More from the Trenches

In a previous post Dr. Susan Kellogg Spadt, a MiddlesexMD medical advisor, described some of the impediments to sexuality that she sees affecting women as they age. The list, which began with internalized ageism, sexual scripts from our families of origin, and low self-esteem, continues in this post…

Performance anxiety. Men aren’t the only ones who worry about “performing.” All those physical changes to our sexual apparatus that are discussed on MiddlesexMD—vaginal dryness, pain, reduced sensation, lack of interest—can contribute to performance anxiety for women, too.

As one 52-year-old woman said, “I can no longer tell how my body is going to behave. It makes me nervous in bed.” As with men, this inability to trust or predict how your body will respond can affect your ability to enjoy or your desire to have sex. Some women (and some men) just decide not to be sexual anymore.

Women need to know that there is help for these physical changes—again, all the things discussed on the blog and the website—such as moisturizers, lubricants, vibrators, and dilators. These tools can help us remain comfortable and familiar with our changing bodies, so that we’re less anxious when we’re with our partner.

Depression. Older women get depressed at somewhat higher rates than younger women. That’s what the research says. Not only that, but the side effects of some antidepressants include decreased desire, vaginal dryness, and delayed orgasm.

So what’s a woman to do?

Talk to your healthcare provider. You need counseling for the depression, and if medications are affecting your libido, discuss alternatives with your provider. It’s not easy, but you could end up feeling better and enjoying sex again.

Lack of attraction to partner. Yes, I hear this from women—the spark is gone. They just aren’t attracted to their partner anymore.

Maybe the relationship was always difficult or lacked physical intimacy, and the couple stayed together for practical reasons. Or maybe physical changes due to the partner’s aging or illness have affected the woman’s physical attraction. According to the literature, this happens in both women’s heterosexual and lesbian relationships.

Fantasy is one way to mitigate the “turnoff.” Use your imagination to turn the frog into a prince. Sex therapy may be another aid to establishing intimacy.

Lack of partners. There’s no sex without a partner. Duh! Demographics and life expectancies being what they are, the older we get, the fewer our options for partners.

Some of us may be able to date casually or to self-pleasure for sexual release, but for others, this may not be an option. Again—no easy answer.

Making peace with the situation. “Normal” covers a lot of ground. And while we clinicians are always seeking to define it, the fact is that “normal” for one patient may be very different for another.

Despite all the impediments and changes, I’ve found that women generally find their way to a sense of equilibrium with regard to their sexuality. And we clinicians have to respect that.

You define what’s normal for yourself. If you are at peace with your decision to abstain from sex, then abstinence is normal for you. Likewise, if you choose to be sexually active well into your nineties, then that’s also normal.

However, if you experience frustration, anxiety, discomfort, or pain regarding your sexuality, then you should bring this up with your healthcare provider. We can help, and sometimes the solutions are simple.