How To Have Better Sex After 50

Q: As a postmenopausal 60-year-old, I have terrible pain during sexual intercourse. I've tried lubricants without success, and as a breast cancer survivor I've been advised against hormone therapy. Is there anything else I can try?

A: Replens, an estrogen-free vaginal moisturizer, plumps up severely atrophied tissue. It must be used several times before you experience changes in the vaginal floor, but it should make a difference. (Pair it with a silicone lubricant such as Pink or Eros.)

Many doctors believe that estrogen-based cream is locally absorbed, which would make it safe for women who've had cancer. Feminist and cancer specialist Susan Love, M.D., has strong opinions on the use of hormones. Though she does not recommend topical estrogen for women who have had breast cancer, she suggests talking to your doctor about a slow-release estrogen ring.

Q: After my wife died three years ago, I became involved with an old friend. Then she died of a stroke three months after I lost my father. Since then, I've been having extreme bouts of loneliness. I'm now dating three women. I know I shouldn't have three gals at once — and that's making me more depressed. What should I do?

A: Take things slowly: It's OK to make sure you're with a great person who's good for you, but only time can determine that. Though all three women may want you to make a decision sooner, you must explain your need to get to know someone very well before you can make a commitment.

The main thing is to be honest. If each woman knows what's really happening, she won't feel betrayed if you don't choose her. In fact, if a woman discovers that the man she's dating is seeing other women at the same time, she always has the option of going out with other men herself. Alternatively, she may conclude that her expectations for the "multi-dater" were too high, and move on. I hope your choice becomes clear before too long. Do this right and you might even remain friends with the also-rans!

Q: My wife gets irked when I drop hints about meeting in the bedroom. But when we do (infrequently) have sex, she has roaring orgasms, which I love to help with. Why has she gotten so hard to seduce?

A: Women's sexual desire is so variable, it's almost impossible to predict. Just because a woman is orgasmic and enjoys sex when she has it doesn't mean she'll be in the mood at the next opportunity. That may strike men as odd, but women's sexual response is governed by so many things — hormonal changes, daily life, the relationship — that you can't draw a straight line between desire and orgasm.

You can, however, draw a straight line between relationship satisfaction and desire: Study after study has shown that high relationship satisfaction is likely to increase both desire for sex and orgasmic response.

So when a man mentions being on a different sexual wavelength from his wife, it makes me wonder how the relationship is going. I'm not saying a woman's sexual interest is dictated exclusively by her happiness with a partner — far from it. All kinds of other things can be involved, ranging from endocrine issues to worries about money or children. But the relationship is always a good place to start.

Q: I'm an active 60-year-old woman, and I'd love to meet my perfect match. I know that age doesn't protect me from STDs [sexually transmitted diseases], but what happens if the man can no longer hold an erection? That means condoms can fall off. When I've suggested to beaus that we have blood tests before having intercourse, I've gotten shocked looks and comments that I don't trust them. What's a gal to do?

A: You could start by finding a guy who's a grownup. Haven't these men read about the prevalence of STDs among single daters over 50? Even long-term care communities have run into problems when residents have not used condoms. Think about making condom use sexy: Get one that's micro-thin (available in drugstores) and present it to the man in question as a "sex toy." If he can't keep it on when he's at half-staff, you might mention Cialis or Viagra as well.

If these options aren't viable, take a second look at the female condom: Recently improved, it no longer feels like a plastic bag inside you.

One other thought: Explore each other's bodies with your mouth or hands, but hold off on intercourse until you both really want it. Then, just before penetration, try an ultrathin condom. If he's very excited, the condom may not deter the proceedings.

Q: I had a knee replacement five weeks ago, and now I can't kneel above my spouse when we have sex. Is there a book that can show us different positions?

A: Is there ever! The Joy of Sex shows all kinds of positions (the first edition has drawings; the second shows photos). British sex therapist Anne Hooper has a number of books with photos of a variety of sex positions. There is also a fun book called The Guide to Getting It On! — it offers detailed instructions on, and drawings of, various options.

Q: Can a person's gender preference change with age?

A: Yes. It's a gobsmacking event when it happens, but researchers are discovering a person's sexual orientation is not carved in stone. In Sexual Fluidity, Lisa Diamond chronicled her research on nearly 100 gay women over 10 years. During that time, several of the women changed their sexual orientation. The most frequent cause for the U-turn? The "switchers" had fallen in love with a member of the opposite sex. Other researchers have compiled case studies of gay men who fell in love with women, as well as of heterosexuals, both men and women, who unexpectedly became involved with a member of their own sex. Love, it seems, really can conquer all.

As AARP's love and relationships ambassador, Pepper Schwartz writes about sex for aarp.org. This article is excerpted from her e-book Better Sex: AARP's Guide to Sex After 50.