Charles, a 72-year-old retired cabdriver, came to see me because of difficulty urinating.
When I walked into the exam room, the medical resident was explaining to him that for men his age, the prostate often becomes enlarged, causing problems passing urine.
Charles had his hands folded across his chest. He didn't look convinced.
I interrupted: "Charles, can I ask a few additional questions? Some might be a bit embarrassing."
We reviewed his symptoms, which weren't typical of those you'd see with an enlargement of the prostate.
"Charles, are you sexually active?"
He was. He reminded me that his wife died two years ago, and he described how lonely life had become without her. He now had several girlfriends and was sexually active with all of them.
I explained that I thought he had contracted a sexually transmitted disease, something he told us he hadn't thought about since his days in the Army.
When we left the exam room, the resident looked uncomfortable. She said she had been embarrassed to ask an older man questions about his sexual behavior. She also acknowledged that she didn't even consider that men this age would be sexually active.
In a recent study looking at thousands of older Americans, more than half of people older than 65 were sexually active (engaging in intercourse), as were 25 percent of those older than 75.
Many older people have sexual concerns that they'd like to discuss with their doctor, yet only about 25 percent of those people ever get a chance to discuss them.
A doctor should not assume that if a patient wanted to talk about sexual issues, he would bring up the topic.
Unless doctors bring up the topic of sex, studies show, older people won't bring it up themselves.
An unspoken collusion allows an enormous number of missed opportunities. Had Charles' infection not been diagnosed and treated, he and his girlfriends would have passed the infection to others.
The rate of sexually transmitted diseases among older people doubled between 1996 and 2003, and according to the Centers for Disease Control and Prevention, older Americans now constitute the fastest-growing group of people with HIV infection.
As a group, older people tend to be the least knowledgeable about HIV and other sexually transmitted infections.
Charles told us he didn't use condoms for two reasons: He assumed they were used to prevent pregnancy, which was not an issue for his older partners. He also suffered from arthritis in his hands, so condoms were difficult to put on.
Doctors can help with many of the problems related to sexual function, but only if there is agreement that the topic is important and worthy of discussion.
Michael Wilkes, M.D., is a professor of medicine at the University of California, Davis. Reach him at drwilkes@sacbee.com.
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