AARP Hearing Center
It Can Be More Difficult to Orgasm as an Older Adult
A woman writes she’s frustrated she can’t climax like she used to
Kiersten Essenpreis
Here’s a condition older women experience but don’t talk about: less intense sensation during sexual stimulation, making climax difficult.
The good news: It’s very treatable. Our medical experts break it down.
More Ways to Benefit
- Related Benefit 1
- Related Benefit 2
- Related Benefit 3
- Related Benefit 4
- Related Benefit 5
I’m a 60-something woman, and due to diminished sensation in my genitals, I am having a hard time reaching orgasm. I’m so frustrated. Can you help? — Submitted via email by T.H.
So much to unpack here. My favorite comment for you is from Vanderbilt Health urogynecologist Melissa Kaufman: “She’s going to get back in action.”
Kaufman says you likely have an “extraordinarily prevalent” condition called genitourinary syndrome of menopause, or GSM. Many of its symptoms are bothersome, she adds, and they’re also underdiagnosed. We’ll talk more about that below, but first, consider these possibilities.
Gynecologist Maureen Slattery, a certified sexual health counselor and sex educator, says several medications and medical conditions contribute to decreased or delayed orgasm. Here’s her list.
Medications that may affect sensation
- SSRIs (selective serotonin reuptake inhibitors): More than 50 percent of people on these commonly prescribed antidepressants have issues with arousal and orgasm, according to Slattery.
- Antipsychotics, antihistamines, beta-blockers and GLP-1s: Slattery’s advice? Check with your doctor about dosing or changing meds.
How Women Can Increase Sexual Satisfaction After Menopause
Medical conditions that may affect sensation
- Diabetes: Chronic high blood sugar can damage small blood vessels and nerve endings, leading to reduced sexual stimulation.
- Thyroid conditions: Thyroid issues have been associated with female orgasmic disorders, according to Slattery. A low-functioning thyroid may lead to fatigue, depression and vaginal dryness, affecting one’s interest in and comfort with sex; while an over-functioning thyroid may result in elevations of a blood protein that can compromise estrogen and testosterone alike.
- Parkinson’s: This disease significantly impacts sexual function because decreased dopamine levels interfere with the nerve signals required to trigger climax.
- Multiple sclerosis: The damage caused to the central nervous system by multiple sclerosis can also disrupt the nerve signals between the brain and sex organs.
- Pelvic floor dysfunction: Slattery says underactive (weak) and overactive (too tight) pelvic floor muscles respond poorly to sexual stimulation. Chronically clenched or guarded muscles can’t relax, making the contractions needed to build and release tension difficult. The fix: a pelvic floor physical therapist.
If you’ve checked all this out with your doctor, your next step is to ask about GSM. Here’s what to know.
A quick definition. GSM, according to Kaufman, is associated with a spectrum of conditions and physical changes that occur when estrogen and testosterone decline during menopause. Affected are the entire genital tract, vulvar and vestibular tissues (the sensitive tissues surrounding the opening to the vagina), the vagina, bladder and urethra.
- Symptoms to look for. Kaufman says classic symptoms include urinary tract infections, an overactive bladder, pain and bleeding from intercourse, a low libido and a decrease in arousal and orgasmic response.
- Start with topical estrogen. If you do have GSM, Kaufman says low-dose vaginal estrogen is “an excellent, high-yield option.” She calls the topical vaginal cream, which has been around for 50 years, “a miracle.”
Topical estrogen restores elasticity and moisture to the genitals, enhancing arousal. (Slattery mentions a bonus: It also decreases the likelihood of overactive bladder symptoms as well as urinary tract infections.)
The cream is administered by an applicator two to three times a week and may be covered by insurance. There are two prescription vaginal creams currently on the market, according to Slattery: estradiol and Premarin.
- And use lube. “As a sexologist, I say: lube, always lube, for sexual activity,” says Slattery. The brands Revaree, Hyalo Gyn, Lubrigyn, Ah! Yes and Good Clean Love are excellent options that can be used several times a week. Slattery warns against any product that contains dyes or perfumes.
Kaufman offers another alternative: coconut oil. “After urinating, apply a little bit,” she says. “It keeps the tissues moist and pliable.”
Build arousal in other ways. Sexuality educator Gretchen Frey, a retired gynecologist, says to spend quality time on foreplay to increase sensation.
Among her recommendations: Stroke the clitoris; use a vibrator; lightly touch genital hair and the fuzzy hair at the back of the neck.
“Our touch sensation diminishes with age, but it’s maintained a little better in hair-bearing skin,” Frey explains.
Make plans for “sexy time.” Frey says planning ahead can be as open-ended or as specific as you wish, and can build anticipation and get you in a state of mind that’s more receptive to arousal.
Her suggestions include looking at pictures, videos or reading something together that gets you both in the mood. Or just talk about your fantasies with each other.
Be kind to yourself. Slattery believes that as a society, we tend to make sex goal-oriented — all about orgasm — and less about connection, fun and pleasure.
“When we don’t orgasm, or it takes a while, this can feel like failure,” she says. “This negative feedback loop of failing or taking too long plays into the psychological factors that affect orgasm, and not in a good way.”
Psychological disrupters include anxiety, stress, self-esteem issues and relationship woes like unresolved partner conflict, poor communication and not being on the same page sexually.
Frey suggests removing orgasm as the goal. “As we get older, it’s not guaranteed anymore,” she says. “Get naked and do the stuff that feels good. If you get there, great; if you don’t, that’s OK too.”
Do you have questions about sex or relationships as a 50-plus adult? Send them to sexafter50@aarp.org.
AARP Membership
Join AARP for only $15 per year with automatic renewal. Get instant access to members-only products and hundreds of benefits, a free second membership, and a subscription to AARP The Magazine.
You Might Also Like
In The Mood
Writer Ellen Uzelac asks experts your most pressing 50+ sex and relationship questionsMy Wife Showers Everyone With Love — but Me
The kids, grandkids and dogs get it. What gives?
I Was Told ‘Sex Is Bad’ Growing Up. What Now?
A woman wants more adventure in the bedroom but can’t move past the idea that sex is dirty