Everything you want to know about sex after 50 but were afraid to ask

When my friends and I were new moms in our thirties, the thought of our parents having an active sex life at 50 or 60 was unthinkable, In fact it was downright cringeworthy. I recall a past conversation during a park outing with friends. My neighbor, Mackenzie, shared her new disturbing realization: parents don’t stop being sexually active. Our friend’s mom, Debbie, quickly confirmed this, much to the mild horror of her daughter, who, by now, is used to her mother’s frankness on the subject. Fast forward a couple of decades, and here we are, realizing that sexual intimacy doesn’t just fade away with age. Instead, it evolves, just like everything else in life.

How menopause and hormones impact female sexual health

These conversations, once unimaginable, are now essential. Sexual health at midlife is complex—affected by hormonal changes, physical shifts, and emotional dynamics that impact how partners connect. Dr. Kristen Austin, an OB/GYN with Swedish Health Services in Washington state, shared that many of her female patients struggle with libido changes, discomfort, and emotional shifts due to menopause. “Patients often say they don’t feel like themselves anymore,” she explains. “Many don’t have the same energy or ability to achieve orgasm, and some experience a mismatch in desire with their partner.”

Besides menopause, Dr. Austin also sees many female patients who’ve had breast cancer, and their hormone status is even more affected because they’ve been told they shouldn’t be on hormones. It’s important to find a medication each patient is comfortable taking, without side effects. Additionally, some patients have had their ovaries removed, which brings similar issues. Dr. Austin strives to educate patients about what they’re experiencing. For example, she explains women have more testosterone than estrogen receptors in the vagina. Ovaries produce testosterone and in menopause, or when ovaries have been removed, this isn’t being produced and can affect libido.

Physical vs. emotional causes of low libido

Dr. Austin says, “I do a lot of investigation to determine if the cause of decreased libido is more physical or emotional.” If the cause is determined to be physical, she may refer a patient to a pelvic health specialist. OBGYN’s have a relationship with these specialists so she’s able to hear back and close the loop. Alternatively, she may ask a patient if they’re able to achieve arousal and orgasm when alone versus with a partner, which would indicate more of an emotional than physical cause. In this instance, she will refer patients to a network of therapists with accreditation in intimacy. While this is fairly common knowledge, unfortunately, therapists and OBGYN’s don’t have a regular dialogue with each other. Therefore, it’s up you as the patient to keep your provider informed.

Understanding male sexual health after 50

Women aren’t the only ones seeing change. Men too may experience any range of issues which understandably affect confidence and intimacy. Dr. Ksenija Stefanovic, a urologist with Virginia Mason Franciscan Health in Seattle, WA says, “I see patients who may be experiencing anything from changes in libido or arousal (erectile dysfunction) to orgasmic difficulty, premature or delayed ejaculation, pain, or penile deformities. Sometimes one thing affects another.” For example, a patient may experience premature ejaculation, but no pleasure or vice versa. Like Dr. Austin, Dr. Stefanovic will complete a full exam and dialogue with her patients to gain a complete picture of the patient’s issues, which of course determines treatment. Depending on the issue, she may recommend hormonal treatment (it’s not just for women) that can be administered topically, orally, or via injection in the muscle or even implantation of pellets. Other options include the use of an external vacuum or implant surgery. While not FDA approved, sound wave therapy, available from reputable clinics like the Cleveland Clinic, is another option. Another reason physical symptoms shouldn’t be ignored is because erectile dysfunction and low desire can be signs of heart disease. See my article “Battle of the Sexes: Health Edition.”

Beyond physical changes, midlife relationships face other challenges—empty nest syndrome, new relationships, or medication side effects. Regarding medication, while it’s good that attention is being given to improving mental health, there’s not a lot known about the sexual side effects of different medications. Perhaps in the future there will be more emphasis on this. Furthermore, when treating patients, Dr. Stefanovic stresses psychological factors can’t be overlooked. She says, “I will always ask about sexual health in addition to physical health because there may be overlap.” This affects treatment too. For example, Cialis can be used for both sexual dysfunction and voiding issues like overactive bladder, urination urgency and nighttime urination. Additionally, dysfunction in one partner may cause issues with the other partner that affect the relationship. The good news? As a specialty, urology pertains to many things related to pelvic health, including sexual health. Therefore, often, urologists can see both partners together or separately and can provide counseling there without having to provide an external referral.

New treatments and changing attitudes in midlife dating

Other changes include many single parents re-entering the dating scene after years away who are surprised at how things have changed. Many advances have been made. Dr. Stefanovic says, “There are many treatment options available today for patients wanting to improve performance and their romantic relationships.” Whereas in 1950, there was far less talk surrounding many sexual health related topics, today there’s a much more liberal approach for all patients, regardless of sexual orientation or preference. Currently, in Seattle, transgender patients are seen and treated physically and surgically. Conversations about hormone therapy, vaginal dilators, and sexual health aids are becoming more common among both physicians and their patients.

Reconnecting with your partner through intimacy

One thing is clear: today’s couples can enjoy longer, more fulfilling sexual relationships than those in previous generations. The introduction of Viagra in the 1990s was a game changer—one I had a front-row seat for while working at a reproductive health trade show. An older gentleman, attempting to charm a woman at our booth, confidently asked if the condom samples on the table came in large. Without missing a beat, she picked one up, stretched it up to her elbow, and quipped, “If you need one bigger than this, I’ll give you my number.” His stunned silence spoke volumes.

Jokes aside, sexual health at midlife isn’t just about function—it’s about connection. Stress, relationship dynamics, and self-perception all play a role. Minimizing stress, communicating openly, and prioritizing both partners’ needs are essential for maintaining intimacy.

Why safe sex still matters in midlife

For those in new relationships, protection remains crucial. Many midlifers haven’t had multiple partners since the pre-HIV era, making it vital to practice safe sex. Additionally, for all couples, understanding the sexual side effects of medications and normalizing discussions around menopause, testosterone decline, and intimacy struggles can help bridge the gap between partners.

What men and women wish each other knew about intimacy

So, what do men and women wish the other understood about midlife sexual health? Women often wish they had a better understanding of menopause themselves—and that their partners did too. Likewise, men may wish women grasped the challenges of male hormonal shifts and how they affect intimacy. Ultimately, knowledge and empathy go a long way in sustaining fulfilling relationships.

Aging doesn’t mean the end of a vibrant sex life. Instead, it’s an opportunity to adapt, communicate, and embrace intimacy in new and meaningful ways. After all, our parents figured it out—and now, it’s our turn. As we’ve come to realize, intimacy doesn’t have an expiration date. And the truth is that’s not such a bad thing.

Finding the right specialist for sexual wellness

If changes in sexual health are affecting your quality of life, it’s time to talk to a doctor. But many don’t know when or how to start that conversation. Here are some signs it’s worth bringing up with a healthcare provider:

• Persistent Pain or Discomfort: Pain during sex isn’t something to ignore. It could be related to vaginal dryness, pelvic floor dysfunction, or another underlying condition.
• Loss of Libido: If a decrease in sexual desire is affecting your relationship or self-confidence, a doctor can help identify potential hormonal imbalances or other
• Erectile Dysfunction: Occasional performance issues are normal, but if it’s becoming a pattern, it could be linked to cardiovascular health, stress, or hormone levels.
• Emotional Distress Around Intimacy: If anxiety, depression, or past experiences are making intimacy difficult, seeking guidance from a medical professional or therapist can be beneficial.
• Changes Due to Medication: Many medications—such as antidepressants, blood pressure treatments, and hormonal therapies—can impact sexual function. A doctor can help adjust or find alternatives if needed.

Who to see for midlife sexual health issues

When it comes to addressing sexual health concerns, knowing which specialist to see can make all the difference. For women experiencing issues related to menopause, vaginal dryness, low libido, or pelvic pain, an OB/GYN is often the first point of contact. Many gynecologists are well-versed in hormone therapy, pelvic floor health, and other treatments that can improve sexual wellness. In some cases, they may refer patients to a pelvic floor physical therapist for targeted exercises to strengthen muscles and alleviate discomfort. For men dealing with erectile dysfunction, low testosterone, or other sexual performance concerns, a urologist is the go-to specialist. These doctors focus on male reproductive and urinary health and can provide treatments ranging from medication to lifestyle recommendations. Additionally, both men and women can benefit from consulting an endocrinologist if hormonal imbalances are suspected to be at the root of their issues.

Beyond physical health, sexual wellbeing is deeply connected to mental and emotional factors. If stress, anxiety, past trauma, or relationship dynamics are affecting intimacy, a sex therapist or licensed mental health counselor specializing in intimacy and relationships can offer guidance. Many couples also find that seeing a couple’s therapist helps open the door to better communication and understanding of each other’s evolving needs.

How to talk to your doctor about intimacy

Bringing up sexual health concerns with a doctor can feel awkward, but it doesn’t have to. Many physicians are accustomed to these conversations and appreciate patients being open about their concerns. A good way to start is by framing the discussion around how the issue is affecting overall wellbeing: “I’ve noticed some changes in my body that are affecting my intimacy and confidence. Can we talk about what might be causing this?” or “I’ve been experiencing some discomfort during intimacy, and I’d like to explore possible solutions.” If unsure where to start, patients can simply ask, “Is this something you can help with, or should I see a specialist?” 

Sexual health is an important part of overall wellbeing. Most healthcare providers will appreciate the initiative and help guide patients toward the right resources.