I've never understood that because You know, you're paying them to live there and especially when somebody has dementia and they're separated from their partner, it's very anxiety-provoking, but you have patients who have cognitive issues, memory issues, dementia issues, and the big thing is consent. You know, how does the facility know that they are consenting and they're afraid of getting sued.

Yep.

And so the easiest solution is to separate them rather than take the time or spend the money to train staff and learn about it. And then you hear stories like, you know, like Sandra Day O'Connor, the Supreme Court Justice in the United States. She just passed away recently. Her husband had Alzheimer's disease and was in a care facility. I don't know if you're familiar with this story. And he forgot all about her, you know, he had no memory of her. But he met a woman in this care facility and fell in love.

Oh my God.

And Sandra Day O'Connor was very public when she came out and said she had no problem with it, that, you know, she was so glad that even with his dementia, you know, he was still capable of feeling love and attraction, and that she knew— she didn't take it personally. She knew he wasn't like setting out to hurt her or set up to cheat on her or anything like that, that he just with his dementia, his Alzheimer's, you know, he just didn't remember her. He didn't remember he was married. But how wonderful it was that he met this person and, you know, fell in love at that stage. And, you know, it was very cool for her to come out publicly and say that because you see that more and more.

Yeah, yeah. No, I mean, gosh, and it must be so challenging, but equally you send your, you know, you send an elder, you know, an elder relative goes in one of these places and perhaps does find someone that they fall in love with or attracted to. And I think in later life, how my, my parents have a friend who they're in their 90s now. And his wife died, she had dementia, she eventually died. And he went online. And he met this woman, and they got married, and they're really happy. And she's like 85. And he's like 91 now, something like that. And we know that these things can happen at any stage of life, you can meet someone at any stage of life, there's no, there's no cutoff date for any of this stuff. So, you know, if you meet somebody when you're, when you're in a home, if you meet somebody on an online site, if you— wherever, you know, however it happens to happen, happen, we all should be able to be grown-ups, right? To be able to have some agency over our own feelings. And I think that's what I find so distressing. I know it's difficult, right? But it's so distressing.

It is, because, you know, we are sexual— what throughout our life cycle, from womb to tomb.

Yeah.

And our need and desire for affection, uh, commitment, uh, communication, uh, sex, intimacy, all of that. Even if sex is no longer physically possible, but the way to finding other ways to express love and intimacy, you know, it's just, it's room to tomb, it's lifelong. And what drives me crazy is, you know, when people see a couple of a certain age and they're so condescending, the 'aren't they cute?' Yeah, 'aren't they cute?' Yeah, yeah, yeah. That's just, it's so condescending, rather than look at them like just two adults who have met and connected and are in a relationship. It's just— my mom always said, don't get old, Kelly, it's hell getting old. And, and as I age, I'm finding out that she was right. Um, but experience certain— experiencing certain things myself now that I've taught about for years Yeah, it's been a very interesting experience.

Yeah, I bet. Do you want to share some of those, or would you rather—

oh, well, you know, just going through menopause.

Yeah.

Um, you know, and in this country, when a woman turns 50, she's, you know, unfuckable.

Yeah, yeah.

You know, and just the way they're viewed, the way women are viewed, you know, that they're not attractive, they're not they're not desirable, you know, all of that. It's very interesting. And if you're single, you're after everybody's husband. And just ridiculous, ridiculous things.

Yeah.

And, you know, a lot of times I also see when people are in a care facility or they are of a certain age and they get into a new relationship, whether their partner has died or you know, or they're divorced, that it's the kids that have a problem with it, that they're worried about inheritance.

Yeah, well, you know, I mean, I, I, I think that there's some horror stories about there, right, about people with dementia and young people recognizing that perhaps that person's a bit vulnerable, and therefore, you know, we've seen TV shows on this sort of stuff. So we also know that amongst this age group that STAs are rife, right? STDs are rife, that there's a lot of nasties going around because people don't think they need to use condoms anymore or any other form of protection. Have you had to advise people about stuff like that?

Like, well, yes. First, let me say the inheritance thing is not just for people with dementia. It's kids of parents of any age that want to remarry. Uh, they, they are worried about inheritance. Uh, yes, sexual health. You know what, I think it's 1 in 5 new HIV infections in this country, in the U.S., is in somebody, uh, or 1 in 10 is over in the age of someone over 55.

Is that true? I didn't know that.

There's been like an 80-some percent increase in chlamydia. Uh, I just heard there's a huge retirement community in Florida right now. I just heard they have a huge chlamydia outbreak. And it's a lot of it is that they haven't been educated. You know, you have somebody that, you know, got married right out of high school and they're married for 50, 60 years and then their spouse dies. You know, dating has changed. You know, their, uh, HIV did not exist. No, the last time these people were in the dating pool. And you know, I had a 74-year-old guy in one of my classes Or he was 74 years old before he ever learned to use a condom.

Yeah, yeah, yeah, yeah.

So it is crazy. And you know, Medicare not paying for STD testing— they were trying to change that, I don't know if they did, but it's extremely expensive. You have aged out of Planned Parenthood services because you're not reproductive age anymore, so you can't go on a sliding scale. So they don't make it easy for, uh, seniors to, uh, stay sexually healthy.

Yeah.

And a lot of times they're more prone to, uh, sexually transmitted infections, just like any infection.

Well, and also because, you know, like all the stuff that we know goes on in women's bodies around, you know, thinning vaginal walls, all that sort of stuff, tears and stuff, make, make it a, a breeding ground for all of that, for that lovely stuff that we, you know, we just love to like, you know, thrush.

What I love is that the sort of the tightrope between— they don't think that seniors are sexual, but then whenever a care facility has an outbreak, it's usually because somebody has brought in a sex worker and, and gotten an STD and then spread it to this resident. And, you know, this— and then you have a little epidemic on your hands.

Yeah, yeah, yeah. So in other words, there's no— if I, if I'm hearing this properly, you can't get, you can't get condoms through Medicare? No, if you're over a certain age, you can't get testing. Oh, you can't get testing? Can't get tested?

A lot of times they don't even think to offer it, you know, the doctors don't even think to offer it because—

and what about like if you're a 65-year-old woman and you want some vaginal estrogen, can you get that? By prescription, but through your healthcare provider, or you have to pay for that privately?

I don't know. I think that that would be covered under their prescription plan depending on what kind of Medicare they have.

Oh, right. Okay. But so they can't get tested for STDs, and, uh, yeah, they can get stuff— they can get stuff on prescription.

You know, at one point they couldn't. I know that they were working to change it, and I haven't heard if they have lately. Because you think the baby boomers started to age. Yeah, you're talking about a group of people that grew up in the '60s, and you know, they're not going to go quietly into that good night. They're going to fight for those rights. Yeah, yeah, because that's what they've been doing their whole lives.

Yeah, yeah, for sure. And that's— and, and I think that's the thing about all of this is that, you know, one of the things that I'm seeing at my age is that the— oh, I'm having the same conversations with everybody, right? Which is there's no way you're going to get me in that facility. I'm never, I'm never going into a facility because I've seen what happens in those places. And I want my autonomy. I want to remain independent. I want to live on a commune with my best friends somewhere really lovely. And everybody's got this kind of ideal of how they want to age out, you know, age, because they just are looking at how all of this is panning out for their parents. And going, that's not— that's— I'm not doing that. I'm not doing that. So, you know, nobody's really keeping up with any of this. And then, and then, you know, like you say, you've got these retirement communities now where these boomers are starting to move into some of these places, and they're still fucking. And lo and behold, like, and they're calling up sex workers and they're doing stuff because, like you said, it's like, I'm not going quietly.

Right, and you know, I don't think anybody wants to end up in a care facility, needing 24-hour care or not being independent, you know, but nobody knows what the future holds.

No.

You know, you just, you just don't know. You know, my aunt lived until she was 99 and a half, and she lived with her son, but she was, you know, 98% independent. Until the day she died. Yeah, you just don't— you don't know. And that's why we need to have these conversations and people need to speak up. But they are afraid if they speak up about anything, uh, they risk receiving substandard care. Not just sexual issues, but so many things. They're afraid of retaliation or that the, the healthcare workers will give them subpar care or ignore their needs because they're very vulnerable, and that's, that's a scary position to be in.

Yeah, yeah. So you go and you give these talks and you, and you make these presentations, and, and what's the, what's the end game for you with this?

Well, you know, I hope to raise awareness. I hope to get healthcare providers, facilities to take a look at their policies and see how they can better serve their residents. And I hope that the patients, the residents, the population that I serve, you know, I hope that they realize that it's okay to be sexual at any age, that just because you're past reproductive age doesn't mean that you give up on sex. Sex is for pleasure. You know, there's a lot of reasons to have sex. It's healthy to have sex. You know, you were talking about hormone replacement therapy. There's a company in the UK called Emotional Bliss, and you can go to emotionalbliss.com, and they are promoting a more holistic method of dealing with menopause because the research shows that sexual stimulation stimulates the hypothalamus, which stimulates the body to make estrogen even after menopause. And so orgasms are very good for you, and they've developed two really great products to help women orgasm. So I would really suggest that everybody check that out because the pleasure that we can receive from sex, and even if it's not intercourse but, you know, sexual activity, sexual interaction connection, intimacy, kissing, touching, holding. There's so many people that have skin hunger at a certain age because they don't get touched. I mean, there's just so many benefits. Yeah, yeah, that people need to be aware of that.

Well, we're still very much stuck in this dynamic of like, you know, men, you know, in heterosexual relationships, the penetrative sex being the thing, right? And I think that's, that's something that we've discussed before of just, you know, how do we move away from that narrative where everything is about penetrative sex, especially in circumstances where people, you know, a man may have had a prostate surgery that may no longer be possible. It may be some other form of disability, like how do we reconnect with intimacy and each other in ways that are different? I think people just generally struggle with that. And I know that, you know, more enlightened people go on workshops and they go and do things and they figure it out. But I think there's a whole nother group of people, which I suspect is the majority of people who go, well, that's it for me then, you know.

Yeah, because they've learned their whole lives that there's only one way to do it. There's only one way to do things. Yeah, no, people learn that about multiple things in their life. There's only one way to do things. And sex isn't any different, you know. And even when they're young and healthy, there's only one way to do things. And, you know, they don't want to try a new position. They don't want to bring a sex toy into the relationship. They don't want to try this. They don't want to try that because they've been taught their whole life there's only one way, one way. And I think that it's, you know, it's hard to change in life in general, but when it comes to sexuality issues, it can be hard to reframe your way of thinking, and that's where education comes in. And, you know, there are a lot of people that may not be able to have penetrative sex, but they have wonderful sexual activity, they have wonderful connection, they have wonderful intimacy. They're very, very satisfied. Yeah, they're very, very happy in their relationships. And then you look at like, what about two women? They don't have penetrative sex.

No. Well, sometimes they use a strap-on.

Well, yes, I mean, without— yes, without sex toys. But it's, you know, you're putting everybody into one box and every kind of sex activity into one box is, you know, is very sad because There's a plethora of things out there that people can do, and this may be the time in their lives to explore other options, and they can find that they're very pleasurable.

Yeah, and besides the group settings in which you work, do you work one-on-one with people?

Sometimes, sometimes, yeah, I'll do education sessions. You know, I'm in the Midwest and it's a conservative area, so it can be kind of hard. To get your foot in the door places. What I have found is, you know, people want the information. They don't know how to go about getting it. They're embarrassed to try to get it, you know, they're uncomfortable with it, you know, they've been raised that this is a private matter, you don't talk about it, you know, but it's— you have to talk about these things. You have to normalize it so that people recognize that it's just It's a quality of life issue and it's just another normal part of life.

Yeah. And so my final question, which is more like a practical thing, because I think this idea of people being intimate in facilities is a, is, you know, something that is a big deal. If somebody, if, you know, if a kid puts their parent, finds their parent is in one of these places and there are, you know, and they're becoming intimate with someone there, and they're getting a bit of pushback about that from the staff, and they actually would like their parent to be intimate because they see that as a good thing. Is there something specifically that you think that they should do? Is there— are there practical tips to encourage people to accept the idea of that intimacy can occur in these settings? Or do you think it's, you know, it's too—

well, you know, one thing I would do before I went into a facility, before I placed anybody into a facility, is I would sit down with them and ask them, what, what is your policy on sexual activity between residents?

Yeah.

And, you know, see how you feel about that. But if that horse is already out of the barn and it's happened and they're getting pushback, I would want to sit down with the care team and I would want to sit down with the administrator and I would want to say, you know, why do you have a problem with this if this is consensual? You know, you're paying to live there. It's like you're paying rent. That's your space. That's your home. You have rights. People think that they don't have rights. And I would be an advocate for them and say, you know, is this about their well-being or your discomfort?

Yeah, yeah, for sure. Yeah. And it's a big question, right? Because there's a lot of challenges around it. But I think, you know, one of the things that we've heard so often is that people do want intimacy at all stages of their life. Some people obviously don't, but for those who do, they should be able to be intimate with other people.

Absolutely.

It's— and it's up to us to figure out how they can do that, right, consensually, and up to us to be able to figure out how we can help them to navigate that. So that everybody feels that it's being done consensually and everyone's happy. So yeah, I think it does— it probably— it's not easy, but I think it's something that we all should be thinking about as our parents age. How can— if sex is important in their life, if intimacy is important, how can we help them to manifest that?

Absolutely. Put yourself in their position. I mean, You know, how would you feel if this was you? If, if, you know, you were in the facility and somebody told you that you couldn't do something you'd been doing the majority of your life?

Exactly. Anyway, Kelly, it has been really fascinating to speak to you from your Midwest location.

Thank you, I have enjoyed it very much.

And, um, yeah, I'll put all your social media and website and everything in, uh, the summary for this so that people know where to find you. Keep doing the good work. Keep doing the good work.

You too.

Thank you.