Q: My husband and I are in our late 50s, and while we love each other and have a happy relationship, we don’t have sex very often. We just don’t feel like it most of the time. I worry that we may be headed for trouble. Should we be having sex every week or is it okay to be happy without it?

A: There are a lot of myths suggesting that as we enter middle age, we lose interest in sex and start to decrease our sexual activity. The New England Journal of Medicine looked at this issue and found that between 10 and 51 per cent of women surveyed complained of too little sexual desire, low arousal and excitement, and infrequent orgasms. The article confirmed that the majority of women and men are capable of having active sex lives in middle age, but three factors are critical: hormones, environment and neurotransmitters.
I have often said our most important sex organ is our brain, and this article confirms that position. Hormonal changes in women and men, levels of estrogen and testosterone, fatigue, anxiety, stress, depression or other mood issues all affect our sexual lives. Other studies have looked at the quality of our marital relationship, the impact of changes in self-esteem, body image and emotional distress. In addition, factors such as medications, heart and other diseases, smoking and alcohol use can impact sexual desire and activity.
The problems you raise focus on frequency, satisfaction and arousal. In its RRISK study from 2006, The Kaiser Group found that the middle-aged group reporting satisfactory sexual activity were younger in age, had an established relationship, were better educated, did not smoke or use alcohol excessively, and had a low Body Mass Index.
See your doctor and provide a history from both of your perspectives; have a physical exam; and, if necessary, consult a psychologist for cognitive behavioural sex therapy.
Barry Worsfold is an adjunct professor of gerontology at Simon Fraser University in Vancouver, where he teaches courses in death and dying, sexuality and aging, and counselling issues for the elderly.
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