Cymbalta — a newer antidepressant, called an SNRI — may have less of an effect, which is the case with Wellbutrin, also not an SSRI. If you really like your SSRI but don’t like the sexual side effects, some docs add a prescription for a small dose of Wellbutrin to solve the problem. Drugs for high blood pressure are notorious for decreasing erectile performance, and they can also block orgasmic response in women. Your doctor can switch your medication. Hypothyroidism, which is a huge problem for women in this age group, is subtle and is associated with decreased sexual response. Ask your doctor for a TSH [thyroid-stimulating hormone] screening test, which we now recommend for all women over 50. It can be performed in her office.Okay, so let’s say the problem isn’t health-related but has to do with getting used to the idea of aging.Minkin: What you think of yourself is crucial. As my good friend Dr. Ruth says, "The most important organ in the body for sexuality is between the ears, not between the legs." Many 40-plus women feel they’re not as attractive as they once were, but if you ask me, it’s bullshit. The young, immature starlets on their third trip to rehab are not so alluring, really. The interesting thing is that when we research societies where age is valued, women have fewer menopausal symptoms, like hot flashes, so there’s something to be said for appreciating your age.We so often talk about over-40 sex being problematic, but aren’t some women having the best sex of their lives during this time?Minkin: Absolutely. Menopause can be liberating, because you no longer have to worry about getting pregnant or deal with painful conditions like endometriosis and fibroids. For a lot of people, menopause turns out to be a blessing for all its sexual benefits. Is Sex Better at 25 or 45?The expert: Laura Berman, PhD, author of The Passion Prescription: Ten Weeks to Your Best Sex — Ever!Why is sex so healthy for us? Berman: There are several reasons. It boosts the immune system and combats depression, and, because it’s exercise, it promotes cardiovascular blood flow. You burn up to 50 calories during 30 minutes of sex, as compared to about 35 calories sitting and reading for 30 minutes. It also increases your genital blood flow, which helps keep your sexual response healthy. It’s the "use it or lose it" phenomenon: Physiologically and clinically, we’ve found that the more often you have sex, the more you’ll respond sexually and the more "in the mood" you’ll be.Why is sex essential for a good relationship?Berman: The more sexual you are as a couple, the better off you’ll be. We’ve found in our national research that the number-one predictor for emotional connectedness in a relationship is the level of sexual satisfaction of the couple. You acquire a sense of closeness with your partner by having sex. It creates an intimate, romantic world for just the two of you. Can sex help relieve menopause symptoms? Berman: Yes. The endorphins sex and orgasms release can help with moodiness and sleeplessness.Is sex better at 25 or 45?Berman: Here’s the thing: A woman in her 20s may be physically in her prime, but that’s just one small part of her sexual response and experience. From what I’ve seen, older women are more confident and empowered, and they feel more comfortable being uninhibited — all of which gives them a huge sexual advantage over the twenty-somethings. It’s good news all around: A doctor can often fix the physiological issues that women over 40 may be dealing with, and the emotional characteristics that older women possess are really the essential ingredient for a great sex life.What if your partner has erectile dysfunction, or ED? Berman: Men who have ED typically shut down sexually. They won’t hold hands or be romantic because they associate those things with the lead-up to sex and they don’t want to face potential failure. So do make an effort to talk about it as a problem you can tackle together, which may lessen his anxiety. Offer to go to the doctor’s appointment with him, even if you just sit in the waiting room. Once he’s been treated, you’ll likely have an increase in your sex drive too.