Couples whose sexual relationship has vanished into thin air like so much birthday-candle smoke tend to blame the ravages of time: boredom, menopause, just getting older. But those aren't the real problems.
A 2008 study of more than 40,000 women found that 45 percent experienced sexual dysfunction, compared with 31 percent of men. The peak age for complaints: 45 to 64.
"Impaired sexuality and sexual function are not normal consequences of aging," says geriatric psychiatrist Ken Robbins, a Caring.com senior medical editor. Adds Elizabeth G. Stewart, an assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School and the author of The V Book, "Sex can be more satisfying than ever during perimenopause and after menopause—if you avoid certain traps."
Here are seven of the most common sex-stoppers of the 40s and beyond:
1: Pain and discomfort
Discomfort during intercourse—usually vaginal dryness—is the No. 1 sexual complaint of women over 40, the years of perimenopause and postmenopause. That's because falling estrogen levels cause the vaginal walls to thin and the usual pH and bacterial balance of the vagina to change (a cascade of changes known, alas, as "atrophy").
Fortunately, it's a problem for which there are many effective, safe treatments today, especially those that replenish estrogen, according to Stewart. "The real problem is the perception out there that estrogen is awful and will give you cancer immediately," she says, referring to popular concerns about the health risks of hormone replacement therapy. "The local options are so safe and release such tiny amounts of estrogen that oncologists may even recommend them for women who have breast cancer, because they don't bump systemic estrogen levels."
Solutions: You don't have to take estrogen by mouth. Estrogen-based treatments available by prescription come in the form of creams (such as Premarin cream), a ring inserted for three-month intervals (Estring), and a dissolvable tablet that's inserted in the vagina (Vagifem). You can also try over-the-counter, water-based lubricants (such as KY Jelly, Astroglide) and longer-lasting vaginal moisturizers (such as Replens and Lubrin).
2: Not thinking of your partner's problem as a joint problem
Men's No. 1 sexual killjoy is erectile dysfunction (ED), the inability to maintain an erection sufficient for intercourse. More than half of men over age 40 experience this with regularity (defined by doctors as more than 25 percent of the time). ED is almost always rooted in physical problems, such as diabetes or high blood pressure, and the medications used to treat these conditions.
Fortunately, it's a problem for which modern medicine has found many good solutions. But for every guy who's sold on those Viagra commercials is another who doesn't think anything can be done about his problem, or who's too embarrassed to bring it up with his doctor. "That can leave her high and dry," says Stewart. "Even if he considers it his private problem, his partner needs to speak up. Pester him to see a urologist or his regular doctor."
Solutions: Many men don't realize that Viagra is only one cure. The most common, effective treatments for ED include a vacuum pump (a hollow tube placed over the penis to create a vacuum that sends blood into the penis), penile ring (devices used during sex to maintain blood flow), penile implant (a surgical procedure to insert an inflatable device), and drugs—chiefly sildenafil (Viagra) and tadalafil (Cialis).
3: Using antidepressants
Studies have variously reported that 30 percent, 50 percent, or even 70 percent of those who take an antidepressant in the drug family known as selective serotonin reuptake inhibitors (SSRIs) experience a dip in desire or trouble achieving climax. Considering that more than 10 percent of all adults take an antidepressant, that's a big problem.
SSRI drugs (such as Prozac, Zoloft, Paxil) raise levels of serotonin, a mood-regulating neurotransmitter, but they also cause a corresponding drop in dopamine, the feel-good hormone crucial to sexual pleasure. Women tend to be slightly more affected than men.
Solutions: Taking a "drug holiday"—skipping a dose or two of the drug—can temporarily restore sexual function without causing a depressive crash, Stewart says. (It's smart to check with your prescribing doctor first; this approach is more effective with short-acting SSRIs than with longer-acting ones, such as Prozac.) You may also want to talk to your doctor about switching to a shorter-acting drug in order to do this, or switching to a non-SSRI antidepressant. For example, bupropion (Wellbutrin) belongs to a different class of medication not linked to sexual side effects.
4: Not liking to talk about sex
"I was raised not to talk about sex, and so my husband and I never did. We just did it," says Maria, a fiftysomething clerk who also takes care of her live-in mother (who has diabetes). "I never felt any need to dissect sex, because Joe never complained and I had no complaints." But lately sex has become painful. She finds it easier to blame stress than to give in to Joe's advances. He's unhappy, she's unhappy—and their sex life is going nowhere.
"If a couple has never been good at communicating about their sexual needs, then any sexual changes in the menopausal years or after become even harder," Stewart says. "She needs to be able to tell him if she needs more foreplay or more stimulation, or what feels good. Otherwise an ongoing problem gets magnified."
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