It’s no fun when sex loses its appeal, or even becomes painful. But before you decide that this important part of your life is over, read on. The solution may be easier than you think.

Having been single for seven years, 56-year-old Sara Thomas* wasn’t too concerned about her low sex drive anymore. It wasn’t until she met her second husband that the reality of falling estrogen levels really hit home. “It was the beginning of a relationship so, of course, we wanted to be together all the time,” she says. “But that wasn’t possible. It wasn’t that I wasn’t interested, it was just too painful to consider.”

This experience isn’t unusual, saysSusan Kellogg-Spadt, PhD, director of sexual medicine at The Pelvic Floor Institute of Tenet-Graduate Hospital in Philadelphia. “The three most common complaints I hear from middle-aged women about sex are lack of desire, difficulty in arousal and response and painful intercourse.” But, she says, it doesn’t have to be that way.

Sex and the SixtiesSex drive slowly declines with age in both sexes, but everyone has a unique experience. Some notice a decline in desire and others have no change at all. Research shows, however, that women are two to three times more likely than men to be affected by a low sex drive, especially when they are in long-standing relationships.

So what’s menopause got to do with it? The relationship between menopause and sexual desire is complex and still under study. Reduced estrogen levels can contribute to hot flashes and night sweats, robbing a woman of restful sleep and reducing her interest in sex. “With less estrogen, the walls of the vagina become thinner and lose their elasticity, and vaginal secretions diminish,” explains Mary Jane Minkin, MD, an obstetrician/gynecologist and professor of medicine at Yale Medical School. Translation: dryness, irritation and pain. Also, loss of estrogen results in an increase in vaginal pH, changing the healthy acidic environment to an alkaline one that is more susceptible to vaginal infection.

This condition, known as atrophic vaginitis, affects an estimated four in 10 postmenopausal women. This not only can make sex painful, but it can increase your risk of sexually transmitted diseases. Fragile vaginal tissues are prone to injury, tearing and bleeding during sexual intercourse or even during a pelvic examination.

At the same time, the ovaries’ production of another hormone—testosterone—lessens with aging, possibly decreasing desire. Women experiencing induced menopause caused by removal of both ovaries or by chemotherapy have an accelerated decrease in both estrogen and testosterone levels, thereby resulting in more severe problems than women having natural menopause.
*Not her real name

The Good News Although hormonal changes may play a significant role in any loss of libido, the Massachusetts Women’s Health Study, which surveyed 2,569 middle-aged wo-men, found a woman’s menopausal status has a lesser impact on her sexual functioning than other aspects of middle age. So consider the following before chalking up your loss of libido to hormones:

Your sexual history. If you used to want sex every night, you’ll still be more interested in lovemaking than a woman who has never had much interest in sex. Occasionally, however, women may have an increased interest in sex at perimenopause possibly due to changes in the ratio of estrogen and androgens.

Your relationship. “If there’s tension in your relationship, for whatever reason, it’s going to affect what goes on in the bedroom,” says Minkin.

Health issues. If you’ve had breast surgery or hysterectomy, you may feel less secure in your identity as a woman and be reluctant to initiate sex or your partner may be concerned and protective.

Stress. “Maybe you’ve got kids or grandkids in the house, and you think you can’t have sex, or you’re worried about putting your parents in a nursing home—all of these things impede your sex life,” says Minkin.

Insomnia. Whether it was a hot flash at 2 a.m. or your husband’s lumberjack-like snoring, irritability from lack of sleep can be a block to sex, says Minkin.

Prescription drugs. “There’s a lot of press about how certain medications affect erectile dysfunction in men, but there’s little understanding about how they affect sexual function in women,” says Ivy Alexander, PhD, an assistant professor of nursing at Yale. One theory is that anything that dries out mucous membranes—such as allergy medications or antidepressants—will also dry out the vagina.

Self-esteem. If you feel unattractive and undesirable, you can create a self-fulfilling prophecy when its time to undress in front of your partner.

Your partner’s attitude toward sex. Whether your partner is disinterested in sex, has a sexual dysfunction or is reaping the rewards of Viagra®—his attitude can affect your sexual function and satisfaction as well. Often, a partner’s sexual issues need addressing also.

TreatmentLifestyle Changes
Lifestyle changes can help you feel better and can make a positive difference to your body image and self perception. Midlife brings about many different physical changes; however, these tips can improve your health and help you achieve a positive self image.

Stop smoking. Giving up smoking is one of the best actions you can do to improve your health, appearance and self-esteem. If you need it, seek support from your healthcare provider.

Reduce alcohol consumption. Cutting down to no more than two drinks of alcoholic beverages per day will help to relieve sleeping difficulties, depression and, with some women, hot flashes.

Drink plenty of water. Increasing water consumption counters the drying effects of aging, helping all organs, especially relieving dryness of the skin.

Healthy diet. Eating an appropriately sized diet rich in fruit, vegetables, protein and good oils will not only provide you with more energy throughout the day but it will also help to stabilize your weight.

Exercise. Regular exercise releases feel-good hormones called endorphins, so find a pleasurable activity, such as dancing or yoga. This way you can spend more time feeling good while enjoying your body.

Reduce stress. Learn how to reduce anxiety. Relaxation techniques and meditation significantly reduce stress.

Drug TherapiesResearch into drug therapy for women’s sexual function is still in its infancy, although changing some medications for other conditions or lowering doses may be helpful. Here are the current options:

Nonprescription therapy. For mild vaginal dryness, consider using a vaginal lubricant or moisturizer. This may be sufficient to reduce friction during sexual activity and enable you to resume premenopausal levels of sexual function. Vitamin E and olive oil can also provide lubrication without adverse side effects, but avoid other oil-based products. Opt instead for water-soluble lubricants.

Prescription therapy. Studies show that estrogen improves blood flow to the vagina, increases the thickness and elasticity of vaginal tissues and lowers vaginal pH to help fight infection. It’s the only treatment FDA approved for atrophic vaginitis. If this condition is the only reason to consider estrogen therapy, choosing a low-dose vaginal estrogen product that delivers local, not systemic doses, is preferred to minimize risk. Improvement should be seen within a few weeks.

Light Your Fire

After decades in a relationship, things can get a little, well, dull, especially when your “mood for love” may be dampened by middle age. To get things moving again, try the following:

Express yourself. “Talking about sexual problems can be hard for women because they feel they’re giving their partners a bad report card, but if you don’t tell them, how are they supposed to know?” asks Alexander. “I tell patients to say, ‘I’m really having a lot of changes with menopause—how about we explore some new avenues together?’ For some women, this is an exciting thing—it’s a turn-on to try new things and see what’s fun.”

Have a honeymoon. Even if it’s just for a weekend, taking a few days to focus on each other often works wonders, says Alexander. “It doesn’t have to be the Bahamas—a downtown hotel can work.”

Go electric. “A personal vibrator can help you—or help your partner help you—achieve orgasm by providing more sensation,” Alexander says.

Wash up. Not only is it relaxing and intimate, but the warmth increases blood flow to both your and your partner’s genitals, says Alexander.

Seduce your mind. “It may sound cliché, but the most important sex organ is between your ears,” says Kellogg-Spadt. So spend 30 minutes, two to three times a week alone reading erotic literature.

Be nice to each other. Flowers, a bottle of wine or a simple note to say, “I love you”-- make a point to do one thoughtful thing for each other once or twice a week, says Alexander. “Libido is enhanced when women feel emotionally connected to their partners.”

Go slow. “Twenty-year-olds can have a little quick one and everyone is satisfied, but it works in a very different way in the menopausal years because it takes much longer for most women to get aroused,” Alexander says. Make time for foreplay to get yourself lubricated—it will make things better for you and your partner.

Medical approaches are available for both women and men to address sexual function difficulties. Psychological counseling can help in coping with difficult medical or family issues and can improve communication between partners. Seeing a specialist for sexual therapy is also an option when other approaches have not been successful.
* Not her real name.