NZNTV

Sheila de Liz, you’ve written about sexuality after age 50. Why? People often think that women lose all interest in sex during menopause, that men eventually develop erectile dysfunction, and that it all eventually fades away.

Isn’t that the case? No! That narrative about sex is false. I see this in my daily work with patients. I’ve known for a long time that maintaining one’s sexuality is important for health. My book explains how to achieve this when you want to—and that’s the case for far more people than is generally thought.

You write that the best years for sex come after age 50. That’s surprising, though. Yes, it’s completely crazy!

What makes sex after 50 so great? Hormonal changes affect women’s mental state. They let go of their fears and have a clearer sense of what they want. Sexual experience, sexual freedom, and the intensity of sexual encounters become more fulfilling.

What makes for good sex? It’s not just about the physical functioning of the genitals. Great lovers have the courage to surrender to another person and to themselves during sex. You connect with the other person on a soul level in the sexual space.

For many women in their 40s or 50s, sex is very low on the list of things to do. That’s because women are simply exhausted and don’t feel sexually desired. I’d be angry too if my partner came over thinking that by fiddling with my breasts a bit, something would happen, like with a drink dispenser.

How can we do better? It’s about having the will to prioritize sex and the relationship. And that starts with putting the woman at ease. Treating sex like an item on a to-do list is bound to go wrong. Sex has nothing to do with “duty,” but everything to do with “desire.”

Yet you write that having a sex life is important for health. We know that sexually active people generally have better blood sugar levels and blood pressure, show fewer signs of inflammation—such as blood abnormalities or pain—and are more attentive to their health. Doctors should therefore do everything in their power to preserve the sexuality of people over 50.

What does that mean in practice? Ask questions and actively offer help if there are problems. And don’t make fun of sexual desire. Patients tell me about comments from doctors such as: “You’re not a teenager anymore, just give it up,” “You can cuddle with your husband on the couch—that’s nice too,” or “You already have children—why do you still want to have sex?”

Are such comments made, for example, when a woman complains of pain during intercourse? Pain during intercourse can be a cause for concern, just like recurrent vaginal infections. For many, it’s the loss of libido.

You describe the estrogen-based vaginal cream as the “new dental floss.” Is this something every woman should use starting at menopause? Yes, please! An estrogen deficiency can cause considerable damage to the vaginal lining: the vagina atrophies, shrinks, and becomes “sticky,” making intercourse painful. Added to this are bladder problems—you become incontinent and have to get up frequently at night. All of this is preventable. It’s amazing what estrogen can do, and it’s baffling that medicine has ignored it for so long.

This is an example of a broader issue that you’ve been speaking out against in your books and on social media. The system’s major failure, exactly.

If the penis shrank, if it hurt so much that a man couldn’t even wear underwear anymore, if he became incontinent by his mid-forties, you’d be able to buy this ointment everywhere, even at the supermarket. For women, we’ve sort of accepted the situation.

If we say that sexuality is important for health, what does that mean for people who aren’t in a relationship? If you don’t want to be in a relationship, I think that’s perfectly fine, as long as the relational dimension—the human connection—isn’t missing from your life.

But? I think it’s important to ask yourself whether you want to maintain your interest in sex. If, for example, I’m not interested in sex because I have vaginal pain, it’s worth considering whether I should take better care of my vaginal health. If my sex drive is low because my testosterone levels are at an all-time low, I can take steps to address that. A healthy testosterone level doesn’t just boost libido; it also protects against dementia, benefits bone health, and helps preserve muscle mass.

Is solo sex just as good an option as sex with a partner? I don’t know if it’s quite as good, because obviously the emotional component is missing and the relational aspect disappears. But if you enjoy masturbation, why not? And that goes all the way into old age!