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Sex at Midlife

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Whether you've been married for 25 years or are only dating, sex at midlife—we're talking 40s and 50s—can hold some unique challenges for you and him.

For women, this time of life is one in which your hormones rise and fall like a roller coaster. As estrogen levels fluctuate, eventually bottoming out with menopause, you may notice certain changes in your body that affect your sexuality. One of the most significant changes occurs in your vagina.

Like many parts of your body, your vagina relies on estrogen to keep it healthy. Low estrogen levels can lead to thinner vaginal walls, increasing the risk of tears during sex and sometimes causing itching, burning and dryness. In addition, there is less lubrication, which can make intercourse painful and further contribute to the risk of vaginal and labial tears.

Estrogen loss can also shrink the clitoris (a major player in a woman's sexual pleasure and orgasm) and reduce blood flow to the clitoris.

Estrogen receptors (as well as progesterone, another sex hormone) are also particularly prevalent in the hypothalamus, the part of the brain that controls sexual function and mood. So, we think, estrogen plays a role in terms of getting you in the mood.

Another hormone that plays a role in your sex life is testosterone. Our ovaries produce half of all our testosterone. As the ovaries shut down production of estrogen and progesterone at menopause, they also shut down most of their testosterone production, which can result in a reduced sex drive.

Finally, hot flashes and disrupted sleep from those fluctuating hormones can leave you tired and irritable, uninterested in sex. Just don't be too quick to blame your lack of desire on your age or even on menopause. When researchers surveyed nearly 2,000 women ages 45 to 55 about their sexual life over the previous year, 62 percent said they had noticed no change. Seven percent even said their interest had increased although, to be fair, most of them had new partners. Only a third said their interest had declined—and we have no way of knowing why that was.

In men, the midlife years are also associated with declining levels of testosterone. But since they make much more testosterone than women and testosterone plays a much greater role in their sexuality than in women's (contributing to their ability to have and maintain an erection), the loss may be felt more keenly.

Like women, men in midlife may face health problems, particularly atherosclerosis, or clogged arteries. Anything that affects blood flow to the penis affects a man's erection Other health condition that tend to pop up in middle age and can affect a man's sexual function include diabetes, Parkinson's disease and benign prostatic hyperplasia, or enlarged prostate. More than half of all men have an enlarged prostate after age 50.

Middle-aged men and women are also more likely to take medications that can affect sexuality, such as antidepressants and blood pressure medication.

And then, of course, there are the ubiquitous relationship and lifestyle issues that can hit in middle age. If you've been in a long-term relationship, it might be getting stale. If you've let your body go and gained weight, you might have some self-image/self-esteem issues. Conversely, if your partner is the one with the weight gain, you may not find your partner as sexually attractive as you once did.

The key to maintaining a healthy sex life through middle age and beyond is maintaining a healthy you! You can start by watching your diet, exercising regularly and managing stress. If you find you're having changes in your sex life that bother you or your partner, see your health care professional. There are numerous options ranging from supplemental hormone therapy with estrogen or testosterone, to medications, changes in your existing medications, topical hormones, lubricants and counseling. All can help. Remember, you have another 50 or so years to go; don't you want sex to be a part of those years?

This content is supported by an educational grant from Wyeth Pharmaceuticals Corporation