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Low Libido in Later Life

One of the most frequent and distressing complaints I heard when taking care of patients who were in middle age and beyond was a lack of sexual desire. Most of these conversations were with cisgender women, who made up the bulk of my practice. Many were married; often they had a male partner, but some had a female partner, several partners, or no partner.
Most often the conversation followed this general pattern:
ME: Can you tell me what lack of desire looks like for you?
PATIENT: Well, I really love my partner, and wouldn’t want to hurt [their] feelings, but I just don’t want sex any more.
ME: Are you having sex at all at this time?
PATIENT: Yes, once in awhile.
ME: Any pain or other problems? Is it enjoyable?
PATIENT: No, no pain or anything. And yes, it does feel good when we do it. In fact, I often think “we should really do this more!”…but I just never seem to be in the mood. I hardly ever think of sex!

What these women were describing beautifully, though they didn’t know it, was the phenomenon of responsive desire. As we come to a better understanding of human sexual response, many authors have written about two different types of desire: spontaneous and responsive.
Spontaneous desire is what we usually think of, as it’s often the first kind of desire we encounter in our youth: what has been described as a “lightning bolt to the genitals”. We see another person and right away feel strong sexual attraction. We may think “I would really like to have sex with that person”, and we may find our bodies also responding (with erection of the penis or lubrication of the vagina, for example). Nearly all romantic relationships involve feeling this way about our partner, especially in the beginning, and that can lead to some really passionate sex!

As we get older, and especially after we’ve been in a romantic partnership for many years, this kind of spontaneous desire comes along less often. Partly it’s because newness is a big trigger for spontaneous desire, and there is nothing new about our partner, even though we may love them deeply. This is important: spontaneous desire doesn’t necessarily have much to do with love! It’s more a matter of “chemistry”, as the young people would say.
The good news is that, for many people, it is possible to feel desire in response to intimacy instead of prior to it. That is, if we begin to kiss or touch our partner, hold or be held by them, communicate love to each other with words, actions, touch, or in whatever way we like best, we will often find desire begins to arise. Arousal follows, and soon we are having sex which can be very passionate and satisfying. In fact, sex with a beloved long term partner can be satisfying in a deeper or more transcendent way than with someone new, because we can feel more known and understood, both more open and more accepted, than is possible with a relative stranger. It’s a different kind of passion.
I love explaining the concept of responsive desire, because it lets people like my middle aged patients know they are absolutely normal. In fact, understanding responsive desire gives us more control over our sexual experience. Rather than waiting for “that moment” to strike, we can plan ahead for romance, take our time, set the stage, and know that the desire will be there when the conditions are right. This understanding can make for a high quality sexual experience. There are some gifts to growing older!

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