Sexual Problems at Midlife: Decreased Desire
What is desire? Sexual desire is your interest in sex and in being sexual. It has three interrelated components:
Drive is the biological component. It manifests as sexual thoughts and fantasies, erotic attraction to others, seeking out sexual activity, or genital tingling or sensitivity. Sex drive varies a lot from woman to woman and often varies from day to day based on a woman’s daily activities, stress, and health.
Beliefs, values, and expectations about sexual activity. Your natural drive may be tempered by your personal attitudes toward sex, which are shaped by your culture, your religious beliefs, your family, your peers, and media influences. The more positive your attitudes are about sex, the greater your desire to be sexual.
This component involves your willingness to behave sexually at a given time and with a given partner. Because it is driven by emotional and interpersonal factors, motivation is the most complex component of desire—and is increasingly recognized by experts as perhaps the most important. Generally speaking, a caring relationship is often required for most women to experience desire.
Desire usually (but not always) wanes with age. In general, sex drive decreases gradually with age in both men and women, but women are two to three times more likely to be affected by a decline in sex drive as they age. Reduced sex drive becomes much more common in women starting in their late 40s and 50s. The effect of age also differs by individual: some women experience a big decrease in sexual desire beginning in their midlife years, others notice no change, and a few report increased interest in sex at midlife.
Those women whose desire increases may feel liberated by their new freedom from contraception or by newly found privacy if their children have recently left home. During the menopause transition, the physical effects of falling estrogen levels—including hot flashes, night sweats, and vaginal dryness—can undermine sexual motivation and drive. Although not directly related to menopause, the age-related decrease in testosterone may reduce desire in midlife women, as this hormone plays a role in women’s sex drive and sexual sensation.
The precise role of testosterone in desire is complex, however, because low sexual desire in women has not been shown to be related to testosterone levels in scientific studies. Also, some women who undergo an abrupt menopause (caused by removal of both ovaries or by chemotherapy), which leads to an immediate drop in both estrogen and testosterone, suffer a greater reduction in desire than women who experience natural menopause. Interestingly, other women in the same situation do not have a decrease in desire.
When decreased desire is a concern. For many women in the menopause transition, a gradual decline in sexual desire does not have an important impact on overall sexuality and quality of life. For others, diminished desire and the rareness of sexual thoughts is a source of distress, undercutting their satisfaction with life and changing their sense of sexuality and self. If you are troubled by a persistent or recurrent lack of desire, you are likely to have what has been described as “hypoactive sexual desire disorder,” the most common sexual complaint among women.
n some cases, a woman’s loss of desire is a problem for her primarily because it frustrates her partner and threatens to weaken their relationship. This may be the case if there is a pattern of avoiding or ignoring her partner when he/she is likely to initiate sex, or if even the most romantic and relaxing vacation or weekend away fails to spark any interest in being sexual.
Causes of decreased desire are complex. Scientific studies have consistently shown that about one third of US women report low sexual desire or interest, and that this low desire is troubling to about one in three of those women.1,2 The upshot is that about 10% of US women are troubled by having low sexual desire. While a troubling lack of desire can affect women of any age, it has been reported in studies at a higher rate (12%) among midlife women (ages 45 to 64) than among women 65 or older (7%) or women younger than 45(9%).
Increasing evidence suggests that when women experience low desire, it’s usually because of a number of factors rather than just a lack of sex drive.3 These factors may include issues or conflicts with their partner, medical problems, cultural issues, and others. A large scientific study of US women with low sexual desire4 found that they were most likel to be troubled by their lack of desire if they:
1.Currently were in a relationship with a partner
2.Were 35 to 64 years old (ie, at midlife rather than older)
In addition to these main factors, a number of other factors also influenced (to a lesser degree) whether women were bothered by their lack of desire. These included urinary incontinence, anxiety, social skills, and whether women also had problems with arousal or orgasm. This and other studies also found that women’s happiness with their overall relationship with their partner had an important effect on desire and any distress they felt because of low desire.