Kim Painter

Special for USA TODAY

Study found midlife women continued to have sex%2C despite physical problems

Author who interviewed 150 women says the oldest told some of steamiest stories

Not all women want to keep having sex%2C and that%27s OK too%2C experts say

Plenty of women at midlife and beyond still have and care about sex, says the latest research, out just this week. While this may come as news to some younger people, it is no surprise to journalist Iris Krasnow.

Krasnow, the author of several previous books on marriage and relationships, interviewed 150 women of all ages for her new book, Sex After… Women Share How Intimacy Changes as Life Changes. She talked with women about sex after marriage, pregnancy, illness, coming out as gay, and divorce, but also after menopause — even long after menopause. Some of the steamiest stories, she says, came from the oldest women.

There was the 88-year-old who fondly remembered rolling around in bed with her husband until shortly before his death at age 91. There was the 75-year-old bookstore clerk who knowingly recommended Fifty Shades of Grey and the 72-year-old survivor of a 1970s "open marriage" who said she was having the best sex of her life, thanks to an attentive and faithful second husband and a vibrator.

"I talked to so many women who said 'I may look 75 and I may feel 75 but in my heart and in my loins, I'm still 25," Krasnow says. "There wasn't one doctor or therapist who didn't tell me that people are interested in their sexuality until the day that they die."

While the newest study did not follow anyone until death, it did follow nearly 600 women for eight years, starting when they were between 40 and 65 years old. Midway through the study, researchers asked the women if they were having sex, and about two thirds said yes. At that time, the women also filled out a standard questionnaire about sexual functioning — assessing such things as lubrication, pain with intercourse and ease of orgasm.

Intriguingly, most of these sexually active women scored in the "sexual dysfunction" range on this test, says lead researcher Holly Thomas, an internist from the University of Pittsburgh. Despite that, 85% were still having sex four years later — and their technical level of functioning seemed to have nothing to do with it, Thomas and colleagues reported in a research letter published in JAMA Internal Medicine.

Instead, Thomas says, the strongest predictor that a woman would keep having sex was that she said sex was important to her.

"The majority of women who go into midlife sexually active stay sexually active," and either find ways to get around physical problems — or find them less of a problem than researchers may have previously assumed, Thomas says. That may be because many older women care more about physical closeness than intercourse per se, she adds.

"I think we have to take a more holistic view," she says. "We need to be considering factors like relationships, intimacy and overall sexual satisfaction when we study sex in older women."

The findings come just as pharmaceutical companies are stepping up efforts to develop and market treatments for exactly the kinds of problems that did not seem to stop the women in the study from having sex. There's a new pill, Osphena, for women who have pain caused by vaginal changes (also treatable with over-the-counter lubricants and vaginal estrogen). Another pill under development is for premenopausal women with low desire.

Krasnow says she isn't sure how many women need that kind of help, but she says many older women do need something to keep their fires burning. For some, she says, it's "experimenting with fruit-flavored lubricants and experiencing the joys of oral sex for the first time." For others, she says, it's leaving a lifeless marriage or finding new love as a widow or divorcee.

"What we're talking about is changing the sexual recipe. There has to be a change as women age," says Gloria Bachmann, an obstetrician and gynecologist at Robert Wood Johnson University Hospital, New Brunswick, N.J. "The same sexual activity that was favorable at age 21 may not be favorable at 61."

And what's delicious for one couple may be too bland or spicy for another, at any age, she says. "For one older couple, sex may be cuddling and massaging; for another, it may be the act of penetration that's critical."

Some women don't want any sex. Krasnow interviewed one 60-year-old woman who said she and her 64-year-old husband grew closer once they stopped having what was increasingly painful, joyless sex. Going sexless is fine, Bachmann says, as long as it doesn't leave a still-eager partner in the cold. When desires differ, she says, committed couples can work together to find compromises.

Couples "may need to make all sorts of accommodations," to keep sex going, says Ginger Manley, a Nashville sex therapist and author of Assisted Loving: The Journey through Sexuality and Aging. But the effort can pay off, she says.

"For a lot of women past midlife, sex takes on a whole new meaning," she says. "It's not about making babies, it's not about being some hot chick … now it can just be about having fun."