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.

Facts About Anatomy That Your Clients Need

Last week, I shared my case for why it’s important to talk about sexual anatomy with your clients. I was delighted to find that the post resonated with many of my readers.

This week, I’m building on last week’s post by sharing some facts and psychoeducation about anatomy. Not enough people know this information, and I’m willing to bet you have at least one client who could benefit from learning it.

  • Fewer than 30% of people with vaginas reach orgasm from penetration alone. If you have a client who is experiencing distress because they or their partner cannot reach orgasm solely from penetration, they should know that is completely normal and to be expected. They are in a solid majority.
  • People with a clitoris take on average 25-30 minutes of direct clitoral stimulation to reach orgasm. Many people have a mistaken idea that clitoral stimulation is not necessary, or that just a few minutes should be sufficient. Again, if this mistaken idea is causing distress to your client, they should know that the way their body functions is perfectly normal and to be expected.
  • Most people with a penis can reach orgasm without being fully hard. A certain degree of hardness is necessary for penetration, but not usually for orgasm.
  • Everyone’s sex parts and bodies are different. Sexual function, preference, desire, and every other aspect of sexuality is individual to the point that comparison is meaningless. All different, all normal.

Too many people are ashamed of their sexual anatomy, the way their bodies look or function, and the ways they experience pleasure. By sharing some simple (but weirdly hard-to-find) facts, you can take away that shame, and ultimately make a huge difference in your clients’ lives and relationships. I’m going to be sharing part two of this post next week, so check back then for more anatomy-related facts.

This topic is near and dear to my heart. One of the biggest motivations for designing my online course, Assessing and Treating Sex Issues in Psychotherapy, was to make sure that therapists have access not only to the techniques and interventions they need to work effectively with sex issues, but also a solid grounding in anatomy, physiology, and sexual health.  This makes it possible to identify pressing issues, normalize human diversity, and be true advocates for clients’ health. I love to help therapists learn how to sort out the physical and emotional aspects of simple and complicated combinations of sex and relational issues. If you’re interested in learning more about the course, which opens for enrollment this February, click here.

Why I Teach Anatomy to My Clients

If you’ve been reading my blog for a while, you know that I think discussing sex in therapy is crucial. Sex issues have emotional ramifications, and I hope I’ve convinced you that the ability to communicate openly and honestly about sexual desires, preferences, and boundaries is an important relationship skill, and that therapists have a role to play in helping clients develop that skill.

In addition to working with the emotional aspects of sex issues, I also very often spend time in the therapy room educating my clients on topics like sexual health and anatomy. Sex is a stigmatized subject, and many people don’t have access to trusted, reliable, and accurate information on sexuality. Many people have had only abstinence-focused sex-ed in school, or no sex-ed at all. Many people have gotten most of their information about sex from porn and peers.

Lack of access to information about sexuality can end up having all kinds of negative effects on mental health and relationships. For instance, many people feel embarrassed by the appearance of their sexual anatomy. This is the result of a lack of accurate and non-judgemental information about sex, and it can do a lot of harm to self-esteem. Sharing accurate information about anatomy can do a world of good. Even something as simple as asserting that  everyone’s body is different, and wide variation is completely normal, can make a huge different in people’s lives.

There are also cases of sexual problems that can be resolved with just a little bit of anatomical info. For instance, many people don’t realize that it takes a person with a clitoris an average of twenty-five minutes of direct clitoral stimulation to achieve orgasm. Lots of people think there’s something wrong with them or their partner if they can’t orgasm just from penetration, or if they can’t orgasm in just a few minutes. In a situation like that, you can provide a lot of relief by supplying a few facts about orgasm and anatomy.

I believe in the importance of providing accurate, non-judgemental information about topics your clients struggle with. I’m always surprised at how many people express astonishment and relief when I provide simple psychoeducation about anatomy, and debunk a myth or two. As I see it, alleviating distress in this way falls well within the bounds of a therapist’s role.

Does this leave you wondering where you can get accurate information about anatomy, and learn how to share it with your clients skillfully? You might want to consider joining my 2019 course, Assessing and Treating Sex Issues in Psychotherapy. Sign up for the waiting list now, and you’ll be the first to know when sign-ups open this February!