How to Make Sex in Midlife the Best Yet

September 29, 2025

If you’re struggling with sex or relationship issues in midlife, you’re certainly not alone. But it doesn’t mean you have to watch your sex life fade into the rearview mirror. Sex can actually be better after 50 – and for many couples, it is.

“I have patients who’ve struggled with orgasms their whole lives and now have them regularly in their 50s,” says Rachel Pope, MD, MPH, an OB/GYN and Chief of Female Sexual Health at University Hospitals. Sometimes, it’s a result of diagnosing and treating a health issue, successfully working through intimacy challenges, or learning more about what makes your body feel good at this stage of life.

Hurdles to Overcome

There are many factors that can affect sexual function and satisfaction in women and men as they age. With the right help, they can all be addressed and improved.

Common challenges include:

Declining hormone levels
Low libido
Heart disease or diabetes
Alcohol and substance abuse
Relationship difficulties
Lifestyle factors (smoking, diet, exercise, stress)
Body-image issues
Some medications

“What I see most often in women is hypoactive sexual desire disorder, or HSDD,” says Dr. Pope. “Many women going through menopause in their 50s experience a decrease in desire, whether for biological or interpersonal reasons.” Low desire isn’t a problem for everyone, but for women who want to revive their sexual desire, there are hormonal and nonhormonal treatments.

“The other extremely common issue for women is vaginal dryness, which can cause a lot of pain during perimenopause and menopause,” says Dr. Pope. Vaginal estrogen is very safe and effective for treating dryness, she says. Other treatments may also help, depending on exactly where the discomfort is.

Difficulty achieving orgasm is another common concern for both women and men in midlife. More than half of men between the ages of 40 and 70 have trouble getting or maintaining an erection, says Nannan Thirumavalavan, MD, a urologist and Chief of Male Reproductive and Sexual Health at University Hospitals Urology Institute. “It gets worse as you get older,” he says. “Many men think they are stuck or that pills are the only option for erectile dysfunction, but there are plenty of well-proven treatments.”

Depending on the cause and severity of erectile dysfunction, treatment options may include:

Oral medication
Injectable medication
Intraurethral medication
Testosterone replacement therapy
Vacuum constriction device (aka penis pump)
Penile implant
Low-intensity shockwave therapy
Sex-focused therapy
Lifestyle interventions, such as managing diet, exercise and substance use, quitting smoking, losing weight and going to couples counseling

Getting Your Partner on Board for Better Sex

Whether you’ve hit a recent rut in your relationship or you and your partner have been struggling with sexual issues for a while, there’s a lot you can do to reopen the lines of communication, strengthen your sexual connection and deepen your level of intimacy.

“Couples will often avoid discussing sex when they’re having difficulties,” says R. Brian Denton, PsyD, a clinical psychologist at University Hospitals Urology Institute. Even if the intention is good (like if one person doesn’t want to hurt the other), it keeps the patterns of avoidance going. “Having more direct conversations about sex can help shift the focus to the positives of desire and connection,” he says.

If you’re not able to make progress on your own, talk to your doctor and get a recommendation for a provider who specializes in sexual medicine or therapy. It may feel uncomfortable to discuss sexual problems with someone outside of your relationship, but it can help turn things around.

Common Relationship Challenges & Solutions

Here are three challenges that couples in midlife commonly face, along with expert-backed solutions that can help.

Challenge #1: Navigating changing sexual function.

Solution: If you and your partner are struggling to find ways to navigate issues like vaginal dryness, erectile dysfunction, or simply how to jumpstart your sex life, addressing a root cause like pain or HSDD can offer a simple solution. Dr. Pope says that a primary care doctor, or sexual medicine specialist in either gynecology or urology can provide treatment for all of these issues.

Challenge #2: Different desire for sex.

Solution: When one person is less interested in being sexual than the other, consider meeting with a trained psychologist. “It may be the most challenging intervention, but couples therapy with someone who specializes in sexual medicine can reap the biggest rewards,” says Dr. Pope. “If a desire discrepancy is putting a strain on the relationship or causing distress, know that help is available and should be sought,” she says.

Challenge #3: One partner is uncomfortable or unwilling to discuss sexual problems.

Solution: “Open and honest communication with your partner around sex can lead to greater satisfaction,” says Dr. Thirumavalavan. But many people feel embarrassed talking about their sexual problems, or they don’t think it’s important, or they may even think there's no point because nothing can be done to help them.

“This is very common,” says Dr. Pope. “However, we have medications, therapies and many treatments, depending on what the issue is – getting help is worth the effort.” She emphasizes that it’s important to tell your primary care doctor, urologist or gynecologist about sexual problems you’re experiencing because they can be signs of other medical conditions, like erectile dysfunction and cardiovascular disease in men and vulvar dermatological issues and nerve injuries in women.

Optimizing Your Midlife Sex Life

The decade of your 50s is a great time to re-explore your body, reconnect with your partner and fine-tune pleasure and intimacy together. Try these tips to improve sexual function and get your spark back:

Don’t overthink things. “Focus on the process of connecting sexually rather than on specific behaviors and outcomes,” says Dr. Denton. “Sexual satisfaction is best achieved by engaging in the interactions of play and connection with a partner.”
Talk more. Try not to let performance anxiety, fears about sharing your fantasies or desires or other problems keep you from communicating and connecting with your partner, suggests Dr. Denton.
Take it slow. “If anxiety is a part of the puzzle for a male partner’s slow or absent erectile response, it takes about 20 to 30 minutes for the body to calm down from an anxiety response,” says Dr. Denton. “Instead of focusing on erection, slow down and explore other ways of touching and connecting physically.”
Prioritize clitoral stimulation. “The way we see sex depicted in the media is not the way women tend to reach climax,” says Dr. Pope. “Understanding the clitoris and its role in orgasm is probably the most important thing for women.” Learn about your anatomy through self-exploration and share with your partner what feels good to you.
Consider vaginal estrogen. “Most women can use vaginal estrogen,” says Dr. Pope. “It’s extremely helpful for women during perimenopause and after menopause.” (It’s not the same as systemic estrogen that’s used for symptoms like hot flashes, she notes.)
Take care of your health and well-being. Make sure you’re practicing healthy lifestyle habits and addressing conditions that may be affecting your general, mental or sexual health. “Staying on top of your overall health can preserve your sexual function for longer,” says Dr. Thirumavalavan. “Specifically diet, exercise, not smoking and keeping blood pressure, blood sugar and cholesterol in check.”
Get help. It can’t be emphasized enough: If you’re struggling with desire, arousal, orgasm or pain, request a referral to a sexual health specialist. “There is stigma around sexual wellness in our culture, but we are not going to get help if we don't ask for it,” says Dr. Pope.