Whether you’re male or female, the basic necessities for sexual activity are the same: working sexual anatomy, normal hormone activity and enough physical and mental health to respond to another person. But when it comes to satisfying sex, men and women are different. Visual cues tend to propel men toward the tangible goals of erection, intercourse and orgasm. A woman’s sex drive can be just as potent, but an emotional connection to her partner plays a larger role in arousal and satisfaction. In a Kinsey Institute survey, women ranked an overall sense of well-being as their top prerequisite for satisfying sex, followed by positive feelings during lovemaking. The frequency of sex, and the intensity of physical pleasure, fell farther down the list. Depression, stress, past experiences and relationship conflicts can easily thwart sexual pleasure. Side effects of many medications, particularly some antidepressants, can also scuttle sexual desire. For women in their 30s and 40s, juggling the demands of career and family can dampen interest as well. It isn’t uncommon for sex to feel like one more thing on an already long to-do list.
The first step to a better sex life may be simply to talk about it. When couples manage to discuss sex openly, they not only identify problems and solutions but also strengthen the emotional bonds that foster satisfaction. While you should tell your partner what feels good (or doesn’t) during lovemaking, tackle larger issues–such as a mismatched sex drive or orgasm troubles–in a neutral setting. Exercise and relaxation techniques can help combat stress, and getting away together can strengthen frayed sexual bonds. Counseling and psychotherapy may ease the anger and resentment that often interfere with satisfying sex. And though many couples shy away from sex therapy, it’s a good way to improve communication and expand your repertoire of sensual pleasures.
Sometimes the obstacles to good sex are physical conditions. Endometriosis, vaginal or urinary-tract infections and vaginismus (vaginal spasms) can all be treated medically. And you don’t have to risk full-strength hormone therapy to counter the vaginal dryness associated with childbirth and menopause. Low-dose vaginal estrogen treatments can strengthen and lubricate the vaginal lining. Over-the-counter lubricants may help, too. Experts also point out a use-it-or-lose-it aspect of sex after menopause: regular sexual stimulation may help maintain vaginal lubrication and elasticity.
One promising pharmaceutical remedy is testosterone, the male sex hormone. Both sexes produce the hormone–men primarily in the testes, women in the ovaries and adrenal glands–and both experience desire and arousal in response to it. A woman’s testosterone levels peak during her 20s and decline slowly and steadily with age. In clinical trials, menopausal women receiving fairly high doses of testosterone report significant increases in sexual pleasure and satisfaction. But the side effects include unhealthy changes in cholesterol and liver function, not to mention acne, excess body hair and a deepening of the voice.
Estratest, an oral medication that combines estrogen and testosterone, was approved to treat estrogen-resistant hot flashes, but doctors also prescribe it for flagging libido. A new testosterone skin patch (not yet approved by the Food and Drug Administration) may also offer a safe and effective sexual boost for women with low testosterone levels. In a recent study of women whose ovaries had been removed, those who got active patches reported 30 percent more satisfying sexual activity than those given placebo patches. Sexual desire also increased.
Sex matters to women. But don’t despair at the first sign of trouble. Most couples don’t need a pill or patch to rediscover the joy of sex. That’s good to know, especially for women, because a woman’s sexual desire and satisfaction are inextricably tied to her sense of well-being and intimacy with her partner, things you’ll never find in a medicine bottle.
