What Will Your Sex Life be Like After Age 50?

By: Holly L. Thacker, MD • Posted on October 31, 2013 • Updated October 18, 2022

I was listening to some of my favorite music from the band Boston last night: “More Than a Feeling,” "Rock N Roll Band,” “Peace of Mind” and “Foreplay Long Time.” And this reminded me not only of the late 1970s, but also of female orgasm, the pervasiveness of female sexual dysfunction and the lack of well-defined therapies. Female Sexual Dysfunction (FSD) is common, under appreciated and complex - just like women!

7 Benefits of Sexual Activity

After age 50 female sexual function depends on several important factors for women. Sexual function and satisfaction is very important for women, and not just for reproduction. Sexual activity can provide the following benefits for women:

Intimacy
Stress reduction
Lowering blood pressure
Boosted immunity
Burns calories
Increases endorphins, which can lower pain and improve sleep
It counts as exercise!

5 Categories of Female Sexual Dysfunction

Female Sexual Dysfunction (FSD) can be broken down into five categories:

Hypoactive Sexual Desire Disorder (HSDD) - also commonly referred to as “low libido”
Sexual Pain Disorders - including Dyspareunia (painful sexual activity usually from menopausal vulvo-vaginal atrophy from lack of hormones) and Vulvodynia (a burning pain syndrome of the genitals)
Sexual Arousal Disorder - can be genital like erectile dysfunction in males or at the brain level, which is more common in females
Sexual Aversion - can be related to a history of sexual abuse
Orgasmic Disorder

Hypoactive Sexual Desire Disorder (HSDD)

As far as HSDD, it is common and sometimes over identified. The purpose of the sex drive is to reproduce. In mid-life and beyond women who have reproduced or not, it is not uncommon or abnormal to notice a diminished or even absent sex drive. However, if one is not distressed by this or if she enjoys intimacy, but just does not actively pursue it, it is not a problem per se. Most of us are driven to eat because of hunger or driven to sleep because of fatigue as sleep and food are essential to one’s survival. Sex is critical for the species survival, not an individual’s survival. Just like many people are not driven to exercise, but once they do, they enjoy it - the same is true for sex for many women.

What Does Testosterone Have to do With Women?

On the other hand, true HSDD can be related to castration (removal of the ovaries), the lack of the sex hormones estrogen and testosterone that can also occur with natural menopause or other conditions. Unfortunately, there is NO FDA-approved way of giving testosterone (T), the “hormone of desire,” to women while there is for men. On a milligram per milligram basis, women have more testosterone than estrogen. Both the adrenal glands and the ovaries make testosterone. And testosterone levels can plummet with age, oophorectomy and other medical conditions, which can lead to the following symptoms:

Low sex drive
Decrease in muscle strength
Low energy level

Off-label testosterone can be used to treat low testosterone levels, but it has to be used very carefully by a hormone expert. Too much testosterone can lead to the following:

Acne
Hair loss
Facial hair growth
Aggressiveness
Permanent voice changes

Currently compounding pharmacies are the mainstay for testosterone or using 1/10 of a commercially available male preparation.

The Latest Studies and Treatments for FSD

Another study looking at Bremelanotide (an on-demand injectable melanortin agonist) is being studied for both HSDD and arousal disorder.
And Femprox, a topical cream, is also being studied for the treatment of arousal disorder.
Currently, over the counter Zestra (a botanical oil to apply to the genitals) is available to enhance a woman’s ability to climax.
The EROS device is available by prescription to help women with climax and can be prescribed by a physician.
There is an electrical stimulating device devised to help treat urinary incontinence in women that may also help with orgasmic capacity.
Off-label use of vaginal DHEA 1% suppository, an adrenal precursor, has been used in women with vaginal atrophy/thinning/decreased sensation in women who cannot or will not use vaginal estrogen.
Vaginal estrogen, which is FDA-approved and available as a cream, a tablet or a vaginal ring, is thought to be the best treatment for genital arousal problems and pain from vulvovaginal atrophy (VVA) that occurs in many postmenopausal women.
The first, non-estrogen oral therapy for moderate to severe dyspareunia (painful sexual activity) due to VVA has been FDA-approved, Osphena - 60mg daily with food. This has been a major breakthrough for women who can not or will not take estrogen or who do not want to use local vaginal therapies for painful vaginal atrophy.

Should All Women Orgasm?

Orgasmic dysfunction can be primary, meaning a woman has never climaxed in her adult life (estimated to be almost 10% of all women) or that she had been able to but now finds it difficult or impossible. Only 10% of women easily climax, the majority of women are in the remaining 80%. I see many women who are relieved to know they are “normal.” Many women think they are not normal if they cannot climax with just vaginal intercourse, which most women cannot!

It is important for a woman to know what her erogenous zones are and communicate that to her partner. For many women it is the clitoris, for others it is the “G-spot” (the anterior part of the lower vagina) or the breasts and for some it’s the “ClitGVa” - meaning the clitoris, G-spot and the vagina.

For women who have secondary, acquired orgasmic dysfunction, meaning they have been able to climax without difficulty in the past, but now have trouble “coming,” they should have history, physical, hormonal and medication evaluations. The following could be the problem:

Medicines such as SSRI
Hormonal deficiency
Partner issues
Medical problems such as diabetes and hypertension
Lack of exercise
Smoking
Drinking
Sleep disorders

For secondary, acquired orgasmic dysfunction, physicians will prescribe an off-label oral bupropion or even Viagra, which is off-label in women who are on SSRI anti-depressants.

FSD is real, causes distress and disruption and can be treated, although we sure need more studies. It is much healthier having a sex life in your maturing years - that is a treat and not a trick!

“It’s just outside your front door”…”It’s been such a long time”….”Deep in my mind, I can’t forget about you”...”taking my time” … “getting crazy, anticipation, love and music.”

Be Strong, Be Healthy, Be in Charge!

-Holly L. Thacker MD

Holly L. Thacker, MD, FACP is nationally known for her leadership in women’s health. She is the founder of the Cleveland Clinic Women’s Health Fellowship and is currently the Professor and Director of the Center for Specialized Women’s Health at Cleveland Clinic and Lerner College of Medicine at Case Western Reserve University. Dr. Thacker is also the Executive Director of Speaking of Women’s Health and the author of The Cleveland Clinic Guide to Menopause. Her special interests and areas of research include menopause and related medical problems including osteoporosis, hormone therapy, breast cancer risk assessment, menstrual disorders, female sexual dysfunction and interdisciplinary women’s health.

female sexual dysfunction, intimacy, love life, low libido, menopause, relationships, sexual dysfunction, sexual health, women

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