The perception that we are given in the media is that everyone else is having sex all the time. Trust me, they’re not. This is just another one of the many unrealistic ideals that are imposed upon us by our culture. I think starting from a place of understanding that low libido is normal when we are married with young children and working from there is healthy. Certainly trying to improve our sex life is important for our relationships and is a healthy aspiration. But thinking that it should be easy and should come naturally can be lonely, disappointing and frustrating. This is an issue that we don’t talk about because of the perception that something is wrong with us, and we fear shame if we expose the truth that our sex lives are not as exciting as they used to be.

Speaking openly and honestly is the best way to disempower shame because we realize that many other people are experiencing the same thing. Most of my patients in this age group describe sex as enjoyable once they get started, but the desire to initiate in significantly reduced. In other words, they would be fine to go without. They don’t miss it and don’t need it. Orgasm can usually still occur but it takes more effort so can become a bit of a “chore” when they would just as soon go to sleep. If you feel this way, you are in a very large company.

So why does this happen and what can we do about it? Sex drive for women is mostly related to issues above the neck not below the waist. My theory is that evolutionary programming makes women desire sex when they are hunting for a mate or trying to get pregnant. Many of us experienced a fantastic sex drive when we were dating in our 20s. I often see a great sex drive return in women in their 40s and 50s who are starting a new relationship. So once we are married and settled, even if we are deeply in love, some of that pre-programmed desire can simply go away.

Once we are done having children and that biological need to procreate also leaves, our bodies may tell us that there is simply no need to have sex anymore. From an evolutionary point of view, it makes sense to stop having sex when one doesn’t want or cannot support any more children since women historically have been most likely to be the primary caretaker. Men don’t have this biological sex drive reduction, as they are fertile often up into their 80s and their bodies continue telling them to procreate.

In addition to the evolutionarily programmed reasons for libido reduction and there are also physical changes that happen in our bodies as we enter our 40s. Bloodflow is dramatically reduced in the genital area as we approach menopause, and reduction in estrogen changes our vaginal tissue making it drier and less elastic. These physical changes can make it uncomfortable to have intercourse and can reduce our ability to reach orgasm easily. I am not suggesting that we should just give in to this natural decline in libido, any more than I suggest giving into other age-related changes without doing our best to stay happy and healthy. But I do think it is important to understand what is normal and not to feel guilty or shameful about a natural and somewhat hardwired process.

The most important step to take is to talk about it. Share with your spouse that this is normal and that there is nothing wrong with you, or with him. Men take this stuff very personally and chances are your spouse thinks that your low libido means he is not good in bed. Men have fears and vulnerabilities too, and this is one of the biggest ones. Realize and accept that it is more work than it used to be, and make a little more time for it. Even if it is only once a week when it used to be 3 times, make sure that it happens.

I tell patients to think of it like going to the gym. Some people don’t have a natural desire to work out. But when they go, they enjoy it and realize that they feel better afterward and they understand that it is healthy. They commit to going regularly and may keep it up for a while, but soon they are back in their old habits and are skipping classes that they committed to do. Those who feel that way have low gym-drive. On the other hand, some of us love the gym and will go to great lengths to get our workouts in and feel physically and emotionally unwell when we can’t go. For those with high gym-drive, going to the gym is easy, it happens naturally. Both types of people need to go to the gym because it is undeniably healthy. But if both types occur in one marriage, and they need to attend the gym together, the number of gym visits a week will need to be a compromise between zero and every day.