There is still sex in the city, beyond the age of 50. But it may come at a price that makes you wonder if it’s really worth it. Or at least, according to the writer behind the cult of Carrie, Samantha, Charlotte and Miranda.

Candace Bushnell’s latest novel-cum-memoir returns once more to her favourite stamping ground, that tiny and exhausting pool of wealthy New York women who will do absolutely anything to stay in the game. Only now they’re older, spending their money not on cocktails but on face creams and fillers, all while debating the merits of undergoing vaginal laser surgery so that the naturally ageing insides of their bodies don’t give the lie to their artificially preserved exteriors.

Bushnell’s brittle, trophy husband-hunting heroines would no doubt jump at the new menopause-delaying surgery promoted so breathlessly in last week’s papers, which involves removing and freezing chunks of young women’s ovarian tissue that can then be transplanted back into their middle-aged bodies years later, turning their biological clocks back two decades. Pause, rewind, and be young again – at least hormonally speaking. But one wonders who else, back in the real world to which the deliciously escapist Sex and the City franchise bears only passing resemblance, is going to want this.

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Its proponents, a team of well-respected fertility specialists, pitch it as a serious medical procedure to reduce the risk of heart disease, osteoporosis and other health complications of growing older. But can there really be no clinical downsides to flooding the female body with oestrogen for an extra two decades? The intriguing question, meanwhile, is why anyone would bother with invasive surgery when it essentially does much what HRT does, except that HRT is free on the NHS and this costs up to £11,000.

One answer is that, in some circles, this surgery looks like a miracle cure not just for night sweats, but for the shame of ageing in public. This way there would be no telltale packets of HRT pills lying around, no jolting daily reminder of getting older, no embarrassing conversations to be had with a new partner. (Handling hot flushes is one thing within the comfort of an age-old relationship, quite another on a first date – and the rising divorce rate among older couples means more “silver splitters” than ever before edging nervously back on to the singles market.) Just slide under the knife, tell nobody you did it, and get on with life as if nothing has happened. We may be heading for a future where richer women can increasingly throw the kitchen sink at for ever passing for 39, while poorer ones age more visibly and face ever harsher economic consequences for doing so.

A truth rarely told about female vanity is that it’s rooted in cold, hard numbers. Never mind getting a date, it’s harder to get hired for a job over a certain age, because what women are deemed to be worth is still so inextricably bound up with how they’re judged to look. The sense of pulverising loss many women feel, as they make that sudden disorientating transition from being stared at on the street to being stared through as if invisible, is not merely for their evaporating erotic capital but for so much more besides. No wonder we are all so tangled up in small hypocrisies, talking a brave game about ageing gracefully but secretly panicked into doing the opposite. Every time I fork out a small fortune for the hairdresser to cover up the greys, I wish I had the courage of those women who dare to go elegantly and insouciantly silver at an age when their peers are still hitting the dye bottle. But every time I lose my nerve, leaving blonder but conflicted.

For there is something oddly cleansing about the loss of one’s looks, as there is about letting go of anything once hoarded. It’s not so much a feeling of relief as a challenge, a brutal but necessary rite of passage which with luck can still open the door to something interesting; an era when looks alone are not enough, when the millions who were never gorgeous enough to trade on their faces may come into their own, and the beautiful have to think of other ways to get by. This is the time of life when carefully cultivated friendships are everything, charm is indispensable, brains matter and so does something that would be best described as character, if it didn’t sound so hopelessly old-fashioned.

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This summer I watched a gender-flipping stage production of Oscar Wilde’s The Picture of Dorian Gray, in which the antihero was played on some nights by a man and on others by a woman, turning the story into something more subtly universal. The night I went, Dorian happened to be female, and something clicked into place that stupidly wasn’t so obvious to me on first reading the story decades ago: it isn’t merely a moral fable about vanity and a treatise on aestheticism, but also a story about the shifting relationship between character and looks, and the point at which one starts to supersede the other.

Dorian’s eternal youth means he can eternally get away with heartless behaviour, the sort of cruelty to lovers or carelessness with friends’ feelings that is indulged in the young and beautiful but begins to look mean and pathetic in middle age. But because he doesn’t grow old, Dorian cannot properly grow up either. He never learns to be kind, or unselfish, or to face the consequences of his actions, and so the portrait in the attic which serves as the only accurate record of his life becomes not only older but too hideously deformed to look at. He has missed the crucial tipping point when looks fade and fully rounded humanity emerges in its place. We are not all Dorian Gray. But there is a price to be paid, perhaps, for hiding midlife truths in the attic all the same.

•Gaby Hinsliff is a Guardian columnist