You can Enjoy a Healthy Sex Life and After 40

How much sex are we having? It depends who you ask.

Last year, research on conducted by Relate adults in the UK over 16 showed that half had not had sex in the past month, but add middle age to the equation and it seems the older we are, the healthier our sex lives are becoming.

New research conducted by dating website illicitencounters.com has found that sign-ups among the over-40s has doubled in the five years since its launch, with almost 50 per cent of married men and 36 per cent of married women over the age of 40 reporting having had sex up to five times in the past month.

Meanwhile, a landmark study on 7,000 retirees from Manchester University last year showed more than half of men and a third of women were still sexually active over the age of 70.

While age doesn't have to be a barrier to a fulfilling sex life, however, biological changes can have a significant impact on libido and performance. So, what really happens to sex drive as we age and, more importantly, once it's lost what can be done to get it back?

Nature's Viagra

Prescriptions for Viagra-like drugs – used to treat erectile dysfunction (ED) in men – have doubled in the past decade with a staggering almost three million written in 2014. But heartening research on 25,000 middle-aged men published last week in The American Journal of Clinical Nutritionfound that consuming three or more portions of food and drink such as red wine, blueberries, cherries, citrus fruits and radishes could reduce a man's risk of developing ED by 14 per cent. Men who exercised regularly reduced their risk by 21 per cent.

"These benefits are to do with flavonoids in these foods," says Rob Hobson, a clinical nutritional therapist and author of the Detox Kitchen Bible. "These compounds are known to help preserve blood vessel health and improve blood flow, which is essential to erectile functioning."

Libido, age and your hormones

"As you reach middle age, libido becomes a bit like the stock market," says Dr Ian Kerner, a sex psychologist based in New York City and author of She Comes First: The Thinking Man's Guide to Pleasuring a Woman, one of the highest-selling sex advice books in the United States.

"It's up and down from day to day and reflects underlying dynamics such as relationship health and the participants' diet, exercise and self-esteem," he says.

Declining sex hormones play a big part in both desire and sexual functioning as we age. In men, for every year after 40, the sex hormone testosterone drops by about one per cent, with one in five men tested showing low levels, says Vivek Wadhwa, consultant urological surgeon at Spire Parkway Hospital and Heart of England NHS Foundation Trust. "Along with low sex drive and erection problems, this can cause symptoms such as lethargy, poor sleep and short-term memory loss."

It's also common for men's erections to become less reliable after 40, says Cate Campbell, a psychosexual medicine specialist and author of The Relate Guide to Sex and Intimacy. "This distresses people," she says, "but few realise not only is it normal, it needn't stop them enjoying sex as men can still orgasm without a full erection."

Still, "there's no point simply prescribing Viagra if a man's testosterone is low", says Wadhwa. Your GP can refer you to a urologist who can measure testosterone levels and, if needed, prescribe replacement through gel, patches or injections. However, he advises that men see a specialist urologist "as testosterone supplementation in men with an undiagnosed prostate cancer can feed its growth".

If testosterone doesn't work, however, drugs such as Viagra or the newer Cialis can be taken. While the former takes about 40 minutes to work and can be taken up to twice a week in 50-100mg dosages, the latter can be taken in a 5mg once-a-day dosage. This means "levels in the blood stay stable, so the sex needn't be planned", says Wadhwa.

If you have erectile dysfunction, ensure you have a screening for cardiovascular disease risk before taking drugs. "Erectile dysfunction can signal heart problems up to 10 years before disease shows," says Wadhwa.

Sex and the menopause

Sex researchers Masters and Johnson found that in middle age, women tended to take less time to reach orgasm than men, but hormones could still have an impact.

From about 45 onwards symptoms of low oestrogen can make sex more painful, which, in turn, reduces desire, says Dr Shirin Irani, consultant gynaecologist at BMI Priory Hospital and Heart of England NHS Foundation Trust. Locally applied oestrogen cream, which can be prescribed by your family doctor, in small doses "is like using a very expensive night moisturiser", she says. Applied twice a week for three months, it moisturises the cells and restores natural secretions.

While many women fear hormone replacement therapy (HRT) because of the highly publicised debates over its increased risk of breast cancer, this is a tiny dose - 10mg compared with 1,000 in a typical HRT pill - and "too low a dose to enter the blood circulation".

Lifestyle measures can help both men and women, says Ian Kerner. "Weight training, for example, can stimulate natural increases in testosterone and, subsequently, sex drive," he says. Brief periods of cardiovascular exercise can also help. A 2012 study published in the Journal of Sexual Medicine found that 20-minute bursts of exercise performed five-to-15 minutes before sex, with the heart rate at 70 percent of its maximum capacity, could enhance the speed of a woman's arousal.

The myth of desire in middle age

Don't fancy it tonight? Get started anyway, say experts.

"For about a third of men and most women over 40, desire doesn't begin until they're aroused," says Cate Campbell.

"It's why often people might have a lovely kiss and then find themselves wanting sex, even if they didn't want it to begin with."

Known as subjective arousal, this get-started-then-get-down approach is thought to be essential to the sexual desire of the over-forties because they are simply not thinking about it all the time as they were when they were in their twenties, says Kerner.

This is a boom area, with products such as "female Viagra" becoming a holy grail for companies seeking solutions for what is dubbed the middle-age "sex problem".

"In middle age, desire follows arousal, whereas in youth it's the other way around, so if you put in the effort at the beginning, you're more likely to find yourself in the mood," says Kerner.

FIVE THINGS NO ONE TELLS YOU ABOUT SEX OVER 40

• Your risk of infection is higher. Thinning skin around the genital area can increase the risk of sexually transmitted infections, which peaked in the over-fifties last year, along with thrush and urinary tract infections.

• A strong pelvic floor isn't just for preventing leaks. It can increase your ability to orgasm. For women, the Pericoach is a new medical device and app that has been shown to strengthen the pelvic floor.

• Antidepressants can hinder sex drive and ability to reach orgasm in up to 70 per cent of users – talk to your doctor as some types may have fewer side effects.

• Sex therapy works. Studies have shown its effectiveness, but you might need to sign up to a six-week sex ban to break bad habits, says Relate's Cate Campbell.

• Some medical conditions and treatments affect sexual performance, especially those that cause damage to nerve endings, such as Parkinson's, multiple sclerosis and muscular dystrophy, along with prostate surgery in men.