February 12, 2018

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arousal ›   intimacy ›   relationships ›  


Can a Man Make Love Like a Woman?

One of the benefits of my work with MiddlesexMD is the networking that makes it more likely that I’ll run into medical information, over-the-counter products, articles and books that could be helpful to my patients, and, of course, the interesting conversations that turned into our podcast, The Fullness of Life.

Love Worth Making book coverI received an advance copy of Love Worth Making: How to Have Ridiculously Great Sex in a Long-Lasting Relationship, by Stephen Snyder, MD, a month or so ago. Steve is a couples therapist, psychiatrist, and writer, as well as associate clinical professor of Psychiatry at the Icahn School of Medicine at Mt. Sinai in New York City. While I’ve met himso faronly via email and his written words, I know we share some perspectives: that intimacy remains important to us no matter what our age, that men and women do have some differences in their approaches to love-making, and that there’s nothing wrongand lots that’s rightabout seeking tools that help us!

I think it’s useful to hear men’s perspective on sexuality, too, so when Steve offered to contribute to this blog, I accepted! Read on for more from Stephen Snyder, “sex therapist in the ‘hood.”

Several years ago, a merchant in my neighborhood learned that I was both an MD and a sex therapist. The next time I was in his shop, he asked me if I could get him some Viagra.

“How long have you had erection problems?” I asked.

“I don’t,” he answered. “But my wife and I have been married for 30 years. To tell you the truth, sometimes I’m too tired or preoccupied to get hard without the Viagra.”

What was this man’s problem, exactly? He wanted to have sex with his wife, even though he wasn’t feeling that strongly turned on. Evidently there were other reasons he wanted to do it. 

Sound familiar? Of course: He wanted to make love like a woman.

Things women take for granted about sex

Women can have sex with their partners any time they want. They don’t have to be very excited. Sure, some lubricant might be required, especially over 50. But the absence of peak excitement isn’t necessarily a deal-breaker.

A woman can make love for other reasons besides strong desire. To feel close or emotionally connected to her partner. To promote loving feelings. Or just for the simple pleasure of the experience. Even occasionally to keep a partner happy, even though she might be too tired or preoccupied to be really into it. A useful book on the subject calls it “good-enough sex.”

One wouldn’t want all one’s sex experiences to be like this. But once in a while it’s okay.  Especially if the alternative is not to make love at all. If there’s one thing that sex research repeatedly shows about successful long-term couples, it’s that they keep having sex even when if the sex isn’t always earth-shaking. The ritual itself is important.

Men traditionally haven’t been able to do sex very easily under conditions of lower arousal.  Especially over 50, when it ordinarily takes more stimulation to stay hard than it did at 20. If a man, for whatever reason, hasn’t been strongly turned on, conventional sex hasn’t usually been an option for him.

Viagra changed all that. Since the blue pill came on the market in 1998, a man can take Viagra and have sex even if he’s tired or preoccupied and just wants some loving and affirmation but isn’t feeling peak excitement. In fact, just having a good erection can help a man feel more in the mood.

Is Viagra good for sex?

There is often strong partner resistance to a man’s boosting his erection through chemistry, though. Women especially are used to the affirmation that occurs when a man gets hard (as Mae West famously put it) simply because he’s “happy to see her.” It’s worth it for a man to communicate that he needs sex for closeness and affirmation and pleasure as well. Just like she does. And that worrying about his erection just gets in the way.

Some couples worry whether taking Viagra under such conditions is a wholesome or natural thing to do. If it just takes more sexual stimulation now to keep him hard, wouldn’t it be more natural to simply intensify the excitement?

Maybe, but not necessarily. Intensifying excitement sounds like a great idea. But in practice, having to do things to get the man hard enough can be a bit of a burden. And it can take time, sometimes so much time that the moment is lost.

Sound familiar? Of course. It’s the same predicament that women find themselves in when they can’t get lubricated or can’t climax. Deliberate efforts to manufacture excitement often backfire. They usually aren’t very erotic.

My advice? It depends on the couple and the situation. But sometimes Eros is best served by taking the Viagra. Then a man can stop worrying about his erection, and get back to making love.

Sometimes it’s best for a man once in awhile to make love like a woman. 

Q: How can I restore arousal after a complete hysterectomy?

You asked. Dr. Barb Answered.The loss of hormones (estrogen and testosterone) with a hysterectomy and bilateral salpigoophorectomy (removal of ovaries) is definitely a “hit” to sexual function for women (I assume based on your message that your ovaries were removed). The genitals are, as we say in medicine, abundant with hormone receptors. In other words, hormones play a big role in the health and functionboth urinary and sexualof the genitals. So now, moving on without those hormones, what to do?

For most women, it’s direct stimulation of the clitoris that leads to experiencing orgasm. In the absence of estrogen, there is less blood supply, and, in turn, loss of sensation and ability to arouse or orgasm.

  • A warming lubricant can stimulate circulation and therefore sensation.
  • If your orgasms are weak, you might use the Intensity regularly on your own to build your pelvic floor muscles, which are what enable us to experience orgasm.
  • Probably the most reliable tool to help in achieving an orgasm will be a vibrator. The genitals need more direct and intense stimulation now, and a vibrator is usually a great solution. There are many great options to consider on the website.

This can also be a time to consider treating the genitals with prescription treatments such as localized estrogen or the non-estrogen options, Osphena or Intrarosa. Using testosterone off-label can help women with arousal and orgasm as well.

I’d encourage a conversation with your healthcare provider to see if there are options that may be helpful for you. 

Good luck! I’m glad to hear that your husband is supportive in addressing this frustration for both of you!

 

 

Q: Can antidepressants have caused my husband’s loss of desire?

I’m so sorry that you’re experiencing this loss in your relationship. Both depression and the medications used to treat it can be culprits in a loss of desire, and given the relatively short time frame in which you noted the change (one or two weeks), the antidepressant is the likely explanation for your husband.

The situation that you describe is probably best addressed with the help of a therapist; someone who does sex therapy would be most helpful (you can find one certified by the American Association of Sexuality Educators, Counselors, and Therapists through their website).

You asked. Dr. Barb answered.As you’ve begun to experience, the longer this dynamic goes on, the more anger and resentment builds. Having a therapist to help you navigate the conversations is extremely helpful. And your suggestion of a therapist sends your partner the clear message that intimacy is really, really important for you and your relationship.

There’s some evidence that Stronvivo, a nutritional supplement for cardiovascular health, can improve both libido and function in both men and women; that could be a consideration as well.

Good luck!

The MiddlesexMD Life Reinvention Project: Step 2

In the last post, we examined where we are right now in life in order to identify where we might want to be in the future: the health of our bodies, our spirits, and our relationships as well as the dreams or passions we have not yet pursued (or maybe even identified).

With this in hand, let’s move on:

Step #2. Same drill. Quiet place; journal in hand. Read through your initial entry. Anything to add or edit? Does it still feel honest?

What leaps out at you from your work? Do you notice any patterns—boredom and overeating; stress and impatience; lack of self-assertion and a feeling of victimhood?

Did you identify something you always wanted to pursue or to learn? Are there disappointments you uncovered? Are some elements of your life story simply incomprehensible to you—how did you end up here, you ask?

Sit with these for a minute. What tugs at your heart? What calls to you? What sounds absolutely awful or completely thrilling? What needs a closer look?

Also read over your assessment of your primary relationships. Any action plan needed here? Fences that need mending or habits that need adjusting?

You aren’t writing anything, necessarily. You’re just noticing habits, patterns, ways of thinking, and how yesterday’s work makes you feel today.

Now. Begin creating your reinvention plan. This is the eulogy moment. What do you want people to say about you after you die? How do you want to feel about your one and only life? Begin to articulate the big, sine qua non items. The ones you cannot die without having accomplished. Make a list of them. Not an overwhelming list—the top three or four. The big ones.

Choose one. This is your project for this year. And maybe for next year. If it’s that important, you may work on it for the rest of your life. Break this goal down into manageable steps that you can start doing tomorrow. What’s the first step, then the second? Travel to Africa? You’ll start by researching your options with the goal of having a plan in place this year. Lose 35 pounds permanently? Research your options with a goal of having identified a realistic, lifelong approach this week that you can begin practicing next week. Learn how to play the flute? You’ll need to find an instrument and a teacher…

Next, review those primary relationships—kids, extended family, spouse. Have you identified tendencies to work on? Habits to develop or break? Relationships that need attention? Relationships that need special nourishment or a new approach?

Don’t overlook the one relationship that is most critical to your longevity and quality of life. “If you’re in a happy marriage, you will tend to live longer. That’s perhaps as important as not smoking, which is to say: huge,” says Lyle Ungar, one of the researchers of that data-driven longevity calculator I mentioned in the first post. Knowing that someone in the world knows you intimately, loves you, and has your back adds measurably to quality of life. It makes sense, then, to focus especially on this relationship in your life review—to test its soundness and ponder how it might be strengthened.

List one or two specific steps you can take immediately that will make any of these relationships stronger. Also write down one or two habits or personality traits that impede them—that you should work to change.  

With a path identified (for the year, at least) and the initial steps delineated, you’re ready to begin. Let me just add the wisdom of a few professionals and life-reinventers who have walked this path before.

Practice gratitude. Every day.  “…allow yourself to be grateful for the things you…have. Anger is never inspirational but gratitude is,” writes the best-selling albeit hyperactive author, James Altucher.

Goals, such as those you just articulated are important because “if you don't have long-term goals, you run the risk of doing lots of little things every day—cleaning the house, sending emails, catching up on TV—without ever making a contribution to your future,” says Art Markman, psychology professor and author in this article.

Stay flexible. Change is never static. Reinvention is an ongoing process. You’ll have to rinse and repeat again next year (or next month) to make sure the goals you set today are still relevant and important and that your progress is unfolding according to plan. “Too often, we give up just when we need to push harder, and persist when we actually should quit,” writes one author.

Change is never easy. Expect setbacks; anticipate resistance. Anything really challenging and worthwhile will take time to accomplish, so if it’s really important, don’t shortchange yourself. Persevere through the tough spots. “The most successful self-reinventors are those who understand that they have time and are willing to use it to invest in their own skills and education,” writes this author.

Declutter. Yes, you read that right. Downsizing, clearing out, cleaning up can feel both psychologically freeing and is also metaphorically linked to ridding your life of things that hold you back—mental clutter, too many commitments and obligations, relationships that are buzz-kills or worse, according to Margaret Manning, blogger and creator of sixtyandme.

There. You did it. I hope you feel empowered or at least optimistic. You should now have a roadmap for the months ahead. I’d love to hear how the project is working for you and if you have suggestions to refine it.

Good luck.

The Fullness of MidlifeNeed inspiration? Some of our “The Fullness of Midlife” podcasts are on topic: Lesley Jane Seymour on reinvention, Kate Convissor on overcoming fears, Deborah Robinson on appreciating our own bodies and treating them wellI, Joan Vernikos on how movement keeps us capable.   

 

 

Reinvent Yourself This New Year: Step 1

I had a shock the other day.

In an unguarded moment, I ran across one of those life expectancy calculators. You know, the kind that will tell you how many years you have left on earth after 10 minutes of softball questions.

Basically, I believe that predicting how long you’ll live is a fool’s errand—any of us could get hit by alien laser rays or a schoolbus tomorrow. But my data-driven heart was sucked in by this calculator, which was developed by professors at the University of Pennsylvania Wharton School and based on 400,000 data samples collected by the National Institutes of Health and the AARP.

Now, I know that I fall in a healthy category for weight, activity level, and absence of chronic disease. But, still, the results shocked me.

Ninety-six. My estimated life expectancy is 96.

This is enough time to live a second adult life. This is enough time to start another career or follow a dream or pursue a passion. This is not enough time to waste.

So, that’s the challenge I put before you (and myself) this January: the macro view; the life-reinvention perspective. Because no matter how much time we have (or think we have), why squander it in self-defeating, fearful ways? Or simply by drifting through a handful of years without direction?

Reinvention isn’t a quick-fix project; it isn’t a lose-five-pounds resolution. It’s a project we could (and should) work on for the rest of our lives, periodically reviewing and adjusting our goals to see if they still fit.

Now—today—is a good time to start.  So I put before you the proprietary MiddlesexMD Reinvention Project. Ready?

Step #1. Take stock. No shortcuts here. Sit yourself down somewhere quiet. Open to the first page of the Reinvention journal that you bought for this occasion. (You did get one, didn’t you?) Today’s task is to examine the important aspects of your life. As realistically and objectively as possible. You can’t envision a new you without a solid understanding of who you are now, right?

How’s your health? (Obviously my first question.) Are you content with how you feel? How do you feel about your eating/exercising habits? Your weight? Your overall mobility? Your blood pressure and cholesterol levels? Your mental acuity? Do not indulge in guilt or leap to quick, feel-good resolutions, just assess your physical self realistically.

How’s your spirit? Do you feel lonely? Optimistic? Afraid? Content? Discontent? Restless? Do a full-spirit wellness scan. Are the physical and spiritual linked in some way—being overweight and depressed, for example? Are you handicapped by free-floating fears or anxieties? Does stress nibble at the corners of your life—or maybe devour the whole enchilada? Do you feel unsettled and discontent or grateful and happy?

What is the source of your greatest joy or satisfaction? What are you good at? What are you happiest doing? Where does your passion—or your pleasure or your interest—lie? What have you always wanted to attempt? Do you have dreams that you decided had passed you by or that you are too afraid to try? Is there anything you would regret not having done before you die?

Examine the health of your most important relationships. Our closest relationships are the sources of our greatest joy and satisfaction as well as our greatest heartbreak and frustration. We expend a lot of  energy repressing, denying, or making excuses for broken relationships, whether with family, lovers, or friends. Does this sound true for you?

Are you keeping up with friends and loved ones, or have you let important relationship wither on the vine? We also sometimes endure relationships that kill our spirits, that are toxic to our psyche and sometimes our bodies. Resolve now to examine them with a clear eye. You don’t have to do anything today except be honest with yourself.

Write it all down in the journal. This is the first day of your new you.

Okay. Take a deep breath. You’re done for today.

The Fullness of MidlifeNeed inspiration? Some of our “The Fullness of Midlife” podcasts are on topic: Lesley Jane Seymour on reinvention, Amy Eller on intentional life design, Druscilla French on understanding ourselves.

 

December 26, 2017

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gratitude ›   relationships ›  


Gratitude. It’s All in How You Look at Things

We had a power outage for a few days mid-month. If you want to discover the stuff you’re made of, experience a small tear in the fabric of life, like losing power in winter. I discovered that I am made of tissue paper.

It was a temporary and brief interruption. An inconvenience. But as the hours dragged on, I became increasingly impatient. Appointments didn’t happen; work piled up; my phone couldn’t charge; I was entirely offline. I couldn’t afford to lose this time! I called the power company. I checked for updates obsessively. I ignored the fact that teams of (mostly) young men were working around the clock in bitter weather to get us all back online.

Then, after power was restored, and I had rescheduled appointments and comfortably reordered my life, I came across a blog post from my colleague, Mary Jo Rapini (who was a recent guest on my podcast, too).

She lives in Houston and, while her house was unaffected, she regularly interacts with those who lost everything to Hurricane Harvey. For these survivors, life can’t be so easily resumed—it isn’t a matter of flicking on a switch. They are living in temporary housing or with friends and relatives. Significant parts of their lives—homes, pets, photographs, precious possessions—are gone forever. Many, if not most, of those affected will deal with PTSD for a long time.

That story is repeated for thousands of people throughout the world—in California and the Middle East and Africa. I can’t really imagine being in those circumstances, and I suspect that tissue paper doesn’t hold up so well.

Mary Jo’s message cast my small discomfort in a new light. I was complaining about a paper cut, while others not so far away are recovering from an amputation. It was a helpful reality check.

“Love is a verb,” says Mary Jo. Love manifests itself in actions large and small. Hidden and heroic. It reveals itself in the work that only you can do in this world, whether that’s taking care of grandchildren or founding an orphanage.

Love and gratitude is what this season is all about. I’m taking that more seriously these days. For starters, I’m grateful for that power outage.

 

 

New Research on Heart Attacks and Sex

Among other things, sex is a nice aerobic workout. You breathe hard; your heart rate goes up, as does your metabolic rate. You burn calories. (Yay!)

Therein lies the rub for us older folks.

Isn’t the stress on the cardiovascular system dangerous for anyone with a heart condition? Especially if he or she doesn’t know about it? Or, even when the doctor gives you the green light to have sex, the specter of a sudden attack always looms in the background.

"I think it's important to healthy relationships to have this anxiety lifted," said Dr. Michael Ackerman, professor of medicine at Mayo Clinic. “[People] always ask about exercise and how active they can become,” he said in this article. “They almost never ask directly about sex,” but, once it’s mentioned, he said, ”the floodgates open.”

Now, a large and robust study provides the most detailed picture we’ve even had of the actual numbers of people who suffered a fatal heart attack during sex. Researchers examined lifetime medical records from 4,557 people in Portland, Oregon, who died of a sudden cardiac arrest from 2002 to 2015.

Of the 4557, the number of people who died of a heart attack during sex or within an hour after?

34.

That’s it. Thirty-four people ranging in age from 37 to 83. Of that number, 32 were men. Thus, the risk of having a heart attack during sex in men is 1 percent, while for women, it’s .1 percent. While doctors always knew the risk of heart attack was slim, now that the risk is quantified, even researchers were taken aback. “I’m a little surprised at the really tiny number,” said Dr. Sumeet Chugh, senior author of the study and a professor of medicine at Cedars-Sinai Heart Institute in Los Angeles.

It goes without saying to follow your own doctor’s instructions for activity if you have a heart condition. But if you’re given the “all clear” for sexual activity, I hope these numbers put your mind at ease. No need to abstain from one of life’s sweetest pleasures.

“[This is] a wonderful answer for those who love sex,” said Dr. Ackerman. And, I might add, for those who recognize the link between sexual health and overall good health.

 

 

Q: What can I do about my husband’s and my mismatched sex drive?

Oh, I feel for you. You say you have pain (and no doubt other symptoms—like fatigue and depression) from lupus, fibromyalgia, and Sjogren’s syndrome. You see your lack of interest in sex becoming a larger problem in your marriage as the difference between your sex drive and your husband’s increases.

The first order of business is to find a health care provider with whom you can discuss this aspect of your health. The pain you mention may be generalized pain from the autoimmune conditions you have, or it may be pain with intercourse. Painful intercourse is nearly always a treatable condition, so addressing that if you experience it is critical.

You asked. Dr. Barb answered.The harder issue is the “desire discrepancy” you describe in your marriage. While the situation is not uncommon, your additional health issues add a degree of difficulty. Assuming any issues with painful sex have been addressed, there are some medications that can be helpful for low libido: Addyi, testosterone, and Wellbutrin, to name a few. Your health care provider can help you understand if any of these can be an option for you depending on your health history and other medications you’re taking.

For more about low libido, you can read this blog post on the emotional component and this one that includes an overview of the condition and common causes. It could be helpful to read these to have some terminology in mind when you meet with your health care provider.

The situation you describe might best be addressed with a (sex) therapistperhaps not a dedicated sex therapist but one who has expertise in health-related relationship concerns. (Here are two blog posts on sex therapy: one I hoped would demystify it and one that explains how it works.) Your health care provider is likely to be able to direct you to someone with experience to assist you and your husband as you navigate this significant challenge.

Best of luck in reaching some common ground! 

 

Six (or More) Ways to Please Your (Menopausal) Lover

Getting old ain’t for sissies, and neither is menopause. For all you guys out there with menopausal partners, maybe you’ve noticed her, um, lack of patience. Maybe you’ve been caught in the crosshairs of her mood swings. Maybe you’ve been awoken at night to her tossing and night-sweat-induced turning.

And maybe she just isn’t interested in sex anymore.

With some work, you'll weather the storm and emerge stronger than before.In my practice, I usually hear the woman’s side, but I know you’re an uncomfortably intimate co-pilot on this journey. You may be feeling confused, hurt, rejected, and helpless. This person you thought you knew is changing before your eyes. You don’t know how to help; you don’t know what this means—and it seems to be going on forever.

You miss the sex, the intimacy, the person you used to know. You miss the way things used to be, and you don’t know if or when any of these things will ever come back.  

You aren’t alone. Says 70-year-old Larry in this article: “When she got to about 65 it started to change. Intercourse became painful for her and she developed an allergy to semen. Now intercourse is out of the question and she has no desire for anything other than hugs.”

Life—and sex—does change during menopause, but that doesn’t mean you’re doomed to a relationship without intimacy forever. Shifting ground is treacherous, but with some work on both your parts, you’ll weather the storm, and emerge stronger than before.

Here’s what you can do:

Walk a mile in her shoes. Depending on the intensity of her symptoms, your partner is going through moods that may swing wildly without rhyme or reason, and over which she has no control. She may experience uncomfortable and embarrassing hot flashes frequently and unpredictably. She may toss and turn at night, waking soaked with sweat.

    She may gain weight, lose her hair, and generally grow old before her own eyes. This can be particularly galling in a culture that is completely besotted with youth and beauty. “A woman’s self-esteem influences her sexuality, and low self-esteem is associated with sexual dysfunction,” according to this article.  

    What you can do: Educate yourself on menopause. Understand the trajectory and the tortuous path it takes. Read this blog. Learn about comfort measures and possible treatment options. There are many. She may be too embarrassed or miserable to do her own research or even to bring it up.

    Armed with understanding, you can reassure and support. You can say, “You seem pretty down [or angry, or forgetful]. Are you okay? What can I do to help?” That alone may make an intimate connection, but this isn’t about sex right now. This is about reaching out to your lover who’s going through one of the most significant transitions in her life.

    Now that you’ve asked, listen. And keep listening. Be an ally and a partner in this journey. Check in frequently to see how she’s feeling. Don’t advise unless you’re asked. Just listen. If she talks with her girlfriends, fine. But let her know you’re in her court. Most important—reassure her that she’s still beautiful to you. Girlfriends can’t do that.

    Nothing says love like taking out the garbage.Follow up with actions. Don’t sit on the couch while your partner makes dinner and then watch the game while she cleans up. Nothing says love like taking out the garbage or doing the dishes so she can take a bath. Once in a while, go out of your way. Cook a special, romantic meal. (You can order from one of those home-delivered meal plans, like Blue Apron or HelloFresh.) Send her flowers or plan a surprise getaway weekend. No expectations; no pressure—just an expression of your love and caring.

    Get healthy. I harp on this all the time, but both you and she will feel a whole lot better (and feel more like sex) if you’re eating healthfully, maintaining a good weight, and exercising. You can gently encourage walks together, healthy eating, and good sleep habits. Don’t be a drill sergeant, but your good example and attempt to make it a couple’s thing can’t hurt.

    Shake things up. Boredom is a slow leak in the sex balloon. I’m not talking about having sex on the kitchen table. But just exploring the array of tools and props that can add sizzle and simple comfort to the routine. Since your partner is probably experiencing the common menopausal complaints of dry vaginal tissue, painful sex, loss of libido, you’ll have to shake up the routine anyway.

    You’ll need lots of foreplay, lots of lube, and some toys. Try reading an erotic story or watching a sexy movie together to get your heads in the game. Don’t downplay the effect of a romantic ambiance—candles, incense, music. Use pillows to cushion joints and prop up the bits that matter. Try positions that might relieve pressure, offer a different kind of contact, or just be more comfortable.

    Take your time and maybe forgo the literal act if the timing’s off. You can kiss, cuddle, spoon. You can use your tongue and mouth. You can masturbate together. Take the pressure off the performance and focus on trust and intimacy.

    Don’t take it personally if she just doesn’t respond the way she used to. It isn’t about you, and it isn’t personal.

    Once in a while, go out of your way.Find a counselor, if necessary. Generally, celibacy isn’t a healthy state in a marriage. If you’ve reached an impasse, and there’s no way out, you may have to get some help. This isn’t an admission of defeat; it’s a sign of maturity and wisdom to look for help when you need it. If your wife won’t go, you need to find a therapist for yourself to acquire the emotional tools to navigate your relationship.

    I’ll leave you with the beautiful and encouraging counsel from the perspective of a 40-year marriage: “…we have found ways to enjoy sex with each other that do not need penetration. Mutual masturbation and oral and always with some nice foreplay, we still enjoy each other.

    “I miss intercourse…but we make it work, and it’s usually fun! I hope some men will read this and decide there’s a way to stay happy with the woman of your youth.”

    April 17, 2017

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    couples ›   menopause ›   relationships ›  


    Midlife Love: Navigating the Landmines

    “Midlife: when the Universe grabs your shoulders and tells you “I’m not f-ing around, use the gifts you were given.” —Brene Brown

    I don’t know about you, but I love seeing old people in love. The way they hold hands toddling down the street. The way they go about their daily tasks having made peace with the past. I think it’s a miracle when love lasts this long and ages this gracefully.

    Relationships encounter lots of challenges in the course of a lifetime, but from my own observations, which are supported by the data, the midlife transition, that somewhat fraught passage, is nothing to sneeze at. Menopause aside, the awareness of time passing often arrives unexpectedly and with surprising intensity, leading both men and women to make decisions that belie common sense, compared to which the red Corvette might be among the most benign. For example, the highest divorce rates from 1990 to 2010 occurred among couples over 50, according to this study. Concurrently, co-habitation rates among over-50s tripled from 2000 to 2013.

    Whatever the cause—longer lifespan, greater economic freedom for women especially, cultural change—the fact is that something shifts when folks approach that midlife marker, and it’s often the woman who agitates for change.

    This isn’t necessarily a bad thing. Periodic reevaluation and readjustment is healthy. So is honestly confronting ingrained habits and responses that ultimately stifle intimacy and deflect communication. Like a vintage car, most lengthy relationships require a major or minor tune-up now and then.

    Still, midlife often opens a Pandora’s box of restlessness and dissatisfaction—the perennial is this all there is? What happened to the passion? Am I missing out? Do I really have to endure the quirks and habits of this individual for the rest of my life? What is really important? What dreams have I buried?

    Those existential questions herald an important crossroad—the frontier between youth and maturity. With regard to your most intimate relationship, you can:

    1. Invest in what you have. Work on ways to reinvigorate and reignite the flame. This won’t be the passion of your youth, but something burnished by time and familiarity. A golden glow rather than red-hot embers. If your relationship is solid and things have just cooled off with time and neglect, it’s worth investing for the future.
    2. Reinvent it. Sometimes a creative change eases the chronic irritations that can erode a longterm relationship. Some couples successfully stay together but give themselves extra space with separate households, for example, or planned time apart, or splitting the daily finances and decision-making that cause problems. Rejiggering the quotidian foundation might ease the annoyances enough to allow a couple to value and appreciate the familiarity and intimacy that has developed over many years.
    3. Scrap it. This is a very tough judgment call, but some relationships have never worked well; some matches are misses; and sacrificing the years you have left may not be worth it for one or both of you. Dismantling a lifetime is a heartbreaker (or—maybe a release), but you may end up in a better place when the dust settles.  

    Major life transitions should never be done in haste. They deserve a considerable degree of mature reflection. We all know people who make fast and sometimes rash decisions in the throes of passion or as a desperate attempt to seize a day that appears to be slipping away. Amid the landmines of midlife, the baby is sometimes thrown out with the bathwater.

    Here’s a little reality check.

    However irresistible the urge, don’t blow up your life. Wait. Reflect. Seek counsel. The demand to create something more authentic, to realize cherished dreams is real and should be honored. But the best path forward probably isn’t over the shattered pieces of your present life.

    You still have time. You can still seek your bliss, optimize potential, maybe with more freedom and effectiveness now that the kids are grown and you’re more self-confident. Start a business. Learn Chinese. Travel. The world is your oyster—just in a different shell than when you were younger.

    Romantic passion is a landmine. Passion is powerful, blinding, and temporary. You can’t make good decisions in its throes. And even the most incredibly passionate relationship will inevitably fade with the demands of daily life. White-hot passion doesn’t last; it’s not meant to. And when reality checks in, the dirty socks on the floor look the same. Trust me on this one.

    Talk to someone if you need to. A therapist. A friend. You can’t see things clearly (even if you think you can). Trust the counsel of someone wise and objective.

    Don’t freeze out your partner. However restless and unsettled you may feel, your partner is probably not the enemy. You want to elicit support, not resistance. Anyone would feel threatened when cracks appear in the foundation of a secure life. Anyone would feel uncomprehending and maybe hurt. If, however, you are able to communicate what you’re feeling, even if it’s confused and incoherent, at least there’s a bridge rather than a canyon.

    “This too shall pass,” writes blogger Deb Blum in this article. “It will pass more gracefully and completely if everyone is gentle and loving and gives the space necessary to get through this time.”

    And that study about over-50 divorce rate also found that the longer a marriage lasts, the less likely it is to end in divorce. So those old folks holding hands in the park? The real deal.

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