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Let's Talk About Sex: In Your 40s
It tends to get really good when people reach their 40s. But health issues can get in the way.
Helen Massy
Written by

Helen Massy

The 40s are a decade where people can fine-tune their sex lives, said Carol Queen, Ph.D., the staff sexologist for Good Vibrations, a sex-positive toy retailer with stores in California and Massachusetts, and the author of the company's "The Sex & Pleasure Book."

"Sex in your 40s can change for many reasons, such as finding yourself in an empty nest or going through a separation or divorce," she said, adding that for many people with a partner, this could prove a period of sexual exploration.

Inevitably, you will experience some physical and hormonal changes, but by the time you reach your 40s, you often develop more sexual confidence and a stronger sense of sexual self. Many people prefer sex at this age compared to in their 20s because they know what they want and how to get there.

Changes in men

As men age, their erections generally tend to lose quality, according to Michael Werner, M.D., a fellow with the American College of Surgeons and the medical director and founder of Maze Sexual & Reproductive Health, with two locations in New York.

"Also, testosterone levels can begin to drop, which can affect libido, energy, mood, focus and sometimes erections," Werner added.

Justin Houman, M.D., a reproductive urologist and men's health specialist at Tower Urology at Cedars-Sinai Medical Center in Los Angeles, noted that anywhere between 40 and 50 percent of men experience erectile dysfunction (ED) in their 40s.

"This can have a knock-on effect on a man's libido," Houman said. "If you're having difficulties with ED, it makes you less enthused about having sex."

Another concern with regard to ED is atherosclerosis—that is the narrowing of the arteries—which increases your risk of a heart attack. Between 35 and 45 years old, Werner said men can begin to experience vascular issues. Because the arteries in the penis are so narrow, erectile dysfunction in this age group can be a warning sign of a wider cardiovascular problem.

"It's your body's way of letting you know you're at a higher risk of a stroke or heart attack," Werner said. "If the arteries are narrowing in the penis, then it's likely happening all over your body."

So if you start to have problems with ED, it's worth getting a few heart health checks done, too.

Houman further noted that having kids also impacts testosterone levels and your sex life.

"Studies have shown that male testosterone levels drop during the time of childbirth and after childbirth," Houman said.

In fact, this drop in testosterone levels is thought to be an evolutionary response beneficial for the family. Researchers theorize that the more testosterone levels drop after the birth of a child, the more interest men have in caring for their child, supporting their partner and investing in the family unit. However, mixing these lower testosterone levels with the fatigue of having children, working in a stressful job and generally balancing life can mean a man's libido and sex life take a hit.

Of course, it's different for everyone and very much dependent on one's stage of life. If you decided not to have children or are past the stage of raising babies, then you may be at a point in your relationship where you can spend more time with your partner and your sex life has soared. A loving and committed relationship that has weathered life's challenges can result in great sex. On the flip side, if you are beginning a new relationship after a separation or a divorce, you could be exploring a whole new world of sexual adventures.

There's no one-size-fits-all roadmap to sex. But being aware of problems like ED and decreasing testosterone and how they can affect your sex life means you're more likely to notice and deal with them quickly, before they become major health issues.

Changes in women

At the end of your 30s, moving into your 40s, fertility begins to decrease, said Linda Burkett, M.D., a physician in the department of obstetrics and gynecology at VCU Health in Henrico, Virginia.

"It's not so much the changes in progesterone and estrogen that start to happen, but studies show that your androgen levels can begin to decrease as early as your 30s and 40s," said Burkett, who specializes in pelvic health and urogynecology. Although usually described as male hormones, androgens—testosterone and androstenedione are two of the primary ones—are present in both men and women. They are thought to play a role in sex drive and sexual desire.

Burkett advised that treatment options are available for sexual desire dysfunctions approved for use by pre-menopausal women.

"If you've tried everything but your sexual desire has significantly changed and it's affecting your relationship, then speak to your doctor," she added.

Again, the stage of your family can impact your sex life. You may find more family stress from your parents or relatives in your 40s as they begin to age and need more support. Career stress can be high. All these pressures can affect stress levels, sleep and sexual desire.

For women in this period of life, Burkett gives them something she dubs "permission."

"It's permission to go and seek what will make you happy and turn you on," Burkett said. For example, give yourself permission to order a vibrator or read an erotic book.

"Sex might start to look a little different," she added, explaining that the way you want to participate in sex might change. Masturbation, oral sex or using sex toys may provide as much satisfaction as you need.

"Sometimes, it takes a healthcare provider to broach that discussion and help you and your partner talk about it," Burkett noted.

She also suggested that if you're having problems engaging in sex with your partner, opening up communication can often make a positive difference.

"It can be as simple as talking through what you both like and don't like sexually and finding ways to be together again," she said. "A third party is sometimes needed to help talk about those topics and take away the embarrassment."

Setting aside time for each other is another important aspect of maintaining a healthy sex life. We schedule everything else into our lives, so why not book some time for your relationship? Book date nights or activities you enjoy with each other. A little planning can go a long way toward a happy sex life.

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