Great Sex in Midlife

Satisfying sex isn’t only for the 20- and 30-something folks. As many happy couples know, it’s possible to enjoy a healthy and satisfying sex life well into your 40s, 50s and beyond.

But it can be complicated.

For many people, hormonal changes, chronic health conditions and medications, stress, fatigue, and midlife weight gain can thwart efforts to have healthy intimate relationships. Many older adults report that, while they consider sex an important part of life, they are not happy with their current sex lives.

If you want to be sexually active, but you’re not enjoying it, it’s important to figure out what is going on. Good sex is a huge quality of life issue. It affects the quality of our relationships and how we feel about ourselves.

Sometimes, the underlying issues need the attention of your doctor. But often, your sex life can be revived with just a bit of ingenuity and patience.

Our Aging Bodies

Aging bodies go through lots of changes. As women approach menopause, their hormone levels decrease. And it’s not just estrogen and progesterone, the “female” hormones. Women also see drops in their levels of testosterone, the “male” hormone that drives libido.

Some of the more noticeable effects of lower hormone levels occur in the vagina. The vagina atrophies, losing elasticity and lubrication. It gets shorter and the walls get thinner. That can lead to vaginal burning, painful intercourse, light bleeding after sex, increased vulnerability to tears and infection (including urinary tract infections), and more. A lack of sexual activity can make it even worse, as sexual activity helps the vagina maintain tone and lubrication. With age, the urinary tract (urethra) can also become irritated, dry or inflamed.

Many women also notice a drop in their libido, or desire for sex, and problems getting aroused and reaching orgasm. Sometimes these issues are caused by hormonal changes, but they can also be related to medications and chronic health conditions such as arthritis, depression and diabetes.

Although many women say sex over 40 is better than ever, others find themselves avoiding it altogether. For some, sex just isn’t worth the trouble. With things like loss of libido, soreness and frequent bladder infections, there’s just not going to be a lot of satisfaction.

Men are not immune to age-related sexual problems. Many experience lower libido and erectile dysfunction (trouble getting or maintaining an erection). Some have trouble reaching orgasm, as well as shorter orgasms and less forceful ejaculation. As with women, these issues can be caused by declining hormone levels (in this case, testosterone). They can also be related to medication side effects, chronic health conditions such as heart disease, high blood pressure, diabetes, depression, and more.

For both women and men, these changes can also be related to issues within the relationship itself; if you’ve been stuck in an unfulfilling relationship for some years, you’re not likely to feel a lot of desire for that person.

Body image can also play a role for both genders. Midlife weight gain, sags and wrinkles can add even more barriers to a good sex life. Some women have trouble seeing themselves as sexual beings once they are past their childbearing years.

Non-Medical Solutions

The good news is many of these common midlife sexual frustrations can be solved. It’s best to start out with non-hormonal solutions. Then, if your sex life is not getting better, talk about other options with your doctor.

Set an Intention

Talk to your partner; what is it that you both want? For many couples, sexual intimacy leads to emotional intimacy, which enhances the relationship. So if libido is low, you might have to be more intentional and more creative about setting aside time for intimacy, rather than just waiting for it to happen. Being clear about your intention to connect with your partner, and creating the time to do that, will benefit your relationship in the long run.

Get to the Drugstore

Over-the-counter vaginal moisturizers and lubricants can be very helpful for women with mild to moderate dryness. Moisturizers are typically applied every day or two, while lubricants are used during sexual activity.

Be a Little Creative

Shake up your routine. Experiment with new activities. Try some new positions (which might also help with pain issues). Read books, watch movies, rent a cozy cabin for a weekend. Send your partner some unexpected texts during the day. Experiment with vibrators and other sex toys. Do some online shopping in the privacy of your home.

Be a Little Patient

If you haven’t been sexually active in months or years, your body might have gone through some changes without you realizing it. When sex resumes, you might find the experience is not quite what you expected or remembered. Regular sexual activity, with or without a partner, can help the vagina to maintain tone and lubrication, reducing the severity of atrophy and dryness. Spending more time on foreplay might help with desire and arousal issues.

Get to the Gym

Losing a few pounds and getting more active can help you to feel more desirable. Losing weight can also help with other conditions, such as high blood pressure, that can contribute to sexual problems.

Medical Options

Talk openly with their doctors about the quality of their sex lives and any problems they are having. A good practitioner will help you sort through problems and explore solutions.

Ask your doctor if any of your medications could be causing problems. Many common drugs, including those used to treat depression and high blood pressure, as well as birth control pills, are well known to have sexual side effects. You might be able to switch to a different drug.

Ask your doctor if you should have your hormone levels tested, and if prescription hormone replacements might help you.

• Men can boost their testosterone level with injections, patches and other formulations. (Be sure to talk with your doctor about the potential risks of taking testosterone, including a higher risk of prostate cancer.)
• For women, local hormone therapy – products that are used only in the vagina – are often helpful in addressing vaginal menopausal symptoms that are causing problems with sex. These products, which come in the form of vaginal rings, creams and tablets, supply estrogen directly to vaginal tissues and can help relieve dryness, irritation and loss of elasticity. Little estrogen reaches the bloodstream, so the risk associated with this kind of estrogen therapy is lower.
• Women who are having other menopausal symptoms, such as severe hot flashes, along with vaginal issues, may want to consider systemic hormone therapy. This type of hormone therapy, in the form of pills or patches, delivers hormones throughout the body via the bloodstream. It can help relieve many symptoms, but it may increase your risk of other serious conditions, such as heart disease, stroke, blood clots and breast cancer. Your doctor might suggest systemic hormone therapy only if you have very severe symptoms of menopause.

Local treatments provide greater relief for vaginal dryness than systemic hormone therapy, with a lower dose of hormones. They are applied directly to the vaginal tissue, so the hormones get right to where they’re needed. That way we don’t need as high of a dosage as with a pill that has to go through the entire body.

Some women who have low libido can use natural testosterone to help increase sexual desire. It can be delivered topically or taken by mouth, and must be obtained by prescription from a compounding pharmacy. Blood testosterone levels should be monitored, and long-term risks of this therapy are unknown.

Your doctor can also assess whether other physical changes might be affecting your sex life.

Some women, for example, experience pelvic organ prolapse, in which nearby organs slip out of place and bulge into the vaginal wall. This can become worse with menopause, as the vaginal tissue thins and has trouble supporting the area. Losing weight, treating a chronic cough and doing pelvic floor exercises (Kegel exercises) can help make the pelvic floor muscles stronger (and also help with bladder control). In some women, the vagina becomes significantly narrower; in such cases, using a series of dilators to widen the vagina over time can help.

Men who are having trouble with erectile dysfunction, which can be caused by low testosterone as well as other conditions, can ask their doctor about using a drug such as Viagra or other methods to improve erections.

A Word of Caution

A word of caution about erectile dysfunction drugs: If you are resuming sexual activity after a long hiatus, take it slow at first. For women, the joy of reconnecting with their partners is sometimes overshadowed by resulting injuries, such as vaginal tears.

And don’t forget about birth control. Even if you are older, until you have gone through menopause (an entire year or more without a period), there is always a possibility of pregnancy.

If you are developing a relationship with someone new, you’ll also need to be careful about sexually transmitted diseases, something you might not have thought about in years. Be sure to use safe sex practices whenever you are with a new partner. This might be especially important for older women. An older vagina, because it often has less lubrication and elasticity than it once did, is at greater risk of tears and exposure to disease. To further complicate things, using a condom, the best protection against disease, can be uncomfortable due to dryness. Your best option is to use a latex condom along with a water-based or silicone-based lubricant (don’t use any oil-based lubricants, such as skin lotion or baby oil, as they can break down the condom).

Reconnect with Relationships

Sure, you are no longer 25. Sex may not be what it was back then, but it has the potential to be something new and even better.

Try to see your middle and older years as a wonderful opportunity, after years spent focusing on family and career. Many people, in fact, find midlife to be a time of great sexual freedom, as the kids have left home and pregnancy is less of a concern.

And remember that many aspects of sexual interest and libido are in the brain, not just the body. Maintaining sexual interest involves enlisting a strong mind and body connection. Take into consideration who you are now and embrace the wisdom and experience that you’ve gained along the way.