Q: Is it possible to become worse in bed with age? — Anonymous

A: I completely relate to this question. What happened to the good old days of crazy, up-against-the-wall sex with someone you barely knew? Here's what: We grew up. We stopped drinking so many martinis. We stopped needing sex for self-esteem. (Or was that just me?) We fell in love, and sex became more about intimacy than fireworks.

This is normal for women, healthy even. But what if you miss the fireworks? I used to get annoyed with men who said their wives didn't want to have sex. At the height of my up-in-my-sexual-stuffness, I believe I said, "Show me a woman who isn't interested in sex, and I'll show you a man who doesn't know how to please her." Now that I'm older, I realize that I had no idea what I was talking about.

No matter how determined a woman is to keep the spark alive, other things come into play (depression, work stress, motherhood, unseen episodes of Project Runway). The good news: Help is on the way. The better news: It's not coming from me (who has more questions than answers this month). It's from Leah Millheiser, MD, who runs the Female Sexual Medicine Program at Stanford University.

Millheiser says that unlike in men, where the issue of performance is mainly related to blood flow to the penis, in women many factors—physical and psychological—can affect sexual desire and enjoyment. And although we gain confidence to ask for what we need as we age, our bodies change. During perimenopause, libido can drop and orgasms can become less intense or harder to achieve. Millheiser says you and your partner might need to revise routines that worked in the past to learn what works now.

Another important thing to remember, she says, is that sexual problems are only problems if you're dissatisfied. Forget what you thought sex should be: Pressure to have sex a certain number of times a week, to conceive, to orgasm…any "to-do" in bed can make "doing it" a chore rather than a pleasure. "We want women to understand that orgasms are not the be-all and end-all of a satisfying sexual experience," Millheiser says. "However, if a woman is trying to have an orgasm but is unable to and it is causing her stress, that's when talking to a clinician may help."

If any sex-related problem is causing you stress, talk to your gynecologist or ask her to recommend a sexual medicine specialist to determine whether your issue is physical or psychological. If it's physical (for example, pain from an STD or other vaginal infection, endometriosis, arousal or orgasm difficulties related to a chronic illness), a specialist should be able to help you. If it's psychological, your doctor might refer you to a sex therapist so that you and your partner can change patterns that aren't working. A sex therapist is not the same as a sex surrogate, by the way, so fear not—all you'll be doing is talking.

Meanwhile, any age is a great age to strip off your sexual "shoulds" and remember that sex is play, not work. Maybe that's all it takes to bring back the fireworks.

Cindy Chupack is the author of The Between Boyfriends Book (St. Martin's Griffin).

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