For women in perimenopause, birth control is a confusing issue. Doctors advise all women who have menstruated, even if irregularly, within the past year to continue using birth control. Unfortunately, contraceptive options are limited. Hormone-based oral and implantable contraceptives are risky in older women who smoke. Only a few brands of IUD are on the market.
Some men go through their own set of doubts in middle age.
They, too, often report a decline in sexual activity after age 50. It may take more time to reach ejaculation, or they may not be able to reach it at all. Many fear they will fail sexually as they get older. Remember, sexual problems can arise at any age if there are doubts about performance. If both partners are well informed about normal genital changes, each can be more understanding and make allowances rather than unmeetable demands.