Illness, Medical Problems, Medications

If the other midlife changes that influence sexual function weren’t enough, the increasing likelihood of long-term medical conditions in these years adds another big wrinkle. In a large survey of sexual behavior among US adults ages 57 to 85,⁵ those who described their health as fair or poor were more likely to report sexual problems.

Many diseases can trigger or worsen sexual problems; here are some of the most common ones among women at midlife and beyond: diabetes, heart disease, high blood pressure, cancer, arthritis, and chronic back pain. Whatever illness you may have, if you believe it’s affecting your sex life, that’s an important issue to discuss with the healthcare provider who’s managing your illness or your primary care provider.

Diabetes. The damage that diabetes may do to blood vessels and nerves can dull sensation in the clitoris, interfere with vaginal lubrication, and hamper arousal and orgasm. Diabetes also can dampen sex drive. Additionally, elevated blood sugar raises the risk of yeast and bladder infections, which can make sex painful or simply impractical. Being overweight, which is often the major cause of adult-onset diabetes, can make women feel less attractive and less interested in initiating sex.

Heart disease. Heart disease is usually related to buildup of fatty deposits in blood vessels, and the vessels that feed into your genitals end up being affected as well. When less blood reaches the genitals, it’s more difficult for the vagina to become engorged, which undermines lubrication and arousal.

People with heart disease may fear that the exertion of sex will trigger a heart attack. That fear is generally overblown, as the demands of sex on the heart are generally no more taxing than a swift climb up two flights of stairs. If you have this concern, however, be sure to discuss it with your healthcare provider. Although women with heart conditions should always follow their providers' recommendations for when it’s safe to consider sex in their individual circumstances, the only common heart condition that might rule out sexual activity for most patients is unstable angina.

High blood pressure. High blood pressure is one form of heart and vascular disease that poses a particular threat to sexual function. The changes it can cause to the body’s circulatory patterns and to the inner lining of arteries may reduce blood flow to the genitals. In women, the result can be painful intercourse, orgasm difficulties, and reduced desire. Additionally, some classes of blood pressure drugs have been associated in some women with low libido (ACE inhibitors and beta blockers) and with arousal and orgasm difficulties (beta blockers and diuretics). It has been hard to tease out in studies what share of women’s sexual problems is due to their high blood pressure, the drugs used to treat it, or both. Interestingly, one class of blood pressure drugs—angiotensin receptor blockers—is believed to perhaps improve sexual function. 

Cancer. Cancer can dramatically change a woman’s sexual function and sex life, both through direct physical effects, such as pain and fatigue, and through psychological effects like fear, depression, stress, and change in self-image.

Treatments for cancer often pose an additional set of challenges, as outlined in the table below. Almost half of women who undergo therapy for breast or gynecologic cancer suffer some long-term sexual problems.

 

Effects of cancer therapy on women’s sexual function

Therapy	Effects
Surgery	Surgery involving pelvic organs can damage nerves and reduce genital sensation  Removal of ovaries before menopause causes abrupt absence of ovarian estrogen and testosterone, often resulting in loss of libido and other sexual problems Breast removal takes away pleasure of breast fondling and may undermine body image; breast reconstruction may result in reduced sensitivity in this area
Radiation	Radiation to the pelvic area can cause scar tissue in the vaginal lining that leads to pain during intercourse Side effects (fatigue, nausea, vomiting, diarrhea) often decrease sexual interest
Chemotherapy	Side effects (fatigue, nausea, hair loss, weight change, diarrhea) often reduce interest, undermine body image, and promote depression Vaginal dryness and pain may be side effects Estrogen levels can fall dramatically during therapy, triggering menopause-like symptoms
Other drug therapy	Tamoxifen, a drug used to prevent recurrent or initial breast cancer, may promote vaginal dryness and tightness in some postmenopausal women, although others note increased vaginal secretions with this drug Tamoxifen also can cause severe hot flashes in some women Aromatase inhibitors (such as Arimidex, Aromasin, Femara), another group of drugs used to prevent recurrent breast cancer, cause very low levels of estrogen and potentially more severe menopausal symptoms such as vaginal dryness

Arthritis and back pain. None of the hallmarks of arthritis—pain, stiffness, and reduced flexibility—is particularly friendly to an active sex life. That’s especially true when the hips, knees, or spine are affected. The same goes for chronic back pain. Women (or their partners) with these conditions are wise to experiment with different sexual positions to maximize comfort. Also consider different settings (such as in a tub, on a water bed, or on top of pillows), different timing (right after taking a painkiller or a warm bath), and different types of sexual intimacy (beyond standard intercourse) to accommodate joints that don’t always accommodate you. The “Resources for More Information” section near the end of this program includes a link to a helpful online guide to sex positions for patients with arthritis.