How to enjoy a healthy sex life after 40
Age is no barrier to desire and performance. Studies show simple steps can improve sexual function
How much sex are we having? It depends who you ask. Last year, research by Relate on adults over 16 showed half had not had sex in the past month, but add middle age to the equation and it seems the older we are, the healthier our sex lives are becoming.
New research conducted by dating website illicitencounters.com has found that sign-up among the over-40s has doubled in the five years since its launch, with almost 50pc of married men and 36pc of married women over 40 reporting having had sex up to five times in the past month.
Meanwhile, a landmark study on 7,000 retirees from Manchester University last year showed more than half of men and a third of women were still sexually active over the age of 70.
While age doesn't have to be a barrier to a fulfilling sex life, however, biological changes can have a significant impact on libido and performance. So, what really happens to sex drive as we age and, more importantly, once it's lost, what can be done to get it back?
Prescriptions for Viagra-like drugs - used to treat erectile dysfunction (ED) in men - have escalated in the past decade, with a staggering €57m spent by the HSE on 167 million Viagra pills for medical card holders between 2009 and 2014. Private patients' prescriptions are not recorded.
But heartening research on 25,000 middle-aged men published last week in the American Journal of Clinical Nutrition found that consuming three or more portions of foods such as red wine, blueberries, cherries, citrus fruits and radishes could reduce a man's risk of developing ED by 14pc. Men who exercised regularly reduced their risk by 21pc.
"These benefits are to do with flavonoids in these foods," says Rob Hobson, a clinical nutritional therapist and coauthor of The Detox Kitchen Bible (Bloomsbury Publishing, €37.50).
"These compounds are known to help preserve blood vessel health and improve blood flow, which is essential to erectile functioning."
Libido, age and your hormones
"As you reach middle age, libido becomes a bit like the stock market," says Dr Ian Kerner, a sex psychologist based in New York City and author of She Comes First: The Thinking Man's Guide to Pleasuring a Woman (Souvenir, €22), one of the highest-selling sex advice books in the United States.
"It's up and down from day to day and reflects underlying dynamics such as relationship health and the participants' diet, exercise and self-esteem," he says.
Declining sex hormones play a big part in both desire and sexual functioning as we age. In men, for every year after 40, the sex hormone testosterone drops by about 1pc, with one-in-five men tested showing low levels, says Vivek Wadhwa, a consultant urological surgeon.
"Along with low sex drive and erection problems, this can cause symptoms such as lethargy, poor sleep and short-term memory loss."
It's also common for men's erections to become less reliable after 40, says Cate Campbell, a psychosexual medicine specialist and author of The Relate Guide to Sex and Intimacy (Vermilion, €13). "This distresses people," she says, "but few realise not only is it normal, it needn't stop them enjoying sex as men can still orgasm without a full erection."
Still, "there's no point simply prescribing Viagra if a man's testosterone is low," says Wadhwa. Your GP can refer you to a urologist who can measure testosterone levels and, if needed, prescribe replacement through gel, patches or injections.
However, he advises that men see a specialist urologist "as testosterone supplementation in men with an undiagnosed prostate cancer can feed its growth".
If testostorone doesn't work, however, drugs such as Viagra or the newer Cialis can be taken.
While the former takes about 40 minutes to work and can be taken up to twice a week in 50-100mg dosages, the latter can be taken in a 5mg once-a-day dosage. This means "levels in the blood stay stable, so the sex needn't be planned," says Wadhwa.
If you have erectile dysfunction, ensure you have a screening for cardiovascular disease risk before taking drugs.
"Erectile dysfunction can signal heart problems up to 10 years before disease shows," he says.
Sex and the menopause
Sex researchers Masters and Johnson found that in middle age, women tend to take less time to reach orgasm than men, but hormones can still have an impact.
From about 45 onwards symptoms of low oestrogen can make sex more painful which in turn reduces desire, says Dr Shirin Irani, a consultant gynaecologist. Locally applied oestrogen cream - which can be prescribed by your GP - in small doses she says "is like using a very expensive night moisturiser". Applied for three months twice weekly it moisturises the cells and restores natural secretions, she explains.
While many women fear taking Hormone Replacement Therapy (HRT) because of the highly publicised debates over its increased risk of breast cancer, this is a tiny dose - 10 micrograms compared to 1000 in a typical HRT pill - and "too low a dose to enter the blood circulation".
Whether you're male or female, lifestyle measures can help, says Ian Kerner. "Weight training for example can stimulate natural increases in testosterone and subsequently sex drive," he says. Short cardiovascular exercise can also help.
One 2012 study published in the Journal of Sexual Medicine found that 20-minute bursts of exercise done 5-15 minutes before sex where the heart rate is at 70pc its maximum capacity could enhance the speed of a woman's arousal.
The myth of desire in middle age
Don't fancy it tonight? Get started anyway, say experts. "For about a third of men and the majority of women over 40, desire doesn't begin until they're aroused," says Cate Campbell. "It's often why people might have a lovely kiss and then find themselves wanting sex even if they didn't want it to begin with."
Known as subjective arousal, this get-started-then-get-down approach is thought to be essential to over-40s' sexual desire because we're simply not thinking about it all the time like we were in our 20s, says Ian Kerner.
This is currently a boom area in product growth with everything from 'female viagra' to devices like Soraya Luxury Rechargeable Vibrator (€194.50, from Ann Summers O'Connell Street, Dublin, and also available online) which comes with a lubricant moisturiser gel, becoming the holy grail for companies looking for solutions for what is dubbed the middle age 'sex problem'. © Daily Telegraph
4 things no one tells you about sex over 40
1 Your risk of infection is higher. Thinning skin around the genital area can increase the risk of sexually transmitted infections (STIs), which peaked in the over-50s last year along with thrush and urinary tract infections (UTIs).
2 A strong pelvic floor isn't just for preventing leaks. It can increase your ability to orgasm. For women, the Pericoach €191 is a new medical device and app proven to strengthen the pelvic floor, see pericoach.com.
3 Antidepressants can hinder sex drive. Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants can hinder sex drive and ability to reach orgasm in up to 70pc of users - talk to your doctor as some types may have fewer effects.
4 Sex therapy works. Repeated studies have shown its effectiveness but you might need to sign up to a six-week sex ban in order to break bad habits, says Relate's Cate Campbell. Ask your GP to recommend a sex therapist.