Sexual difficulties in middle age are just as natural to the aging process as a change in hearing, vision, or physical strength. While it’s important to understand why most men over 40 experience some form of sexual difficulty, it’s more important to understand that sexual difficulties in middle age (and beyond) can be managed.

Types of Sexual Difficulties

Ejaculation disorders
This includes premature ejaculation (the inability to delay ejaculation until it is mutually desirable by both partners), inhibited or delayed ejaculation (ejaculation that is slow to occur, or doesn’t happen at all) and retrograde ejaculation (ejaculate is forced back into the bladder rather than through the urethra and out the end of the penis at orgasm).

Premature ejaculation is the most common of these problems, especially among younger men. There are techniques men can use to help delay ejaculation—and using condoms may help too (and, as a bonus, they help protect against STIs and unintended pregnancy). While medications can play a role in ejaculation problems, both premature and inhibited ejaculation may have a psychological cause, like anxiety about sex or sexual performance, or sexual trauma. A qualified therapist or counselor may be helpful in resolving the issue, if this is case.

Retrograde ejaculation can be the result of side effects from medication, nerve damage, or surgery, such as prostate or bladder surgery. Depending on the cause, the treatment usually consists of changing an existing medication or prescribing a new medication. If surgery is the underlying cause, the condition may not be correctable. However treatment isn’t medically necessary—unless pregnancy is goal. In that case, treatment would be needed to allow a man to ejaculate semen through the penis.

Loss of Libidio
A loss of libido, also called inhibited desire, is a decrease in desire for, or interest in, sexual activity. This can affect both men and women, and for some of the same reasons—stress, depression, side effects of medication, or relationship problems. But loss of desire for sex in men can also be the result of a decrease in testosterone levels, which is natural as men age.

Erectile dysfunction
Erectile dysfunction, or ED, is the inability to achieve or sustain an erection suitable for sexual intercourse. While more common as men get older, ED is a medical condition that can affect men of any age. ED happens when there is not enough blood flows to the penis, preventing an erection. Causes are largely physical, but there can be psychological and lifestyle causes as well.

The majority of cases of ED have physical causes, often related to vascular diseases (related to blood flow) such as heart disease, high blood pressure and diabetes. It can also be caused by other types of physical conditions, like neurological problems (e.g. stroke or Parkinson’s disease), trauma to the pelvic area (including trauma from surgery, such as surgery related to prostate cancer), hormonal problems (e.g. thyroid disease) or chronic illnesses.

Sometimes there are psychological reasons behind ED. These might include depression, relationship problems, or a fear of intimacy. Lifestyle factors can also play a role, including drug abuse, alcoholism, smoking, obesity, and a sedentary lifestyle. Sometimes prescription drugs taken to treat a variety of conditions are the source of the problem (there are many prescription drugs that can cause ED.)

It is however, not uncommon to see ED in an otherwise completely healthy person, both physically and psychologically. Read more about ED here and check out our video on myths and facts about ED below.

Managing Sexual Difficulties

The quality of your sex life affects your entire life. So, if you’re having a hard time enjoying or desiring sex it’s important to find out why. There are a number of reasons for this, such as culture, background, and past sexual experiences. Emotional, physical, and psychological factors can affect intimacy and sex, too. These can include:

  • Relationship problems
  • Depression, anxiety, and stress
  • Age-related changes
  • Hormone changes
  • Certain medical conditions such as diabetes, heart disease, and multiple sclerosis
  • Medication side effects (for instance, from medicines used to treat depression, anxiety, and blood pressure)

Troubles with having sex or enjoying it are sometimes called female sexual dysfunction or female sexual difficulties (FSD). It can be life-long or can develop over time. FSD is defined as persistent problems with sexual response, desire, orgasm, or pain that causes you distress or strains your relationship with your partner. While every woman deserves a fulfilling sex life, more than 40% of women will have sexual difficulties at some point in their lives.

There are four main types of FSD:

  • Low sexual desire. Lack of interest in sex and sexual activity.
  • Sexual arousal disorder. Difficulty in becoming aroused or lack of sexual response during sexual activity.
  • Orgasmic disorder. Consistent difficulty (or inability) to reach orgasm.
  • Sexual pain disorder. Pain during intercourse (called dyspareunia) or with vaginal stimulation.

Many women experience one or more of these problems at one point or another, from trouble reaching orgasm or just not feeling “in the mood.” But for some women, these problems are ongoing and can affect a woman’s sense of well being and relationships.

The good news is that these problems can be treated. While there’s no magic bullet promising a quick and easy cure, there are ways to deal with sexual difficulties. The first step is to look at the possible causes.



There are a number of physicial conditions that can affect a woman’s sexual response and reduce pleasure and satisfaction. For example, conditions such as thyroid disease and diabetes can result in reduced vaginal lubrication which can make sex uncomfortable and less satisfying. Hormonal issues, such low estrogen levels, can also reduce lubrication and thin the vaginal lining, while lowered testosterone levels can lower the sex drive.

A decreased sex drive can also be the result of certain medications, including drugs to control blood pressure and some antidepressants, and can make it difficult for a woman to reach orgasm. Endometriosis, uterine fibroids, or vaginitis can all make sex uncomfortable or even painful, as can vaginal infections, pelvic surgery or bowel difficulties.


A woman’s sexual response involves not just the body but the mind, of course, and emotional factors play a role in sexual satisfaction. Anxiety, depression, and simply the stresses of everyday life can contribute to sexual problems, as can problems in a relationship. Issues with body image as well as religious and/or cultural factors can also contribute.

Dr. Pepper SchwartzListen to ASHA’s three-part conversation with sociologist and sexual health expert Dr. Pepper Schwartz on female sexual difficulties. She discusses the range of female sexual difficulties, the impact of sexual difficulties on a relationship, and offers practical advice and resources for women (and their partners). You can listen on ASHA’s website or via iTunes.

Sometimes the issues that lead to sexual problems are temporary – such as stress or medication use – and can be resolved easily. But when does the occasional difficulty become a real problem? If difficulties are ongoing and causing distress, then it may be time to seek help.

Finding Help for Sexual Difficulties

A healthcare provider can help you figure out what might be behind the difficulties you’re experiencing and find ways to resolve the problem. Your provider will likely ask you about:

  • your medical history
  • any medications or supplements you may take
  • your sexual history
  • current and past relationships

Depending on your symptoms and concerns, she or he may do a pelvic exam to look for signs of infection or irritation or perhaps a pelvic ultrasound to identify any anatomical issues. If psychological issues seem to be the principle cause of the problem, your provider may offer a referral to a counselor.

If your problem has a hormonal cause, such as low estrogen or a thyroid deficiency, the provider may suggest a medical treatment option. She or he might also suggest adjusting or changing your current medication whose side effects may be causing your symptoms. But there are also non-medical options that can help.

Communication: Talk to your partner about your concerns and problems you are having and what your needs are. A caring partner will be willing to work with you to find solutions.

Experiment: Sometimes trying something new can help. For example, if pain is an issue, try new positions to discover what might be more comfortable. To address a lack of arousal or trouble reaching orgasm, you might spend more time on foreplay, explore sensual massage, or experiment with vibrators or other sex toys to see what you find pleasurable. The Sinclair Institute is one resource that offers sexual health products for adults.

Lubrication: Vaginal dryness can make sex uncomfortable, even painful. While this can be a result of different problem and medications, is it also a common problem among post-menopausal women. Using lubricants can make sex more comfortable and enjoyable. For some women, local hormonal therapy, such as an estrogen cream, might be recommended by a provider.

Talk with a professional: A counselor or therapist who specializes in sexuality and sexual problems can help both you and your partner better understand your sexual problems and offer and strategies to improve intimacy. The American Association of Sexuality Educators, Counselors and Therapists (AASECT) allows you to search for a sex therapist or counselor in your area.