Navigating Sex During Perimenopause

Having considered himself quite the stud in his 20s, Tom, now in his 40s, is noticing it takes longer to get an erection. He doesn’t want the pressure of having to perform, so he decides to initiate sex less often.

Gabby, Tom’s wife, also in her 40s, discovers her sexual desire has gone underground. Between a demanding job, toting kids to and from school, and managing a home, she struggles to meet daily demands. Having sex with Tom falls to the bottom of her list—so Gabby puts sex on hold. (Besides, she notices that Tom doesn’t seem as interested in sex these days either.)

Sound familiar? It’s a common scenario for couples at midlife. Changes in hormones often beget changes in relationship. As a relationship therapist, I notice that partners are reluctant to talk with each other about their sexual relationship. The problem with keeping things hidden is that partners often make erroneous assumptions—they assume the worse. I encourage my couples to be transparent, because once their concern is brought into the open, it is often manageable.

Impact of Changing Hormones. Perimenopause—the transition to menopause—is an extended period of time where women’s bodies experience a precipitous drop in estrogen and progesterone. According to Dr. Christiane Northrop, periods may stop for several months and then return, and they may also increase or decrease in duration, intensity, and flow. The progesterone declines may result in trouble sleeping, weight gain, and irritability, while estrogen decline can beget vaginal dryness, decreased energy, hot flashes, and night sweats. Testosterone may also start to decline in women, causing a loss of sex drive, decreased sexual response, and decreased sensitivity in erogenous zones.

Men also experience a gradual drop of testosterone until age 60. Dr. David Schnarch, author of Resurrecting Sex, reports decreased testosterone in men spurs such symptoms as lack of energy, irritability, erection problems, hypersensitivity to touch, and decreased sexual desire.

Perimenopause doesn’t need to be the death of sex for couples. Dr. Stan Tatkin, PsyD, MFT and author of We Do, notes that when it comes to stress reduction, nothing compares to touch, which can facilitate a sense of well being better and faster than eye contact or vocal tone.

Differences in Desire. The most common issue I hear among couples during perimenopause is how to manage differences in desire between partners. Sex expert Emily Nagoski, PhD, author of Come as You Are, says low desire is likely not due to hormonal changes. What is predictive of low desire, she writes, is stress, depression, anxiety, trauma, and the nature of the couple relationship.

For example, stress due to family demands can drain a couple’s time and energy for sex. Not only are many perimenopausal couples dealing with the challenges of parenting, they may also be managing care for aging parents. Having to attend to so many needs can cause interest and desire to wane.

Dr. Nagoski has a helpful framework for addressing differing desire levels. Arousal, she explains, begins when we turn on the ons and turn off the offs. Desire then occurs when arousal meets great context. About 75 percent of men and 15 percent of women have a spontaneous sex-out-of-the-blue desire style. But about 30 percent of women and some men have a responsive style—wanting intercourse only after sexy things occur. Both inclinations are normal. The latter case is not indicative of low desire or brokenness when it comes to sex. (Read about mindful sexuality.)

One level of desire is not superior to another—just different. Problems arise when one partner is aroused and the other partner needs time. Exploring context can help. Dr. Nagoski recommends partners think back to the turn-ons in a positive sexual experience and the turnoffs in a less pleasurable one so as to incorporate those arousing factors into foreplay to address the needs of the partner with a responsive desire style. The more we understand how and what our body responds to, the better we can identify those cues—thus adding pleasure to our relationship.

Having awareness of perimenopausal changes and exploring new bridges to desire are vital to maintaining a happy, healthy sex life, according to Elizabeth Harrison, LCSW and AASECT sex therapist. Sex at midlife may feel different: What was once comfortable and exciting may now feel uncomfortable and dull. And night sex may need to move to morning sex—or whatever time is most accessible.

Confiding in Your Partner. Problems stemming from poor communication around sex, body issues, and sensory issues are abundant. Thus, honesty and collaboration are key. Couples frequently express concern that they aren’t having sex often enough and other couples must be having sex more—therefore they have a problem.

Dr. Tatkin maintains that there is no problem in the bedroom when partners are matched in libido, whether that means a lot of sex or very little sex. Couples should avoid comparing their sex life to their social media network or disclosing it among friends. A healthy step may be to forget what is culturally “normal” and talk about sex in terms of how you and your partner thinks and feels.

Individuals can harm their relationship when they make conclusions about their sex life without discussion with their partner. Instead, I recommend partners turn toward each other and talk about the changes they are experiencing as a couple. I suggest they create a menu of choices (think deep kissing and mutual back rubs) that feel loving and potentially arousing. Whatever feels safe and pleasurable is on the table.

Couples can create their menu somewhere where they can relax, be in each other’s eyes, and feel playful as they talk about their preferences. When they next want to make love, the roster items can serve as inspiration.

Flexibility during perimenopause is key. Partners become each other’s confidante, healer, and romantic partner—and that is sexy.

Read about yoga poses for functional fertility.