Why a Woman's Sex Drive Is Complicated
The expert: Joann Pinkerton, MD, president-elect of the North American Menopause Society and director of the Midlife Health Center at the University of Virginia in Charlottesville
What is it about being over 40 that can make sex go less smoothly?
Pinkerton: Perimenopause causes a host of hormonal fluctuations that can contribute to libido problems. This time of life is sometimes worse than menopause because hormone levels can be all over the place: Your levels of estrogen and progesterone can fluctuate widely -- sometimes going much higher or lower than before perimenopause. Testosterone, largely responsible for your sex drive, tends to decline in your 40s, around the same time that perimenopause begins. Then, in menopause, your estrogen level usually falls steadily, which, along with a lower level of testosterone, lessens desire further.
That said, hormones aren't the whole story. This may be a significantly stressful time in our lives. Our careers may be at their busy and time-consuming peaks. We may have concerns about our children. Our own parents may be failing and need more care. Any of these things can extinguish the libido's pilot light.
The upside is that simple lifestyle changes can help. Just getting regular exercise can relieve stress and hormonal mood swings and give you energy for the things that are important to you, like sex.
Why is it that women seem to experience the lion's share of libido problems?
Pinkerton: Women are complex -- much more so than men in this arena. When patients ask "What can you do to fix my libido?" my response is that it's complicated. We have to look at hormonal status, general health, relationship status and stress, to find out what's going on.
Is it common not to seek out sex the way you used to?
Pinkerton: Very. As women age, they often find that they stop having the kind of everyday sexual urges they used to have. It doesn't have to be a problem; you can redefine what successful sex is to fit your own and your partner's wants now. In your 20s, such sex may have meant simply getting aroused and having an orgasm. Now it might be more intimate: giving massages or stimulating each other with or without an orgasm.
What's important to think about if you're dating?
Pinkerton: STDs. You have to use a condom, which surprises a lot of my patients. Women at this age are more at risk for herpes and HPV than younger women are. You also have to think about pregnancy prevention. The next-highest unintended pregnancy rate after teenagers' is actually that of women in their 40s.
What if you have kids at home? Finding time to be intimate can be difficult.
Pinkerton: Morning is a great time. The house is quiet, and your sex drive is high because testosterone levels are at their peak in the morning. If you have a teenager who goes out until his midnight curfew, maybe make love at seven in the evening. Or try for later in the weekend if you're too exhausted on Friday night.
