Should Older Women “Use it or Lose It?

I’ve consulted with several women lately who are 50-65 and are planning to have vaginal intercourse after a multi-year break.  Their main concern has been whether that old “use it or lose it” adage is true.  It can be, since the ability to enjoy penetrative sex depends in large part to tissue moisture and suppleness. The good news is that women can maintain and regain their sexual enjoyment.

Decreasing estrogen in an older woman’s body plays a large role in her level of sexual enjoyment.  If you look at sex from a strictly biological standpoint, once there’s no guarantee of “good eggs” due to age, the body shuts down the reproductive factory, starting with estrogen production. Estrogen keeps tissues supple and triggers transudation (the process of natural lubricant flowing through tissues in the vagina and vulva). Once a woman can no longer reproduce, the body has no biological use for sex; ergo, there’s no use fornatural lubrication or supple tissues.  But that’s not what women want to hear!  Women consider ourselves more than reproductive vessels, and many women want to be sexually active — for myriad reasons — until the day they die.

Because the loss of estrogen causes tissues to thin, the already delicate vaginal, vulvar and anal skin is more apt to tear or feel painful from handling that once might have felt great. Also, the muscles in the pelvic floor start to get lax, so the bladder and other organs may droop, causing unpleasant pressure during penetration. This news can sound dreadful, and many women just assume their sex lives are over. However, if women make accommodations mentally, behaviorally, and, if need be, medically, they can enjoy post-menopausal sex. The key to enjoying sex while aging is to understand naturally occuring changes and to adapt to them. 

Older women may need to consider some sexual behavioral changes, i.e., body positioning to protect joints and tissues, using condoms or dental dams if they have new partners, and rethinking when they engage in sex. For example, switching from late night to late afternoon sex can be behelpful because medications have kicked in and fatigue hasn’t. Now’s also the time to load up on lubricant — silicone or waterbased or even olive oil from the kitchen cabinet — to lubricate vulvar tissues and the entrance to the vagina or anus.  If tissues are uncomfortably dry, see a healthcare practitioner for advice on whether an estrogen-containing product is indicated.  

The act of sex, solo or partnered, exercises muscles and increases flexibility. The clenching and unclenching of vaginal muscles during sex and orgasm conditions the vaginal walls and works the tendons and muscles of the pelvic floor.  And, if a woman expends a modicum of energy and movement during sex, the heart and joints get a workout. Orgasm has another benefit — research has shown it to ease pain for hours. All of these benefits point to the power of “using it.”  If you don’t have partnered sex, pleasure yourself. If you’ve never masturbated before, experiment with what feels good to you.  If you have a partner who’s willing to get back into the groove after a long break (or if you have a new partner), schedule an internal exam with your healthcare provider to see whether your vagina is supple enough for penetration. If you’ve had some atrophy, stretching with dilators or physical therapy may be indicated.

Communicating with a partner is  important because older women may require more time to become aroused enough to naturally lubricate. And those delicate tissues mean that the level of sexual touch and/or penetration may need to change.  Older adults typically feel an decreased need for athleticism in the bedroom, too. Getting used to this change may require on-going conversations so both partners get the sexual satisfaction they desire.

Older women also need to attend to their self-esteem as they deal with the loss of their younger body — including less firm breasts, changing fat deposits, the thinning and graying of pubic hair and less plump labia. There may also be the diminishment of a partner’s looks or sexual function to adapt to, as well.  It can be helpful to re-think was sex “looks like,” so to speak. Perhaps the goal need no longer be orgasm, but intimacy — at least some of the time.  It’s also good to be aware that intimacy may be very different in older age if one’s partner dies and cuddling with a friend becomes the easiest way to satisfy skin hunger.