Normal sex life as we age? It's complicated
There's no one right answer for women who wonder if their sex life is normal in their mid-life years, and there are American doctors who say they can prove it.
In an attempt to go beyond surveys of women in their 40s and 50s asking them about their sex lives, physician Holly Thomas, women's health researcher at the University of Pittsburgh School of Medicine, recently led a more open-ended interview-based study of 39 sexually active women ages 46-59, with an average age of 58.
It found both a range of attitudes about change - including more satisfying sex - and adaptations to sex-function difficulties that arise in mid-life.
"In general, studies have shown many women have negative changes," Dr Thomas said. "We were surprised in this work that found that a substantial number of women were discussing positive changes."
At the annual meeting of the North American Menopause Society, Thomas reported on her study that gave women a chance to explain how they're doing with changes in sexual function, as most were apparently going through the transition to menopause.
Twenty women were questioned in one-on-one interviews, and the remainder were in one of three focus groups with a trained facilitator.
"We got complex, nuanced answers," Thomas said. She received a new investigator award from the society in recognition of the quality of her abstract, a summary of the study.
Among the conclusions are that, as expected, changes such as decreased responsiveness, vaginal dryness, lower libido and difficulty reaching orgasm are common.
"Even for women who experienced some negative changes - for example, vaginal dryness - these women found ways to adapt to these changes," Thomas said.
"Women talked about using lubricants, trying different types of sexual activity, to try to help with those changes they experience."
Other adaptations included lengthening foreplay, using other types of sex besides intercourse, trying other sexual positions, masturbating more and encouraging use of erectile dysfunction treatments in their partners.
Also, some women said they adapted by putting more importance on the emotional intimacy that sex brings and less on physical pleasure.
Rather than blaming the changes on menopause, more women said family and career stress was to blame, and for some of them negative change was attributed to issues such as their partner's own health, the partner's sexual dysfunction and relationship problems.
Sex when a woman is in her 40s or 50s isn't simple, said Judith Balk, a gynaecologist with Midlife Women's Associates in Bethel Park.
"In my experience," Dr. Balk said, "when I ask women why they are not having sex, there are a lot of issues."
Changes in midlife can include weight gain, adult children living in the home and health of the partner.
"Weight gain is a libido issue," Balk said. "Your sex drive might be really low. It's a body image issue. I try to assess how important it is to them. If it's related to a medical problem, like diabetes, then I encourage them to get treatment. Partners are not typically worried about it."
In general, the incidence of sexual activity goes down as women get older, Balk said.
Among women ages 50-59, she said, studies have found 51 per cent are not having sex as vaginal intercourse. In the next age group, ages 60-69, that number goes up to 58 per cent.
A number of women in these age groups are widowed or divorced, Balk said. "A lack of a partner is a big impediment to vaginal intercourse."
But she knows many women are satisfied with their sex lives, often because their relationship with their partners is in good shape.
"Sexual dysfunction is defined as sexual distress," she said. "There's such a wide range of normal. If there's not distress or marital discord, it's not a dysfunction in their point of view."
Thomas found four areas of good news in the study group of women:
- Confidence: "They felt more comfortable in their own skin, with their bodies," Thomas said.
- Self-knowledge: "They knew themselves better," she said, and have learned what sexual activity works for them.
- Communication skills: "They were better able to convey what works for them with their partner."
- Libido: Some women had no problem with having less sex drive; others said their libido is higher than their male partners. "That goes against what we usually assume about women and men in midlife," Thomas said.
Issues about sexual function should come up at routine doctor's visits, Thomas said, and doctors should expect not all problems will be biological and women have a range of responses to changes.
"Doctors do have to be the ones to bring it up," she said. "Depending on the problem, there are things a health care provider can do to help.
"If you have problems, talk to your doctor. If you're not having a problem, celebrate that."