Sexual health is an important component of quality of life at midlife, and an appropriate, timely, multidisciplinary approach is key to expanding the 'sexspan' of aging couples by addressing biopsychosocial changes in both partners.
Sexual difficulties increase significantly in both sexes with aging, affecting every domain of sexual response and reducing frequency of sexual activity.
Hypoactive sexual desire disorder (HSDD) and genitourinary syndrome of menopause (GSM) are identified as two very common biologically driven midlife conditions in women that are often comorbid.
Delayed or inappropriate diagnosis of sexual dysfunction risks chronification, potentially making the condition refractory to treatment.
The recommended therapeutic algorithm for midlife sexual dysfunction comprises a multidisciplinary approach combining pharmacologic and non-pharmacologic management.
Individualized treatment is identified as the key strategy for expanding the 'sexspan' of both partners in midlife relationships.
This paper, presented at a major international menopause conference, reviews what happens to sexual health and intimacy for couples as they reach midlife. The authors explain that aging brings biological, psychological, and social changes that tend to increase sexual difficulties for both men and women, reducing both the quality and frequency of sexual activity. For women specifically, two very common conditions — hypoactive sexual desire disorder (HSDD), which is low or absent sexual desire, and genitourinary syndrome of menopause (GSM), which involves physical changes to genital tissues — often occur together and can be made worse by personal and relationship factors. This research suggests that getting an accurate diagnosis early is critical, because untreated sexual dysfunction can become harder to treat over time. The authors advocate for a personalized, team-based approach that combines medical treatments (such as hormonal or other pharmacological therapies) with non-medical strategies (such as counseling or lifestyle changes). Importantly, they frame the problem and the solution as involving both partners in a relationship, not just the individual experiencing symptoms. The paper introduces the concept of 'sexspan' — analogous to 'healthspan' — as a goal: helping couples maintain a satisfying sexual relationship for as long as possible as they age. This research suggests that with the right combination of timely diagnosis, individualized care, and a couples-centered perspective, many midlife sexual difficulties can be meaningfully addressed.
Nappi R, Tiranini L, Martini E, Martella S, Barbagallo F, Cucinella L. (2025). Bringing sex back into the relationship in midlife couples.. Climacteric : the journal of the International Menopause Society. https://doi.org/10.1080/13697137.2025.2489460