But sex doesn’t have to be perfect, happen a certain number of times a week, or look the way it did when you were 25. It needs to work for you, in the body and relationship you have now. If it doesn’t, that’s not a personal failure. It’s a reason to ask what needs to change.
Here are the most common midlife sex problems I see – and what you can do about them.
Your hormones are playing havoc with your sex life
Of course, some of the reasons older couples stop having sex are physical which can have a knock-on effect on the relationship.
By their 60s, many men experience lower libido due to declining testosterone, reduced erectile function and longer recovery times between sexual activity. Prostate problems are more common at this age and treatment can impact erections. A gradual decline in the frequency, rigidity and duration of morning erections is to be expected.
For women, the drop in oestrogen during and after menopause can lead to vaginal dryness, thinning of vaginal tissues and discomfort during sex, as well as UTIs, which can all dampen libido and arousal.
But these problems shouldn’t be written off as part of getting older. For women, there are great off-the-shelf vaginal oils and moisturisers to help ease dryness, while lubricants can help reduce friction during penetrative sex, making it more comfortable and pleasurable.
If problems persist, see your GP who may suggest vaginal oestrogen (available on prescription) to help restore vaginal tissues.
If they are experiencing fatigue, or are suffering from a low mood, men can request a testosterone test from their GP. A sudden change in morning erections always needs to be checked out as it can indicate underlying health issues such as diabetes or heart disease.
You’re putting up with painful sex
One area where I think we’ve particularly failed women is in sexual pain. While erectile dysfunction medications – such as Viagra – have become a multibillion-dollar industry, research into female sexual difficulties continues to lag behind.
A good example is vaginismus, a painful condition affecting at least two in 1000 women, where involuntary muscle tightening of the pelvic floor can make penetration painful or impossible. A woman can have pain-free sex for years, then develop vaginismus due to hormonal changes, surgery or experiences that have made sex feel stressful or anxiety-provoking.
Endometriosis, a gynaecological condition, can cause deep pain during sexual penetration while vulvodynia causes chronic pain in and around the vulva, making sex difficult or impossible. These conditions can overlap: a woman with endometriosis may begin avoiding sex because it hurts, and subsequently develop an anxiety response around penetration, leading to vaginismus. Conditions like lichen sclerosus which can create intense itching and soreness can have a huge impact on your sex life and relationship with your body.
Men may develop pelvic pain as a result of prostate issues, stress or cycling injuries. Painful ejaculation can occasionally occur due to conditions such as prostatitis (inflammation of the prostate). Penile skin can also be affected by conditions including eczema or infections like thrush.
While sexual pain is common, it doesn’t mean it’s normal or should be tolerated. Simply seeking advice from your GP or sexual-health specialist can transform your experience. For example, if you suffer from vaginismus a psychosexual therapist can help you develop strategies for managing any anticipation of discomfort to avoid problems spiralling.
You’ve got performance anxiety
The most common issue I see in my patients, whatever their age or gender, is anxiety. It’s particularly common in midlife because we fear changes to our sex life mean there might be something wrong with us, and we worry about the onward impact of that.
Take erections, for example. If your erections aren’t as reliable as you want, say because of diabetes, high stress levels or the side effects of medications such as SSRIs (the commonly prescribed antidepressant), you may start worrying about losing it during sex and that anxiety can make it even harder to maintain one. This anxiety loop can remain even when the physical problem has been treated. This is where psychosexual therapy can help: medical interventions correct the chemistry; therapy unravels the fear.
For women too, anticipatory anxiety over sex not going to plan can detract from enjoying physical sensations and arousal. The more we focus on achieving an orgasm, the more difficult it can be for us to reach.
My advice? Slow down. Identify what helps you to push on your accelerators sexually – it might be your partner’s touch or your desire – and what’s pumping the brakes (phone alerts can be a huge turn-off). Try to remove the pressure and expectation around sex and communicate to your partner what’s going on for you so they can be on board trying to work through it.
You’re still expecting to have the sex life you had at 25
It’s rare that the sex we have in our early 20s will be the same as the sex we have after having children, in the aftermath of an affair or during a stressful time at work.
Illness, stress, trauma, cancer and surgery can all change how someone feels about their body and their sexuality. Habituation also plays a role in desire – the more familiar a sexual relationship becomes, the less exciting it can feel.
However, regularity of sex is a poor sole metric for a healthy sex life; genuine satisfaction, pleasure and connection are what matter.
People who report satisfying sex aren’t necessarily thinking about whether they’re performing at their best. They are present, in their bodies and responding to what feels good.
The product I recommend most often is lube. We still sometimes view using it as evidence someone isn’t sufficiently aroused. But we don’t have that attitude towards other forms of healthcare. If something is safe, inexpensive and makes an experience more enjoyable, why not use it?
The same is true of sex toys. We need to move on from the idea they’re replacements for a partner and start seeing them as tools we can bring into our sexual encounters to add variety and pleasure.
You’re suffering in silence
Too often, people define themselves as “failing at sex” and frame themselves as the problem – I can’t tell you how many times I’ve heard the word “broken” used in my therapy room. They wonder: “Am I normal?”, “Will this ruin my relationship?” “Am I good enough?”
We’re remarkably good at looking after other aspects of our health, yet when something happens involving our genitals or sex lives, we can feel we’re supposed to cope with it silently. I’d like people to think differently about that. One person can’t usually fix a sexual problem on behalf of a couple because sex is always in a context and dynamic.
Changing the sex you’re having requires the understanding of both parties so you can work together, otherwise it can leave you with unanswered thoughts or questions. Communication is the first step and, generally in life, we’re more open to something when we understand why.
If you’ve been struggling with a sexual issue, it’s unlikely to magically resolve itself. That doesn’t necessarily mean you need a psychosexual therapist. It might mean reading a book on sexual health, listening to a podcast, talking honestly to your partner or making an appointment with your GP, gynaecologist or urologist.
The thing I hear repeatedly in my therapy room is: “I’ve never heard anyone describe this before.” And yet, I’ve heard it hundreds of times. This is why we need better conversations about sex. Not because everyone needs to talk about sex all the time, or announce their private lives to the world, but because you shouldn’t have to suffer in silence simply because you’re embarrassed.
As told to Lizzie Newton
Kate Moyle is a psychosexual and relationship therapist and UK Sex Expert for sexual wellness brand LELO. She is the author of The Science of Sex, a “sex-education book for grown ups”, and hosts The Sexual Wellness Sessions Podcast.
