A satisfying sexuality is a fundamental element of physical and psychological health and must be protected at any age. When problems arise, open communication between partners and medical support are the key to resolving the situation.
Sexuality is not just a source of pleasure, but an essential aspect of the physical and psychological health of every person, man or woman, regardless of age. This has been recognized and affirmed for several decades by the World Health Organization (WHO), which includes sexuality as one of the pillars of the official definition of health.
However, at every age, men and women experience sexuality differently and may encounter various issues that risk turning what should be an extraordinary source of balance and well-being into a significant problem, sometimes leading to the avoidance of sexual relations altogether to avoid feeling uncomfortable.
An essential concept to remember in these cases is that sexuality is never an individual matter, but an experience shared by a couple. It should be addressed as such, whether everything is going perfectly or something is wrong. There are many effective solutions in most cases, but they work best when handled together, with serenity, cooperation, and mutual affection.
The difficulties of youth
In youth, in the absence of specific pathologies of the genitourinary system or severe systemic diseases, the main sexual issues are generally related to insecurity and the fear of “not measuring up” (because one feels not fit enough, sensual enough, or “technically prepared”), or to inexperience and a lack of confidence with one’s own body, which leads to difficulty in managing one’s emotions and the physical reactions that accompany them.
All of these unresolved psychological difficulties can interfere with desire or lead to reaching the peak of pleasure too soon, too late, with great difficulty, or even never. These types of sexual dysfunctions include performance anxiety, erectile dysfunction, premature or delayed ejaculation on the male side, and insufficient desire, unpleasant or painful intercourse, and difficulty reaching orgasm on the female side.
Problems can arise from the very first sexual encounters and may be particularly difficult to face due to both partners’ limited experience and, often, the instability of their relationship. These early issues can affect the quality of future sexual life if not addressed early, by openly discussing it with one’s partner and/or seeking support from a trusted doctor or, if necessary, a psychologist specializing in sexual disorders.
Generally, disorders that have no clear organic basis are more common and significant in brief relationships and those marked by a lack of empathy, whereas they improve significantly (even disappearing) when a deep and lasting relationship is established, allowing for good physical and psychological harmony and a more relaxed and natural experience of sexuality.
On the other hand, even young, healthy, and initially well-matched couples may, at some point, lose interest in sexual activity or derive less pleasure from it. In such cases, the origin of the problem often lies in various factors, such as instability or work stress, concern over financial difficulties, exhaustion from too many commitments, lack of sleep, or an unhealthy lifestyle.
It should be remembered that smoking, alcohol, being overweight, lack of physical activity, and disorganized lifestyles are declared enemies not only of general health but also of sexual health (especially for men). Their negative impact is felt at every age and becomes increasingly pronounced as one approaches middle age.
Another critical phase for couples of childbearing age is pregnancy and the postpartum period, due to a mix of physical and psychological factors that can test both partners, for different and sometimes opposite reasons, especially during the first child.
Reduced desire, fear of harming the fetus, anxiety about becoming parents, physical and psychological disorders following childbirth, the arrival of the newborn, and the redefinition of family dynamics can seriously interfere with sexuality for several months, especially if these issues are not discussed within the couple and if support from the gynecologist (for the woman) and possibly a psychologist (for both partners) is not sought.
Disorders of middle age
Like all bodily functions, sexual function also changes over time, and while some may find this change bothersome or disappointing, it must be accepted as inevitable. However, it does have some positive aspects, such as increased experience, a more relaxed approach to sexual relations, a deeper understanding of oneself and one’s partner, etc.
In both men and women, the main factor driving this transformation is the gradual decline in the levels of sex hormones (androgens and estrogens, respectively) starting from the ages of 40-50, along with a gradual decrease in muscle and cardiovascular performance. Additionally, in many cases, the onset of health conditions or disorders can directly interfere with sexuality or affect it as a consequence of the treatments required to manage these conditions.
In men, for example, many cardiovascular diseases, type 2 diabetes, and prostate disorders can reduce the ability to achieve or maintain an erection. Similarly, medications needed to lower blood pressure or blood sugar, treat coronary heart disease, or manage the symptoms of benign prostatic hyperplasia, improve heart function in cases of atrial fibrillation, or heart failure, can also have an impact.
In women, sexual function can be affected by ovarian, thyroid, or pituitary dysfunctions, as well as symptoms associated with menopause or post-menopause, starting with decreased lubrication and gradual changes in the sensitivity and structure of the vaginal mucosa (all changes that can result in unpleasant or painful intercourse).
Psychological distress should also not be overlooked, as it can become particularly widespread and pronounced in women over 40, with depression and anxiety being the most common conditions (which are less frequent in men). The negative effects of certain medications needed to treat these conditions (antidepressants, mood stabilizers, etc.) can also affect sexuality. On the psychological front, especially when facing a new partner, older individuals may experience issues related to concerns over their body not being aesthetically desirable, at least according to prevailing standards. In such cases, greater self-awareness and a bit of self-irony are key to success.
How to solve the situation?
Since sexuality is a matter for the couple, the first piece of advice for addressing any physical or psychological issues is to talk openly with your partner, with simplicity and serenity. This will also help the partner avoid feeling like the “cause” of the reduced desire or lesser pleasure and will increase the level of intimacy and cohesion in the couple. Sometimes, it will also make it easier to find an appropriate solution together.
If sharing the problem and tackling it together with simple strategies (such as creating more stimulating situations, extending foreplay, changing positions, adjusting the timing of orgasm, etc.) is not enough to improve the situation, the next step is to consult a trusted doctor to check overall health, evaluate the specific issue, and determine possible interventions to alleviate it (e.g., medications for erectile dysfunction or hormone therapies).
Consulting a doctor before taking any medication or supplement is essential, as medications to improve sexual performance may have various side effects and can be dangerous in certain clinical contexts. Additionally, sometimes sexual dysfunction may be a sign of an underlying undiagnosed condition that needs to be evaluated and managed (such as cardiovascular diseases, hormonal disorders, or prostate problems).
When sexual dysfunction appears to be related to genitourinary issues, it is important to seek a gynecological consultation (for women) or andrological/urological consultation (for men). Especially after the age of 50, it is primarily at this level that disorders can arise that significantly reduce the ability to have satisfying (or any) sexual relations. It is crucial to have an experienced specialist explore the causes and suggest appropriate solutions, whether pharmacological or surgical.
Sources:
- National Institute on Aging – NIH (https://order.nia.nih.gov/publication/sexuality-in-later-life)
- Mayo Clinic (https://www.mayoclinic.org/diseases-conditions/female-sexual-dysfunction/symptoms-causes/syc-20372549)
- Mayo Clinic (https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776)
- Mayo Clinic (https://www.mayoclinic.org/diseases-conditions/premature-ejaculation/symptoms-causes/syc-20354900)
- Mayo Clinic (https://www.mayoclinic.org/diseases-conditions/delayed-ejaculation/symptoms-causes/syc-20371358)
- von Hippel C et al. Sexual Function among Women in Midlife: Findings from the Nurses’ Health Study II. Women’s Health 2019;29-4:291–298
- Hatzichristou D et al. Clinical Evaluation and Management Strategy for Sexual Dysfunction in Men and Women. Journal of Sexual Medicine 2004;1(1):49-57
- Knoepp LR et al. Sexual Complaints, Pelvic Floor Symptoms, and Sexual Distress in Women over Forty. Sex Med 2010;7:3675-3682
- Avasthi A et al. Clinical Practice Guidelines for Management of Sexual Dysfunction. Clinical Practice Guidelines for Management of Sexual Dysfunction. Indian J Psychiatry 2017;59(Suppl 1):S91-S115
- Mernone L et al. Psychobiological Factors of Sexual Functioning in Aging Women – Findings From the Women 40+ Healthy Aging Study. Frontiers in Psychology 2019;10:546
