Sexual Crisis in Midlife

Guest blog by Practitioner Dr. Marilyn Mitchell MD, BHSP

We are often surprised by changes that occur in our sexual lives during middle age. The two hormones that most affect sexual physiology, estrogen and testosterone, tend to decrease during midlife, in both women and men. As a result of these hormone decreases, the most common symptoms we experience are a decreased libido (desire) and changes in sexual response. But this is just the tip of the iceberg. Sexuality is complex, especially at this life stage, and we go through other shifts on the physical, mental and emotional levels. Our roles and relationships change. While it is common for people to experience changes in sexuality during the middle years, it may not happen to both partners at the same time, further complicating the issue.

There are four components of sexuality that may be challenged at midlife: 
• Self-perception: At midlife, it is common to experience changes in weight, fitness, appearance and mood causing us to feel less desirable and therefore less interested in sex. The challenge is to do what is reasonable to improve health and appearance, and then move to embrace and accept ourselves as we enter this new phase of life.
• Sex role behavior: Women at midlife experience shifts in their psyches and often have a shift in priorities. Commonly, women begin to focus on their own needs and self care, and have more time to devote to creative endeavors. They often have a change in career and focus. Men are more likely to slow down at work and are looking to balance their lives with more leisure. This impacts behaviors, including sexual behaviors, and can require negotiation of the relationship. This is true in same sex relationships as well. 
• Sexual desire (libido): Loss of libido is common in women as they go through peri-menopause into menopause. Typically, women in this life stage don’t think about sex, don’t initiate, and don’t care that they don’t care! They are surprised at the sudden change. For some, just going ahead and starting foreplay will cause arousal and interest to follow. This dramatic change is the result of a drop in testosterone (mostly) along with lowered other sex hormones. Men may have a decreased libido as well, as their testosterone slowly wanes.
• Sexual response: Women tend to complain of slow arousal and difficulty coming to orgasm. Orgasms may elude them altogether, or be less satisfying. At the same time, men who are having difficulty with sexual response most often report erectile dysfunction. This may be an early warning sign of cardiovascular disease and a medical workup is advisable.

What you can do:
• Healthy diet: Eating for health, mostly fresh whole foods without preservatives, additives, and trans fats will provide energy to all your cells.
• Exercise: Women who exercise has been shown to have fewer symptoms of menopause, including sexual symptoms. Men and women who exercise have better cardiovascular health and sexual interest.
• Sleep: Adequate, uninterrupted sleep is important for stress reduction, hormone production, and sexual desire and response.
• Manage stress: Stress often increases at midlife, especially with the many changes that occur. Taking an honest look at your stressors and working to eliminate any of those that are possible will help. Finding practices to manage stress will improve well being in general, including sexual interest and response. Deep breathing and meditation (even 5 minutes twice a day) have been shown in formal research to improve medical health and sexual health and satisfaction.
• Improve self image: It may be enlightening to focus on your own thought messages to self Working on the above factors can enhance your positive self talk. Improving your relationship with yourself has a positive effect on sexual health. . 

Therapies for treating sexual dysfunction:

• Medications commonly used include bioidentical testosterone supplementation, either oral or cream. This will usually accompany hormonal treatment with bioidentical estrogen or progesterone in either an oral form, as a cream for local external treatment, or in a vaginal form. 
• Medicinal treatment may also extend to adjunctive anti-depressants for you or your partner or a change in current therapy for other diseases. Some antihypertensives and antidepressants will alter sexual function in men or women. 
• Herbal therapies include the herbs Damiana for improved libido, Chinese ginseng for improved libido, potency and fertility, and Yohimbe. Ashwaganda is also helpful on a long-term basis for improving sexual response. 
• Behavioral approaches can help improve sexual satisfaction. An aid to sexual health may be a change in sexual foreplay to accommodate changes in each partner and to rekindle interest. Couple therapy may be helpful, either with a professional or with the couple alone. Intimacy "planning" can help when this part of life seems to get squeezed out. 
• Energy Healing has profound effects on improving sexual health and connection. Higher levels of healing, as used in Energy Touch work, can assist with connections through multiple sets of chakras and quickly improve sexuality on the physical, emotional, spiritual, and relational levels. 

When dealing with the sometimes sudden changes that come in midlife sexuality, it is important to approach this with the same openness and honesty that is used in other areas. Sexual problems often seem insurmountable and confusing, difficult to approach and embarrassing to talk about. Knowing that this is a common problem and there are effective solutions can be helpful in working through the issues. By focusing on specific factors and symptoms and improving communication, a healthy sense of sexual balance can be achieved.