Care with Roscoe Nelson, MD, board-certified urologist.
Why it changes
Desire and function change with age in both sexes, usually for more than one reason: hormones, blood flow, sleep, stress, medications and the relationship itself. That is why one fix often falls short.
Most people wait years to bring it up. In my office it is a normal conversation.
Women
Low desire is the most common complaint and the most often waved away. Testosterone matters here, and in most women it has been drifting down since the late twenties. Pain with sex after menopause is usually thinner, drier tissue from estrogen loss, and unlike hot flashes it gets worse if nothing is done. Arousal that stalls, orgasm that has become hard to reach and the side effects of antidepressants all deserve a direct question rather than an assumption.
The tools I reach for: vaginal estrogen, systemic hormone therapy where it fits, carefully monitored low-dose testosterone, PT-141 for desire that has not answered to getting the hormones right, oxytocin, agents that improve genital blood flow, pelvic floor physical therapy, and a hard look at the medication list.
Men
Erectile dysfunction is mostly a blood vessel problem and an early warning. The arteries feeding the penis are about a third the diameter of the coronaries, so the same disease shows up there first, often years ahead of the heart. New erectile trouble before sixty with no obvious cause earns a blood pressure, lipid and HbA1c check and an honest talk about weight and smoking, not just a pill.
Low desire in men is often testosterone, but also thyroid, depression, opioids, alcohol, or anxiety after erections have failed a few times. Premature ejaculation is the commonest male sexual complaint at every age and responds well to treatment. Delayed ejaculation usually traces to a medication or diabetes.
The tools: PDE5 inhibitors used properly, since roughly half of the failures come from how the pill was taken; injections when pills fail, which work in the large majority of men; testosterone when it is indicated; PT-141 and oxytocin; direct treatment for ejaculation problems; and a cardiovascular and metabolic workup, because ED is often an early sign of heart and blood vessel disease.
Coming in as a couple
Sex involves two people. If one partner is treated and the other is not, things rarely improve much. I am glad to see either of you, or both together.
Bring your medication and supplement list, what you have already tried and how you used it, and a rough timeline of when things changed.