Relationship issues obviously play a part. A stale relationship, poor communication, physical or emotional disinterest, etc., does not promote sexual closeness. Certain medical conditions (fatigue, depression, hypertension, diabetes, etc.)and the medications used to treat them can lead to desire, arousal and orgasmic dysfunction. Frequently implicated here are certain antidepressant and anti-hypertensive medications. Additionally as well, sometimes orally administered hormones (birth control pills and hormone replacement therapy) can diminish desire.

The fatigue issues of midlife either secondary to stress, inadequate sleep or hormonal factors diminish sexual interest and satisfaction. And of course, if your rollercoaster estrogens are causing moodiness and hot flashes or if stress is increasing, sexual interest wanes.

Hugely important is hormonal "support" of the vagina. women's vaginas respond by being dry and "scratchy". Without adequate moisture, lubrication and pliability, lovemaking can become uncomfortable and distinctly unpleasurable.

But hormonally, as much as anything, it is the slow, steady decline of androgen levels at midlife that most likely produces the decline in desire and sexual ennui experienced by so many midlife women.

Totally,sexuality issues can occur in three areas: Loss of sexual desire, ("low libido"), poor arousal, and difficulties in achieving or satisfaction of orgasm in previously orgasmic women .

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