A decline in the quality and frequency of women’s sexual activity as they approach midlife is nearly a matter of fact. Past research has attributed it to biology — specifically, menopause. But that’s something we’ve probably been conditioned to believe — because, according to emerging research, lifestyle changes brought on by gendered expectations could play more of a role.

Published in The Journal of Sex Research, the study indicates middle-aged women experienced significant dissatisfaction pertaining to their sex lives. The researchers interviewed more than 2,000 women between the ages of 40 and 59; a third of them hadn’t had sex at all in the last month. Among those who did engage in sexual activity, less than half admitted to being dissatisfied. Delving deeper, the researchers found that age and menopausal status had less to do with the declining levels of sexual satisfaction, function, and frequency among the participants than lifestyle factors — stemming from the demands and stresses of modern life.

The decline in women’s sexual activity in midlife is an issue that has been investigated in the past. But the results have been largely inconclusive. “The factors associated with sexual activity in menopausal women are complex, indicating that an individualized approach to improving sexual activity is required,” a 2017 study noted.

The present study attempted to address the ambiguity plaguing past research by analyzing the decline in sexual activity among middle-aged women in the context of both social change and individual circumstances. “Few studies have taken women’s views into account in trying to understand the range of factors influencing sexual experience in middle age,” noted lead author Kaye Wellings, a professor of sexual and reproductive health research at the London School of Hygiene and Tropical Medicine in the U.K. “Women in middle age today are often dubbed the ‘sandwich generation’ — they’ve married and had children later than previous generations, they’re working, and they may find themselves supporting both dependent children and elderly parents, while possibly coping with emerging health issues.”

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According to Wellings, being in charge of “double caring duties” is what largely leaves women with little time and energy for a satisfying — or, even a regular — sex life as they reach midlife. The women interviewed by the researchers complained about a multitude of factors — aside from caregiving — draining them on a day-to-day basis: managing a career; balancing time between work and family, and the pressure to have a social life worsen the simultaneous caregiving burden. And, often, there’s no escape; it is “expected,” of women to perform these responsibilities — likely, without much practical or emotional support to help them cope. As such, sex can come to assume low priority in one’s life.

The infamous “orgasm gap” — or, the disparity in orgasms between cis-gendered men and women in heterosexual relationships — may have a role to play here. Research suggests that experiencing fewer orgasms accustoms people to expect fewer orgasms — leading to women, who already got the short end of the “frequency”-stick, giving up trying after a point. With other priorities taking up their mental space, then, sexual intercourse can be reduced to a chore, rather than an activity to derive pleasure from.

But that’s not where society’s adverse impact on middle-aged women’s sex lives ends. A 2019 study, which also probed into middle-aged women’s sex lives, also identified logistical hurdles — like managing responsibilities — as a cause. In addition, it also cited poor self-image as a contributing factor. Research shows that an overwhelming majority of middle-aged women aren’t happy with the way they look; the wrinkles on their skin, and the way their faces and midriff look as they age, were reported to be the leading causes of dips in the self-esteem of middle-aged women.

The pervasive beauty norms are already unrealistic for young women. As one ages, the standards become even more challenging to keep up with. “[M]iddle-aged women are also bombarded with messages from mass media, telling them how to fight every wrinkle, how to zap body fat, how to defy aging, because these things are not acceptable,” states an article online. It goes on to explain that unresolved body image issues from adolescence, too, can rear their heads in middle-aged women — especially as they deal with empty nests, career shifts, relocation, or becoming single again as a result of either being widowed or divorcing their partners.

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“As a society, we are taught to conceal our pain, to focus on the outward adornment of our bodies and not the aching heart within. And though that woman has aged into maturity, those wounds of early childhood are ever present,” the article adds.

Being conditioned to not discuss their insecurities can impede open dialogues between partners, further endangering sexual satisfaction between them. In the context of healthcare, too, the same social conditioning can get in the way of women seeking advice from their doctors. “Lack of communication, both between healthcare professionals and women, and women and their partners hinders appropriate support for those who need it,” noted Helena Harder, co-author of the 2019 study in her capacity as a research fellow at the University of Sussex.

This isn’t to say that biological factors — like drops in the levels of libido-boosting hormones like estrogen with menopause, and testosterone with aging — don’t have any role in the hit that middle-aged women’s sex lives take. What it suggests, instead, is that patriarchal norms — as always — bear more responsibility for this than we tend to acknowledge.

The present study, however, provides hope, too. Lifestyle factors can be easier to control than biological factors — provided, of course, that one’s position on the ladder of socio-economic privilege grants one the option to re-organize their priorities. With past research having shown that believing sexual satisfaction takes work can, in fact, lead to better sex lives, the power of knowledge that the new study brings, can, perhaps, improve the sex lives of middle-aged women.