Ultimate guide to having your best sex EVER in middle-age: Top doctor’s medically-backed advice for women on how to treat the hurdles stopping you having an incredible love life

It is a claim that will, undoubtedly, raise eyebrows – or, even more likely, make eyes roll with faint boredom. But hear me out – British women in midlife are not having enough sex. And, in my view as a women’s health GP, we need to be having more.

Women aged 55 to 64 report the least sexual activity of any age group, a recent study from researchers at University College London found.

And with any combination of the stresses of motherhood, a busy career, ageing parents and the onslaught of menopause-related issues – from hot flushes to mood changes – it’s no wonder that sex isn’t at the top of many middle-aged women’s agendas.

But I believe wholeheartedly that this is a tragedy – because sex is so important for our health, especially as we age.

And I think it’s vital we’re able to discuss this in a frank, grown-up way, much as we would any other personal health issue.

A multitude of studies have shown that sex – of any kind, not just penetrative – and orgasms are good for your heart. It can lower blood pressure, ease headaches, improve sleep, reduce stress and help you feel relaxed by triggering the release of endorphins.

According to a study published by researchers in the US last month, it could even reduce menopause symptoms – a kind of natural HRT, if you like.

Among the 900-plus women involved in the trial, those having regular sex – defined as intercourse within the past three months – were less likely to report common symptoms such as vulval itching, pain and dryness.

This is likely because orgasms increase blood flow to the genitals, helping maintain tissue health and elasticity, while also enhancing lymphatic circulation, the researchers concluded.

Last month, actress Dame Emma Thompson – who recently starred in Good Luck To You, Leo Grande, playing a woman who hires a younger male sex worker – went one step further, calling for sex to be brought under the purview of the NHS.

‘It should be,’ she urged. ‘It’s so good for you.’ And she’s not wrong.

But as a 45-year-old mother of two teenagers and a tween, and as someone who has undergone cancer treatment not too long ago, I understand the challenges.

Our bodies in midlife aren’t what they were. Changes to the vulva and vagina, following childbirth and due to dwindling hormones, can make sex feel more difficult.

Libido may feel lacklustre – and then there are aching joints, back pain, bills to pay, endless chores… the list goes on. But we don’t have to just accept these things. There are solutions, workarounds and even treatments.

I’m not saying you have to do this if you don’t want to. But if, deep down, you do wish you were able to enjoy sex more, then read on.

Here is my medically backed guide that will, hopefully, help improve the picture – and perhaps even ensure you can have the best sex ever in midlife, and beyond…

YOU CAN OVERCOME OBSTACLES

For many of us, midlife brings a host of health challenges that can make sex feel less appealing or even difficult. This might include chronic pain, low thyroid function, stress, depression or simply poor sleep.

If sex feels impossible or too painful to contemplate, speak to your GP. You can ask to see a female doctor – and many practices will have someone, like me, with a special interest in women’s health.

Don’t dismiss genital itching as thrush – yeast infections are common when we’re younger, but less so with age.

Itching or soreness may signal lichen sclerosus – a chronic inflammatory condition that makes the vulval skin thin, inflamed and fragile. White patches may appear and the skin can split or bleed.

This needs prescription steroid ointments. Other causes can include psoriasis and eczema.

Rarer – but more serious – are vulval and vaginal cancers, which become more likely later in life. That’s why it’s important to flag any changes with your doctor.

If arthritis or joint pain is affecting mobility, try different positions or take a warm bath or shower to loosen joints. Pillows, cushions and lubricants can help you feel more comfortable.

More severe flare-ups might need physiotherapy, pain relief or steroid injections – improving your quality of life and your sex life.

And remember – intimacy isn’t just about sex. You can still get the health benefits of physical touch through cuddling, massage and affection.

HORMONE TREATMENT BOOSTS LIBIDO

It is a misconception I hear often – that as you age, you naturally become less interested in sex. I don’t think this should be a given.

Perimenopause and menopause, when levels of certain hormones fluctuate and fall, may cause some changes to sex drive.

The length of time it takes to get aroused or reach orgasm, or even the intensity of orgasms, can alter too.

And if you’re suffering with headaches, insomnia and hot flushes, you may simply just not feel

in the mood as much as you once did. HRT, which treats the symptoms of menopause by increasing oestrogen levels, may help

with many of these issues. If low libido continues to be an issue, even on HRT, then you can be prescribed testosterone.

Bear in mind, though, that a lack of sexual desire may also have a psychological cause. Depression and anxiety are increasingly more common in midlife, and both can dampen desire.

Mood changes related to the menopause can be treated with HRT, but if the cause is not hormonal, antidepressants and talking therapy may be useful.

Taking antidepressants can impact libido and make it harder to orgasm for some, but others may see their libido improve as any underlying mental health condition is treated.

Poor body image can also influence your sex drive – and can be triggered by weight gain, female pattern hair loss or changes to your physique more generally during midlife.

For this, you may want to consider talking therapy, which can address underlying problems and provide you with techniques for improving your confidence.

MY SIMPLE FIX FOR INTIMATE DISCOMFORT

For some women, a fall in libido may be due to menopause symptoms that can’t be fixed with HRT.

Known as genitourinary syndrome of the menopause, or GSM, common issues such as vulval pain, irritation and itching often cause sex drive to drop – and affect more than half of all women.

Caused by a dip in oestrogen, GSM can lead to painful penetration, urinary symptoms and recurring urinary tract infections, all of which make sex more difficult.

So what can we do about it? Luckily, lots.

First, stop using irritants or any ‘feminine hygiene’ products. The vagina – the internal muscular tube – cleans itself and should never be douched, even with water. The vulva – the external genitals – can be washed with water or an emollient, but avoid powders, fragrances or special soaps.

Vaginal oestrogen is the mainstay treatment for GSM.

Available over the counter or on prescription, these treatments are not the same as systemic, whole-body HRT.

They come as a cream, gel or vaginal tablet inserted daily for two weeks, then twice weekly – or as a ring that lasts three months.

They don’t carry the same small risks as HRT or its systemic

benefits, but they can make a huge difference to GSM symptoms. They’re safe even for women who’ve had breast cancer or are taking tamoxifen – though if you’re on an aromatase inhibitor, speak to your oncologist first.

DON’T LET FRICTION BE YOUR ENEMY

Irrespective of age, lubricant is an important tool for comfortable, enjoyable sex. During menopause, when the vagina produces less natural lubrication, it becomes even more valuable.

There are three main types, all widely available in High Street chemists. Water-based lubricant feels very natural but doesn’t last as long as others – though you can, of course, reapply.

Oil-based lubricants feel richer and creamier and last longer, but they are not compatible with condoms. Silicone-based lubricants are very slippery and long-

lasting, but they can stain sheets and shouldn’t be used with silicone sex toys as they can degrade the material.

All have their benefits – it depends on your needs.

When choosing a lubricant, avoid anything that may irritate the vagina. Look for one with a pH close to that of the vagina – around 4.5 – and steer clear of scents, flavours or anything marketed as warming or cooling, as these usually contain irritants.

You can also combine lubricants. For example, using an oil-based lubricant in the vagina and a water-based one on the penis, fingers or sex toy creates a

‘double glide’ effect – as water and oil don’t mix – which can feel more natural and long-lasting.

DON’T BE WORRIED ABOUT USING SEX AIDS

Patients are often surprised when I bring up this up in clinic. But if a woman is suffering from low libido, genital issues, or simply struggling to enjoy sex as she once did, I see it as a highly effective treatment.

I’m talking about sex toys.

There are now a wide variety available – different shapes, sizes and materials. You don’t need to go online or visit a sex shop – they’re sold in Tesco.

Battery-powered, rechargeable, remote-controlled, designed for use during sex, and more, they stimulate the clitoris to help you reach orgasm more easily.

A massive misconception is that using one reflects poorly on you or your partner’s sexual prowess.

In fact, they can add interest and variety when used together – and help you explore what feels good solo.

Using a vibrator increases blood flow to the genitals, which can improve orgasms and support genital health.

As women age, blood supply to the nerve endings around the clitoris decreases – reducing sensitivity and responsiveness to touch. In a small number of women, the clitoris may even recede, known as clitoral atrophy.

Regular orgasms can help relieve these symptoms – strengthening pelvic floor muscles and preserving the anatomy of the vulva and vagina, which can also support bladder control.

Some vibrators are even approved as medical devices and have been shown to treat a range of menopause-related sexual dysfunctions.

Choose a skin-safe toy – ideally made from silicone, toughened glass, metal or ABS plastic – and use plenty of lubricant.

PUT SEX BACK ON THE SCHEDULE 

Making time for sexual pleasure isn’t easy, and during menopause, changes in how arousal works can make it more difficult.

In younger years, it may be spontaneous – sparked by attraction or a passing thought. But during and after menopause, it tends to become more responsive – triggered by physical stimulation like kissing.

That’s why being intentional about sex matters. Scheduling it doesn’t make you boring – it shows you value it.

As relationship therapist Esther Perel says, planning sex can itself be meaningful, signalling commitment and care.

It also helps get you in the mood – especially if you know you often enjoy sex once it starts, even if the desire isn’t there at the outset.

Regular sex can also increase libido. Orgasms release a rush of feelgood chemicals – and the more positive the experience, the more you want it again.

DON’T BE AFRAID TO ASK FOR HELP

The interplay of physical and psychological factors behind low sexual desire can be hard to untangle.

If there’s no obvious cause, I’ll often refer patients for psychosexual counselling. This can help you – and your partner – understand what’s going on and explore new ways to connect intimately.

Counterintuitive as it sounds, this might mean taking penetration off the table for a while – easing pressure and allowing time to reconnect through other pleasurable sensations.

Or it could be as simple as saying what you still find attractive in each other.

That said, if the real issue is the fact you can’t stand your husband, no amount of testosterone will help.

It’s also worth remembering that not all relationships involve sex – and sex doesn’t have to involve another person.

Prescriptions can be powerful, giving us the sense that something is guaranteed to work. But not everything can be fixed with a drug. We need to start viewing lifestyle changes as medicine – they can be just as effective.

Doctors already prescribe exercise and time in nature for better health, so maybe a prescription for sex will be next.

But don’t wait for it. Just get busy – with a partner or on your own. You won’t regret it.

HORMONE CREAM CHANGED MY LIFE

Suzanne Noble was in her mid-50s, dating a man in his early 30s, and having great sex when the menopause hit – and the mother-of-two’s libido suddenly vanished.

‘I didn’t really know what to do about it. I just didn’t feel particularly sexual, especially with all of the hot flushes and the brain fog I was getting,’ she says. ‘It just felt generally uncomfortable.’

It wasn’t until Suzanne, who lives in London, discovered vaginal oestrogen that things changed.

‘It completely transformed my ability to have sex,’ she says. ‘I was finally able to have sex without pain again.’

Now she actively works to maintain a healthy libido.

‘After menopause, I realised my ability to become aroused was no longer spontaneous – it takes more than it used to,’ she adds.

‘So I now set aside my Sunday afternoons for having sex. I’ll shower, put on something that I feel good in. And because my brain is thinking about what’s going to happen, my body gets turned on.’

Now 64, Suzanne hosts a podcast called Sex Advice For Seniors, where she talks about sex after menopause.

‘It’s only anecdotal, but people say I look good for my age – and I suspect that’s as a result of having regular sex,’ she says.

‘It’s given me a more positive outlook on life.’