The Smart Older Woman’s Guide to Safe Sex

Having a positive experience without testing positive.

By
Published July 11, 2022
photo collage of couple getting intimate, safe sex, sex education
Elena Lacey

Great guy, great date … until two weeks later, when a funny discharge appears and my receptionist gets a call begging for an emergency appointment. Next comes the nerve-racking visit with me, the gynecologist, followed by the realization that along with a new relationship has come a new infection.

Unless your new partner was a virgin before he or she met you, avoiding a sexually transmitted infection (STI) is a reality that comes with being sexually active.

Midlife-to-older women are at much greater risk for STIs than most people appreciate. If exposed, a woman is twice as likely as a man to contract hepatitis B, gonorrhea or HIV. Women are also less likely to have symptoms than men, which means diagnosis is often delayed or missed altogether. And for most menopausal women, vaginal tissue is thinner and more fragile, which can allow infection an easy portal. 

I know what you’re thinking: I’ll always insist on a condom, so I have nothing to worry about, right? Wrong. Even if your partner does agree to wear a condom, and even if the condom doesn’t break, roll off or leak, sometimes the condom doesn’t go on until there has been plenty of skin-to-skin contact. HPV, herpes and a number of other STIs are not in semen but live on skin, so intercourse is not necessary to transmit them. Since a condom covers only the penis, short of strapping on a Hefty bag to cover a man’s scrotum, anus and surrounding skin, there is no such thing as total protection.

There’s another issue that often precludes condom use, even in the well intentioned. The older a guy gets, the more difficulty he’s going to have getting and maintaining an erection under the best of scenarios. Add a few glasses of wine and a condom, and it’s game over.

While contraception is no longer an issue as we age, a good man is hard to find — and a hard man, just about impossible. Consequently, some older women might be reluctant to insist on condom use. While my patients all intend to use condoms, they often don't; since the situation can be "lose the condom or lose the guy."

One solution is to stay home, watch Sex in the City reruns and stick to self-stimulation. A better solution is to take matters into your own hands and protect yourself using something other than a male condom. Obviously, this also holds for women who have sex with women.

The smart woman’s guide to safe sex

If you’re going to depend on a male condom, it goes without saying that you should not depend on the man to come prepared. But it can be really confusing to know what to buy, since condoms are available in a variety of shapes, colors, sizes (except small and extra small) and thicknesses; with or without lubricants or spermicides; and with or without reservoir tips. Some are flavored, which I assume is for purposes of oral sex, since your vagina doesn't care what flavor a condom is.

● Rubber (latex) Approximately 80 percent of male condoms are manufactured from natural rubber latex. Latex condoms are not compatible with oil-based lubricants, which can degrade the condom and make it more prone to breakage. That means no coconut oil, no olive oil, no baby oil. Water or silicone-based lubricants are fine.  

● Natural membrane About 5 percent of condoms are made from the intestinal cecum of lambs and are called “natural skin,” “natural membrane” or “lambskin” condoms. Natural membrane condoms contain pores that may allow viruses to get through. No contraceptive or STI prevention effectiveness data is available.

● Synthetic Polyurethane and other synthetic materials make up the remaining 15 percent of condoms. Synthetic condoms are generally nonallergenic and compatible with both oil-based and water-based lubricants.

Dental dams

When HIV first became a health hazard, there was a lot of buzz about using dental dams, small sheets of latex used by dentists, for protection. The idea is to place the latex square over the vulva during oral sex. Here’s the problem: Have you ever seen dental dams in a store? Have you ever actually spoken to someone, other than a dentist, who uses dental dams? Neither have I. But I have good news for you. You don’t need to be Martha Stewart to make your own version of a dental dam. Take a non-lubricated condom and cut off the tip. Then cut through one side of it to make a square of latex, which can then be stretched over your vulva. 

Female condoms

The FC2 condom is a non-latex, very soft, thin sheath that not only covers the cervix and vaginal walls but also shields the outside of the vagina. No special fitting is needed: One size fits everybody. A ring on the outside of the condom prevents it from getting pushed inside during intercourse and also provides protection during oral sex. The female condom is lube compatible and protects against STIs better than a male condom. Some women say that female condoms also increase genital sensation. And here’s a bonus: The external ring may stimulate the clitoris!

Sex panties

The newest innovation for safe oral sex is disposable latex panties. These are thin enough for wearers to experience all the sensations of oral sex while providing a barrier between the vulva or anus and the tongue. Lorals for Protection have received FDA clearance for use to help reduce the transmission of STIs during oral-vaginal and oral-anal sex. While they’re a little pricey at $25 for a pack of four, peace of mind is priceless.

Food wrap?

A popular alternative to dental dams is plastic wrap, as in the plastic wrap intended for food storage. That’s right. Many women stretch a piece of plastic wrap over their vulva to prevent any diseases that lurk on a partner’s tongue from infecting their vulva or vagina. So, the next time you’re in the grocery aisle and the lady in front of you puts a jumbo box of plastic wrap in her cart, consider that it might not be for her leftovers. But buyer beware!  Plastic wrap intended for food has never been tested for this purpose. There is concern that products intended for microwave use may be too porous to keep out infectious bugs. My advice: Stick to dental dams or female condoms, or splurge on the panties.

Lauren Streicher, MD, is a Clinical Professor of Obstetrics and Gynecology at Northwestern University’s medical school, The Feinberg School of Medicine and is the medical director of the Northwestern Medicine Center for Sexual Medicine and the Northwestern Medicine Center for Menopause in Chicago. She is the host of the hit podcast, THE Menopause Podcast, and the author of Dr. Streicher’s Inside Information Series, which includes: Slip Sliding Away: Turning Back the Clock On Your Vagina-A gynecologist’s guide to eliminating post-menopause dryness and pain, and Hot Flash Hell: A Gynecologist’s Guide to Turning Down the Heat. She is also the author of Sex Rx: Hormones, Health and Your Best Sex Ever, and The Essential Guide to Hysterectomy. Dr. Streicher is a Fellow in the American College of Obstetricians and Gynecologists, a member of the Sexual Medicine Society of North America, Inc. and is a Certified Menopause Practitioner of The North American Menopause Society. She was the 2019 recipient of the North American Menopause Society Media Award.