Great Sex At Midlife


Reading some comments in response to last week’s post about the attempts to develop a female equivalent to Viagra made me aware that although there are many women who are eagerly awaiting such a drug, there are many others who would not consider a drug to boost their libido.

That’s why it’s so important to try to understand and examine what’s really going on with libido at midlife, a time when so many changes are taking place in our bodies and catching us unaware.

The North American  Society (NAMS) has a thing or two to say on the subject. Sex drive decreases gradually with age in both men and women, they say, but it’s different for women: they are two to three times as likely to lose that lovin’ feeling.

Menopause, along with its infamous hot flashes, night sweats and vaginal dryness as a result of plunging estrogen levels, can pose a challenge to a woman’s libido and sexual desire. That’s one reason why drug companies are busy trying to create a female equivalent of Viagra. Other treatments women consider, like testosterone, have modest effects and there’s limited knowledge about the long-term safety as it relates to breast cancer or heart disease (although studies are ongoing).

My recent visit to Tucson’s famed Miraval Resort & Spa shed some light on the topic when I attended a lecture, “Let’s Talk About Sex (for Women Only),” led by Sheryl Brooks, a registered nurse and certified menopause practitioner.

I had the opportunity to ask Sheryl some key questions.

  1. Q. What are the changes that come with perimenopause and menopause that can have an impact on a woman’s libido and sex life?
  2. A. For some women, the perimenopause transition or becoming a postmenopausal woman has little effect on their libido or vaginal comfort during sex. But for others there can be one or several”like sleep disruption, night sweats, mood swings or decreased vaginal lubrication (that can make sex uncomfortable).
  3. Q. What about the emotional changes? Perhaps women are stressed, fatigued, have an emotional disconnect with their partner, etc. What are some problems you see that may get in the way of a satisfying sex life? And what would you recommend women do to help overcome this and maintain, or perhaps rediscover, their ability to have a satisfying sex life with their partners?
  4. A. All the things you mentioned can impact our sex lives. Making time to connect on a regular basis with their partner, getting at least seven hours of sleep most nights and getting some stress management tools, like meditation, are all things to consider.
  5. Q. So many midlife women worry about their body image and as a result may feel self-conscious or a lack of desire. Any advice?
  6. A. Realize that you are looking at your body in a much more critical and negative way than your partner does. If your partner admires your body, believe what they say instead of pointing out the flaws you think they missed.
  7. Q. How can a woman get back in touch with her body at midlife?
  8. A. Set the intention to be fully present in your body throughout the day as well as during sex so you can really appreciate and enjoy the sensations we are designed to experience.
  9. Q. Can you suggest a dialogue a woman can have with her partner to open the discussion about wanting a more satisfying sex life?
  10. A. I think the best approach is to be honest about what is going on from her perspective”not criticize”and to let her partner know that she would like to work together to make their relationship and sex life a priority. We all know how to talk with our own partners and what approach is best.
  11. Q. What about the vaginal changes, like thinning tissue, diminished blood supply, lack of lubrication, etc.? What can women do?
  12. A. You just described the changes that often occur with lack of estrogen. For some women, these changes will be significant; for others, not. Lubricants used during sex and vaginal moisturizers (both used on a regular basis) can reduce discomfort during sex. Also, regular vaginal sex activity helps to maintain vaginal tissue. When sex becomes uncomfortable or painful, a woman should make a point to discuss treatment options with her health care provider.

We are often surprised by changes that occur in our sexual lives during middle age. The two hormones that most affect sexual physiology, estrogen and testosterone, tend to decrease during midlife, in both women and men. As a result of these hormone decreases, the most common symptoms we experience are a decreased libido (desire) and changes in sexual response. But this is just the tip of the iceberg. Sexuality is complex, especially at this life stage, and we go through other shifts on the physical, mental and emotional levels. Our roles and relationships change. While it is common for people to experience changes in sexuality during the middle years, it may not happen to both partners at the same time, further complicating the issue.

1. Self-perception:

At midlife, it is common to experience changes in weight, fitness, appearance and mood causing us to feel less desirable and therefore less interested in sex. The challenge is to do what is reasonable to improve health and appearance, and then move to embrace and accept ourselves as we enter this new phase of life.

2. Sex (gender) role behavior

:Many times in midlife partners fall out of sync with one another. Women at midlife experience shifts in their psyches and often have a shift in priorities. Commonly, women begin to focus on their own needs and self care, and have more time to devote to creative endeavors. They often have a change in career and focus. Men are more likely to slow down at work and are looking to balance their lives with more leisure. This impacts behaviors, including sexual behaviors, and can require negotiation of the relationship. The same is true in same sex relationships as well.

3. Sexual desire (libido):

Loss of libido is common in women as they go through peri-menopause into menopause. Typically, women in this life stage don’t think about sex, don’t initiate, and don’t care that they don’t care! They are surprised at the sudden change. For some, just going ahead and starting foreplay will cause arousal and interest to follow. This dramatic change is the result of a drop in testosterone (mostly) along with lowered other sex hormones. Men may have a decreased libido as well, as their testosterone slowly wanes.

Some people have a consistent or even increased libido and this may pose problems to those whose partner is not available or not interested, or to those who have no partner due to divorce, breakup, death.

4. Sexual response

Women tend to complain of slow arousal and difficulty coming to orgasm. Orgasms may elude them altogether, or be less satisfying. At the same time, men who are having difficulty with sexual response most often report erectile dysfunction. This may be an early warning sign of cardiovascular disease and a medical workup is advisable.

What you can do:

5. Healthy diet:

Eating for health, mostly fresh whole foods without preservatives, additives, and trans fats will provide energy to all your cells.

6. Exercise:

Women who exercise has been shown to have fewer symptoms of menopause, including sexual symptoms. Men and women who exercise have better cardiovascular health so better sexual interest and response.

7. Sleep:

Adequate, uninterrupted sleep is important for stress reduction, hormone production, and sexual desire and response.

8. Manage stress:

Stress often increases at midlife, especially with the many changes that occur. Taking an honest look at your stressors and working to eliminate any of those that are possible will help. Finding practices to manage stress will improve well being in general, including sexual interest and response. Deep breathing and meditation(even 5 minutes twice a day) have been shown in formal research to improve medical health and sexual health and satisfaction.

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9. Improve self image:

It may be enlightening to focus on your own thought messages to self. Working on the above factors can enhance your positive self talk. Improving your relationship with yourself has a positive effect on sexual health. .

10. Medications 

commonly used include bioidentical testosterone supplementation, either oral or cream. This will usually accompany hormonal treatment with bioidentical estrogen or progesterone in either an oral form, as a cream for local external treatment, or in a vaginal form.

11. Medicinal treatment 

may also extend to adjunctive anti-depressants for you or your partner or a change in current therapy for other diseases. Some antihypertensives and antidepressants will alter sexual function in men or women.

12. Herbal therapies

include the herbs Damiana for improved libido, Chinese ginseng for improved libido, potency and fertility, and Yohimbe. Ashwaganda is also helpful on a long-term basis for improving sexual response.

13. Behavioral 

approaches can help improve sexual satisfaction. An aid to sexual health may be a change in sexual foreplay to accommodate changes in each partner and to rekindle interest. Couple therapy may be helpful, either with a professional or with the couple alone. Intimacy “planning” can help when this part of life seems to get squeezed out.

14. Energy Healing 

has profound effects on improving sexual health and connection. Higher levels of healing, as used in EnergyTouch work, can assist with connections through multiple sets of chakras and quickly improve sexuality on the physical, emotional, spiritual, and relational levels.

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15. Taoist and Tantric Practices

These are spiritual practices that originated in ancient China and India. Both have techniques of sexual practice to assist in generating more life force and directing sexual energy for increased health, pleasure and spiritual well being. Both work on energy channels through the body, much like the energy healing. These practices are beneficial to individuals who are without a partner as well.

When dealing with the sometimes sudden changes that come in midlife sexuality, it is important to approach as much openness and honesty as possible. Sexual problems often seem insurmountable and confusing, difficult to approach and embarrassing to talk about. Knowing that this is a common problem and there are effective solutions can be helpful in working through the issues. By focusing on specific factors and symptoms and improving communication, a healthy sense of sexual balance can be achieved.

Actually midlife can be the perfect time to improve our sexual lives. It is a time when we are re-evaluating life in general, and taking the time to reawaken our sexual/ spiritual selves can be truly rewarding.

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