How the ‘Big O’ Changes With Age

“Unfortunately, a lot of these medications put you in jeopardy for sexual function,” he notes. “It gets problematic.”

Goldstein says you could add meds to improve ejaculation and orgasm. “You need to be a good sex detective,” he says. “Find out what the risk-benefit ratio is” and talk to your doctor.

Among the meds that can help:

• Testosterone, if your levels are low. Goldstein says testosterone is available as a pill, a topical gel or solution, or an injection. While most people prefer a pill, the method of administration may depend on which is covered by your insurance.
• Vyleesi, prescribed off-label. Vyleesi is FDA-approved to treat hypoactive sexual desire disorder in premenopausal women, but Goldstein says it also has been shown to improve sexual function in men. It’s an injection in the thigh, administered one hour prior to sex, that releases the hormone dopamine. It is not covered by insurance.

Ways to amp up stimulation. To heighten arousal, Frey suggests trying a penis sleeve or masturbation sleeve made of silicone, latex, rubber or plastic. 

“They can bring novelty and fun to the sexual experience,” Frey says.

She also recommends reading or viewing erotica or fantasizing. “Any increase in mental arousal is likely to help reach and intensify orgasm,” she notes.

What women are up against. In older women, diminished sensation and lower hormone levels can also make it harder to climax – meaning it may take you longer to become aroused and to reach orgasm, Frey says.

What exactly happens? The loss of estrogen that occurs in menopause affects structures like the vestibule and the vagina, according to ob/gyn Maureen Slattery, a certified sexual health counselor and sex educator. Because of that, you can become sore, and sex can be uncomfortable due to dryness and loss of elasticity. 

Pelvic floor muscles that respond to orgasm also can weaken in later life, reducing the intensity of orgasm, Slattery says, adding that masturbation can help keep the pelvic muscles toned.

Women typically become more dependent on external clitoral stimulation as they age. “Women don’t orgasm from penetration — vaginal or cervical or uterine — all that often,” Slattery adds. “Most women don’t, but those who did in the past will become more reliant on the clitoris.”  

What to rule out. The clitoris has a hood that retracts. Sometimes with older women, the hood can shut over the head of the clitoris, Slattery says.

“It can be uncomfortable and decrease sensation because the clitoris isn’t fully accessible,” she explains. “It’s not unusual, and I see this with some frequency.”

What causes it? Poor hygiene, the loss of estrogen or inflammation. Slattery says if you see white debris around the clitoris — basically dead skin cells — wash it away with water. If it is fused, she says to see a gynecologist who specializes in sexual medicine. A physician can correct it by using strong topical numbing medication and, typically, manual traction, according to Slattery, who adds that there is little recovery time, if any.

Consulting a gynecologist every one to two years should help you know if you are at risk, she notes.

How to heighten desire. Painful intercourse is a surefire way to kill arousal. But there are a few different options you can try, says Slattery.

Masturbation and topical estrogen can increase blood flow to the genitals, which contributes to arousal and orgasm. Slattery also recommends all types of pressure on the genitals: using fingers, running water in a bathtub, and toys (there are many just for older adults).

Frey’s go-to toy is the vibrator, due to the strong stimulation it produces. “These come in all shapes and sizes and can be enjoyed solo or during partnered sex.” 

And visualize, she says, because women, like men, can reach orgasm more easily by increasing their mental arousal by viewing or reading erotica or indulging in sexual fantasies.