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Midlife sex can be an intimacy challenge

By David Rogers
NY TIMES NEWS SERVICE, PALM BEACH, FLORIDA
Sunday, Apr 16, 2006, Page 19

"Men are very goal-oriented. They believe in the here-after. An orgasm is what they are here after."

Alan Altman, assistant professor,Harvard Medical School

A number of factors -- family responsibilities, work pressures, body image and physical changes -- can put a damper on a woman's desire for sexual intimacy in midlife.

Sometimes, a lack of desire is based in physical discomfort. After menopause, women can find intercourse painful, according to Alan Altman, an assistant clinical professor of obstetrics, gynecology and reproductive biology at Harvard Medical School.

The majority of time, however, others issues are respon-sible for decreasing the desire of middle-aged women to have sex, Altman told an audience here recently.

"Men are very goal-oriented. They believe in the hereafter," Altman said. "An orgasm is what they are here after."

"Women's sexuality has a lot to do with intimacy. It has a lot to do not so much with foreplay so much as after-play and between play. If after sex he rolls over and starts to snore, that's not going to stimulate her to want to have sex again the next time," said Altman, co-author of Making Love the Way We Used To ... Only Better (Contemporary Books).

The kind of day a woman has had and the way her husband or partner has treated her before he initiates intimacy can influence how receptive she will be, Altman said.

"I've heard numerous times, `If he'll take out the garbage and help me in the kitchen, I'll feel better about having sex with him,'" he said.

"There are so many things that go into it," Altman said. "The kind of power play that goes on between the two of you goes into it. Everything enters into desire. [It's] far more complex than arousal."

Exercising and eating right keep the body more healthful and more capable of sexual intercourse, he said. Those steps also decrease body image issues.

Quite often, a women's desire will wane if her partner starts having performance trouble, Altman said.

"Fifty percent of men over 50, 60 percent over 60 and 70 percent over 70, have some degree of erectile dysfunction. That's a lot of guys," he said. And the more men worry, the more likely they will not be able to perform.

Women, feeling sympathetic for their partners, will tell themselves they no longer desire sexual intimacy.

"So he's staying away from her and she doesn't want him to feel badly, so she now builds these protective, defensive walls around her. `I don't need to have sex,'" Altman said.

When a man starts taking a pill to restore his ability to perform, his female partner should be informed and should be given time to adjust to the idea of increased sexual intimacy, he said.

Although recent studies indicated estrogen-only hormone replacement therapy can increase the risk of ovarian cancer, Altman said a topical Estrodiol gel can be helpful in certain cases for postmenopausal women experiencing vaginal dryness.

Using a limited dose of synthetic testosterone off-label can increase the libido for some postmenopausal women, Altman said. Each woman's needs are different, Altman added.

Just staying in the game helps maintain sexual health, he said.

"I write prescriptions for my patients [and say]: `Bring this home to your partner: Have sex once a week.'"
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