Pleasures Of Loving

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Sex and you, your life and relationships

Mid-life Sex and Love

Between the ages of approximately 40 and 65 most people's concerns are about dealing with teenage children, family finances, success and failure, planning for the future, and so on. Sexually there are no sudden changes, but during some part of this period, probably toward the age of 50, both men and women may go through a difficult psychological phase called the climacteric.

In addition women experience menopause, which means that they cease to ovulate or menstruate and are no longer fertile. It is helpful to separate the notions of climacteric and menopause: there is plenty of information about sex in midlife here. Menopause is about physical change and comes to every woman, whereas the mid life crisis or climacteric cannot be so precisely defined and may or may not affect both women and men.

The Climacteric/Menopause

Menopause is surrounded by myths, fear and misinformation. It is often read as a wholly negative as some kind of disease; some people call it the "change of life" to show how marked an event they (wrongly) think it to be. Menopause is as much defined by ignorance and superstition as menstruation.

This is what happens during menopause. As a natural result of aging, the quantity of female hormones produced by the ovaries slowly declines. Gradually, ovulation ceases and so does the menstrual flow. Once a woman has stopped ovulating she is infertile. There is no single moment at which one can say this has happened.

The reduction in hormone production is over a number of years, but the ovaries will continue to produce small amounts of estrogen, and so will the adrenal and other glands. Ovulation and menstruation may become irregular (rather as they are for girls in puberty) until neither happens at all.

The main physical changes that accompany menopause are hot flashes - also called flushes - and reduced vaginal lubrication. Neither of these need make any difference to sexual desire. In fact some women, free of the possibility of pregnancy, relax and enjoy a greater level of sexual activity than before. All women retain their capacity to enjoy sex and orgasm - menopause should make no difference at all.

The psychological response to menopause varies enormously. Women who have been trained to believe that menopause is a disaster signaling the end of their femininity and of their value as people may react with severe anxiety and depression. They may accordingly seek medical help.

Other women who, on the other hand, accept menopause as a natural stage life-cycle and who are secure in their roles and relationships often find themselves looking forward positively to the next stage in their lives rather than looking back with regret.

Some doctors do not help. They prescribe tranquilizers or sleeping pills when an explanation of normal physiology and the meaning of what the patient is feeling could bring greater relief.

The most controversial treatment of menopausal symptoms is hormone replacement therapy (HRT). Many physicians believe that HRT is a proper treatment for menopausal symptoms such as hot flash symptoms and severe vaginal wall dryness and thinning (estrogen creams are used here). Always get medical advice.

Combining progesterone with the estrogen reduces the chances of adverse effects to levels comparable with those of women who are not having any therapy at all. In addition to combating the common menopausal symptoms of hot flashes and vaginal dryness, HRT also helps prevent osteoporosis, a loss of bone density that causes weakening and may lead to bone fractures (especially of the hip). Osteoporosis is not so much a result of menopause as a natural part of aging.

Q. "Why do so many women have serious emotional problems during what should be a natural menopause?"

A: "They don't. Some get depressed for a while, but the impression that large numbers of women have serious emotional problems is a false one. The premium placed on youth in our culture is very high, so such an obvious sign of aging as menopause causes some women distress. On the other hand, most women by the time they reach the age of 50 or so have come to terms with the fact that they are no longer young.

The inability to have children in the future worries some women, but on the other hand in reality they would almost certainly have no more children even if they remained fertile.

Children are often leaving home at about the time of the menopause and the family seems to be breaking up - that is a reason for distress which, entirely understandable though it is, does not relate specifically to menopause. Then there is the matter of most people's uncertainty about what menopause is and means.

The confusion between the physical event of menopause and psychological aspects of the climacteric can result in temporary feelings of depression. The menopause can indicate the approximate mid-point in a woman's adult life, with as much lying in the future as there was in the past."

Q. "What are hot flashes?"

A: "In response to local variations in hormone levels, blood vessels suddenly expand. More blood comes close to the surface of the skin and the woman appears flushed; this is because the skin is warmer and the body reacts by perspiring. They are entirely unpredictable, may last for seconds or for a minute or so, may recur the same day or not for weeks. Hot flashes can occur anywhere on the body and may be accompanied by heavy sweating.

Women who have them feel temporarily hot and tingly. Perhaps 50 percent of women experience hot flashes during their menopausal stage. If the flashes are severe a physician may treat them with estrogen for a while, but many women tolerate the mild inconvenience of flashes and wait for them to cease naturally, without medical treatment."

Q . "A friend of mine told me she didn't understand what all the fuss was about menopause and a changing sex life. She said she had no problems and her sex. life got better. Can this be so?"

A: "Yes. Some women experience very minor menopausal symptoms and the new freedom from worry about getting pregnant can mean a gain in the spontaneity of their lovemaking.

Incidentally, the changes in hormone levels that set off menopause can work to a woman's advantage. The new balance of androgen and estrogen arrived at during menopause can actually stimulate sexual interest. In addition to having few menopausal symptoms, it sounds as though your friend was fortunate in experiencing none of the problems that may come with the climacteric or mid-life crisis."

Q. "Is it true that during menopause all women have pain during intercourse? "

A: "No. During menopause, especially toward the end of that period, perhaps 25 percent of women experience pain or burning during intercourse. This is due to the thinning of the vaginal wall that comes naturally with age. Vaginal lubes may be sufficient to overcome this problem, but in some cases estrogen cream is prescribed as it helps thicken the vaginal lining. Since the estrogen is absorbed into the body, this treatment must be carefully monitored.

Q: "When I started to feel signs of menopause, I got confused, angry, and wasn't myself. I handled it after a while, but was what I was feeling abnormal?"

A: "No. What you felt is quite common. After all, most of the literature on the subject arouses fear; the language used to describe this natural stage of life for all women is enough to cause every woman to react with panic: 'change of life,' 'hormonal imbalance,' 'loss of femininity,' 'drying up,' 'hot flashes,' 'treatment' all suggest something negative and lead us to have confused, inadequate and angry feelings about menopause.

Many women handle menopause as you did - successfully. But we must all work to change society's negative attitudes that make people view the prospect of menopause with dread and its occurrence with confusion."

Q. "My husband was more worried about menopause than I was. He kept asking how I felt, if it was happening and other questions like that. It happened all right, but it was no big deal."

A: "Like so many of us, your husband has been influenced to see menopause as a disease rather than as a natural stage in the life cycle. Public discussion of menopause has been slanted toward the problem aspects, spending too little time on its naturalness and the ability of women to experience the process without anguish. Literature describing the benefits of estrogen replacement therapy frequently portrays the husband as a helpless victim of menopause and depicts the wife as irritable, depressed and in pain.

For many women (and for many couples) this simply is not true. If they approach menopause and the climacteric positively and with a clear understanding of what is involved physically and what may be involved psychologically, they are much less likely to find it a traumatic stage in their lives."

Q. "I'm one of those women who had a tough time during menopause. I had these awful hot flashes, headaches, my skin looked old and wrinkled, my breasts started to sag, I started getting heavy.

I wondered whether this was real or imaginary and I just felt ugly. I thought everyone was looking at me, and my husband thought I was having a nervous breakdown. I went to several doctors, and between tranquilizers, sleeping pills, estrogen pills, and estrogen creams we were spending a fortune and nothing changed.

I really felt I was about to have a nervous breakdown. Believe it or not the thing that really helped me was going to a woman's group with women my age and listening to them talk about something I thought was only my problem and concern. The support and suggestions really helped turn things around for me."

A: "More and more women are being helped by sensitively run groups of this sort. The bonds of common experience and the opportunity to express feelings and fears honestly and to receive constructive feedback from peers has been a liberating experience. Such groups can give women the chance to appreciate the variability of the menopausal stage.

Andropause is a much better term for the kind of emotional/psychological crisis that overtakes some men in mid-life.

Some men experience no crisis at all, some experience it mildly. Perhaps 25 percent of men are profoundly affected. Regardless of whether a man experiences the midlife crisis in any way, he will notice certain physical changes at this stage in his life. Just as estrogen production diminishes in women, so testosterone levels are educed in men.

The physical consequences are: taking longer to achieve an erection, less strongly felt ejaculation and a longer refractory period - the time it takes a man to recover from one erection/ejaculation and be ready for another.

On the other side of the equation, ejaculatory control is likely to be increased, desire and pleasure are in no way impaired and the man remains fully able to cause a pregnancy.

Apart then, from a slight slowing down, a man need not suffer any adverse consequences of aging through the mid-life period, nor need he suffer any anxiety.

Some men, however, who are perhaps insecure in their masculinity, react with something near panic. They may question their virility and then seek to prove they are as "good" as they ever were by seeking out the maximum possible number of sexual encounters.

It is this group that has given rise to the myth that middle-aged men generally look around for younger women as sex partners. Their behavior may well be alienating and embarrassing, but fortunately such phases do not usually last long.

Some men have a similar reaction to their gradually declining levels of strength and endurance. Far from accepting that these changes are natural and understandable, a minority of men will rebel and go all out to prove that they are still strong young men - which they simply cannot be.

They may associate muscular strength with virility and indulge in all sorts of excessive behaviors to prove that there is no diminishment of their manhood. If a man responds in this way for any length of time, he may be building up problems for himself.

If his concept of his masculinity is inseparable from youthful activity levels he may temporarily withdraw from sexual activity, saying that he won't settle for "second best." This in its turn will create problems of private frustration and can only damage his relationships.

When a man does experience the psychological/emotional crisis of the mid life crisis, the indicators are likely to be vague and hard to assess. It is something more than the natural reflection of a middle-aged man on the direction his life has taken and on what the future holds, and seems to be more to do with a profound depression for no obvious reason and maybe some personality changes that put a strain on his relationships.

The duration of this period is highly variable. It may be concentrated into a few months or it may, on and off, last for several years at any time during a man's 40s, 50s or early 60s.

Q. "I don't know if I had a mid-life crisis or not, but in my early 50s I got very depressed, spent a lot of time thinking about my life and achievements. When I needed to be alone my family let me be and at other times they were there to cheer me up.

Anyway, it just seemed to disappear. I don't think I did anything unusual, I just started feeling like my old self again. When I look back at that time it was just a weird period."

A: "For some men it is just that - a strange time of their lives. A period of private intensity, of serious reflection and planning, a time when their identity is explored and evaluated, and because of this very serious examination and appraisal, the man's usual demeanor is changed, his moods may swing as he struggles to get a better sense of his identity and what he wants for himself and those around him. Your experience and your reaction to it sound very normal, and your family's response sounds thoroughly sensible because of their sensitivity."

Q. "I read about a 55-year-old guy who had low testosterone and high levels of PSA in his bloodstream. Is there a connection?

A: "Not in my opinion, though many would differ. You can get information on the subject of prostate disorder here - know your prostate - and you can advice on natural remedies for the prostate here.

Later years

The most likely change in people's sexual expression in later years is some degree of slowing up. All the other changes are conditional upon circumstances: society does not expect older people to have sex and so, in order to conform with what is expected, many individuals will try and avoid it; the older a person is, the greater the likelihood of some significant physical impairment that can adversely affect sexual expression; partners die, and for many reasons new ones are hard to find; lack of privacy can also be a problem for older people who are no longer living independently in their own homes.

Older people need support so that they feel their sexual behavior is a matter of their choice, not of restrictive societal expectation. These are the important factors that need to be considered:

  • Sexual interest and sexual pleasure are not related to age
  • general health - the presence of gout, arthritis, hiatal hernia, acid reflux, high blood pressure, and so on
  • the changes that occur during menopause and the male climacteric do not signal the end of sexual expression or desire
  • reduced frequency of sexual activity is not a sign of a physical or emotional problem in later years, nor does it impair sexual fulfillment
  • frequency of sexual activity in later years seems to be related to health
  • caressing, fondling and kissing, as well as genital acts, are important expressions of love and affection at every stage of the life cycle
  • masturbation is not a sign of a problem; it Is a perfectly legitimate form of sexual expression throughout the life cycle
  • continuing interest in sex in later years is normal
  • physical disorders may require some modification to the manner of sexual expression, but not end it so, for example, check out whether or not you can use some of the best information available about gout and effective remedies. And you might wish to do that right now, because, after all, gout is a terribly debilitating disease.
  • barriers to active sexual expression in later years include boredom, overindulgence in food and drink and fatigue due to poor physical condition
  • reduced sexual activity in later years is more likely to be due to lack of a partner than to lack of interest.

Q. "What do widows and widowers do for sex?"

A: "Part of the expression of grief when a partner dies is very often a temporary loss of interest in sex, but as the survivor comes to terms with his or her grief, sexual interest usually revives. It is however much more difficult to find a new partner in one's 70s than in one's 20s. Masturbation helps many people, but not if they have spent a lifetime rejecting it as wrong.

Retirement communities and senior citizen centers provide places for older people to meet and form new relationships. Sometimes these relationships become permanent, as in marriage or living together, or each person may maintain an independent life but have a regular, affectionate relationship in which sexual activity is included.

Some older people suffer considerable guilt about having sex with a new partner, but with time, patience and understanding such guilt usually passes."

Q. "My mother is 70 and a widow and she still makes sexual references. Is this a put-on or can she really mean it?"

A: "She certainly could mean it, especially if she enjoyed an active and rewarding sex life in her earlier years. She may also be testing you to see if you disapprove of her sexual interest. Children are frequently horrified that their parents are still sexually active or remain interested in sex: this may be a big test for you - don't fail."

Q. "Is it true that nursing homes are allowing older people to have sexual contacts?"

A: "Yes. Some nursing homes are providing privacy for their residents so they can express their sexuality in an appropriate way. The staff of progressive and sensitive institutions make it easy for people in their care to view sexual acts as proper if they so choose. Privacy can be provided during visits from a spouse or from a friend."