Bored in bed? Feeling pain? Partner taking Viagra? Your middle school health class never covered those issues. Experts explain how to cope—and get the sex life you want
You'd think by now we'd have gotten the hang of this sex thing. After all, we've been at it for 20 years or more. But if you're feeling the ground has shifted a bit (or a lot), there's a reason: In midlife, hormones are fluctuating, relationships are changing, and self-esteem is soaring. The net net: Bedroom moments may be more challenging in some ways but can also be much more fun.
Here, three leading women doctors tackle the sex questions of women like you. Our experts include Jennifer Berman, MD, director of the Berman Women's Wellness Center in Los Angeles and coauthor of For Women Only: A Revolutionary Guide to Reclaiming Your Sex Life; Christiane Northrup, MD, author of The Secret Pleasures of Menopause; and Gail Saltz, MD, professor of psychiatry at the New York-Presbyterian/Weill-Cornell Medical Center and author of The Ripple Effect: How Better Sex Can Lead to a Better Life.
Q. How is sex different for women over 40?
Northrup: It's often a lot better. In midlife, you get to a place where you realize you'll never again have the body you had at 18. But because of your ego strength, skill set, and clout in the world, you can have sex on your own terms. You know what you like, and if sometimes you don't know, this is the time of life when you'll find out. Your soul is waking up. You have the spirit and sense of adventure that 9- to 11-year-olds have -- so you can reinvent yourself sexually. The truth is, most men don't care if you are 40, 50, or 60. What they want is someone who is fun, who responds, and who makes them feel good.
Q. Why do many midlife women find it harder to climax?
Northrup: You may have trouble reaching orgasm because your body is asking for more. "Wham, bam, thank you ma'am" simply won't work anymore. Your body is demanding that you recruit other neurological pathways. Your job is to explore the pleasure potential of your body. It's not going to be what it was in your 20s when you were horny as hell and ready to reproduce. But you're not going for Ripple anymore; you're going for fine wine. You don't gulp that, do you?
Saltz: If it's difficult to climax, there's the possibility that your estrogen has dropped so much that arousal has been affected. You may have lost a lot of lubrication, causing painful intercourse and making it more difficult for you to have an orgasm. Or your testosterone is lower and that's diminishing your libido. A word about testosterone: It, not estrogen, is the hormone of desire. If you really feel no desire at all, you should ask your doctor about checking your testosterone level. The hormone is not approved for women in general, partly because it carries cardiac risks. There are other negative side effects as well: You might find yourself growing a beard, speaking in a lower voice, developing acne, and feeling more aggressive. Simply bringing testosterone back up to a normal level with a patch will not cause these problems, but your doctor ought to watch you carefully.
Q. What else can help women achieve orgasm?
Berman: Topical sensation; enhancing products like Zestra or Vibrel can help by enhancing arousal and increasing sensations in the genital area.
Q. After 20 years with my husband, things have gotten pretty routine in bed. How can I make sex fun again?
Saltz: By midlife, most couples are doing exactly the same thing over and over. It's pretty hard to get excited about that. But people tend to be nervous about being rejected by their partner if they try something new, even if the couple has been together for a long time. If you're thinking of experimenting, I recommend you bring up the subject outside the bedroom. Suggest trying a different position or some form of foreplay that you haven't used, or watching a little erotica beforehand. If you talk about it when you're not having sex, you won't lose your nerve. And it can create some anticipation.
Northrup: Figure out what would be really fun for you, and practice with anything that turns you on -- underwear, wigs, whatever. Sex research shows that women are turned on by most erotic acts they see: men with men, men with women, two women together.Men have a much narrower repertoire of enjoyment. So explore your range!
Q. Does a woman's fantasy life change at this age?
Saltz: Women may become more accepting of their sexual fantasies now; that's important, because they play a huge role in arousal. In my practice, the top fantasies for women include having sex with a stranger or celebrity and performing new acts with their partners. One common fantasy women have is about being overwhelmed by a man. Some women are disturbed at being aroused by that, so let me explain: In the real world, rape is about the man exerting his power, and it isn't anything you would ever want. But in the fantasy version, the thought is, I am so desirable he has to have me, no matter what the cost. I have no responsibility for this sex because this person reached out and threw me down on the ground and had me. Or a woman may identify with the rapist: I'm completely in control. I get what I want when I want it.
Unfortunately, a lot of women don't realize that the fantasy of being taken has nothing to do with the violent reality of rape. So they shut off those thoughts and think instead about picking what they should cook for dinner. Then they wonder why it's harder to get aroused and have an orgasm. But as women age they get easier on themselves. They think, okay, I have that idea and obviously it does not mean I actually want to be raped. It's just a thought. The fantasy is perfectly normal and can work for you during sex, as can imagining sex with a stranger. Or approach your partner and suggest something you've never tried but have been fantasizing about.
Q. He is taking Viagra and wants sex all the time. I don't.
Saltz: This problem occurred the minute Viagra came out. He may be approaching you every day because he has felt rejected and is trying to undo that. Or because he had sexual dysfunction, which made him feel less like a whole person. Sex makes him feel manly and alive, and if you can help him sense those things in other ways besides intercourse, that would help bridge your libido gap. You can make him feel desired by holding hands, giving hugs, or making out a little. In fairness, you have to tell him you are working on it, and ask him to back off a little to give you room. But obviously, sexual relationships are always about compromise.
Q. Could my hysterectomy have hurt me sexually?
Northrup: If a woman has a hysterectomy with the ovaries removed, she goes through instant menopause. That's a shock to the body, and those women almost always need a little dusting of hormone replacement. If you've had a hysterectomy, it's important that you not feel as if something has been irretrievably lost. It hasn't. In fact, in women who are quadriplegic, the earlobe can be trained to be a trigger for orgasm.
Q. Why do I leak urine when I climax?
Berman: There are two things that might be happening. Some women confuse urine with female ejaculation (fluid that is excreted during orgasm from the Skene's glands, which are located around the urethra). Female ejaculation is normal. But if you are indeed leaking urine when you have an orgasm, that is due to pelvic floor relaxation and lack of support of the urethra and bladder, as well as the proximity of the urethra to the G-spot. In that case, you need to see a urologist or a urogynecologist. A physician may prescribe estrogen that is applied to the vagina. It helps maintain the supporting connective tissue around the bladder and urethra. Measures like emptying your bladder prior to sex can also help, as can Kegel pelvic floor exercises. If urine slips out at other times, your doctor may recommend additional therapies for incontinence, like minimally invasive surgery.
Originally published in MORE magazine, May 2009.
