Both men and women experience physical and psychological changes during middle age that can impact sexual health and relationships with their partners. Addressing this natural part of the aging process can lead to happier and healthier aging. Like wine, a person’s sex life can age gracefully. And, dare we say? Be enjoyed.
In this life stage, men and women don’t experience the same demands of their youth. Children may have moved out and pregnancy is no longer a concern. Midlife can be a time of sexual freedom, says
Ildiko Kovacs, MD, a board-certified psychiatrist who
specializes in caring for individuals and couples experiencing issues related to sexual function, sexuality and gender.
“Once women go through menopause they can find a new comfort zone and become more confident,” said Kovacs. “Some women become sexually more active because they don’t have the same pressures, they know themselves better and they are not afraid to be more assertive. Men, for their part, can experience improvement in some previously bothersome sexual problems, such as premature ejaculation or stress-related sexual problems so their sex lives improve.”
Wrinkles along the way
Physical and psychological problems during this stage of life can express themselves as sexual dysfunction. For men, erectile dysfunction can be linked to other medical problems, such as cardiovascular illness or sleeping disorders, said
Mike Hsieh, MD, director of
UC San Diego Health’s Men’s Health Program.
After a comprehensive evaluation, men may simply have a natural hormone imbalance that can be corrected with medication or testosterone supplementation to fix such problems as orgasmic dysfunction, premature ejaculation or erectile dysfunction.
“There are modifiable things that middle-aged men can do to age better overall and improve sexual health starting now,” said Hsieh. “Make lifestyle changes that will help both you and your partner. Since obesity can impact your heart and your sex drive, exercise together to lose weight. Eat healthier and stop smoking.”
Don’t avoid warning signs of health conditions and, if problems do arise, go to the doctor as a couple.
“There is evidence that with support of a partner, men do better in therapy. Usually men are more open to seeking help with sexual health than women,” said Hsieh. “One reason women have longer lives is they ask for medical assistance. But, when it comes to sexual dysfunction it’s the opposite.”
In a 2008 study, nearly 15 percent of women age 45 to 64 years old reported some kind of sexual problem. It is more common than people realize for women to experience issues related to sexual desire or function as they age. Unlike men’s health, women don’t discuss or hear about simple treatments that can cure or improve problems.
“Frequently, women don’t seek help for sexual health concerns because they may be embarrassed or think there are no treatments available,” said
Erin Gross, MD, a board-certified gynecologist who specializes in vulvar and sexual health issues, including pain during intercourse and lack of desire. “In regards to low libido and especially pain during intercourse, women may think they’re the only ones with this problem. It’s simply not true.”
With the
recent approval of the “female Viagra” flibanserin for hypoactive sexual desire (marketed as Addyi), female sex drive has been more widely discussed in the public sphere. Still, other sexual health issues can be under- or misdiagnosed because they’re not as well known.
“Sexuality is an important part of a woman’s well-being that tends to be downplayed,” said Gross. “Women should advocate for themselves as this affects both their physical and mental health. Women who suffer may never get better unless they ask for help.”
Finding help from an expert can lead to an accurate diagnosis of vulvar problems that may impact sexual function. A variety of conditions can cause discomfort during sex, such as chronic infection, hormonal changes due to menopause, vulvodynia (a type of chronic vulvar pain) or lichen sclerosus (a vulvar skin condition that can cause burning, itching and skin thinning).
UC San Diego Health’s Sexual and Vulvar Health Clinic offers physical and psychological care to help patients get their groove back. This could include prescribing medications, referral to a pain clinic, surgery or pelvic floor physical therapy.
Mind games
If left unchecked, problems in the bedroom can affect a couple’s relationship and each other’s self-confidence, said Kovacs.
“Hormonal changes during menopause can cause insomnia, anxiety, changes in mood and how the body looks,” said Kovacs. “Some women experience these changes as a sense of loss of control over their bodies. If, at the same time, the male partner has erectile dysfunction, some women worry that their perceived decreased attractiveness is the cause.” If these problems become chronic and not discussed, a couple’s intimacy suffers. One partner’s sexual issues can aggravate or cause the other’s problems.
Thankfully, there are ways to cope. Regular exercise, healthy eating and understanding the aging process can have a significant impact on mental and physical health. Sexual desire and arousal dysfunctions can benefit from mindfulness-based exercises, where individuals learn to connect with their own bodies and focus on the present. A single sex therapy session can provide each person a better perspective on each other’s experiences and may open up lines of communication, said Kovacs.
Anxiety about sexual performance can interfere with the enjoyment of sex for both men and women. Men who worry about losing an erection may be unable to complete a sexual act, said Kovacs. Women who feel pressured to have an orgasm might not be able to relax enough to be aroused. For couples, these issues can become a stressful focus and a source of disappointment. Cognitive behavioral therapy, techniques that help end negative thoughts, can be beneficial for this and other issues.
Men and women experience sex drive a bit differently. Women tend to be more responsive—their desire can be activated through romance and seduction. Introducing playfulness, honest conversations and finding new ways to please one another are important to improving intimacy, said Kovacs.
“Society teaches us not to talk about sex and aging. Sometimes all that’s needed is to become educated about what’s normal,” said Kovacs. “This is a phase, not a disease. Our goal is to help you through it as smoothly as possible.”
Care at UC San Diego Health
Male Fertility and Sexual Health Program
Sexual Health
Sexual and Vulvar Health Clinic