Just do it

Just do it

The changes and challenges of sex as women age

It might be radically different at 40 or 60 than it was at 20. Or it might not. And regardless of a woman’s age, it is often, in a word, complicated.

Yes, we’re talking about sex.

“In a woman’s 20s it’s all about contraception, avoiding STDs and the drama of relationships going on,” said Dr. Kathryn Wadland, a gynecologist with All About Women in Portland. “Moving into the 30s, it’s often busy moms trying to figure out how to get into the right headspace for sex. There may also be pain associated with nursing and having sex. They’re often busy, and tired from chasing toddlers and other demands. In their 40s women are looking at and thinking more about their relationships and finding connection with their spouse, often of many years.”

While most women would agree that they would like to have a “lifelong, dazzling experience of sexuality,” what that means depends on the individual, says Jennifer Wiessner, a Cumberland-based certified sex therapist.

“Women may think that a man’s libido stays relatively stable throughout the decades, yet they themselves wonder why they were so orgasmic in their 20s and 30s but beyond those years their desire and ability to orgasm decreases,” said Wiessner. “On the other hand, I see women who share that they felt inhibited and unsophisticated in their younger years, but find that later in life they feel good about their bodies and are confident in their sexual intimacy. In sum, women’s view of their own sexuality changes throughout their life spans, but the experience is absolutely individual.”

Wiessner said that while sex hormones peak for women in their 20s, one study showed younger women are less orgasmic than older women due to inhibition and lack of sophistication.

“In their 30s and 40s, as women are bearing and raising children, their sex hormones may be decreasing and desire fluctuating, but they may be finding their passions in their careers and favorite pastimes, and confidence in themselves as parents and partners,” said Wiessner. “By focusing more on their joie de vivre and less on their flaws, their desire may increase and the ability to experience passion is a function of that internal fire.”

Dr. Sasha Rose is a board-certified naturopathic doctor, licensed acupuncturist and yoga teacher with Wildwood Medicine in Portland. While women in their 40s who come to see her rarely mention loss of desire as their chief complaint, she said, they do joke about how their interest in sex isn’t what it once was.

Rose said research indicates that what may appear to be low libido for women in this age group who are in long-term relationships may in fact be boredom.

“Physiologically, women still have a strong libido, as seen in studies where they are shown erotic movies, or demonstrated by the dreams that women have about men other than their husbands. But they are often bored by the monogamy. This is true in loving, caring relationships,” said Rose. “The women do not want to leave the marriage, they’re just not that inspired by sex with their husbands like they used to be.”

Stress is another factor in lack of interest in sex.

“When a woman is feeling stressed or overwhelmed it is difficult for her to feel desire,” said Rose. “This isn’t always the case for men. For them sex is more of an outlet or stress reliever.”

In her 2014 blog post, “For women, sexuality changes with age but doesn’t disappear,” Heidi Godman, executive editor of the Harvard (Medical School) Health Letter writes: “The activity that once consumed us now has to fit into the patchwork of our lives that also includes work, kids, aging parents, and, oh yes, glorious sleep. But it does make me wonder about the future. Is there a time when sex will no longer be on the agenda? And can we – should we – change that? The answer, it turns out, is that it’s likely up to each of us. A research letter (in JAMA Internal Medicine) reports that women between the ages of 40 and 65 who place greater importance on sex are more likely to stay sexually active as they age. In other words, if it’s important to you, you’ll keep on doing it.”

As fertility wanes in perimenopause and menopause, women may view sex as simply to be enjoyed now that their children are grown and moving on, according to Wiessner.

“(But) the constant fluctuation of sex hormones can also affect mood, body image and sensation, so women may prefer more simple pleasures to a sexual frolic. The women I see in my practice wonder if there is an age where sexual activity should be properly shelved. Again, that is a purely individual choice and experience, and certainly not a dogma,” said Wiessner. “The National Survey of Sexual Health and Behavior in 2010 found that nearly three-quarters of 50-something women surveyed said that their latest sexual experience resulted in orgasm.”

Wadland said women in their 50s and beyond are dealing with the impact of menopause and post-menopause on their sex life, including decreased libido, estrogen, and perhaps new medications and/or health concerns. Intercourse can become painful as the lining of the vagina becomes thinner and there is less elasticity and naturally produced lubrication.

According to the North American Menopause Society (NAMS), a nonprofit organization “dedicated to promoting the health and quality of life of women,” sex drive may also decrease with age for women, as it does for men. But women are two to three times more likely to be affected by the decline as they age.

That’s not to say every woman will experience a waning desire. While some experience a decrease in midlife, for others it remains unchanged or strengthens. Women with increased desire, NAMS reports, may feel freed from contraceptive concerns or are enjoying new-found privacy as children grow up and leave home.

During menopause, dropping estrogen levels, which can bring about night sweats, hot flashes and vaginal changes may also impact sexual motivation and drive. Let’s face it. Being soaked with sweat and feeling flushed makes it hard to think about anything but cooling down.

Rose said that it isn’t until women are in their 60s that she starts to hear about libido being an issue.

“I hear it from some men, as well,” said Rose. “Sometimes vaginal dryness is an issue and that certainly contributes to low interest in sex. But sometimes that isn’t an issue or a lubricant is taking care of it, but the desire still isn’t there.”

“What interests me is when this is bothersome enough for them to seek treatment. I think a lot of women lose interest over time but they are OK with that,” said Rose. “Sometimes a woman will present with low libido and want it to increase in order to please her husband/partner. Sometimes she herself is bothered by her lack of sex drive.”

Wadland said there are some treatments for decreased libido, including testosterone creams, compounded estrogen creams, and pharmaceutical options such as those that work with serotonin receptors, which, she said, are a “big step” for women to take. And not all of the options are approved for women by the FDA, or paid for by insurance.

“Men get Viagra,” said Wadland. “There seems to be a higher value placed on sex and aging for men.”

But Wiessner has found that age does indeed bring wisdom for women.

“They have a wealth of knowledge about their own bodies to draw upon; they stay in their careers and practice physical fitness longer than ever and that contributes to self-esteem, which in turns sustains libido,” she said. “Yes, there are biochemical and physical changes that can be very hard to navigate. (But) mature women can have very satisfying intimate experiences.”

While needs, desire and practice may change over time, sex and sexuality play a significant role in women’s well-being at any age and merit the same care and attention as other health concerns.

“You have to invest in anything to get a good return, including a healthy sex life,” said Wadland, who has been in practice for eight years.

And Wadland finds that women need to have satisfying, enjoyable sex, not an obligatory experience, to really engage.

“It does matter. Women’s sexuality is an important component of health, although it is often not seen as important. We need to know our bodies, to connect with our spouse (or significant other), to take the time to have a good sex life,” said Wadland.

Jennifer Daigle, a nurse practitioner at Wildwood Medicine, also views sexuality as an integral part of one’s health and wellness.

“What has struck me the most is how willing women are to share their stories with me around sex and sexuality,” said Daigle. “Based on my experience, the 40s and 50s tend to be a time when a woman feels most in touch with her sexual self, whether it be due to emotional maturity or body comfort/wisdom; the reasons are irrelevant in my opinion.”

Daigle has begun exploring the concept of asexuality, particularly among women.

“I think it is important not to assume that all beings are sexual and that it is not ‘abnormal’ if a person, in this case a woman, identifies as asexual,” she said. “My goal as a healthcare provider is to try and meet a woman where she feels most comfortable when discussing sex. There are many reasons why this might be a charged topic for women, trauma, pain, etc., but sometimes it’s just that women are asexual, yet they still have deep, meaningful, intimate relationships.”

Wadland encourages women to talk to their health-care provider about all aspects of sexuality and that the dialogue about sex should be a two-way street. She would also like to see all women in tune with a health care provider before they become sexually active to ensure a healthy sex life.

“Talk about it. Sex has to be in a woman’s mind to effect change. It is complicated for women. It’s a shame if a woman has to bring it up,” she said. “I will ask sometimes, ‘Are you having sex?’ I want patients to know it’s part of the job of a gynecologist. Our work is all about sexual organs and the sexual being. If you have an issue and want to talk about it and your doctor is not receptive, get a new one.”

Wiessner agrees.

“Consulting with your health-care provider for medical advice or seeing a sex therapist for ways to navigate the natural emotional and mental changes is a proactive way to take charge of your sexuality,” she said. “You know yourself best. Check in with yourself at every stage.”

On the CoverKathryn WadlandSasha Rose

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