When we approach our relationship this way, we all know what happens. The relationship becomes full of resentment, rejection, and disconnection. Often it ultimately leads us to reach out to others for connection. All of this is so “normal” that we accept it. Even our physicians tell us this is “just the way it is” when we’re over 45, and “everybody feels the same way, so maybe you should just take this antidepressant, or here’s the phone number for the sex therapist that I recommend,” or in one way or another invalidating that this is shattering to yourself and to your relationship. Your doctor is saying without words “can you get out of my office because I don’t know what to do about this.”

Having been told by our physicians that there’s nothing that can be done, we meanwhile notice that most of our friends feel the same way. So, we continue in this perpetual unhealthy relationship with sexuality where one person is initiating most or all of the time, and the other one is consenting occasionally but never with a whole body yes. Meanwhile a giant elephant is growing in the room that nobody wants to talk about. Eventually, your partner’s interest also fades.

If sex feels like work to you, you are in a huge majority of women over 45. What you’re experiencing is normal. But as I frequently say, normal is often not optimal. Of course, I only see the patients who have made an active decision that they want their relationship with sex to improve. Unfortunately, the great majority of women are not coming to see me because they have resigned themselves to “this is just the way it is.” We all know the stories: I’ll just suck it up because the relationship is not that bad. Maybe we can just have sex once a week on Saturday and that will make him happy enough not to leave me. I’m just counting the days until all the kids leave to go to college and then I’m out of here. I’m having an affair on the side that he doesn’t know about or maybe he is too – but for sure this is something so deeply painful and vulnerable that we just can’t talk about it.

Now for the good news: Not only is it possible to transform back into having a healthy relationship with sex, where sex is fun and something that you would rather do then just about anything else, but that there is a clear path that has been mapped out by many women before you of how to get there. And if you are willing to, you can get there too. Yes. Even you. Notice that I used the word willing, rather than wanting to. Wanting to do something rarely results in transformation, because we are often not ready to take the steps necessary to get to our goal. Willingness is different. It implies a deep commitment and understanding that there will be things that really need to change, and things that need be let go. Ultimately a lot of us are not really willing to let go of our old behaviors and remain stuck. And it that’s the case for you, you will stay stuck. But it will be your choice. Because there is another choice.

Why does this happen? And what can we do about it?

To answer the first question, I have a number of theories developed from working in this space for 22 years, from being a woman myself who has gone through every version of this transformative process, and from working with thousands of women doing the same thing. In my book “Sexually Woke” I explored a lot of these theories. One of them is straight up biology related to the reality of our fertility, or lack of it. When we are fertile, the part of our brain that wants to keep the species going its programmed to make sex seem like something good to do. Without that, the human race would disappear, so our primitive brain has a very loud voice -including increasing our sex drive around the time of ovulation when we are fertile, or when we are scouting for a mate with good reproductive potential.

Once that primary problem has been solved and we are partnered up with a person who can be a good breeding mate, and especially after we are finished having children, the desire to procreate disappears. At that point, the biological drive to have sex also disappears. Unless we discover a different reason to have sex, there just doesn’t seem to be a very good reason to do it. If we were cave people, it would be a massive waste of energy that we couldn’t afford to lose, so it would be a great idea to stop having sex when we are no longer fertile. Our problem is that were stuck with this ancient brain but have moved past life being a quest to survive and into a place where we can now explore learning how to thrive. Learning how to thrive means questioning the messages coming from our ancient brain and realizing that we are probably the only species on the planet that has develop the ability to have sex for pleasure, connection, and fun.

The other nuances of why this disinterest in sex happens when we’re done having children are related to the three primary reasons found in my research to decrease libido in mature women.

1. Hormonal change, which again is related to the biological reality that we are no longer fertile. Approaching menopause, with decreasing testosterone and irregular and eventually absent ovulation, our brains stop wanting to have sex. The brain is flooded with receptors for the three primary ovarian hormones (estradiol, progesterone, and testosterone), and as these three hormones drop to levels that approach zero around the time of menopause, our brain function also dramatically changes. One of the most dramatic changes related to hormone depletion is a decrease or complete lack of desire for sex.
   
2. Resentment, which comes in many flavors, but I think of as unspoken anger or withheld feelings which leave us feeling disconnected and unseen. When we don’t show our true feelings or speak our truth, we remain unseen to the other person. And we don’t let the other person in. Over time that can feel incredibly disconnecting.
   
3. Body image issues come in a multitude of flavors too, but to suffice to say, when we do not feel comfortable with our bodies, we certainly don’t want to have our bodies seen and touched by our partners. We are afraid that our vagina is too loose, or our breasts look funny, or our increased weight around the middle is no longer sexy, that those wrinkles that are developing are not going to be welcomed by our partner… or all the different ways that we make up stories about not being good enough.

So, what do we do about this situation, and how can we change sex back from being something we consider work, into something that we consider fun? Back into one of the primary elements of the “glue” that keeps our relationships healthy, happy, and connected?

1. We need to address the anatomic and physiologic realities of hormonal change by optimizing our hormones. As a woman who went through more than 10 years of not initiating sex, I can tell you with absolutely certainty that hormonal optimization changes everything. Getting my estradiol, progesterone, and testosterone levels back to where they used to be when I was in my 30’s made me feel… well… like I did when I was in my 30’s.  Along with hormonal optimization, we need to address the anatomic reality of decreased blood flow to the clitoris and vagina and make sure that our anatomy is being fed with blood and the appropriate nutrients to stay healthy and vibrant. There is no such thing as joyful sex if we have developed vaginal dryness and pain. No animal on the planet wants to do something that will hurt. While estrogen is a key player in this picture, we can also use platelet rich plasma, laser treatments and other techniques to make sure that the clitoris and vagina continue to act like a 30-year-old and not like an 80-year-old.
   
2. We need to clean up our resentment by making a commitment to tell the truth. This might sound easy, but it’s probably one of the most difficult challenges that I’ve ever committed to in my life. Telling the truth doesn’t mean saying that I’m right or that I have the truth figured out with a capital T; it means committing to saying what is true for me every moment of the day and expressing what I’m really feeling in a kind and timely manner, and not withholding parts of the truth or manipulating them to achieve a certain outcome.

We have to deal with whatever body image issues we are hanging onto that prevent us from wanting to be seen. While for women, body image issues often circulate around weight, there are plenty of others to choose from, and they have controlled many of our lives for way too long. Points 2 and 3 represent huge topics worthy of their own space, and I will take a deep dive into them in my next blog.

So Now For The Fun

Once we have remembered that sex is a celebration of life, love and connection based purely in generosity and joy, and have addressed the barriers above, it’s time for the fun to begin. One of the best parts about midlife is that we have developed some wisdom, self-awareness, openness, and a little more knowledge than when we were in our sexy 20’s. A certain freedom develops for us to try new things, buy new things, experiment with asking for what we want, listening to what our partners want, and becoming experts at self-pleasure. As sexy as women in their 20’s may seem, we were really pretty clueless. Before I reached my 40’s I didn’t even own a vibrator and was way too self-conscious to consider games like role-playing or acting out a sexual fantasy. Without a doubt, they best sex of our lives awaits us in midlife when we can forget the pressures of fertility, menstruation, trying to figure out who we are and all the other messy challenges of youth. We can simply be present, fully engaged, fully seen, and play.

If there is one thing I can leave you with, it is the promise that you have the choice to get your sexy back if you want to. As we say in my office, “She’s not dead, she’s just taking a nap. And you can wake her up.”