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Sex and the Midlife Woman

New research finds surprises about how sexually active women are at this age

By Rita Rubin | March 3, 2014

You’re probably familiar with the maxim that midlife women don’t like sex as much as they did in their younger days. You might even believe it.

But Dr. Holly Thomas would beg to differ. In a study published today, Thomas and her co-authors found that most sexually-active midlife women stay that way.

“I think there is a cultural bias,” says Thomas, a general internal medicine fellow in women’s health at the University of Pittsburgh Medical Center. “Culture tells us that this (sex) is something older women shouldn’t be interested in.”

(MORE: 8 Reasons Why Sex is Better After 50)

Thomas’s research, funded by the National Institutes of Health’s National Institute on Aging, involved 602 women, virtually all heterosexual, who were between age 40 and 65 when the study began in 2005.

Each year, the women completed a questionnaire about their health, menopausal status and symptoms, sexual activity (ranging from kissing to intercourse) and demographic characteristics, such as whether they were married or in a committed relationship.

In the fourth year of the study, the women completed a brief questionnaire called the Female Sexual Function Index (FSFI), which is commonly used by researchers to assess women’s sexual function and asks about their “sexual feelings and responses during the past four weeks.”

Rating the Importance of Sex

Thomas and her co-authors also asked the women about the importance of sex in their lives.

Two-thirds of the women in year four said they were sexually active, so they formed the baseline group for the study. Four years later, 85 percent of that group said they remained sexually active.

(MORE: Before Menopause, There's Perimenopause)

Thomas says research that she and her co-authors haven’t yet published found, not surprisingly, that “whether a woman has a partner available or not is one of the biggest predictors of whether women will continue to have sex.”

Being white, having a lower body mass index (BMI) and placing a higher importance on sex were also associated with maintaining sexual activity, Thomas’s team reports in JAMA Internal Medicine. “A woman’s age and whether she had gone through menopause didn’t seem to be important to whether women continued to have sex,” Thomas says. “We were surprised to find that.”

And women’s scores on the FSFI weren’t relevant, either, leading Thomas to conclude that the questionnaire may be too narrowly focused on vaginal penile-intercourse.

Broadening Definitions

“Other aspects of sex may become more important to women as they get older,” she says. “I think it is important to keep a broad definition when we look at sexual function in this population.” She and her co-authors write: “As women age, kissing and intimate touching become more important relative to penetrative intercourse.”

(MORE: Boomers Redefine Sex as Extended Foreplay)

Menopausal and postmenopausal women consistently score low on the FSFI because of physiological changes in hormones, blood flow, muscles and nerves that can make intercourse painful, Dr. Rossella Nappi, director of the Gynecological Endocrinology and Menopause Unit at the University of Pavia in Italy, noted in an email to Next Avenue. “Therefore, not every woman at menopause is dysfunctional.”

In an article published this month in the journal Climacteric, Nappi writes that about half of postmenopausal women experience vaginal discomfort attributable to a chronic condition called vulvovaginal atrophy. Symptoms include vaginal dryness, soreness, itching and burning. Unfortunately, awareness of the condition is low among women as well as their health-care providers, she writes in the article, even though it has “a significant impact on sexual health and quality of life.”

Sex is Good for You

But safe and effective treatments are available, Nappi writes. In the U.S., they include vaginal estrogen and ospemifene, a non-estrogen oral pill approved last year by the Food and Drug Administration and sold under the brand name Osphena. Nappi is on the European board of Shinogi, which markets the drug (another company manufactures it).

Thomas says she and her co-authors “want to emphasize that just because a woman might be middle-aged, if she comes to her doctor with a sexual complaint, the doctor shouldn’t just automatically brush her off [with] ‘oh, that’s a normal part of aging.’”

Women who find intercourse painful might avoid any kind of sexual contact and report low sex drive, but “other women still engage in non-penetrative sex, kissing, etc.,” Nappi says. “I believe the most important issue here is to help people to understand that sexual health is an important part of physical and mental health.”

Clearly, sex is one of those rarities: something that’s not only pleasurable but good for you, too.

Says Thomas: “Those who are sexually active tend to live longer and have a higher quality of life.”


Rita Rubin is a former USA Today medical writer who now writes about health and science for publications including Next Avenue, U.S. News, WebMD and NBCNews.com.