It starts when you’re thirteen, and those tight shorts make your crotch wet when you ride your bike. You like these shorts, the way they make you feel this new way: sexy. You fall asleep at night thinking about sex. You listen to songs that encourage you to think about sex, and you discover you can even think about it at church and in the classroom without anyone knowing, if you keep a certain demeanor and cross your legs a certain way.

Eventually you start having almost as much sex as you used to think about, but you still keep fantasizing about the sex you’re not having and reminiscing about what you’ve had, remembering the exact details: the dimensions of the lips, the shape of the tongue and how it first entered your mouth, the precise smell of the shoulders and neck, each lover’s body, as poet Jack Gilbert writes, a country in which you lived for a time.

All your life, you think, you’ll want it. You think the wanting will be a constant companion, like a faithful dog. You think you’ll always be up for it, through sickness and health. Oh, sure, as you get older, there are times when you feel less like having sex, or times when you get bored with your lover, or depressed, but then you just find a new partner, and there’s sex again. You are sure it will never go away. You know this because movies and TV and advertisements for Viagra tell you that old people have sex too, that it is not strange to have sex after you get old. You decide you will be an old woman who still has sex. You will have sex until you die. Maybe, in fact, you will have it on your deathbed. You will die a well-fucked woman.

You are so determined to keep on having sex that, when you find yourself in a long relationship in middle age, it’s difficult to acknowledge that your desire for sex is starting to wane. You explore sex toys and read books about how to spice up your sex life. There’s a kind of desperation in your search for ways to make yourself want it the way you once did. You feel like a nonbeliever who continues to go to church because she can’t admit she’s lost faith.

Your strategies seem to work for a while. As long as you keep changing partners, or having long-distance relationships where the sex is only every other weekend, everything is fine.

But then you marry late in life, and you don’t want to change partners, and all of a sudden (or so it seems) you can’t keep up with your husband’s desire, and you are mortified. It’s like a terrible secret: you feel not yourself, freakish, and, worst of all, boring.

You’re able to talk yourself into sex for the sake of your marriage and out of love for your husband, but it’s not pleasant because, although you don’t want to admit it at first, penetration has started to hurt. No longer do you welcome that once-sacred entering, in fact. It’s as if your whole body cringes when he tries, and sometimes — and now we’re getting to the part that no one prepares you for, not mothers or aunts or even kindly physicians — sometimes you bleed when you have sex because, as a male doctor explains to you later, your vagina has “atrophied.” Your body, the doctor says, is experiencing penetration as physical trauma.

How can this be? You are still a young — or youngish — woman. But when you get home and phone your mother, who is the only one outside of your husband you can tell about this, she says the same thing happened to her at the same time, in her early fifties. (Why didn’t you tell me this before now? you think, as if you could have somehow prepared for this moment.)

“I haven’t had sex in twenty-four years,” she says in a cheerful way — a fact that is really not at all helpful at this point.

You begin to notice that there are an awful lot of men your age who are with significantly younger women, and you are starting to understand why. Your vagina has shrunk — there’s no other word for it — and every act of sex is as painful as the first time, maybe more so. You think the inside of your vagina must look like a shrunken morel. You examine it in a mirror to see if it looks any different on the outside, but it doesn’t. You look at your face, too, in the mirror, and think you are still beautiful in a deep, older-woman kind of way, but you feel awful. You wish the word atrophied did not exist.

The male gynecologist you consult says atrophy is common in women your age, and he gives you a prescription for some hormonal cream — much safer than orally administered hormones, he assures you. He recommends an over-the-counter vaginal lubricant and tells you to be patient.

“If you were seventy-five,” he says patronizingly, “this wouldn’t be a problem.”

You want to hit him.

“It’s the lowered estrogen levels,” he continues, “that cause dryness of the vagina, which can cause severe burning, discharge, and dyspareunia” [dis-puh-ROO-ne-uh], the clinical term for painful sex. Though you wish he would speak to you in a way that acknowledges you are a suffering patient and not a medical student, you are grateful for the information.

You go online to learn more, careful to visit only sites such as the Mayo Clinic and Medscape, where the comments are written by physicians and make reference to clinical trials and papers. One doctor writes that chronic and progressive vaginal atrophy is the twenty-first-century health issue affecting quality of life for women. Researchers conservatively estimate that 50 to 60 percent of postmenopausal women experience it, although it’s difficult to get accurate numbers because many are too embarrassed or ashamed to talk about it.

The Mayo Clinic confirms that thinning, shrinkage, and inflammation of the vaginal walls are due to a decline in estrogen levels as you age. Both sites suggest hormone-replacement therapy, creams, and gels. Ads pop up that promise relief. One shows an attractive older woman with gray hair smiling and blowing bubbles. You hope that the cream will work for you and that you will soon be blowing bubbles again, because the latest study shows that women on hormone-replacement therapy are more susceptible to heart disease, breast cancer, stroke, and blood clots.

You try the hormone cream and the lubricating gel for a few months, but they don’t seem to help much. Your vagina just doesn’t want to open the way it once did, and the pain remains. You keep trying, though, hoping that continued intercourse will force it to stay open. Finally you decide it’s time to find a new gynecologist. A friend recommends a woman doctor she’s been seeing for some time: “She’ll be more understanding.”

Dr. Hugo looks to be in her late fifties. She has a head of curly locks, full lips, and an intense, seemingly genuine interest in you. After she performs the exam, she peels off her plastic gloves and says, “You can still have sex. I can get two fingers in you. Some women with atrophied vaginas, I can’t even get one finger in. But if you don’t keep having sex, you’ll eventually lose the ability to be entered at all.”

You discuss the pros and cons of hormone therapy, and you decide it’s worth the health risks to give it a try. She also prescribes a stronger hormone cream and a special vaginal ring that exudes hormones over a period of three months. The ring looks like a doughnut.

“The same thing happened to me,” Dr. Hugo says as she’s writing out your prescriptions. “I married in my fifties, too, and couldn’t keep up with my husband. The cream, the rings, and the hormones will help with the physical pain.”

“What about desire?” you ask.

“It differs with each woman.”

“How long did you stay on hormone therapy?” you ask.

“Three years,” she says.

You are afraid to ask what she did after that.


So you start taking hormones, and you use the stronger cream and the ring faithfully, and you and your husband wait for things to improve. But each time you try to have what your husband calls “regular” sex, it still hurts. A typical encounter goes like this:

He asks ahead of time if you might want to have sex that evening or the next morning, so that you can be prepared. You agree. At the prescribed time he lights candles, draws the blinds, and gets out all the various lubricants and gels you will need. He starts with a back rub, kisses you sweetly, touches your breasts, tries to excite you with words. You try to get into it, but all you can think about is that at some point he will enter you, and it will be painful. You use your yoga training to focus on the moment and the pleasure he’s attempting to give you, but all your legs want to do is clamp shut. You open them, though, remembering that you must have intercourse if you want to remain able to have it. Finally you are as ready as you will ever be. He climbs on top and tries to enter you, gently, just a bit.

“Does it hurt?” he asks, excited but concerned.

“A little,” you say. “But it’s OK. Just go slow, not too deep.”

You close your eyes and try not to cry out as he moves in and out, slowly and not too deeply. There are tears in your eyes, but you don’t let him see. Finally, after three minutes that seem like an hour, he’s finished. You are quiet for a while, hurting but happy to be in his arms. A few minutes later you excuse yourself to go to the bathroom, where you clean yourself, wiping off the bright-red blood.

Still the doctor insists that you have to have sex once a week, or you’ll really lose it all. “Think of it as your homework,” she says.

You try to adapt. You and your husband joke about doing your “homework.” You tell him you think you might try to write about the whole matter, that it might make you feel better, and would he mind if you got something published?

He thinks for a few seconds and says, “No, as long as you say that I have a big penis.”

You smile and are happy for the levity. If you didn’t both have a sense of humor about this, it would be much worse. The truth is, he does have a large penis, and you have sometimes wondered if sex might not hurt so much if his penis were smaller. You used to love his penis, the way it filled you. And he is a strikingly handsome man — one of your friends even called him “drop-dead gorgeous.”

Your husband tries to spice up the homework. He puts up red curtains, brings a bottle of wine, and plays music: soft jazz, blues, and, inexplicably, Gregorian chants. Sometimes he spins out fantasies to whet your interest: he pretends he is a sailor returned from a long voyage, and you are his beloved. When penetration still hurts, you take to having sex without it. You feel guilty, though. You know that’s not what he wants, even though he tells you it doesn’t matter that much. You tell him it would be OK with you if he wanted to have an affair, although you are not really sure how you would feel about this. He does not want to have an affair. He loves you, he says.

At some point you wonder if it is just that you no longer want your husband, but as soon as you wonder it, you know that this is not the case. There is no one else you want. You don’t even want yourself. You just want to be left alone.

You have begun to think about not having sex almost as much as you used to think about having it, and while you are trying to be patient and wait for the hormones to make a difference, you slowly begin to bring up the subject of waning desire with women who are around your age, and you learn — surprise! — that you are not alone.

You visit a couple you’ve known for about twenty-five years. They seem to have a happy marriage. They are Buddhists, gardeners, collectors of art and music. A., the husband, has recently recovered from prostate cancer and told you, when he was going through treatment, “If I can’t fuck anymore, I’m going to be really pissed off.” C., his wife, had a hysterectomy and has been on hormone-replacement therapy for years.

You are sitting with them in their backyard, surrounded by oaks, bamboo, dark-leaved tropical plants, and a dizzying number of large-belled, sweet-smelling flowers. It feels like the Garden of Eden.

After C. had the hysterectomy, she tells you, it induced an early menopause, and she lost the desire for sex. “It felt like my whole body was drying out. I only worried about the risks of hormone therapy for about two minutes.” She smiles and takes a sip of her iced tea. “There was no way I was spending the rest of my life like that. Sex or death!”

“So it worked?” you ask.

“Oh, yeah, honey, it worked. But I had to get on the natural hormones, and it took a while to get the right dose. A few years.”

“I’m fine too,” A. says, smiling. “Viagra is a lifesaver.”

When C. reveals the huge dose of hormones she’s taking, you’re shocked, but you can’t argue with success.

Not long after, C. tells you that she has developed some life-threatening health issues that her doctor thinks are related to the hormone therapy, and she is considering stopping or lowering the dose. You wonder about the kind of mind-set that values sexual activity over health.

Other friends admit to waning desire. One successful literary editor says she’s told her husband he always has to be the one to initiate sex, and that she’ll comply, but he can’t expect that she’ll ever really want it again. Another has given her partner permission to have sex with anyone he’d like, as long as it’s not her. A former rock-musician friend says simply, “It will never be what it was. We’ll never have that feeling again. Never.”

You don’t ask them for specifics because it seems too private (So, do you have an atrophied vagina?), but you can’t help but wonder how many of them have the same problem. Some talk about just living with their partner’s unhappiness until something happens to him — like prostate cancer, say — and then sex becomes a nonissue, at least for a while. These are vibrant, smart, beautiful women in their fifties and early sixties. They are strong, they are healthy, they lead meaningful and interesting lives, but they don’t feel like having sex much anymore.

Of course there are exceptions. You meet a friend for lunch one day, an energetic woman around your age. You both eat spicy lamb curry and dal and chat about your personal lives.

“Bill and I never have sex anymore,” she says. Bill, her husband, was treated for prostate cancer a few years earlier. “He just can’t do it.”

“Do you still want it?” you ask.

“Wow, yes, but I can satisfy myself with a vibrator if need be. I just wish he still wanted me.”

She then goes on to tell you how she is thinking about having an affair. She can hardly stop talking, between bites of curry, about how much she still wants sex and how sad it makes her that her husband doesn’t.

You can’t bring yourself to tell her about your problems.


You find a forum online devoted to vaginal atrophy with many stories like your own: women confused about the pain and trying the hormones and creams, mostly without success. Some recommend other ways to boost desire: vitamin E, testosterone, caffeine (yes, caffeine!).

One post, however, breaks your heart:

I feel like a failure. I would be quite happy to never have sex again, and my husband just can’t understand that. Why isn’t there some sort of surgical intervention, a vaginal transplant or replacement, like for burned skin or something? I really feel alone and miserable. Doctors don’t seem to want to talk about this, and everyone just seems to sigh and expect me to live with it. I could, but what about my husband? Please, can anyone out there give me hope for a happy ending to this story?

A happy ending. Some of your older, single women acquaintances do talk about living without men, happy with their female friends in a world of dinners and movies and book clubs. This is the route your mother, whose husband died some years ago, has taken. Still others take the hopeful pills that don’t always make much of a difference and go on living their full and busy lives, carrying this small sadness within them, this wish that they could again love something they once did.

You wonder if longing for the strong libido and the supple sex organ you had as a younger woman makes you like those women who keep having face- and breast-lifts. Is it possible for you to accept the waning of sexual desire as a rite of passage to a quieter, more reflective time, a time in which the blinders of sex are gone and you can focus on other things? Perhaps this waning is your body’s way of suggesting that there are more important matters to which you might pay attention in this last third of your life. You’re embarrassed to remember how much time you wasted as a young woman thinking about sex.

Eventually you stop the hormones and decide to try to live with the fact of diminished desire. After all, doing the same thing over and over again and expecting different results is one definition of insanity. Maybe you’ve just lost the desire to try to recapture the desire of your youth. Your husband says he understands.

It sometimes seems that aging is only about loss: not only does our desire diminish, but our hearing and eyesight weaken, memory becomes a struggle, and the physical body in general loses tone and elasticity, no matter how much you work out. It’s hard to imagine being happy about this, but you can be present in it, accept it, interrogate it, meditate on it, learn from it the way you have learned from other losses all your life. When sex is mostly out of the equation, you are surprised to find that there is this gift: the irrefutable proof that you can love someone without sex as the primary driver of the relationship. There’s a depth to the affection you have for your husband now that feels rich and complex, more nuanced than when you first met and spent almost every night having sex.

Happy ending? Not if the only thing that makes you happy is the return of the libido and body you had fifteen or twenty years ago. But if happy can mean contented, at ease, appreciative, then maybe this is a happy ending, one in which you find beauty outside yourself, in the small things you hadn’t noticed before: the careful way a bee enters a foxglove’s flower; the feel of a heavy, ripe tomato when you pick it from the vine; the dark beauty of your son’s new mustache; the breathtaking intelligence of your daughter; the vibrant, angry tattoos on your female students’ skin; the precise tea-brown color of the Atchafalaya Swamp in Louisiana; the sweetness and patience of your husband as he works at his desk, or paints the basement, or walks the dog, and tries to understand the haunted sadness you carry, this memory of a country where you once lived, whose language you seem to have forgotten.