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Sexuality in Midlife and Beyond


Sexuality in Midlife and Beyond

The physical transformations the body undergoes with age have a major influence on  sexuality. This Special Health Report, Sexuality in Midlife and Beyond, will take you through the stages of sexual response and explain how aging affects each. You’ll also learn how chronic illnesses, common medications, and emotional issues can influence your sexual capabilities. Finally, you’ll find a detailed discussion of various medical treatments, counseling, and self-help techniques to address the most common types of sexual problems.

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The physical transformations your body undergoes as you age have a major influence on your sexuality. Declining hormone levels and changes in neurological and circulatory functioning may lead to sexual problems such as erectile dysfunction or vaginal pain. Such physical changes often mean that the intensity of youthful sex may give way to more subdued responses during middle and later life. But the emotional byproducts of maturity — increased confidence, better communication skills, and lessened inhibitions — can help create a richer, more nuanced, and ultimately satisfying sexual experience. By understanding the crucial physical and emotional elements that underlie satisfying sex, you can better navigate problems if they arise. The advice in this report applies broadly to people of all sexual orientations. It will take you through the stages of sexual response and explain how aging affects each. You’ll also learn how chronic illnesses, common medications, and emotional issues can influence your sexual capabilities. Finally, you’ll find a detailed discussion of various medical treatments, counseling, and self-help techniques to address the most common types of sexual problems.

Prepared by the editors of Harvard Health Publishing in consultation with Jan Leslie Shifren, M.D., Director, Massachusetts General Hospital Midlife Women’s Health Center, Vincent Trustees Professor of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, and Suki Hanfling, MSW, LICSW, AASECT Certified Sex Therapist, Founder and Director of The Institute for Sexuality and Intimacy in Waltham, Mass. 48 pages. (2019)

  • Understanding sexuality
    • How do you define “sex”?
    • Your sexual anatomy
    • The phases of sexual response
    • The impact of aging
    • What is sexual dysfunction?
  • Trends in sexual behavior among older adults
    • How often and how important?
    • Contributing factors
  • Emotional and social issues
    • Lack of a partner
    • Relationship issues
    • Performance anxiety
    • Body image and self-esteem
    • Expectations and past experiences
    • Stress and lifestyle issues
  • Health problems and sexuality
    • Heart disease
    • High blood pressure
    • Diabetes
    • Arthritis
    • Cancer
    • Depression
    • Incontinence
    • Medications
  • Treating common sexual problems
    • Erectile dysfunction
    • Low libido
    • Female sexual arousal disorder
    • Vaginal pain (dyspareunia)
    • Orgasm difficulties
  • SPECIAL BONUS SECTION: Everything you always wanted to know about sex therapy
    • Helping yourself to a better sex life
    • Talking to your partner
    • Using self-help strategies
    • Maintaining good health
    • Putting the fun back into sex
  • Resources
  • Glossary

Everything you always wanted to know about sex therapy

Sexual problems are nearly always intertwined with psychological and relationship issues. As a result, treating the physical problem (if one is present) is only half the job. If sexual issues persist for any length of time, performance anxiety, anger, frustration, low self-esteem, lack of physical affection between you and your partner, and a sense of hopelessness can further harm your sex life. So can a tendency to blame yourself or your partner for the problem. Most people need help repairing the emotional distance created by the problem before they can regain a healthy sexual relationship.

Licensed sex therapists are particularly well suited to this task. Although they’re qualified to understand the same broad emotional issues as individual or couples therapists, sex therapists have advanced training in addressing specific sexual problems, and they use a more targeted approach. Initially, underlying personal dilemmas and relationship conflicts are addressed mainly in the context of your sexual problems. As a result, sex therapy will probably return you to sexual functioning sooner than traditional counseling. However, as the sexual issue is being resolved, many people choose to continue working with the sex therapist to tackle deeper personal and relationship issues.

What to expect during sex therapy

To understand what takes place during a sex therapy session, it’s important to know what doesn’t happen. Contrary to what some people may think, you will not be physically intimate with each other while the therapist is watching. If having to discuss your sex life is an obstacle to getting help, you can rest assured that the sex therapist will not push you too quickly. Also, remember than an essential part of the treatment is learning how to talk about your sexual feelings more comfortably.

The role of sex therapy is to help people explore the nature and possible causes of their sexual concerns, better communicate their sexual needs and preferences, and expand their repertoire of sensual and sexual activities. By increasing the overall pleasure and intimacy of sexual contact, a couple will be able to enjoy expressions of sensuality that are free from what are often the goal-driven pressures of intercourse and orgasm.

William H. Masters and Virginia E. Johnson pioneered sex therapy in the 1960s. The original model consisted of an intensive two-week treatment program revolving around daily therapy sessions. Couples traveled to the Masters and Johnson Institute and stayed in a hotel for the duration of the treatment. Although intensive weeklong or weekend programs are still available at a few centers around the country, most sex therapists use a modified format in which the couple meets with the therapist in his or her office for weekly 50-minute sessions. There are certified sex therapists in most major cities, so you most likely won’t need to travel far from home to get help.

Much of the behavioral and relationship-building work of sex therapy is actually done at home between meetings with the therapist. After the comprehensive assessment is complete and the couple feels comfortable with and trusts the therapist, the therapist will probably assign behavioral exercises to practice at home. You’ll be asked to focus on your feelings, sensations, and thoughts during the home assignment and to discuss them with the therapist in the next session.

The therapist may also serve as a sex educator. In many cases—for example, with age-related changes or vaginal pain syndromes—understanding the physiological basis of the problem often goes a long way toward relieving your anxiety, as well as your partner’s. The therapist will discuss such issues with you during therapy sessions and may suggest useful books and DVDs. He or she will also help you question erroneous beliefs and assumptions that stand in the way of enjoyable sex, such as “All sexual contact must lead to intercourse,” “The man must be in charge of the sexual activity,” or “Foreplay is only for teenagers and isn’t really sex.”

Sex therapy can also help you learn to take some control of other factors that inhibit your sexual enjoyment. By understanding where stressors lie and how they influence sexual functioning, a couple can take steps to create a relaxed, distraction-free environment for sex. Older couples, who often need more time and stimulation to feel aroused and reach orgasm, may find they benefit from making an extra effort to set a leisurely romantic mood.  


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