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Sexual Problems at Midlife

What’s “normal”? Behind any discussion of sexual problems lies an incredibly loaded question: Exactly what is normal, healthy sexual response and function?

The World Health Organization defines sexual health as a “state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity.”

A more comprehensive definition may be hard to come by, since normal sexual response and function is about as individualistic as anything can be. Each person has his or her own standard of what sexual health or satisfaction is, based on his or her individual culture, background, personal sexual experiences, and biological makeup. This individual variation seems to be especially strong among women.

Does the problem bother you or your partner? That said, a few basic principles are common to what’s considered healthy sexual response and function for most people:

  • Some degree of desire for sex
  • An ability to enjoy sex
  • Comfort with your level of sexual desire, response, and function

The issue is not the sexual “problem” or condition itself but whether it is bothersome or troubling to the person or partners involved.

The question of being troubled is key when it comes to any potential sexual disorder, since the issue is not the sexual “problem” or condition itself but whether it is bothersome or troubling to the person or partners involved. For instance, if both partners in a couple are content to live without an active sex life, then a condition such as vaginal dryness or erectile difficulty does not really represent sexual dysfunction. Similarly, a woman who notices some decline in sexual desire over time may not be troubled by it if she is not in a relationship. However, if she meets a partner with high libido, she may start to see her low sex drive as a problem.

How are problems defined? Sexual response is usually described as having four phases: desire, arousal, orgasm, and resolution. Likewise, sexual problems are often discussed in terms of these phases, so that interest in sex (desire) is understood to be different from the physical changes the body undergoes in anticipation of sex (arousal), both of which are different from the experience of the sex act itself (response/pleasure/orgasm). While all of these phases are related and sexual problems can include elements from more than one phase, different factors can be involved in problems at each phase.

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