Midlife Intimacy: Myths vs. Reality

That your sex life has to sour after a certain age may be one of the biggest myths of midlife sex.

Challenges exist, to be sure. However, issues with lagging libido or performance anxiety can be largely addressed with modern treatments. Cheryl Iglesia, MD, a urogynecologist at MedStar Washington Hospital Center, explains the many steps you can take to prevent your sex life from becoming ho-hum.

For example, women who are experiencing perimenopause or menopause and going through hormonal changes often encounter dryness in the vaginal area, or what’s been coined genitourinary syndrome of menopause (GSM).

Dr. Iglesia recommends starting with either a lubricant during sex or a daily moisturizer, both of which are non-hormonal. Many moisturizers are designed to reset pH levels and prevent overgrowth of unhealthy bacteria.

If either of those options don’t ease the dryness, you may want to look into a hormonal topical treatment. Topical creams include  Estrace® and Premarin®. Other options are a vaginal tablet (Vagifem®) and a ring (Estring®) that is inserted in the vagina and releases daily estrogen for three months.

Might the extra estrogen present health risks? “Now that these treatments are FDA-approved, the doses are so low that there really isn’t any significant cancer, blood clot or heart disease risk,” explains Dr. Iglesia.

Another issue couples face is waning libido. Men have had solutions for some time now, such as name brand Viagra® or Cialis®. And even though Flibanserin has been touted as the new “female Viagra,” it’s only FDA approved for premenopausal women.

Dr. Iglesia reassures this doesn't have to be a roadblock. In fact, lowered libido may be more mental and emotional than chemical, particularly in women. "There’s a lot of things that go into desire, just in terms of the way women feel about their bodies. Changes can occur in the architecture of the vagina, particular after you’ve had children. It takes longer to orgasm, maybe you don’t feel as much, you’re just feeling very different about your body, less confident. And, of course, there can be relationship issues."

The key is to switch things up.

“Everybody’s got to change their game. I would say change the location, change the time of day, even get some toys in there. Read the Kama Sutra, look at different positions, start doing other fun things together to revitalize your relationship.”

If you and your partner have unresolved issues, a couples therapist or sex therapist can also be beneficial.

Finally, don’t neglect any outside influences. Many drugs can negatively impact libido, including antidepressants and blood pressure medications.

Dr. Iglesia’s last piece of advice is to not give up. “If it’s something that’s really bothering you and really bothering your partner and you really want to make improvements, don’t blame all your problems on age. You can see a specialist, someone who’s going to validate these concerns and offer a very thorough evaluation, give you the appropriate referrals, and provide advice on other things to try.”

By giving yourself permission to explore your options, you can push past the misconceptions and maintain your sex drive well into your elder years.

Listen in on Dr. Iglesia’s full podcast interview here.

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