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Sex: The Ups & Downs

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When you’re young and in love, sex is, well, really hot. But odds are that “we-can’t-keep-our-hands-off-each-other” feeling isn’t going to last a lifetime. Just as there are ebbs and flows in life, your sex life will have its ups and downs as well.

But don’t panic. Just because you no longer feel the same intensity you once did doesn’t mean that sex will never again be satisfying. Quite the opposite, say the experts. Knowing and even embracing the healthy transitions that lay ahead can ensure a fabulously satisfying sex life well into mid-life—and beyond.

“It’s absolutely going to change, but it doesn’t have to end,” says Wilmington sex therapist Dr. Debra Laino.

Engaging in regular sexual activity has some definite perks. Sex burns calories, improves mood, boosts immunity, and alleviates stress and pain. A vigorous sex life might even help you maintain a more youthful appearance, according to researchers at Royal Edinburgh Hospital in Scotland.

But a lack of desire prevents many women from enjoying the benefits and pleasure of a robust sex life. Numerous studies show that about half of all women experience some type of sexual dysfunction during their lives, with low libido accounting for the majority of those problems. What’s more, it’s a condition most of them choose to ignore, especially after they’ve gone through “the change.”

True, menopause does reduce levels of the hormones estrogen and progesterone. Those changes cause the vagina to shorten and narrow. The walls become thinner and a bit stiffer. Most women will also have less vaginal lubrication, making intercourse less spontaneous and somewhat painful.

But for women, feeling the desire is about much more than hormones and internal plumbing. Unlike a man, who can get an erection at the drop of a hat—or bra—a woman needs to be aroused psychologically and physically.

“For men, sex creates intimacy,” says Dr. Estelle Whitney, staff physician and clinical instructor in the department of obstetrics and gynecology at Christiana Care Health System. “Women have to have emotional intimacy before they’re willing to allow themselves to have sex.”

That explains why a woman’s libido differs from a man’s and why there are variations among individual women as well. It also helps to explain why sexual desire waxes and wanes throughout the fabric of a woman’s life.

Indeed, it’s not just post-menopausal women who experience a decreased interest in sex. Contrary to popular belief, the 20s are not necessarily a period of sexual bliss. Many young women stress over body image, performance and the fear of contracting a sexually transmitted disease, which can short-circuit desire.

“Younger women have many of the same concerns as older women. They’re just better at covering them up,” says Dr. Nancy Fan, an obstetrician-gynecologist with Women to Women at St. Francis Hospital in Wilmington.

Hormonal changes can also impact sex drive. A woman may find her libido ebbing at the start of her monthly period and peaking at ovulation. “It has a lot to do with nature wanting to reproduce itself,” says Dr. Maxime Moise, an OB-GYN with DelMed Health in Lewes.

Pregnancy and childbirth can also send a woman’s libido on a roller coaster of highs and lows, he says.

Even if hormone levels are stable, the pressures of parenthood can throw a bucket of ice on anyone’s desire. Between the demands of work, child-rearing and housekeeping, women are under tremendous pressure, putting sex at or near the bottom of their to-do list.

“Coming home at the end of the day after working all day, then feeding the kids and helping them do their homework, the last thing at night you want to think about is having sex,” says Fan.

Mid-life can be a time of sexual reawakening, as women find themselves less burdened by the stressors that undercut desire earlier in their lives. But this is also the time when women enter perimenopause, the period preceding menopause when production of libido-fueling hormones begins to level off. But even though desire may flag, a woman can still reach new heights of sexual satisfaction.

“They have an internal confidence that a lot of younger women don’t have, a deeper sense of themselves,” says Laino. “They often know what feels good because they’ve gotten to know themselves better.”

An underactive thyroid—a common disorder in women over 40—can also diminish a woman’s sex drive. Hypothyroidism can cause weight gain and feelings of depression, both of which can lower libido.

“If it is not well-controlled, your general sense of well-being is not there, you’re not feeling energetic, so you’re not going to have a good libido or desire,” says Dr. Sonal Pathak, an endocrinologist at Bayhealth Medical Center in Kent County.

Menopause typically kicks in around age 50, ushering in a dramatic change in sexual desire. Little wonder. With menopause, there’s a significant decline in the production of estrogen, the hormone that increases blood flow to the genitals and helps lubricate the vagina.

“I think at some level our bodies know we’re going to stop reproducing, and it gets transmitted to our brains that we’re not going to have any more children,” says Fan.

This is also the time when many men go through hormonal changes as well. “Just like women go through menopause, men go through something similar, but not as dramatic, where they have a decline in testosterone levels and that results in reduced sexual interest,” says Dr. Gregory Spana, a urologist with Bayhealth Medical Center in Dover.

Health problems can also affect a man’s ability to have and enjoy sex. Conditions like atherosclerosis—a narrowing of the arteries—and diabetes can impede blood flow causing erectile dysfunction, says Spana. Medications used to treat these conditions can also cause sexual problems.

Men who have had a heart attack may avoid sex for fear it will trigger another attack, even if the chances of that occurring are practically nil. “The fear is always at the back of their minds,” says Dr. Bryan Villar, family medicine chair at Milford Memorial Hospital.

Does turning 50 mean an end to quality time under the sheets? Hardly. Many older adults retain their ability to enjoy sex well into old age.

“The belief that because they’ve reached menopause their sexual life is finished is not necessarily true,” says Moise. “I have patients in their 70s and 80s who are sexually active on a regular basis once or twice a week.”

Experts stress that women—and their partners—need to know what happens to their libidos and bodies as they age and to embrace these changes as normal and natural.

“I think the media plays a role,” says Fan. “A lot of patients come in thinking there’s something wrong, that it’s a disease and we should have a cure for it.”

But many women find menopause to be a liberating experience—one that frees them to be more creative and to rethink their options. “A lot of women feel that that’s their second peak sexually when they get into menopause and lose those associated stresses,” says Whitney. “The minor physical aspects of it can be addressed really quickly and easily.”

Moreover, the hormonal changes that occur with age can bring a couple into a kind of sexual synchronization. “As men age they become better lovers because they slow down,” says Laino. “The act takes longer now and couples are closer to each another with respect to climaxing—if they climax.”

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