Dear Sex: We Need to Talk.

Remember when sex was spontaneous?

😂😂😂

Cute.

Now it requires approximately the same level of planning as an international business conference.

"Hold on... Did we lock the door? Did someone feed the dog? Is one of the kids still awake? Did I answer that email? Why does my shoulder hurt? Do I smell like garlic? Is that a hot flash? Hang on—I need chapstick."

Nothing says take me now quite like mentally adding toilet paper to the Costco list while someone is kissing your neck.

And somewhere around 40-ish, a lot of women start wondering:

Wait. What happened to me?

Maybe sex doesn't cross your mind anymore. Maybe you still want sex, but your body apparently didn't get the memo. Maybe everything works, but it takes approximately 47 minutes and a very specific set of circumstances. Maybe penetration suddenly hurts. Maybe your orgasms aren't as strong. Or maybe you look at the person you've loved for twenty years and think:

"I love you dearly. Please stop touching me."

Welcome to midlife sexuality.

Nobody gave us the brochure.

Let's Discuss the Great Bait-and-Switch

For years, sex may have been relatively straightforward. You thought about sex, wanted sex, had sex. Your body generally cooperated.

Then hormones start changing and suddenly the equipment has developed terms and conditions.

Estrogen receptors exist throughout the vulva, vagina, urethra, and bladder. As estrogen declines, those tissues can become thinner, drier, less elastic, and more easily irritated. Blood flow and lubrication can change. The clitoris and vulvar tissues can become less sensitive. It may take longer to become physically aroused, and orgasms can feel different or require more stimulation than they used to.

There's actually a name for many of these changes: genitourinary syndrome of menopause, or GSM.

I realize "genitourinary syndrome of menopause" is perhaps the least sexy collection of words ever assembled.

Nevertheless, it matters.

GSM can cause vaginal dryness, burning, irritation, painful sex, urinary urgency, recurrent UTIs, and that delightful sensation of suddenly being very aware that you own a vagina.

And unlike hot flashes, GSM generally doesn't just disappear when menopause is over.

So if sex suddenly feels like someone replaced your vagina with sandpaper, please don't accept, "Well, you're getting older" as a treatment plan.

We can do better than that.

But My Vagina Is Fine. I Just Don't Want Anyone Near It.

Also fair.

Because sexual desire is not just a vagina problem.

Libido is influenced by hormones, yes, but also dopamine, medications, sleep, stress, depression, anxiety, ADHD, body image, relationship dynamics, pain, caregiving, and whether you've had another human touching you approximately every seven minutes since 2004.

And then there's testosterone.

Women make testosterone too—considerably less than men, obviously, but it still plays a role in sexual desire and arousal. Testosterone levels change with age, and for some women, low sexual desire becomes significant enough that it causes real distress.

But—and this is important—there isn't one magical hormone level where I can point to a lab result and announce:

AHA! WE HAVE LOCATED YOUR LIBIDO.

I wish.

Sexual desire is considerably messier than that.

Here's the Thing Nobody Tells Women About Desire

Sometimes you don't want sex.

But sometimes...

you don't want to START sex.

Huge difference.

We tend to think sexual desire is supposed to work like it did when we were 22. You're sitting there innocently folding laundry when suddenly:

"SEX. I WOULD LIKE SEX NOW."

That's spontaneous desire, and some women continue experiencing plenty of it.

But responsive desire is also completely normal, particularly in long-term relationships and as we get older.

Responsive desire can look more like:

"Sex? Meh."

Then your partner kisses you.

"Okay, that's nice."

Then you keep kissing.

"Ohhhhh. Right. I like this."

Your body essentially says, "I wasn't hungry, but now that you've brought out the appetizers..."

That doesn't necessarily mean something is wrong with your libido. Sometimes your ignition system changed.

You used to turn the key.

Now apparently we need to preheat.

And Then There's the Mental Load

Here's something no hormone panel is going to capture:

It's difficult to transition directly from household air-traffic controller to sex goddess.

If your brain is currently tracking a work deadline, your mother's doctor's appointment, whether the dog got his medication, which kid needs poster board tomorrow, the weird noise the washing machine is making, and the fact that nobody but you seems capable of noticing that you're out of milk...

"Hey babe, wanna fool around?" may not immediately ignite the fires of passion.

Your brain is part of your sexual response.

A very large part.

Arousal requires enough psychological space to actually notice what's happening in your body. Stress, resentment, exhaustion, distraction, and feeling chronically responsible for everyone else's needs can make that remarkably difficult.

Which brings us to...

Can We Also Talk About Men?

Bless them.

Some of them believe foreplay begins approximately 17 seconds before penetration.

Sweetheart.

Foreplay started at 7:15 this morning when you unloaded the dishwasher without being asked.

It continued when you remembered my coffee order.

Things were getting downright erotic when you handled bedtime without asking me where the pajamas were.

And when you scheduled your own dentist appointment?

Sir.

Take your pants off.

I'm joking.

Mostly.

But there is a real point here: emotional connection, feeling cared for, novelty, affection, equitable partnership, and having enough mental space to actually inhabit your own body can all influence desire.

The female brain is attached to the female body.

If my brain is still running tomorrow's agenda, the rest of me may not be coming to the party.

Sometimes It Isn't Desire at All

This is why I don't love when every sexual complaint gets dumped into the bucket labeled LOW LIBIDO.

Maybe you want sex, but it hurts.

Maybe you become mentally aroused but don't lubricate the way you used to.

Maybe you can orgasm, but it takes longer.

Maybe your pelvic floor is too tight.

Maybe you've developed vulvar pain.

Maybe your antidepressant is making orgasm nearly impossible.

Maybe you're exhausted.

Maybe your relationship is struggling.

Maybe you're having hot flashes and nothing makes you feel quite as alluring as spontaneously bursting into flames.

Those are different problems.

And they have different solutions.

Which is why the conversation should be more sophisticated than:

"How's your sex drive?"

Fine.

What does fine mean?

Are you interested in sex? Do you become interested once sexual activity starts? Does your body become aroused? Is penetration comfortable? Can you orgasm? Has orgasm changed? Are you avoiding sex because it hurts? Do you like the sex you're actually having?

Those answers tell me much more than a testosterone level ever could.

Please Stop Having Sex That Hurts

I would particularly like to retire the idea that painful sex is simply the price of admission for getting older.

No.

Pain is information.

If penetration hurts, something needs to be evaluated. Depending on the cause, treatment might involve lubricants or vaginal moisturizers, vaginal estrogen or other prescription treatments, pelvic floor physical therapy, treating an underlying vulvar condition, changing medications, or addressing something else entirely.

And while we're here: lubricant is not an admission of defeat.

It is a product.

Use it.

Nobody stands in the kitchen staring at a dry skillet saying, "If this pan really loved me, it would lubricate itself."

Sex After 40 Can Actually Get Better

Here's the part nobody puts on the menopause symptom checklist.

Sex after 40, 50, and beyond doesn't have to be a sad imitation of the sex you had at 25.

It can be better.

You know your body better. You're hopefully more comfortable saying what you want—and what you absolutely do not want. Pregnancy may no longer be hanging over every encounter. The kids eventually leave the house. You've had enough life experience to understand that nobody gets an award for pretending mediocre sex is fantastic.

And sometimes your body changing forces you to expand your definition of sex.

Maybe you need more time.

More stimulation.

More lubricant.

Different stimulation.

A vibrator.

A different position.

Actual foreplay.

Tuesday afternoon instead of 10:30 p.m. when you're both essentially corpses.

None of that means your sex life is failing.

It means you're adapting.

So, Dear Sex...

We've been together a long time.

You've changed.

I've changed.

Apparently my vagina has opinions now.

Fine.

But I'm not willing to accept that aging means sex becomes painful, obligatory, nonexistent, or something I used to enjoy back when my knees didn't make noises.

If something has changed, let's figure out what changed.

Hormones?

Desire?

Arousal?

Pain?

Medication?

Sleep?

Stress?

Relationship?

Pelvic floor?

All of the above because apparently we're overachievers?

There are things we can do about all of those.

Because women deserve good sex throughout their lives—not just reproductive-age sex, not just married sex, not just penetrative sex, and definitely not "Well, I guess this is as good as it gets" sex.

Good sex.

Whatever that means for you.

And if your body changed the rules?

Fine.

We'll learn the new game.

But for the love of all things holy...

somebody unload the dishwasher first.