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Special Health Reports

Sexuality in Midlife and Beyond

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Sexuality in Midlife and Beyond: Reclaim your sexual vitality and put the fun back into sex

The physical transformations the body undergoes with age have a major influence on sexuality. This Special Health Report, Sexuality in Midlife and Beyond, will take you through the stages of sexual response and explain how aging affects each. You’ll also learn how chronic illnesses, common medications, and emotional issues can influence your sexual capabilities. Finally, you’ll find a detailed discussion of various medical treatments, counseling, and self-help techniques to address the most common types of sexual problems.

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The physical transformations your body undergoes as you age have a major influence on your sexuality. Declining hormone levels and changes in neurological and circulatory functioning may lead to sexual problems such as erectile dysfunction or vaginal pain. Such physical changes often mean that the intensity of youthful sex may give way to more subdued responses during middle and later life.

But the emotional byproducts of maturity — increased confidence, better communication skills, and lessened inhibitions — can help create a richer, more nuanced, and ultimately satisfying sexual experience. By understanding the crucial physical and emotional elements that underlie satisfying sex, you can better navigate problems if they arise.

The advice in this report applies broadly to people of all sexual orientations. It will take you through the stages of sexual response and explain how aging affects each. You’ll also learn how chronic illnesses, common medications, and emotional issues can influence your sexual capabilities. Finally, you’ll find a detailed discussion of various medical treatments, counseling, and self-help techniques to address the most common types of sexual problems.

Prepared by the editors of Harvard Health Publishing in consultation with Medical Editor Jan L. Shifren, MD Director, Midlife Women’s Health Center; Massachusetts General Hopsital; Vincent Trustees Professor of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School; and Nikki Haddad, MD Attending psychiastrist, Division of Women's Mental Health, McLean Hospital; AASECT-certified sex therapist, 52 pages. (2026)

Everything you always wanted to know about sex therapy

Sexual problems are nearly always intertwined with psychological and relationship issues. As a result, treating the physical problem (if one is present) is only half the job. For best results, it’s important to address psychological issues—performance anxiety, anger, frustration, low self-esteem, hopelessness—as well. Many couples need help repairing both emotional and physical distance before they can regain a healthy sexual relationship. A certified sex therapist can help you and your partner do just that.

Many aspects of sex therapy have already been addressed in this report. This chapter explores in greater depth what may happen in a sex therapy session and explains sensate focus, which is one specific type of sex therapy.

What to expect

A certified sex therapist is a licensed mental health professional who treats sex and relationship
problems. Although sex therapists are qualified to understand the same broad emotional issues as individual or couple’s counselors, sex therapists have advanced training in addressing sexual problems, and they use a more targeted approach.

Assessment and intake

Contrary to what some people may think, you and your partner will not be physically intimate with each other while the therapist is watching, and the therapist won’t touch either of you. Sex therapy is a branch of traditional psychotherapy and is considered a form of “talk therapy.” That means you’ll be doing a lot of talking about your relationship in and out of the bedroom. The therapist will also educate you on physical and emotional issues that pertain to your circumstances, as well as prescribe specific exercises for you to try at home.

If having to discuss your sex life is an obstacle to getting help, rest assured that the sex therapist will not push you too quickly. Also, remember that an essential part of the treatment is learning how to talk about your sexual feelings more comfortably.

  • Sex ed for grownups
    • Myths and misconceptions about sex and aging 
    • Sexual response through the years 
    • What's normal—and what’s not
  • Treating common sexual problems
    • Vaginal pain and dryness
    • Erectile dysfunction
    • Mismatched or low libido
    • Female sexual arousal difficulties
    • Orgasm difficulties
  • Health problems and sex
    • Heart disease
    • High blood pressure
    • Diabetes
    • Arthritis
    • Depression
    • Incontinence
    • Chronic obstuctive pulmonary disease 
    • Cancer 
  • Emotional and social issues
    • Relationship issues
    • Performance anxiety
    • Low self-esteem
    • Expectations and past experiences
    • Stress and lifestyle issues
    • Loss of a partner 
  • Helping yourself to a better sex life
    • Talking to your partner
    • Using self-help strategies
    • Maintaining good health
    • Putting the fun back into sex
  • SPECIAL BONUS SECTION: Everything you always wanted to know about sex therapy
  • Resources
  • Glossary

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