Why So Many Women Between 40 and 50 Develop Sexual Issues

For many women, the years from 40 to 50 are psychologically fraught. They’re not quite menopausal, but they must contend with pre-menopausal (“peri-menopausal”) changes: feeling older, increasing menstrual irregularity, possible weight gain, and the beginnings of hot flashes and vaginal dryness. The peri-menopausal years may also include emotional and sexual problems: moodiness, irritability, insomnia, depression, and decreased sexual interest, function, and satisfaction, which, in turn, may challenge their relationships.

Physiologists explain that peri-menopausal changes stem from declining estrogen levels. This change eventually eliminates menstruation, and often causes vaginal dryness and thinning of the vaginal wall (“atrophy”), which may make intercourse uncomfortable, painful, or impossible. Psychologists explain that these physical changes are at the root of peri-menopausal distress.

However, Chinese researchers offer a ray of hope. The conventional wisdom on peri-menopause has overlooked the importance of weak pelvic floor muscles. These muscles run between the legs and play a key but often under-appreciated role in women’s sexual function, orgasms, and erotic satisfaction. Weak pelvic floor muscles can be strengthened, which may reduce or even eliminate peri-menopausal sex problems.

The Study

The researchers surveyed 250 healthy Chinese women, age 40 to 55, who complained of peri-menopausal sex problems. The women provided extensive medical and sexual histories. Then one member of the research team, who had not seen the completed histories, inserted gloved, lubricated fingers into each participant’s vagina and asked them to contract the muscles in that area, their pelvic floor muscles. That researcher graded the contractions from none to weak, moderate, or strong.

As pelvic floor muscle strength increased, the women reported fewer and less severe sex problems. Compared with those who had the weakest pelvic floor muscles, those with the strongest reported significantly more sexual desire (p = 0.001), more orgasms (p = 0.009), and greater sexual satisfaction (p = 0.001). There were also trends toward more vaginal lubrication and easier arousal, but they did not quite reach statistical significance.

Kegel Exercises to the Rescue

In 1948, Los Angeles urologist Arnold Kegel, M.D. (KAY-gell), was treating women suffering from “stress incontinence,” embarrassing urine leakage triggered by coughs, sneezes, and laughter. He wondered if the cause might be weak urinary sphincter muscles that were unable to stay closed under the abdominal pressure caused by these actions. The urinary sphincter muscles are part of the pelvic floor muscle group. Kegel theorized that exercises focused on strengthening the pelvic floor muscles might help women keep their urinary sphincters closed and cure stress incontinence. He was right. His exercise program, Kegel exercises, improved his patients’ bladder control and usually cured stress incontinence within a month or two. Since then, Kegel exercises have become a standard treatment for the condition.

But Kegel’s patients also reported something he never expected—more pleasurable orgasms. In addition to controlling urination, the pelvic floor muscles are also the ones that contract during orgasm. As those muscles become stronger, orgasms become more intense and pleasurable.

Since Kegel, many studies have shown that strengthening the pelvic floor muscles enhances orgasms. In one study, Iranian scientists worked with 145 menopausal women who complained of decreased sexual function and enjoyment. Some received standard medical care. Others attended a sex education class. And some attended the class and also practiced Kegels. After 12 weeks, the Kegel women reported the most sexual enhancement and the strongest orgasms.

The recent Chinese study extends those findings. It also offers a new explanation why middle-aged women who gain abdominal weight often complain of sex problems. The standard explanation is psychological. Weight gain hurts women’s self-esteem, which impairs their sexuality. True enough. But the Chinese researchers point out that abdominal weight gain also presses down on the pelvic floor muscles, and over time, weakens them. (To learn how to do Kegel exercises, directions abound on the Internet.)

If you don’t benefit sufficiently from do-it-yourself Kegels, you might consider pelvic floor muscle-toning devices offered by many personal care catalogues and variously called Kegel Exercisers, Kegelmasters, or other names that usually include “Kegel,” “pelvic,” or “PC.” Working these gadgets tones the muscles between the legs. Biofeedback offers another way to improve pelvic floor muscle tone. But a 2017 analysis by Canadian researchers shows that home practice of plain old Kegels is usually the most cost-effective approach.

Menopause Essential Reads

Early Menopause: Symptoms, Causes, and Coping for Under 40s

The Woman in the Changing Room Mirror

PS: Kegels Also Enhance Sex for Men

Like women, men also have pelvic floor muscles running between their legs that contract during orgasm. And like women, Kegel exercises can also intensify men’s orgasms.