TIME Aging

Why Nursing Homes Need to Have Sex Policies

The question of consent is complicated by Alzheimer's and dementia

No one wants to talk about sex in nursing homes.

The need for sex doesn’t disappear as we age, yet many facilities for the elderly have no policy on sex at all and only acknowledge that it happens when there’s a problem, like concern that an Alzheimer’s or dementia patient is being abused. Whether it’s out of ageism or just discomfort with the idea of senior sexuality, nursing homes are not eager to raise the issue, leaving a massive gray area where the line of consent is blurry.

“We’ll ask them about their religion, the music they like, what kind of food they want to eat. We don’t dream of asking them about their preferences around sexuality and intimacy,” said Dr. Cheryl Phillips, a senior advocate at LeadingAge, an association of nonprofit senior services.

The risks of ignoring residents’ sex lives are real. The issue most recently came to light in Iowa, when Henry Rayhons, 78, a longtime state lawmaker, was charged with sexually abusing his elderly wife, an Alzheimer’s patient, while she was living in a nursing home. Rayhons was acquitted this week, after testifying that he and his wife had shared a loving, consensual relationship. The case, which involved family tension between Rayhons and his step-daughters, was complicated by questions of whether someone with dementia can give consent, and whether Alzheimer’s patients have the right to have sex or the right to be protected from it.

Mr. Rayhons could not be reached for comment, and the administrator for the nursing home where his wife resided in Iowa, Concord Care Center, declined to comment.

When Phillips was a practicing geriatric physician, she dealt with sex often. In one particularly thorny case, two residents of a nursing home who both had dementia had begun kissing and holding hands, even though they were both still married to spouses who lived elsewhere. The nursing home lovebirds, though, each believed the other was their spouse. After consulting with the families, the nursing home decided to allow the budding relationship to go forward, since it was bringing the two so much happiness.

“The lesson we took out of that is that it is good to talk with families and be open about values and preferences,” Phillips said. However, she added, “There’s a flip side. Elders deserve privacy. If I’m in a nursing home and I’m attracted to a man, do you have to get my son’s permission for me to be intimate? Where are the boundaries with intimacy? That is where we as a country are really struggling. We don’t have good answers.”

When it comes to managing the sex lives of nursing home residents, the problems are not going away. By 2030, nearly 20% of the U.S. population will be 65 or older, according to Pew Research Center. And according to the World Health Organization, there are 47.5 million people with dementia, a number that will nearly double by 2030.

Today’s aging Americans also grew up with fewer sexual limits than earlier generations and may be unwilling to live in nursing homes that don’t accommodate their sex lives, experts say. “Let’s be real. Baby boomers brought the sexual revolution to America in the ’60s—what are they going to bring to nursing homes?” Roberta Flowers, co-director of the elder law center at Stetson University College of Law, told TIME.

But elder advocates, physicians and nursing home experts say that there is no national standard of best practices for how nursing homes should accommodate residents who are sexually active. The policies that do exist are archaic, regressive and even ageist, and do not acknowledge that nursing home residents could happily have consensual sex with each other.

One exception is the Hebrew Home at Riverdale in the Bronx, which is cited by many as the leader in progressive policies on sex. The Hebrew Home has a Sexual Expression Policy, which “recognizes and supports the older adult’s right to engage in sexual activity.”

Daniel Reingold, the CEO of Riverspring Health, which operates the Hebrew Home, said they developed the policy in 1995 after realizing that residents were having sex and the home had no plan for dealing with it. The problem became clear to him one day when he was walking down the home’s hallway and a nurse came up to him and asked him what she should do about two residents having sex in one of the rooms. “Tiptoe out and close the door!” he replied.

Reingold says many of his colleagues in the nursing home community are reluctant to adopt policies because of liability, and also just plain nervousness around sex. The issue is also complicated by adult children who are uncomfortable with their parents’ sexual lives, particularly if there is adultery. “It reflects ageism at its worst. People don’t want to acknowledge that old people have sex,” he said. “Intimacy and sexuality is a civil right no different than the right to vote.”

The question of whether the elderly should be having sex is most troubling when it comes to dementia. But experts and elderly advocates say people with dementia are capable of consenting to sex, that they are able to express that consent, and that sex and touch can be good for them, which makes it difficult to know when it is appropriate to set limits. Hebrew Home’s policy is explicit that patients with dementia and Alzheimer’s can give consent to sex, either verbally or non-verbally.

“A 12-year-old can’t consent to sex with an adult today or tomorrow. You can’t have the same black-or-white rule for someone suffering from dementia,” said Flowers, the expert on elderly law. “Someone with dementia is not incapacitated all the time for all things. If they are not incapacitated at the moment of the sex act, they have a right to have sex.”

She added, “It’s a difficult issue and it’s not going away.”

Nursing homes must establish policies, and must be comfortable talking about sex with residents and their families, advocates said. “People want to have sex. That doesn’t change merely because you have gray hair,” Flowers said. “We have got to be willing to talk about it.”

TIME Infectious Disease

HPV Vaccine May Work For People Who Already Had the Virus

TIME.com stock photos Health Syringe Needle
Elizabeth Renstrom for TIME

A new study underlines the effectiveness of the HPV vaccine, showing the vaccine is protective against the virus on multiple sites on the body, even for women who have been infected in the past.

In a randomized controlled trial—considered the gold standard of scientific research—scientists wanted to know if the HPV vaccine protected against cervical, anal and oral HPV. Daniel C. Beachler, a postdoctoral fellow in the Infections and Immunoepidemiology Branch of the National Cancer Institute (NCI), and his colleagues followed 4,186 women between the ages of 18 to 25 who were either vaccinated with a HPV16/18 vaccine or a control vaccine (a hepatitis A vaccine). Cervical samples from the women were collected at their annual visits and oral and anal samples were collected at a four-year follow-up visit.

“We were interested in the question of whether the vaccination may protect non-infected sites against HPV infection or re-infection in women who were previously exposed to HPV prior to vaccination,” says Beachler. The study was presented at the American Association for Cancer Research annual meeting.

The results showed that the efficacy for the vaccine in all three sites was 83% among the women with no evidence of prior HPV exposure and infection, 58% among women with prior HPV exposure, and a 25% among women with active cervical HPV16/18 infection (the percentage was considered nonsignificant). In total, the researchers report that the overall vaccine efficacy was 65% for all sites and 91% for protection in at least two sites.

Among the women in the trial, some had no evidence of HPV, some had an active HPV infection, and some of the women did not have an active infection but had antibodies for HPV, suggesting that they had been exposed to the virus previously. That’s not uncommon, considering the U.S. Centers for Disease Control and Prevention (CDC) estimates that nearly all sexually active men and women get HPV at some point in their lives.

The CDC says teen boys and girls who did not start or finish the HPV vaccine series when they were younger should get it, and young women can get the vaccine through age 26 and young men through age 21.

The CDC says that girls who are already sexually active can still benefit from the vaccine, but it may be less effective since it’s possible they have already been exposed to one or more HPV strains. Still, the CDC says that since young women are not necessarily infected with all types of HPV, they can still benefit from the vaccine. This new study underscores that guidance.

“[This study] is supportive that there could be some benefit at these older ages,” says Beachler. “Close to 90% of individuals are able to clear an HPV infection on their own. This is not a therapeutic vaccine but it could still help protect from acquisition of new infections.”

Dr. Miriam Lango, a head and neck cancer surgeon at Fox Chase Cancer Center, says that the new study is some of the “best kind of evidence we have,” in support of vaccinating against HPV in women of that age. “My understanding was always that you get the vaccination before you get the infection and that after you’ve been infected there’s no benefit to having the vaccination,” she says. “That’s really not what the data tells us.” Lango was not involved in the study.

Beachler noted that at the end of the study, the women in the control arm of the trial were able to get vaccinated against HPV.

TIME Food & Drink

People Who Love Grilled Cheese Sandwiches Have Way More Sex Than Those Who Don’t

Grilled cheese sandwich
David Bishop Inc.—Getty Images

Hey, don't knock this totally groundbreaking survey

Did you know Sunday is (un)officially National Grilled Cheese Day?

Well neither do most people, but in light of this tasty holiday, social-networking and dating site Skout did a survey of 4,600 users to find out what their taste in sandwiches said about them.

Turns out that grilled-cheese-sandwich lovers are having way more fun in the bedroom, with 32% having sex more than six times a month, compared with just 27% of people who don’t like the sandwich. Also, 73% of those who like the sandwich said they had sex at least once each month, compared with the 63% of those who say they don’t like the snack.

That might be because 84% of grilled-cheese-sandwich lovers are more adventurous and likely to travel, vs. 78% of nonlovers. Or it could be because the grilled cheesers are more charitable (81% vs. 66%).

If you’re skeptical, well, remember that Skout’s interest in grilled cheese is for a good cause. The site will donate to food banks in San Francisco and Marin County to help feed hungry kids every time users give a “grilled-cheese gift” to someone else on the site.

Read next: 7 Reasons to Have More Sex

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TIME Sex/Relationships

Teens Aren’t Using the Most Effective Birth Control

IUD birthcontrol
Photo Illustration by Mia Tramz for TIME; Corbis

A new CDC report reveals few teens use IUDs and implants

American teenagers are getting better at practicing safe sex, but a new federal report reveals very few teens are using the most effective forms of birth control.

In the new report, the Centers for Disease Control and Prevention (CDC) looked at 2005–2013 data from the Title X National Family Planning Program on teen contraceptive use and found that teen use of long-acting reversible contraception (LARC)—such as the intrauterine device (IUD) and the implant—are up but still very low. The numbers show that U.S. teen LARC use increased from under 1% in 2005 to 7% in 2013. Implants were used more than IUDs by women of all ages. The state with the highest use of LARC among its teens in 2013 was Colorado at 26%. All other states ranged from use of less than 1% to 20%.

Currently, teens are opting for methods like condoms and birth control pills, which while still good options, are less effective and more prone to incorrect or inconsistent use.

MORE: Why The Most Effective Form of Birth Control is the One No One Uses

The benefit of contraceptives like the IUD and implant are that they are low maintenance and highly effective. For example, the typical use failure rate of the IUD is 0.2% and for the implant it’s 0.05%. By comparison, the birth control pill and vaginal ring have a failure rate of 9% and condoms have a fail rate of 18%.

In 2012, the American Congress of Obstetricians and Gynecologists (ACOG), considered an authority on reproductive health, concluded that IUDs and implants are safe and appropriate for adolescents and teens. In 2014, the American Academy of Pediatrics (AAP) agreed and said it recommends LARC for adolescents.

“Long-acting reversible contraception is safe for teens, easy to use, and very effective,” said CDC principal deputy director Ileana Arias in a statement. “We need to remove barriers and increase awareness, access, and availability of long-acting reversible contraception such as IUDs and implants.”

CDC

According to the new CDC report, there are a variety of reasons why a young person may not opt for the IUD or implant. Many teens don’t know very much about them and they often think they are too young to use them. As TIME reported in June, some physicians may remember the IUDs of past, which caused severe problems for women and were discontinued. Modern-day IUDs are safe and appropriate but there are still misperceptions about the device that persist within the medical community. Many providers are also not properly trained on insertion or removal of the IUD and implant. However, a recent report showed that among female health care providers 42% use LARC, which is much higher than both the general population of teens and adult women.

Overall, the CDC report shows that American teens are waiting to have sex, and when they are sexually active, nearly 90% report using birth control. The teen pregnancy rate in the United States appears to be steadily dropping, though in 2013 over 273,000 babies were born to girls between ages 15 and 19. The CDC says encouraging young women to consider LARC is an important strategy for further reducing teen pregnancy.

TIME relationships

Here’s What One Woman Learned From Taking a Year Off From Her Marriage

Lessons from a year spent sowing wild oats

Robin Rinaldi did what many women dream of but few actually do: she took a year off from her marriage and made an agreement with her husband that they could both sleep with other people for a set period.

Rinaldi’s book, The Wild Oats Project, is a summary of what she learned during the year she spent in an open marriage. The idea came to her when her husband got a vasectomy after a long battle over whether they would have children — she wanted them, he didn’t. Faced with a future without a family, Rinaldi made a decision: “I refuse to go to my grave with no children and only four lovers,” she wrote, “If I can’t have one, I must have the other.”

That’s when she embarked on the Wild Oats Project. Rinaldi and her husband had three rules: no serious relationships, no sex with mutual friends and no sex without condoms. Both broke multiple rules over the course of the year, and it eventually took a toll on their relationship, but Rinaldi says the project wasn’t as much a choice as “a calling.”

“It was unlike me to act that way,” she says. “I had always been a very cautious and somewhat anxious person, I had always played by the rules. It was something instinctual, and something very female driving me to do this. It wasn’t really planned and strategized as much as felt.”

Still, Rinaldi found that, while many of her friends were supportive, some people thought her project was threatening, even terrifying: “The tale of a woman giving up security, even in an above-board way and allowing her husband to do the same thing, giving up all that security in pursuit of passion and adventure, is a scary idea for a lot of people,” she says. “I certainly didn’t write it to intentionally push anyone’s buttons.”

And ultimately, for Rinaldi and her husband, this was their last chance at saving their marriage. “We knew how risky it was, and we might not make it through, but it was really the only choice we had,” she says. “So we both agreed, two consenting adults, to try this first.” Ultimately, she and her husband went their separate ways, but Rinaldi says the project taught her much more than a simple divorce would have.

The biggest thing Rinaldi says she learned from the Wild Oats Project is that she was putting too much pressure on her husband. “Expecting your spouse to provide passion and security and purpose, it’s a lot,” she says. “I was asking too much of that one person… So now, as a result, I don’t look to someone else to kind of unfairly provide all of those things. That’s the biggest thing I learned from it, and I couldn’t have learned it unless I actually went through it.”

She also learned a lot about sex, and about her own body. Rinaldi spent much of the project in new-age sexual workshops and orgasmic meditation classes, so she came away a greater awareness of her sexuality. “The sex was the classroom, but the sex was not the lesson,” she says. “Your body has wisdom, that is very powerful and can kind of show you your path, and you don’t always have to think it through or necessarily act based on other people’s rules.”

Still, Rinaldi wouldn’t necessarily recommend that other women take exactly the same path she did. Instead, she’d advise younger women to “sow your wild oats before you settle down — that’s a no-brainer.”

Read next: Who Needs Marriage? A Changing Institution

TIME health

What Experts Got Wrong About Viagra

Small blue Viagra pills, Pfizer's pharma
Suzanne Opton—The LIFE Images Collection/Getty Small blue Viagra pills, separated by machine, in 1998

March 27, 1998: Viagra is approved by the FDA

It was the miracle drug to beat all miracle drugs; an instant bestseller that topped the sales figures of Big Pharma’s other greatest hits: Prozac and Rogaine. After the FDA approved Viagra on this day, March 27, in 1998, sales of the drug rose quickly — pumped by an early rush that yielded at least 10,000 scripts a day, per a TIME cover story about the drug — and had staying power, as evidenced by Pfizer’s annual profit of about $1.8 billion as of 2013 and the fact that our email inboxes are still routinely barraged with spam offers for the drug.

It was a magic bullet for many men, but one that TIME initially feared would herald “the end of sex as we know it.”

“Could there be a product more tailored to the easy-solution-loving, sexually insecure American psyche than this one?” Bruce Handy wondered in the 1998 piece.

There were many who saw chemically-induced erection as a slippery slope to a Sleeper-style orgasmatron.

“People always want a quick fix,” one psychiatrist complained to TIME. “They think Viagra is magic, just like they thought the G spot worked like a garage-door opener.”

Seventeen years later, sex as we know it hasn’t ended — it’s still happening in more or less the usual ways, whether or not Viagra is a part of it. But what was a godsend for men hasn’t opened any doors for women with sexual dysfunction. That’s not for lack of trying: A drug hailed as “the female Viagra” has undergone extensive clinical trials and been submitted to the FDA three times so far, most recently last month, but has never been approved, as Cosmopolitan reports.

The two drugs operate differently, as one might expect: while Viagra stimulates blood flow to the genitals, it doesn’t act on the brain. The proposed drug for women, flibanserin, instead works on neurotransmitters to increase sexual desire.

The fact that there are now several drugs on the market for men’s sexual troubles and none for women constitutes sexism, some have argued, especially since an estimated 16 million women over the age of 50 suffer from some form of sexual dysfunction. A new campaign called “Even the Score” focuses on just this disparity, calling on the FDA to make “safe & effective treatments for low [female] desire” a priority.

In the meantime, a North Carolina doctor has patented a spinal implant that can produce orgasms at the push of a button, although he’s had trouble securing the funding to perfect the device. He calls it the Orgasmatron.

Read the 1998 cover story, here in the TIME Vault: The Potency Pill

TIME Research

Women Who Sleep More Also Have More Sex, a New Study Finds

Each additional hour of sleep is found to increase the next day's possibility of sex by 14%

Women who get more shut-eye generally have more sex, according to researchers from the University of Michigan, who spent over two weeks tracking the sleep and sexual patterns of 171 young women.

The study discovered that not only did more sleep for women lead to more sex, it often led to better sex. Good sleep hygiene, which refreshes a person’s mood, energy and concentration, is linked to increased sexual desire and arousal. In the study, women reported higher physical arousal after a longer average period of sleep, with the average sleep duration clocking in at seven hours, 22 minutes. More impressively, each additional hour of sleep increased the next day’s possibility of sex by 14%.

“If there’s anything women or their partners can do to help promote good sleep for one another, whether it’s helping out around the house to reduce workload, planning romantic getaways, or just practicing good sleep hygiene, it could help protect against having problems in the bedroom,” the study’s author David Kalmbach told CBS.

Read next: 8 Ways Sex Affects Your Brain

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TIME mating

Why Women Like War Heroes More than Any Other Kind of Guy

A stock image of a man in a military uniform lifting up a woman
Getty Images

And why men don't find brave women attractive

In a study that could explain so much about the Brian Williams thing, it has been found that women are more sexually attracted to men who have been deemed heroic during conflict than men who have merely served in the armed forces. And—sorry, humanitarians—men who were deemed heroic during a non-war-related crisis didn’t have nearly the same game.

Meanwhile, women who were considered heroic for any reason were found to be less attractive to men than regular women. (You read that right. Less attractive.)

The findings are the result of three studies done by researchers in England and the Netherlands. First, the researchers established from archives that World War II veterans who were Medal of Honor winners had more kids on average (3.18) than other returned servicemen (2.72).

The number of offspring is not completely correlated with the frequency of springing into bed, however. So the researchers asked 92 female British students to rate how attracted they were to various profiles and the war hero came out as the No. 1 most dateworthy type. Military service was attractive to women generally, but interestingly, if the guy had no war honors, whether he had served overseas or never left home base made no difference to his magnetism. In other words, men who see more action don’t necessarily see more action.

In the third study, 159 women and 181 men studying in Holland were given various profiles to rate and again the decorated war veteran was the female favorite. Soldiers who had been honored for their work in disaster zones or humanitarian crises got no spike in interest. And, depressingly, guys were less interested in women who had done something amazingly brave than women who hadn’t, even though the participants in the study were the supposedly gender equal Dutch.

The researchers were looking at the impact of medals not to enhance the dating resumes of veterans, but to examine the effect of conflict and bravery on evolution. (Those who attract the most mating partners have the highest chance of passing on their genes.)

So why are women drawn to guys who are demonstrably willing to engage in life threatening behavior? Because they’ve proved their genetic hardiness, suggest the researchers.

“Raids, battles, and ambushes in ancestral environments, and wars in modern environments, may provide an arena for men to signal their physical and psychological strengths,” says Joost Leunissen, a psychologist at the University of Southampton and co-author of the study. The thinking is that those who have the clarity of thought to try something life-saving and the physical prowess to pull it off must be built to survive, and are therefore a good evolutionary bet.

Leunissen also seems to offer, perhaps unintentionally, some eggheady advice on whether women should be on the front lines. “In light of the physical dangers and reproductive risks involved,” he says, “participating in intergroup aggression might not generally be a viable reproductive strategy for women.” Translation: not if they want to have kids.

TIME Dating

This Is Exactly How Much You Need to Drink to Seem More Attractive, Backed by Science

healthiest foods, health food, diet, nutrition, time.com stock, red wine, alcohol
Photograph by Danny Kim for TIME; Gif by Mia Tramz for TIME

No more, no less

Want to seem more attractive to the opposite sex? Drink one — exactly one — very large glass of wine.

That’s what a recent study by a group of researchers at the University of Bristol’s School of Psychology, published in Science Daily, suggests.

The researchers asked 40 heterosexual men and women, divided equally between both genders, to complete an attractiveness-rating exercise. The volunteers were then shown two images of a person, one taken while the subject was sober, one after the subject had consumed 250 ml of wine (equivalent to a very large glass), and one after 500 ml of wine (two-thirds of a bottle) had been consumed.

The photos of those who drank 250 ml wine were rated as more attractive, followed by images of sober subjects. The photos of those who had drank 500 ml were considered least attractive.

The researchers attributed this to the increased facial flushing that comes with consuming low amounts of alcohol, along with additional muscle relaxation and subtle smiles that portray a heightened positive mood.

One more good reason to drink in moderation.

[Science Daily]

TIME Sex

Women With Disabilities Are Three Times More Likely to Face Abuse: Report

Violence against women with disabilities is often ignored in several countries

Women with disabilities are three times as likely to be raped, physically abused or sexually assaulted, according to Human Rights Watch.

A resource on gender-based violence designed for people with disabilities, released by HRW ahead of International Women’s Day on Sunday, states that women and girls with disabilities are increasingly susceptible to violence but are often ignored when it comes to prevention programs.

The organization documented several cases across Zambia, India, Uganda and Turkey, finding a host of problems related to discrimination, vulnerability, accessibility and awareness.

“Women and girls with disabilities are too often the victims of violence, yet get too little information on where to go for help,” said Shantha Rau Barriga, HRW’s disability-rights director.

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