What’s Normal? The Sexual Slowdown

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Not all couples experience sexual slowdown, yet it's important for those experiencing it to be self-aware and willing to understand issues as they arise—such as dryness from menopause or erectile dysfunction from age.

"Many women will report a slowdown in spontaneous desire around the time of menopause, which has an average age of 52," said Diana Bitner M.D., NCMP, FACOG, Medical Director of Midlife, Menopause & Sexual Health, Spectrum Health; Assistant Professor, Michigan State University College of Human Medicine. It's important, she adds, to define further what a sexual slowdown means by detailing types of desire.

  • Spontaneous desire means spontaneously thinking about sex and then initiating with a sexual partner.
  • Responsive desire is when a person's sexual partner initiates sex and the response is "OK, give me a minute ... sure," followed by a good experience and afterward being glad it happened. "This can be very normal and doesn't mean there's a slowdown, just a change," said Dr. Bitner. "My patients are often very relieved to know they have not 'lost it' and want to know more about how to navigate the change."

Natasha DeHaan, NP-C, SC, who works with Bitner, describes the three stages of love she learned about in her training—a concept from expert Dr. John Gottman.

In the first stage of love with a partner, physical sensations and emotions are strong and powerful.

"During this time, sexual fantasies abound—there is passion, mystery and risk," said DeHann, who added that this typically lasts around two years.

The second stage challenges couples to ask the more difficult questions of one another: Will you be there for me? Can I trust you?

"The passionate sex may be less frequent," said DeHaan. "Couples get bored and bodies change. It is common to neglect self-care and focus on things like kids or a career. This is an important time for intervention when experiencing sexual frustration, including grieving the ways sex changed, but also appreciating the advantages and stability of bonding sex."

The third stage is an evolution resulting from true commitment and work—creating a balance and acceptance of self and partner.

Reasons for Sexual Slowdown

  • Physical: Pain during sex (perhaps due to menopause or cancer-treatment), medical conditions such as arthritis and diabetes, incontinence, poor self-image, vaginal dryness, depression, difficulty with orgasm.
  • Psychological: Job stress, history of emotional or physical abuse, fear of pain with sex.
  • Interpersonal: Insufficient intimacy, lack of trust, lack of intimacy, lack of mutual lust or attraction.

Natasha Peoples, NP-C, NCMP, who also works with Bitner, notes there are so many changes occurring during the menopause transition that patients often find themselves overwhelmed, with hot flashes, night sweats and sleep disturbances being common.

"My patient 'Cathy' had noted some of the 'typical' menopause symptoms but was more concerned with the fact that her sex drive had dwindled. She had always had a good relationship with her husband of 27 years, but she felt that what used to be a healthy libido had all but vanished," said Peoples. "We talked at length about the many reasons that this is common during midlife, including physical changes, life stressors, fatigue and anxiety."

Peoples went on to explain that hormone changes such as decreasing estrogen and testosterone—combined with vaginal dryness or pain with sex—can all contribute to a sexual slowdown.

"While I reassured Cathy that the decrease in libido she was experiencing was normal, we also worked together to find ways in which she might be able to experience an increased sex drive again," said Peoples. "Cathy was relieved to learn that she was not alone in her experience, and together we made a plan to help her get her sex life back."

There can be many solutions to sexual slowdown, Bitner notes.

"Just being brave enough to have the conversation is the first step. Next, is figuring out the cause. I recommend starting by agreeing that there is a sexual slowdown, that neither are OK with the current state of affairs, and you're in agreement to figure it out."

The Midlife, Menopause & Sexual Health practice at Spectrum Health could help, as well.

"We're very comfortable with these conversations and can help to determine the cause and then give options," Bitner said. "We're here to help!"

Written by Sarah Suydam, Staff Writer for West Michigan Woman. Read more about this and other topics in the Sex & Relationships Special Section.

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