According to a study that followed more than 3,200 women over a period of about 15 years, it is a myth that women lose interest in sex as they reach middle and older age.
“About a quarter of women consider sex very important, regardless of their age,” says the doctor. Holly Thomas, lead author of an abstract presented at the September 2020 Virtual Annual Meeting of the North American Menopause Society.
“The study showed that a significant number of women still value sex highly even as they get older, and that’s not abnormal,” said Thomas, an assistant professor of medicine at the University of Pittsburgh.
“If women can talk to their partner and make sure that sex is satisfying and enjoyable for them, then they are more likely to rate it as very important as they get older,” she said.
“It’s actually really nice that there is a quarter of women for whom sex is not only on the radar, but very important,” the doctor said. Stephanie Fobion, Medical Director of the North American Menopause Society, was not involved in the study.
“Studies like these provide valuable insights for healthcare professionals who might otherwise dismiss a woman’s waning sex drive as a natural part of aging.”
It’s true that past research has shown that women tend to lose interest in sex as they age. But women’s health practitioners say that attitude doesn’t match the reality they see.
“Some of the previous research suggested that sex downhill and all women lose interest in sex as they get older,” Thomas said. “That’s really not the story I hear from all my patients.”
One problem, she says, is that past studies have taken a snapshot of a woman’s desire at some point in her life and compared it to similar snapshots in later decades of her life.
“This type of longitudinal study will just show averages over time,” Thomas said. “And if you look at things on average, it might seem like everyone is going the same way.”
Study presented in 2020 used a different type of analysis that allowed researchers to trace the trajectory of a woman’s desire over time, Thomas said at the time.
“We wanted to use this different type of technique to see if these different patterns really exist,” she said. “And when you look for those trajectories, you see that there are significant groups of women who are following a different path.”
A study that analyzed data from a national multicenter study called SWAN, or women’s health survey in the countryfound three different trends in women’s attitudes towards the importance of sex.
About a quarter of women (28%) had a traditional opinion on this issue: they valued sex less in middle age.
However, another quarter of the women who participated in the study said the exact opposite. About 27% of them said that sex remains very important in their 40s, 50s and 60s – a surprising contradiction to the belief that all women lose interest in sex as they age.
“Sex will look different,” said Fobion, director of the Mayo Clinic Women’s Health Center.
“At 40, he will look different than at 20; at 60 she won’t look the same as she did at 40, and at 80 she won’t look the same as at 60,” she said. “We may have to make some changes, but in general, people who are healthy and in good relationships remain sexy.”
Women in the study who valued sex highly had the following characteristics: they were more educated, less depressed, and experienced greater sexual satisfaction before middle age.
“Women who had more satisfying sex when they were in their 40s were more likely to continue to appreciate sex as they got older,” Thomas said.
She also added that there could be socio-economic factors at play. For example, more educated women may have higher incomes and feel more stable in their lives with less stress.
“So they have more leeway to make sex a priority because they don’t have to worry about other things,” Thomas said.
The study found another factor that is important for both low and high interest paths is race and ethnicity.
African-American women were more likely to say that sex was important to them in middle age, while Chinese and Japanese women were more likely to say that sex was unimportant in middle age.
“I want to emphasize that this is more due to socio-cultural factors than to any biological factors,” Thomas said. “Women from different cultural backgrounds have different attitudes… different levels of comfort with aging… and whether it’s ‘normal’ for a woman to continue appreciating sex as she grows older.”
The majority of women (48%) chose the third path: they valued a healthy sex life during menopause, but gradually lost interest in it in their 50s and 60s.
Experts say there are a number of emotional, physical and psychological factors that can affect a woman’s attitude towards sex. Most of them can be divided into four categories:
Medical conditions: When women enter perimenopause in their 40s and 50s, they begin to experience hormonal changes that can make sex less satisfying or even painful.
The drop in estrogen causes the tissues of the vulva and vagina to become thinner, drier, and more easily broken, damaged, or irritated. Arousal may become more difficult. Hot flashes and other signs of menopause can affect mood and sleep quality, leading to fatigue, anxiety, irritability, mental fog, and depression.
Many diseases can arise or worsen in middle age, which can also affect libido.
“Do they have conditions like hip arthritis that cause pain during sex? Or hand arthritis, which can make things more difficult? Or things like diabetes where they don’t feel the same, or they have heart disease?” Phobion asked.
“But there is modifications that we talk about all the time to help people stay sexy even when paralyzed,” she said. “There are ways to stay sexy despite a disability.”
Mental and emotional considerations: The psychological component of sex can have a huge impact on a woman’s level of sexual desire. A history of sexual or physical abuse, struggles with substance abuse and depression, anxiety and stress are the main players in this category.
“I can’t tell you enough about the effects of anxiety and stress on sex,” Fobion said. “Think of this fight-or-flight mechanism—your adrenaline pumps you up so you’re back in your caveman days and you’re being chased by a lion.
“Are you going to lie down on a grass mound and have sex while the lion is chasing you? The answer is no. And women do that all the time, so anxiety is a huge, huge factor in whether women will be sexy.”
Although the study did not specifically look at anxiety, the results showed that women with more severe symptoms of depression were much less likely to prioritize sex in their lives. In addition to the emotional impact, reduced libido is a side effect of many antidepressants prescribed to treat depression.
Partner component: Middle-aged women may also face dramatic and troubling changes in their romantic lives that can take a toll on their interest in sex.
“Do they lose a romantic partner through divorce or death? Does a romantic partner develop health problems that make sex more difficult or uncomfortable? Are they busy with other aspects of their lives — careers, caring for grandchildren, or even adult children who are returning home? It makes it hard to prioritize sex,” Thomas said.
Even if they have a partner, there can be ups and downs in the relationship that can affect how a woman feels about intimacy with a significant other.
– Do you like your partner? Phobion asked. “Is your communication good? Even logistics can get in the way—are you in the same place at the same time?”
Social mores: Society also influences how a woman views sex. Religious, cultural and family values in this topic can play a big role in sexual ease and satisfaction.
“Then there is what society teaches us about aging women,” Fobion said. “And so for some women, being sexy is somehow bad. Women shouldn’t like sex.”
“I have seen many women in my clinic in the 60 to 65 age group who have never received any sex education, their partners have never received any sex education, and they really don’t want to know about all of this.”
Of course, if a woman isn’t bothered by a lack of sex, then there’s no reason to see a doctor, Fobion and Thomas said. But they both said that past research has shown that 10% to 15% of women who have a lower interest in sex are concerned about it and would like to find a solution.
There are ways doctors can help, including medications and treatments, but first a woman should contact her doctor and talk to him.
“Previous research has shown that women are often really hesitant to see their doctors, perhaps because they are embarrassed or consider it part of normal aging and don’t think it’s worth talking about,” Thomas said.
Fobion added: “The bottom line: women should talk to their providers if they have concerns about their sexual health. It’s an important part of life and there are solutions for women who struggle with it.”