How Sex Changes in Midlife

I’m continuing to answer questions sent in by my readers. This week, I’m tackling one that comes up quite a lot: Why does sex change so much for women in midlife, and what can they do about it? First off, it’s worth acknowledging that everyone, regardless of gender, moves through different life stages that affect sexual function, connection, and desire in all kinds of ways, including in midlife. Some of the most powerful shifts involve hormone changes, and midlife is a time when hormones typically change a lot. To keep it simple(ish!) I’ll narrow my answer to the hormone changes experienced by cisgender women.

Estrogen drops substantially in midlife, and that drop has a wide range of effects on the body. Here’s a rundown of the most common effects:

  • Vaginal dryness
  • Lower sexual desire
  • Weaker orgasms
  • Decreased muscle tone and flexibility including in the pelvic floor muscles

If you want to learn more about how midlife affects sexuality, the Femani Wellness website is an excellent resource; you can start here.

It’s definitely possible to mitigate some of these shifts with lifestyle choices and specific interventions:

  • If your orgasms are weaker than they were before, it may be the result of changes in your pelvic floor muscles. Just like any other muscle, you can strengthen your pelvic floor with exercises. You might consider contacting a pelvic floor physical therapist to start; your primary care MD can give you a referral, or you can contact a PT directly.
  • If you’re not experiencing as much desire for sex, many people find that exercise helps; it increases free testosterone in the body, which often boosts desire.
  • A mindfulness practice, with a focus on perceiving and experiencing subtle physical sensations, can help a LOT with both desire and the experience of orgasm.
  • One possible effect of lower estrogen levels is vaginal atrophy, in which the skin of the vaginal walls becomes less padded and thinner, leading to pain with penetration. Thankfully, there’s an awesome treatment for that: the Vaginal Renewal Program, a non-pharmacological program that works through a combination of moisturizing, vibration, and massage. It can make a huge difference for people experiencing vaginal atrophy. Refer to the FeMani Wellness website for more information.
  • My #1 recommendation for sexual health, improved sexual function, as well as overall health, is reducing inflammation in the body. Eating an anti-inflammatory diet, doing strength training, and ensuring that you’re sweating through 30 minutes of cardio every day can make a huge difference. You could end up feeling better than ever before, and enjoying sex more too.
  • Use it or lose it. The more sexual pleasure you enjoy, the more you will have the physiological structures and neural connections to enjoy sexual pleasure. Have some orgasms, alone or with a partner. Enjoy genital massage with or without orgasm. Get the blood flowing, and learn to enter a pleasure-focused state of relaxation.

I want to emphasize one point: It is 100% possible to have awesome sex, no matter what age you are or what bodily shifts you are experiencing. The strategies I’ve mentioned above can be a huge help, but the truth is, there’s only one indispensable skill you need in order to have an awesome sexual connection over the course of a lifespan: flexibility.

By flexibility, I mean the ability to roll with the punches, respond to what’s happening in the moment, and not get dragged down by negative assumptions or meaning-making when things don’t go as planned. It’s totally fine if you’re not there yet; flexibility is something you can cultivate, and the best time to start is now!

The changes many cisgender women experience in midlife can disrupt their settled patterns of sexual connection. That can be quite distressing and scary, particularly if you haven’t yet had a lot of practice cultivating flexibility in your sexual interactions. But if you can get past that distress, and embrace flexibility, it’s also a fantastic opportunity to learn a lot more about yourself and about your partner, and possibly discover some new and exciting ways to explore intimacy together. Many people have the best sex of their lives past midlife, for exactly this reason.

Here are a few mindsets you might choose to experiment with,, which are designed to help you
cultivate flexibility:

  • It’s completely normal and expectable for things not to go as planned when you’re having sex. It doesn’t mean that there’s anything wrong with you or with your partner.
  • There are infinite ways to connect intimately, from self-pleasuring together, to sharing fantasies, to pleasuring one another with toys. If one particular activity isn’t pleasurable or possible today, this is your chance to explore some others!
  • You and your partner are teammates; your goal is to create as much pleasure and connection as you can together. Keep your eye on that goal, and let go of any sense you “should” engage in any specific activity.

Experiencing a Desire Discrepancy? Here Are Some Resources to Help

If you’re struggling with desire discrepancy in your relationship, I want you to know that you’re not alone. Desire discrepancy is one of the prevalent sources of conflict for partners. In part, that’s just because it’s so common; in fact it is SO common I would call it normal. Everyone is different, and everyone experiences desire slightly differently; in fact, it would be more surprising to me if you and your partner had exactly the same level of desire all the time! 

It might help you to know that there’s no such thing as desire that’s “too low” or “too high.”  Every level of desire is normal. For more info about that, check out this article; it also has a few questions at the end that you can consider in order to start to understand where your basic assumptions about desire come from, and how to change them, if you choose to. 

However, just because desire discrepancy is totally normal and expectable doesn’t mean that there’s nothing you can do to bring yourself and your partner closer together in terms of desire. I’ve worked with many, many partners who are experiencing desire discrepancy, and I’ve helped train other therapists to work more effectively with desire discrepancies in their practices. I’ve seen just how stressful and painful it can be, and I’ve also picked up a lot of useful ideas that may help you and your partner. 

One of the most important things I’ve learned over the years is that before you can start making progress with a desire discrepancy, you have to make sure you stop doing anything that might make it worse. For instance, sometimes attempts to connect by the higher-desire partner can manifest as pressure for the lower-desire partner. It may seem counterintuitive, but if you want to reduce the difference in desire between yourself and your partner, the first thing to do may be stepping back a bit. That’s because pressure creates anxiety, and nothing kills arousal faster than anxiety. For more info about this very common dynamic and what to do about it, check out this article

Another issue that tends to make desire discrepancy so much worse is sex pain. Unfortunately, many of us don’t have access to good sex ed growing up, and because of that, we may not know that sex pain is not just something you have to put up with. If you’re experiencing painful sex, I want you to know: it’s not normal or expectable; it’s a blazing red flag from your body indicating that something is going wrong, and that you should stop doing the painful activity immediately. Continuing to engage in painful sex will certainly make the desire discrepancy worse, perhaps even ultimately leading to a sexual aversion, and potentially causing damage to your body. The good news is that with the help of the right medical practitioner, sex pain is usually fixable. A good first step is contacting a sex therapist, who can help refer you to the right medical provider for your situation. If there are no sex therapists in your area, ask your doctor to make a referral to a pelvic floor physical therapist.

It’s also very common for desire discrepancies to begin after one partner gives birth; in my series on postpartum low desire, I pick apart the physiological and emotional causes of postpartum low desire, and offer suggestions for how to help partners move forward. Read this article to gain an understanding of the physical causes, with tips for how to access medical help; read this article for an in-depth account of the emotional causes; and check out this article for guidance on improving intimacy postpartum. 

Once you’ve removed the blocks, you may find that desire starts to bloom. One great next step is to start intentionally cultivating a relationship with your own sense of eroticism. Exploring your own connection with your body and your own sense of fantasy, sensuality, and pleasure in a pressure-free environment can be a great way to build desire for partnered encounters, as well as being a joyful, life-affirming exercise in and of itself. This article offers some suggestions. And if you are feeling charged up and ready to engage with your partner, it may be time to run an experiment with reconnecting sexually. All it takes to run an experiment is willingness–but you have to be truly willing. This article offers some questions you can ask yourself to identify whether or not you are willing. 

My Approach to Working with Desire Discrepancy

If you’re struggling working with desire discrepancy in your practice, first off, I want you to know that you’re not alone. My #1 request from therapists, by far, is for help treating desire discrepancy. There’s a good reason for that. Desire discrepancy is tough. It’s incredibly complex and multifactorial, involving everything from physiology to spirituality to relational dynamics. In fact, my 16-week online course, Assessing and Treating Sex Issues in Psychotherapy, started as a full guide to working with desire discrepancy and expanded from there! 

Over the years, I’ve written and taught a lot about working with desire discrepancy, so in this article, I want to point you to all the different free resources I’ve created. I’ll walk you through when and how to use each resource, so that you can fit them into a framework for approaching desire discrepancy, however it happens to be presenting in your practice. 

As you approach tackling a desire discrepancy, it can be helpful to understand just why it’s such a challenge. This article explains some of the underlying dynamics at play in a desire discrepancy in order to offer an account of why it can be so difficult to work with.

A great first step for working with desire discrepancy is normalizing both partner’s experience of desire. It’s common for partners to feel shame about their level of desire, whether they fear that it’s “too high” or “too low.” Often, that’s the result of societal expectations. Perhaps they believe that it’s wrong for a female partner to have higher desire than a male partner, or they’ve been led to believe that relationships should reflect the perfect compatibility of “soulmates.” 

In fact, part of the reason desire discrepancy is so common is that it’s completely normal and expectable for partners to have different levels of desire–and if you frame things in that way to your clients, you can quickly reduce their distress and get them on the path to making progress. This article explains why normalizing all levels of desire is so useful, and shares some questions you can ask your clients to help them understand where their assumptions about desire come from, and how they could begin to change them. Likewise, this article presents some guidance for framing desire discrepancy as a very normal difference in preferences, similar to how one partner might prefer a cleaner kitchen than the other. 

You may have heard that the best way to treat a desire discrepancy is to encourage the partners to “just do it.” This article responds to that common advice, lays out a series of questions your clients can consider in order to identify whether or not they are willing to try such an experiment, and offers guidance for framing the experiment in a way that ensures no harm is done. 

One thing you should certainly be on the lookout for is a particular, very common dynamic that tends to worsen desire discrepancies: pressure from the higher-desire partner, or even internalized pressure within the lower-desire partner. Whether pressure from a partner appears in the form of anger and resentment about not having sex, pushiness around physical contact, or anything else, it causes relational issues that often result in worsening the desire discrepancy. This article explains this dynamic and offers suggestions for what to do about it. Another key underlying cause of desire discrepancy is sex pain; this article focuses on how sex pain can destroy desire, and points to further resources for identifying its presence. In the most dramatic cases of desire discrepancy, one partner may be experiencing sexual aversion. In that case, turn to this article for ideas on where to go with a treatment plan. 

It’s also very common for desire discrepancies to begin after one partner gives birth; in my series on postpartum low desire, I pick apart the physiological and emotional causes of postpartum low desire, and offer suggestions for how to help partners move forward. Read this article to gain an understanding of the physical causes, with tips for how to help your clients access medical help; read this article for an in-depth account of the emotional causes; and check out this article for guidance on improving intimacy postpartum. 

Once some of the blocks to desire have been removed, many couples find that reconnecting sexually after a long time feels a bit awkward. This article offers some tips for making “breaking the ice” a little easier and more comfortable, as well as some advice for lower-desire partners who are looking to reconnect with their bodies and their sexual selves.

If you’re not certain how to present this advice to your clients, I just published a version of this article intended for partners experiencing a desire discrepancy; you can borrow my language, or just send it to your clients. It’s available here.