Sex and Health

By John Camoriano, MD, Mayo Clinic Arizona

Part 2: Overcoming Common Obstacles to Sex

In the Summer 2023 issue of “From the Heart” we listed ten health benefits from sexual activity, including longer length of life, less depression, reduction in prostate cancer risk, and reduction in heart disease to name a few. We made a compelling case that engaging in sex helps us be healthy.

For some, however, an active sex life is easier said than done. For much of the population, sexual activity is suboptimal, especially as we age. In a study of nearly 5,000 adults, sexual satisfaction declined with age. About 60% of individuals aged 40–50 years were satisfied or very satisfied with their sex life. This number dropped to approximately 42% for individuals aged 70–80 years.

“If sex is good, it's 5 to 10% of a good relationship, but if sex is bad, it's 95% of a bad relationship.”

Bad sex is common, stressful, and unnecessary.

Sexual Dysfunction: 4 Primary Groupings

1. Desire disorders — lack of sexual desire or interest in sex

2. Arousal disorders — inability to become physically aroused or excited during sexual activity

3. Orgasm disorders — delay or absence of orgasm

4. Pain disorders — pain during intercourse

   
   

When a couple find that one or both partners have physical obstacles to sexual intercourse, it does not have to spell the end of intimacy, nor should couples allow it to.

As our bodies age, both men and women can acquire physical impediments to traditional sexual intercourse.

• For men, it can be erectile dysfunction or Peyronnies disease, two disorders of penile function that can often be remedied with medications or surgery.

• For women, it can be painful intercourse and/or vaginal dryness, which also may have medical remedies.

While waiting for such medical remedies to alleviate the situation, couples can still connect physically in ways that may be different for them than in the past.

Expert Insights

One article from Harvard Specialists stated:

“Even though older adults go through physical changes, they often expect their sex life to stay the way it was decades earlier, and that is just not always realistic... Still, there are many ways to continue a strong, healthy sexual relationship without always relying on regular intercourse. Couples should see this new phase of their sex lives as an opportunity to explore different and exciting ways to satisfy each other.”(Source)

If you or your partner are suffering from any of these issues, a visit to an appropriate medical specialist is indicated. Many subspecialists—gynecologists, urologists, endocrinologists, psychiatrists, and primary care physicians—have training to address these complex issues.

How Much Sex is “Enough”?

One of the most common obstacles to good sex is disagreement between partners on how much sex they should engage in.

Across three studies of over 30,000 subjects, researchers demonstrated that among people in committed relationships:

• The association between sexual frequency and well-being is curvilinear (not linear).

• More than once a week does not significantly increase well-being.

• The optimal frequency associated with well-being was about once a week.

“Sexual Frequency Predicts Greater Well-Being, But More is Not Always Better.”

Desire Discordance

In the movie Annie Hall, Woody Allen’s character and his wife each answer the question about frequency of sex:

• Woody: “Hardly ever… maybe 3 times a week.”

• Wife: “Constantly. I’d say 3 times a week.”

This is called desire discordance.

This issue is so common that it is better described as a feature of relationships and not a bug. Even highly sexually active couples face this.

Strategies to Address Discordance

1. Increase the desire of the low libido partner

2. Manage the higher desire of the high libido partner

3. Optimize communication about sexual desire and activity

Medical and Communication Solutions

For low libido, there are medical strategies:

• Testosterone replacement

• Flibanserin (Addyi)

• Bremelanotide (Vyleesi)

(See Podcast: The Drive by Peter Attia, Episodes 259–260 on women’s and men’s sexual health.)

Not all issues are solved medically—communication remains essential.

• The Passionate Marriage by David Schnarch emphasizes techniques for autonomy and sharing intimacy.

• Esther Perel in Mating in Captivity reminds us that mystery, risk, and novelty fuel desire, while stability and comfort fuel long-term love. Couples need to nurture both.

Additional Resources

Books

• Tell Me What You Want — Justin J. Lehmiller

• Better Sex Through Mindfulness — Lori A. Brotto

• Sensate Focus in Sex Therapy — Linda Weiner

• DESIRE — Jennifer Vencill, PhD, and Dr. Lauren Fogel Mersy

Blog Posts

• Four Things You Can Do to Keep Passion Alive and Boost Sexual Satisfaction

• How Common Are Sexless Marriages?

• When You Want More Sex Than Your Partner

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References

1. Sexual Satisfaction Among Sexual Minority and Heterosexual Middle-Aged and Older Adults — Elżbieta W Buczak-Stec, PhD, Hans-Helmut König, MD, MPH, André Hajek, PhD, PD. Innovation in Aging, 2023.

2. Does Marriage Really Improve Sexual Satisfaction? — Elyakim Kislev. The Journal of Sex Research, 2020.

3. Exploring Relationships Among Communication, Sexual Satisfaction, and Marital Satisfaction — Samantha Litzinger, Kristina Coop Gordon. Journal of Sex Research, 2007.

4. Sexual Frequency Predicts Greater Well-Being, But More is Not Always Better — Amy Muise, Ulrich Schimmack, Emily A. Impett. Social Psychological and Personality Science, 2015.