Good Sex Over A Lifetime

Our bodies are diverse in shape, size, color, and ability, among other things. Every body is unique. One thing, however, binds us all together. We all age, and as we age, our bodies change.

One of the things that is likely to change over the lifespan is sexual function. Over a lifespan, hormone levels shift, as well as muscle tone and flexibility, and vascular function. Bodies experience illnesses, pregnancies, and health/lifestyle shifts for the better and worse. All these things have an effect on how the body responds to arousal and how pleasure is experienced.

Many people have the best sex of their lives later in life. However, if body changes in midlife make it more difficult to have familiar and well-practiced kinds of sex, the changes can be painful and distressing particularly when negative meanings are made of the changes.

Lifestyle choices, like eating a healthy diet, reducing and managing stress, and incorporating regular exercise into your routine, can make a big difference, so consult with your doctor. However, one of the most productive changes is to think about change differently, and respond more skillfully.

A sexual repertoire for a lifetime must include multiple activities that do not depend on any particular body part, function, or experience. If we define sex as “penis-in-vagina penetration”, or “orgasm,” or any other particular experience, I can guarantee at some point things won’t go as planned. However if we define sex as “activities that are pleasurable,” or “anything sexy,” or “connection plus pleasure,” the likelihood of creating a satisfying sexual encounter skyrockets.

I’m a strong advocate for making this shift in thinking early. When a young couple comes to me to work with a particular sexual challenge, they often feel quite broken, because everything is “supposed to be easy” sexually. But I always feel very optimistic about their long-term sexual connection. This is because we can learn this shift of perspective early in life, later in life, or never. The earlier we get good at this, the more good sex we have. Simple as that.

What are we learning in order to support a lifetime of good sex?

  • Improvisation. There is no script, and the more you follow a script, the more things go “wrong”. The more improvisation, the more fun you discover.
  • Encourage your sexy, creative brain. That’s the part of you that comes up with ideas, tries them out, shares curiosity with a partner, and makes sex playful.
  • Control your naughty brain. I’m referring to your meaning-making brain. The part of your brain that says: “I’m not sexy because I…..”. “This wouldn’t be going like this if my partner were still into me”. Any thought that makes you feel bad about yourself or your partner during a sexual interaction is not helpful if pleasure OR connection are your goals.
  • Recognize that things not going as planned is just part of the landscape. Everyone experiences it and HOW you respond is the key to good sex.

Here’s an example: If your partner loses his erection, will it be more fun and productive to
a) begin to make meaning about not being attractive, or even comfort your partner with “nobody’s perfect” messages, or
b) tell him how hot he is, that you love his erection but don’t need it, and initiate an activity that you both enjoy and that doesn’t require an erection?

Reader Question: Is Abstaining from Sex Healthy?

I know someone who says she plans to be non-sexual through her life. Can this be considered a healthy choice?

Thank you for this question! It raises some very complicated and very interesting issues. The first thing that comes to mind is that the person you are referring to may be asexual. Asexuality is a fascinating but, unfortunately, little-researched identity. It’s complicated, and there’s no one-size-fits-all description of how asexual people experience and understand their (a)sexuality. Put simply, an asexual person is someone who does not experience any desire for sex. Sex may be actively repulsive to an asexual person, or it may simply seem completely uninteresting. For an asexual person, not desiring sex is not really a choice, in the same way that people generally aren’t able to choose who they’re attracted to.

Given how unique and individual we all are, I would not leap to a label or any assumptions. If the person wanted to discuss sexuality, I would validate everyone’s right to make their own decisions about their sexual identity and sexual behavior. I would get curious about what she thinks, feels, and prefers. There are lots of good reasons to choose not to have sex for awhile or for a lifetime; asexuality is not the only possibility, and this person is the only one who can speak for her own reality.

If your friend is asexual, she could still choose to engage in self-pleasure, partner sex, semi-sexual relationships, purely romantic relationships, purely platonic relationships, or whatever she and her partner/s want. Willingness is enough. If a person feels willing, desire is not necessary for a healthy sexual experience.

If she does not have any desire for sex, certainly abstaining is much healthier than having unwanted sex. She’s the expert on her own desires, and it’s up to her to decide what’s best for her. The same is true for all of us, by the way. The healthy choice is the congruent choice, meaning actions match with thoughts and feelings. There’s nothing inherently healthier about desiring sex than about not desiring it.

Orgasm and Heart Conditions

Q: Can women of mature age experience lack of orgasm due to coronary artery problems?

First, I want to make the point that it’s been clearly established  that erectile dysfunction is an early warning signs of heart disease–so much so that I would urge any person who has experienced a sudden change in their erectile capacity to consult a doctor immediately. Changes in erectile capacity very often precede a heart attack by 3-5 years. It’s not just a sex problem, it’s a health problem, and taking swift action could save your life.

It’s important to make a distinction between erection and orgasm. Erection I will define here as filling of the erectile tissue regardless of gender. Orgasm, on the other hand, is a reflex response to sustained stimulation. Erection and orgasm are very different, but related. In many cases, people with impaired erectile capacity can still reach orgasm. They just don’t think they can because nobody told them to try. On the other hand, erection/engorgement feels good and increases enjoyment and arousal. Engorgement makes orgasm easier and more likely.

Most female-bodied people aren’t really aware of their clitoral engorgement; it is harder to notice and comes and goes more than for males. While male-bodied people are very conscious of their erections, female-bodied people are more likely to notice the presence or absence of an easier-to-spot sign: orgasm.  While engorgement necessarily involves blood vessels, diminished or absent orgasm has dozens of causes.

Engorgement works very similarly between all genders and sexes. We all need healthy blood vessels for the blood to make it to the erectile tissue. So I’d say a woman in midlife might well experience a lack of ENGORGEMENT due to arterial damage. She might then face more difficulty noticing feelings of arousal (some of which are related to the engorgement itself) and thereby more difficulty reaching orgasm.

Heart attack is the leading cause of death for women. It’s diagnosed much later than with men, and with a much lower survival rate. If you notice changes in your arousal patterns, see a doctor. Better safe than sorry.


  • Start to notice signs of engorgement in the vulva and clitoris
  • Regardless of gender and sex parts, take lack of engorgement seriously
  • Since orgasm and engorgement are related, lack of orgasm could hypothetically be the first sign a female-bodied person notices that could be related to coronary artery disease.
  • Orgasm is possible without engorgement/erection. So keep on trying while you wait for your appointment with your cardiologist.