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The midlife sexual transition is different for women and men. A woman cannot stop the process of changing from a fertile, child-bearing woman into a woman who is incapable of bearing children. The process of the menopause is as inexorable as old age and death. The permanent ending of ovulation and menstruation is a milestone in every woman's life. The process by which it is brought about - usually some time between the ages of forty-five and fifty-five - is a complex and potentially frustrating one. On the other hand, once the changes have been completed, she is still not only capable of enjoying sex, she is also capable of a positive response through to orgasm and may have a sex-drive which can be as strong as it was before the menopause. In fact absence of the fear of unwanted pregnancy can produce a quality of sexual experience she never achieved in her middle twenties, at the peak of her sexual potential.
A man has not such a definite sexual milestone to define his entry into middle-age. But man men have mid life symptoms attributable to loss of testosterone, similar to those experienced by women going through the menopause - depression, moodiness, headaches, depressions, irritability, becoming easily exhausted, and hot and cold flushes.
After a certain age, the semen may contain sub-standard spermatozoa incapable of fertilizing the egg, or even no spermatozoa at all; the Cowper's glands' secretion may progressively become less in volume and disappear altogether after a time; the volume of semen ejaculated may become less, though it rarely dries up completely; and it is true that the prostate and testicles become markedly changed; but none of these things is an end to reproduction in the way the menopause is for a woman. There are many men who, even if they have a reduced sex drive, are still capable of producing healthy children in their sixties and seventies. A man's greatest fear is that he will lose the ability to have an erection, that is, that he will become impotent. Erection, not fatherhood, is the true test of a man's manhood. A man's sense of masculinity is closely supported by his ability to have a firm erection and to sustain it for a period longer than is necessary sexually to satisfy his partner.
This threat to a man's virility produces a shocked reaction in middle-age. He will openly admit to being incapable of running for the train without experiencing breathlessness, or to being exhausted by two hours' fairly heavy gardening, but the thought of not being able to enjoy sex with his partner and satisfy her is too horrible to contemplate! Some men reject the onset of middle age by changing into shorts as soon as they get home and running three miles before supper, or indulging in strenuous squash or tennis, or by going wild in their sexual life. It's as if a man's partner is not sufficient sexual challenge to him, and he has to prove that his powers of seduction and lovemaking are as strong as ever by embarking on a round of promiscuity with women half his age, or any mature woman who will get into bed with him. His attempts to prove to himself that he's a modem Casanova often lead him deeply into difficulties; for, if his partner or wife discovers his affair and does not understand what is really happening to him, she may want to separate or else, while not going to this extreme, she may exclude him from her sexual life. Not only this, if he does actually indulge in sexual excesses he may, after a time, find that he has developed premature ejaculation, intermittent total erectile dysfunction or a form of permanent semi-impotence.
If he does find himself at any time unable to complete intercourse - and the condition persists - he may develop even more inappropriate behaviors to try and boost his flagging sexual drive - including dirty talk, porn, BDSM, and so on. Sometimes his wife or partner is sexually willing to accept his sudden excess of sexual activity; sometimes she is not. If she has let middle-age overwhelm her, she may also set in motion her own compensating mechanism. Very often this takes the form of making the menopause, or rather the onset of the menopause with various aches and pains and irregularities, the excuse for initially becoming sexually disinterested, and then for withdrawing from sexual experience altogether.
Indeed, where sex becomes a problem it is often the woman's response to middle age that is one of the major factors in bringing about what is, in my view, little short of tragedy. A satisfactory, well-attuned sex-life is the cement which holds together relationships: it is the basis of trust, affection, empathy, understanding, love, co-operation, and companionship. Sexual activity between two loving partners is the visible, concrete expression of love. Their love can be measured by the thought and care which a couple devote to their sex life, and by the depth of their mutual gratitude for the experience of sex.
At the outset of a relationship emotional love is a prime ingredient of the couple's life together. This love can be expressed in the intimate relationship of physical sex. In a solid relationship, the sexual expression of love remains steadfast; it develops the deeper the relationship becomes. Conversely, if the sexual relationship breaks down at middle age, then it is practically certain that a couple has not been deeply emotionally connected.
By "not deeply connected" I mean they have not made attempted to improve their technique of love-making much, if at all, beyond the basic requirements - arousing the woman in foreplay so that she reaches orgasm at some time during sex, and putting the penis in the vagina and thrusting until ejaculation occurs. They have not tried to improve their orgasmic experience, probably because they never knew that techniques of foreplay and sex exist which can greatly intensify the sensations at orgasm. They have made love, or rather, they have had sex, merely in response to the sex drive of one or the other. Their enjoyment of sex has been simply in the pleasurable sensations of orgasm and the tension-relief in the aftermath; they have not had much joy from their lovemaking, because they have not deliberately made it an occasion for joy.
A short time ago 174 men and 136 women, married and over the age of fifty, completed a questionnaire on the most intimate side of their sexual lives. Those who were sexually active and clearly enjoyed their love-making had invariably taken trouble with their sex lives from the first days of their relationship; while those who hardly made love to their partners, or grumbled about their partner's withdrawal from sex - all too often, complete withdrawal - had invariably used their sexual experience, as I have described above, merely for relief from sexual tension; or had been content for the man to have sex in the usual man on top position - often no other - purely to satisfy their sex drive. In the final section I have given some facts and figures, and some case-histories, from the material provided by these questionnaires.
It is chiefly to those over fifty who have, to all intents and purposes, 'given up sex,' 'dropped out of sex,' or have run into difficulties when they make the occasional attempt at love-making, that I want to advise with this website. In addition to a lack of sex, there may be several gaps in the overall relationship. You may take it for certain that where there is an undoubted deep companionship between a middle-aged or elderly couple, there will also be a deeply satisfying sexual relationship. And the converse is equally true. Where it is obvious to the onlooker that the marriage relationship is nothing more than a comfortable arrangement - based on financial security, say - the sexual relationship will be either wholly non-existent, or where it does exist, be wholly or partially unsatisfactory to both partners. The tragedy is that it need not happen. Middle-age, far from being the beginning of the end, can open up brand new sexual experiences. It can be the time when a couple start to consolidate all they have learned of life and living in their first half-century. By this time they have grown to know - or should have grown to know - exactly what makes their partner tick. On the basis of this knowledge they can have a way of life that is fulfilling and in which sex has a definite and major role to play.
On Passing Into Middle-age Sexuality
From the moment when full physical maturity is reached, a gradual degeneration sets in in all the physical organs of the body, including the sexual organs. The process of deterioration is so slow, however, that we are not aware of it until suddenly, as I have suggested, something happens to bring it home to us. A sudden awareness of tiredness, the insight that things you could once accomplish with ease are no longer so easy, that jobs take longer to complete and are harder to accomplish, and that you have less energy - these are the kind of things which show us our age. The rate of deterioration is variable from individual to individual and may be complicated by the effects of disease. Thus, a fairly healthy man may be overtaken by old-age at sixty, whereas another man in the same state of general health may be alert mentally and spry physically at eighty; one woman may be lined in features at fifty-five, another may be physically attractive and a lively companion at seventy-five.
As a general rule, however, and for all practical purposes, fifty is the age at which, these days, the majority of men and women enter the middle phase of their lives. It is in the years after fifty that awareness of physical deterioration begins: but middle-aged sexuality comes to us all at some point!
Men and women do not have the same experience of ageing sexually. For the woman there is the definite indication of the menopause or 'change of life'. During a period of from three to five years, the woman's ability to conceive and bear a child is slowly extinguished. The ovaries no longer release a mature egg at the end of the woman's cycle as regularly as they did. With this irregularity of egg-release the natural accompaniment of the shedding of the egg during menstruation is affected. Some women experience great irregularities in the cycle itself. There may be as long as six months or more between one menstruation and the next, and just as she is beginning to take hope that the menopause has been completed, she has a series of periods with only a few days between the end of one and the beginning of the next. For other women, this is a regular experience for two or three years.
Yet others may go on longer than five years, during which they may have only half-a-dozen periods a year before the changes have become finally completed. Nor are these irregularities the only disturbances with which many women have to contend. At times the woman may experience alternative waves of heat and cold - the so-called 'hot flushes' - followed by troublesome sweating. Few women escape this really uncomfortable symptom, though doctors can do much to alleviate the most unpleasant physical symptoms. Many women, too, suffer from heart-pounding and headaches, and depression and restlessness. They become very irritable, easily exhausted physically, feel weak all the time and unable to overcome the very noticeable slowing down of actions and reactions. Probably most upsetting of all for the woman herself is that in addition to these trials, she finds that she suddenly begins to accumulate fat at an alarming rate, and in such quantities that she cannot disguise it. She may be able to conceal the irregularities in her periods, but her added weight she cannot hide, and this may cause some anxiety.
The changes that are taking place within the body at this time are as subtle as they are formidable. In the man the testicles and in the woman the ovaries are operating more slowly. Lowered testosterone may produce lower sexual desire in men. Other glands which play an important part in the sexual experience of men and women are the man's Cowper's glands, which are situated at the base of the penis in the urethra, and which, when the man is sexually aroused, produce a lubricating liquid that passes up the urethra and out of the opening where it spreads over the penis-head and makes it slippery. The woman's counterparts, the Bartholin's glands, situated in the entrance to the vagina, and the Skene's glands, sited just inside the urethra, as well as the vagina itself, both produce fluids which lubricate her vaginal entrance and vulva; and the man's prostate and seminal vesicles produce secretions by which the sperms are carried from the seminal vesicles out of his body.
The essential function of the ovaries is two-fold - to develop the ova (eggs) and to produce hormones. The ovum continues to develop after it has been fertilized by the male sperm, and the ovary and its secretions play a major role in this development. There are two ovaries, one lying on each side of the upper end of the uterus. They are oval in shape and between one and one-and-a-half inches long and half an inch thick. Until the girl begins to menstruate, the surface of the ovary is smooth. As each egg matures, a small bump (known as a follicle) appears on the surface of the ovary, grows larger and larger, and at last bursts, releasing the fully ripe egg, which enters the Fallopian tube where it waits for a sperm to come along and fertilize it. If fertilization does not take place it makes its way down into the womb, which at once begins to shed its lining. This lining makes its way out of the vagina - in menstruation - carrying the unfertilized egg with it. If, on the other hand, the egg is fertilized, it goes down to the womb and embeds itself in the lining. Since all women produce far more eggs than they could produce children, by the age of forty-five to fifty the ovary becomes a mass of scar tissue, from the monthly rupture of the follicles, and eventually no more follicles develop. Only the tissue that secretes hormones is active, and the body adjusts itself by compensations of one kind or another, the chief being an increase in activity of the outer portions of the adrenal glands, which are capable of producing sex hormones. This is a very important fact, and I shall return to it later. But I would like to underline it at this point, because what it means in practical terms is that although the ovaries stop producing eggs and the ovarian production of sex-stimulating hormones markedly decreases, the woman's desire for sexual intercourse does not come to an end. Though not so pronounced, perhaps, or so frequent, she still has a sex drive.
There's obviously a link between how much testosterone and estrogen a man or woman's body produces, and how high their sex drive may be. Now, the focal point of the menopause in women is the ovaries. The changes which take place during the final years leading up to the menopause are subtle and gradual. Were it not for the obvious symptoms a woman would probably remain unaware of the hormonal changes. However, as the years advance after the menopause has taken full effect, the gradual slowing down of the production of sex hormones by the ovaries does begin to have other effects. Perhaps the most common of these effects is the thinning of the lining of the vagina. Before the menopause when the vagina receives considerable stimulation from estrogen, its walls are thick and corrugated. With the reduction in estrogen, by a very gradual process over at least five years, and, more commonly, much longer, the walls become much thinner. This means that they may not protect the urethra and bladder from the friction of the thrusting penis in sex, so that sex becomes painful. The penis can also cause pain through the shortening and narrowing of the vaginal barrel and the constriction of the vaginal opening. While the shortening and lengthwise capacity for stretching may mean that the vagina cannot accommodate the full length of even the average six- to six-and-a-half-inch penis, the narrowing is much less.
As for the constriction of the vaginal entrance, the pain that this gives rise to is not so much from the constriction itself as from the lack of lubrication. It is the experience of most women, that there is less vaginal lubrication after the cessation of ovulation. The attempts of a dry penis to enter a dry vaginal entrance can be very painful indeed for the woman. Fortunately, as I shall be explaining later, there are ways of eliminating all these various pains.
The female menopause means the complete end of the woman's fertility, and it is an experience undergone by every woman. But even after the menopause, all women are capable of sexual desire, sexual arousal and enjoyable intercourse, as well as satisfying orgasm. So long as she remains in good general health, a woman can lead an active sex life well into her seventies. In fact many women develop a far more active and satisfying sex life after the menopause than they ever had before.
Now, it is a fact that most men in their fifties begin to have a gradual decline in fertility. In other words, their semen does not contain sufficient sperm or sufficiently healthy sperm to ensure that every time they make love to a woman in conditions otherwise favorable for conception, they would get her pregnant. Nevertheless, the number of men in their sixties and seventies who become fathers is considerable. But even if the man produces no sperm at all, his sexual desire and his sexual ability to have satisfying orgasms do not disappear. The latter, however, is dependent upon his being able to have an erection. Unfortunately there are many possible problems of sex after fifty: impotence, partial impotence, weak erections that do not allow the penis to enter the vagina, retarded ejaculation, and oddly a reversion to a condition of the ardent days of youth, namely, premature ejaculation; all these are the troubles that beset the middle-aged male - or, more generally, the man over fifty seeking to enjoy sex.
There is a slowing-down in the frequency of sexual desire as well. If the man who made love four times a week in his peak years can, at fifty or sixty, make love satisfactorily both for himself and for his partner twice a week he is doing well: he is not the approaching the end of sexual activity. But he may feel emasculated by this reduction, for reduction there will be, no matter how often he made love as young man: and this can further undermine his desire, his physical responses and his sexual performance. Many cases of partial or complete impotence and of weak erections are mostly due to anxiety - for example, the fear of impotence. In other words, we have here a vicious circle in which fear of becoming impotent creates impotence.
It's also true that there's a need for good general health for normal middle-aged sexual functioning. If a man's general health is impaired, his sexual health is bound to suffer too. This, in its turn, adds to the psychological effects. Let me try to illustrate what I mean by the case-history of John.
John was fifty-seven. He had been married for thirty-one years, and though the marriage had not been wildly romantic, his relationship with his wife had been a happy one. She was two years younger than he, and was completely over her menopause by fifty-one. She was also an intelligent woman, and had decided that she was going to respond to the changes with a new lease of life, gaining new qualifications and new employment. When they had first married in their middle twenties, John and Mary had made love on an average of three or four times a week. John had been a capable lover: Mary had no complaints on that score, though she later admitted to me there had been times when she had wished for more exciting lovemaking, though not often. After her menopause she gradually began to realize that she was becoming more preoccupied with thoughts of sex than she had been at any time during her earlier life, and her sexual desire was also increasing.
She was aroused more often, wanted to make love more often, and also wanted a deeper sexual experience than she had had before. John, on the other hand, by this time had fallen into the habit of making love to her only on Saturdays or Sundays, and then not always every week. She would have made love every other day if she'd had the opportunity, but she did not criticize John for his lack of desire, accepting that his greatly increased responsibilities at work made him too tired for love-making during the week. However, this did not solve the problem of her increased desire, and after a time, she made one or two tentative approaches. To her delight John responded, but on a couple of occasions rebuffed her gently but firmly. Her successes, however, encouraged her to a strong desire for oral sex. John was surprised, but delighted. On the other hand, he suddenly realized that Mary had changed. For the first time for a long time, he really noticed how attractive she was, and it struck him that she was much more sexually active than she had ever been. His work was tiring and he often had to bring a case full of papers home with him, and by bedtime all he wanted to do was sleep. That is what he had been doing: but now he was aware that he ought to pay more attention to the new Mary. But he could not readjust to her straight away, and, in fact, though he kept telling himself he really ought to do something about it, he never did. Then another incident occurred. He went to bed very tired one night, and when Mary wanted to make love to him, he refused, turned over on his side and went to sleep.
A little later he awoke, and became conscious that Mary was masturbating. As a result of this incident he was shaken out of his rut. He really would do something about it. But almost immediately the increase in Mary's desire for love-making struck him even more forcibly than before, and in a moment of panic he thought, "What if I can't keep pace with her?" Instead of telling himself that he would have no problem, he let the idea begin to get to him, and when he finally did take the opportunity to make love to her, he had some difficulty in getting a really firm erection, and this added to his anxiety. Then the sex was a failure in his eyes, because, for the first time in thirty years, he came as she touched his penis to guide it into her vagina. This was a fatal experience. Almost every time, for several months when they made love, he either ejaculated prematurely or he could not get a firm enough erection to penetrate her. He did not even get an erection from fellatio.
For a time both were plunged into depression, which did not help John at all, and it was in utter desperation that he came to see me to ask me if I could recommend a specialist he might consult. 'I don't mind betting you've nothing physically wrong with you,' I told him, when he had told me his story. 'Do you still have morning erections?' He seemed surprised by my question. 'Well,' he said, 'come to think of it, I do. Not so often, perhaps, but two or three times a week.' 'In that case,' I replied, 'I think a counselor would be able to help you more.' 'You mean you think I'm imagining I'm impotent?' he asked. 'Yes,' I said. 'If your impotence had any physical cause, that would prevent you having even an involuntary erection!'
As it turned out, there was no need for him to consult a counselor. He was able to readjust, on the basis of what I told him: that fear of failure breeds failure. The case is a common one. More often than not, the counselor rather than the doctor has the cure for middle-aged sexual disorders.
In cases where a man is impotent, or has weak erections or retarded or premature ejaculation, and there is no traceable psychological origin, there may also be a definite absence of sexual desire. This stems from the fact that the testosterone output of the testicles which control sexual desire has greatly depreciated or ceased altogether. This lack of hormone production can be corrected by testosterone replacement therapy. So there is really no need - except in a very small percentage of cases which will respond neither to hormone nor to psychological treatment - for a man or a woman to consider themselves incapable of sex in their later decades after their fifties.
To sum up, both the man and the woman do undergo physical changes, the woman on a much greater scale than the man. But whatever the changes, whether it's the complete menopause of the woman, or the much less drastic changes in the man, both are normally quite capable of having great sex, though perhaps slightly less often. Where there are detectable deficiencies - thinning of the lining of the vagina, failure or partial failure of lubrication, hormone under-production, and so forth - there are many ways to correct them.
The best way of avoiding sexual failure of almost any kind is to maintain regular sexual activity throughout life. The more often a couple make love between twenty and forty, the longer they will remain sexually active in their middle and later years. Regular and fairly frequent lovemaking - sometimes even when you are not prompted by desire - plus a new adventurousness in sexual techniques, is one of the surest ways of maintaining a satisfactory sex-life for most, if not all, of the rest of your life.