Women’s motivations to engage in sex are often quite complicated and influenced by many factors including their age, hormone status, past sexual experiences, the type of relationships they are in, and lifestyle factors including career and family demands. The influences that each of these factors will have typically evolve and change as women age.1 Sex in your 40s, 50s, 60s, and beyond can be fun, exciting, and fulfilling.
As women enter perimenopause and menopause, there are profound changes in hormone levels that will impact their sex drive (libido), ability to self lubricate, and even lead to painful sex. During peri- and menopause women can experience huge fluctuations in the levels of the hormones estrogen, progesterone, and testosterone. With these changes in hormones, women can start to notice changes in their vaginas, like dryness and thinning vaginal tissues.
An understanding of these sexual changes can help women get back on course to a healthy, happy, and satisfying sexual life. In this article, we will review the physiological and psychological sex-related changes that occur as part of the normal aging process in women, especially during their menopause journey.
Women’s Motivations for Sexual Activity
Women have sex for many and sometimes competing, reasons. The reasons that motivate women to engage in sexual activity have long been studied, and scholars assume that women engage in sexual activities for these primary reasons: love, pleasure, commitment, and/or a desire to procreate/ reproduce.2
Psychological, social, and physical factors must all work together to create a healthy libido. We know that there can be many factors that lead to an elevated or decreased sexual desire, and a woman’s reasons for engaging in sex are often very different from a man’s.
Women typically engage in sex because they are seeking enhanced emotional closeness, intimacy, and commitment as rewards for engaging in sexual activity. So, even though a woman may not need to experience an orgasm for her own sexual pleasure, she may agree to a sexual encounter because she is seeking affection, a relationship, or some sort of other benefit.2,3
Women's sexual motivations change with age, especially when they reach peri- and menopause. Scientists state that women aged 31–45 years have more ‘motives’ for engaging in sexual intercourse compared with women aged 18–30 years, but the top three reasons for engaging in sex do not differ for women between age ranges. Whether a woman is 18 or 45 the top three reasons for engaging in sex are: pleasure, love, and commitment.1
Women also engage in sex for stress reduction, physical desire, experience-seeking, resources (to receive a benefit), social status, revenge, expression, self-esteem boost, and “mate guarding.” Mate guarding is true for both males and females and is the guarding of a partner in order to deny rivals the opportunity to mate with them.1
While the top reasons for having sex are virtually identical across age groups, with the vaginal changes that naturally occur as hormones decrease with age, sex can become painful resulting in sexual dynamics changing dramatically. Pain with intercourse can impact a woman’s sexual function, particularly her desire and arousal.1,2,3,4
As women enter peri- and menopause sometimes they have sex with their partner out of a sense of duty. Some women share that they don’t really feel the desire, but they go along with it because they have not had sex in a while, and feel like they owe it to their partner. 1
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The Physiology of Sex As We Age
While we all feel like we understand sex, there is much that is still left unanswered about the human motivators to engage in intercourse. Human sexual arousal serves both a reproductive and a recreational function.3,4,5 From the reproductive standpoint, sexual arousal for women is at its greatest during their reproductive years, and specifically right before ovulation.
Sexual arousal causes enhanced blood flow to the genitals, and increased fluids in the genitals that are combined with mucus which provide lubrication during sexual arousal and intercourse. There are also changes in the pH of the vaginal fluids that enhance the functions and survival of the sperm that may enter. When a woman experiences orgasm the vagina and uterus contract to de-coagulate the sperm and possibly help propel the sperm to the waiting egg(s).3
Sex As We Age
While the US culture often appears overly focused on sex, it also doesn’t seem to value sex for aging women. That’s unfortunate. The physical and mental changes that occur in a woman’s 40s thru 60s are some of the greatest changes she will experience. But sadly, there is not enough conversation surrounding these changes, especially when it comes to mitigating the negative shifts in their sexual desires and sexual experiences during this time.
As women’s bodies and minds mature and change, their relationships with sex can sometimes become heightened. But with menopause, and changes in the vagina, sex can also devolve into avoidance, irritation, and even resentment.
Women between the ages of 31-45 have the strongest sex drive when compared to other age groups. These 31-45-year-old women also have more frequent and more intense sexual fantasies than both older and younger women. The 31-45 female age group also engage in sex at a higher rate and are more likely to have it sooner in a relationship than older or younger women.1,4,6
Female Sex Over 40
With peri- and menopause comes a drop in the sex hormones estrogen, progesterone, and testosterone, which can bring some unwelcome physical menopausal symptoms like painful sex. Painful sex and menopause often go hand in hand.
Peri- and menopause can last more than a decade - even 20 years for some women - and depending on the severity of the sexual discomfort, untreated vaginal pain with sex (dyspareunia) can have a negative impact on the quality of life and on relationships.
The pain with sex varies for each woman, but ranges from pain only at penetration, to a burning or throbbing sensation that lasts long after penetration. The discomfort can also include a feeling of dryness to a feeling of vaginal “tightness” and severe pain during sex.
According to the North American Menopause Society, up to 45% of postmenopausal women find sex painful due to increased vaginal dryness and thinning vaginal tissue caused by falling estrogen levels. Over time, and without treatment, the inflammation, and insufficient vaginal lubrication can lead to tearing and bleeding of vaginal tissues during sex.
Between 17% and 45% of postmenopausal women say they find sex painful.7
The main reasons why between 17- 45% of postmenopausal women say they find sex painful (the condition called dyspareunia) is vaginal thinning and dryness. Pain during sex (or simply fear of anticipation pain during sex) can trigger performance anxiety or future arousal problems in some women.7
This worry over whether the pain will come back can diminish natural lubrication or cause involuntary—and painful—tightening of the vaginal muscles, called vaginismus. The results can be a vicious circle of avoidance and even resentment due to untreated hormonal deficiencies.
Sex is supposed to be fun, and women have every right to have satisfying sex with their romantic partners. However, with perimenopause, not only can sex can become painful, but the desire for sex drops. It may also take longer to become sexually excited due to the drop in the hormones. Orgasms may be somewhat shorter than they used to be, and the contractions experienced during orgasm can be less intense.4,8
Unlike other menopause symptoms (e.g. hot flashes which usually improve over time), women’s vaginal changes get worse with time when not treated. Regardless of the degree of vaginal change, women can get treatment for their symptoms and enjoy a pain-free sex life.3,5,6
Ways to Avoid Painful Sex
The key to great sex after 40 is knowing your body and its changes. As we age, it’s natural for us to change — both physically and psychologically - so it’s important to understand your body so you can know what pleasures you. Remind yourself that the result will hopefully be great sex! Some ways to enjoy sex again include:
Hormone replacement therapy (HRT) can relieve vaginal dryness/thinning. You can talk with your Winona doctor about vaginal estrogen creams and HRT; both options have been shown to help vagina dryness and may increase the physical and mental desire for sex. Vaginal estrogens and dehydroepiandrosterone (DHEA), are fast, safe, and effective treatments for vaginal symptoms.
One option for women to take is their own type of "viagra". Winona offers "blossom", a viagra specifically made for menopausal women.
The vagina can become narrower if you are not sexually active, so try to have penetrative sexual activity/intercourse regularly to avoid vaginal atrophy.
Using over-the-counter water-based vaginal lubrication can make penetration more comfortable, and reduce vaginal dryness or irritation. Try using a water-based lubricant during sexual activity that is fragrance-free, and don’t douche as it can be drying. A Winona doctor can also prescribe a vaginal cream containing estrogen which can help reverse the changes in the vaginal tissues.
Keep it interesting; try something new. When you’ve been with the same partner for a long time, you may want to come up with ideas to add a little variety to your sex life.
Remember that there are other causes of sexual problems beyond discomfort and pain. Depression, medical problems, and relationship issues can all adversely impact the enjoyment of sex. Talk to your Winona physician about other possible causes for sexual issues.
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Available Solutions and Treatment Options
The good news is that peri- and menopausal women can resolve painful sex, and improve their sexual health and even their quality of life by appropriately treating their symptoms.10,11,12,13 Sex in your 40s, 50s, and 60s and post-menopause can be really exciting and fulfilling.
Because of the complexity of a woman’s anatomy, they may need a combination of treatments before they are pain-free. Painful sex after menopause is common, but treatment may include hormone replacement therapy, lubricants, and their own type of ‘Viagra’ (at Winona it is called “Blossom”). These kinds of thoughtful treatments can help to increase their libido, and remedy the symptoms of menopause in their vaginas so that they are prepared to enjoy sex once again.
While you can’t cure menopause, you can certainly manage its unpleasant symptoms. The sooner you meet with your Winona doctor, the sooner you can get relief from symptoms like painful sex. Options for relief can include hormone replacement therapy (HRT), lubricants, and vasodilators (Blossom for women). Check out Winona today to learn more.
"This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatments."