Ask Debby Herbenick - Are we just too old for sex?

Q How safe is oral sex? I’ve heard different things and don’t know what to believe or if we should be using condoms.

A It is possible to get or transmit chlamydia, gonorrhea, HIV, herpes and other sexually transmitted infections from oral sex. Some research suggests that the human papillomavirus (HPV), when passed through oral sex, can lead to head and throat cancers. It’s uncommon to get HIV from oral sex, but possible. Using condoms or dental dams reduces the risk of STI transmission, but the truth is that people rarely reach for the latex before they dive into another person’s genitals. People sometimes ask me if vaginal fluids or ejaculate are harmful for other reasons, as if there is something inherently bad about sex fluids, and the answer is no. They’re not unusually high in calories, protein or sugars. Especially given how the low volume of fluids that come from a person’s body during sexual excitement or orgasm, it would be hard to OD on either semen or vaginal fluids. You can have fun trying, though.

Q We are elderly, married almost 60 years, and wondering when it is wise, if ever, to stop having sex. We have had a satisfying sex life, yet now are beginning to notice physical and emotional changes where one or the other of us is struggling with interest, arousal or performance. Is there ever a time when one should just “give it up,” as with driving a car? We believe in cuddling and intimacy generally, but are referring to traditional oral, anal, manual and vaginal sex, if that makes sense.

A Without ever having met you, I can’t help but want to hug you both. Thank you for sharing a perspective on sex and aging that many younger people never get to hear or read about. It’s heartening to hear that it’s been such a satisfying experience, on the whole, for you and your partner. If you two are physically and mentally able to experience sex together in ways that are mostly as comfortable as your normal daily activities, then I see no reason you should stop. Modify? Perhaps. But stop? Why? Sex is not like driving a car. After all, in sex, one doesn’t risk getting rear-ended by an impatient driver—well, except in a fun rear-entry kind of way. And you’re not putting others at risk if you don’t see things as clearly as you used to. If you or your spouse no longer wants to have partnered sex, then that’s a reason to stop. And if your health-care provider suggests that you stop for health reasons, then take that advice (or get a second opinion). If one of you becomes mentally incapacitated to the point where sex doesn’t feel enjoyable, or borders on non-consensual because one of you cannot make a fully informed choice, then those may be reasons to stick to more cuddling and fewer penetrative activities. If vaginal dryness becomes an issue, in spite of the use of vaginal moisturizers or lubricants, then you might want to spend more time with oral or anal sex. Another thing to consider is whether you and your spouse are looking into long-term care, such as at an assisted living facility. If so, you might begin looking for places that allow couples to live and sleep together. Some homes separate women and men or otherwise have policies that make it difficult for residents to have sex; others are more progressive. From my perspective, if sex remains a fulfilling gift that you and your spouse have the privilege of sharing, then losing that shared intimacy may pose greater risks—such as feelings of loss or sadness—than any physical risk you might face in continuing to have sex. Some research suggests that having sex boosts your immune system, lowers stress and even reduces the risk of some cancers. Though I wouldn’t say that these are “reasons” to have sex, if you are already having and enjoying sex then they may be the whipped cream on your pudding (or breasts).

Q My little sister just discovered that she has HPV and mild cervical dysplasia. She and her boyfriend were virgins prior to having sex, and the only other sexual experience she has had was anal sex with a previous boyfriend. Is it possible to get a lesion in your vagina from anal sex?

A One doesn’t get HPV inside the vagina (including on the cervix, which is at the back end of the vagina) from anal sex. However, it is possible that one or both of their sexual histories are not quite what they seem. Perhaps your sister’s current boyfriend had fooled around with others before he and your sister got together. Then, even if the first person he had vaginal intercourse with was indeed your sister, he still could have passed the human papillomavirus (HPV) to your sister. He could have gotten it while receiving oral, during (unclothed) dry humping, or by playing “just the tip” with someone. It’s also possible that your sister had engaged in dry humping, or that, in the process of having anal sex, her previous partner’s penis rubbed around her genital area. Most HPV-related cervical changes that cause abnormal Pap test results improve within a year, though your sister should make sure to follow her health-care provider’s recommendations for follow-up Pap tests, colposcopy or other care. She’s fortunate to have a sister who cares about her health. You can learn more about HPV at cdc.gov.

Q Recently married, my husband and I started having sex without a condom. I have noticed though that after sex (usually the next day), a glob of his semen is still inside me. It is a thick mass, not runny like I remember it with other partners, though I have to say it has been years. Is this normal, and my memory is wrong? Or is this an indication of something serious? Is he healthy? Am I allergic to his semen? Could this affect our ability to have kids?

A It’s hard to know much about the state of your husband’s semen after it has had time to mix in with your vaginal fluids and anything else (such as lubricant) in one big chemistry experiment happening inside your vagina. Seminal fluid does not exist in a constant state once it’s ejaculated from a man’s penis. At first, it’s often fluid-like and then it tends to get globby or harden. If you are curious about your partner’s semen, you could ask him to ejaculate on your stomach so that you can see what it’s like. If you or he wonders if his ejaculate is unusual in color or consistency, he might check in with a urologist to determine whether anything’s awry with his prostate gland or other glands that contribute fluids to his semen. Only a small amount of the volume of a man’s semen is composed of his sperm and a little globby-ness is usually not an indication of a fertility problem. If you were allergic to his semen, you would likely experience genital irritation and possibly even difficulty swallowing or breathing (which would hopefully prompt you or your husband to call the paramedics). Assuming that your husband’s doctor vouches for his health, it’s likely that your next-day clumps are just par for the sex course. You may even find that it’s fun to play with the clumpy mass in between your fingers; it’s not often you get to have fun with sex science experiments!

Send letters to Debby Herbenick, Ph.D., c/o Time Out Chicago, 247 South State Street, 17th floor, Chicago, IL 60604, or send e-mail to inandout@timeoutchicago.com.